Morphogenesis of Candida albicans in human serum. Mycelial and pseudomycelial tubes observed in 250 strains

The morphogenesis of Candida albicans, more peculiarly the mycelial and pseudomycelial tubes production, was investigated during 24 hours in human serum: on 250 strains at 37 degrees C, and on 24 strains at 25 degrees C. The characteristic of the tubes, their first apparition and maximum production time are reported. The yeast influence (origin, saprophytic or parasitic state, serotype, maximum temperature for growth of the strain) on the tubes production is discussed.     

Platelet interactions with Candida albicans.

The interaction of human platelets and Candida albicans was studied. Platelet-rich plasma was obtained from freshly drawn blood or outdated platelet concentrates. From the platelet-rich plasma, a platelet extract was derived which stimulated germ tube formation by C. albicans when incubated with yeast cells at 37 degrees C. The active component(s) was heat stable, trypsin sensitive, and ribonuclease and deoxyribonuclease insensitive, and possessed cationic properties since it readily attached to carboxymethyl-Sephadex. The active component(s) seemed to bind to heparin also, since germ tube-promoting activity was eluted from a heparin-cyanogen bromide-activated Sepharose 4B column. In addition, platelet-derived growth factor (Collaborative Research, Inc.) stimulated germination when incubated with low amounts (0.4% final concentration) of bovine calf serum. The aggregation of platelets, prepared as platelet-rich plasma by C. albicans cell wall or alkali-extracted cell wall fractions, was also studied. Aggregation of platelets was observed when cell wall or cell wall fractions were incubated with platelet-poor plasma at 37 degrees C for 20 min and then added to platelet-rich plasma. The component of platelet-poor plasma which promoted aggregation of platelets by C. albicans cell wall or alkali-extracted fractions was inactivated at 56 degrees C (30 min) and by cobra venom factor, indicating a role for the alternate complement pathway in the aggregation response.     

Inductions of germ tube and hyphal formations are controlled by mRNA synthesis inhibitor in Candida albicans.

Candida albicans is a pathogenic dimorphic fungus. When yeast cells were pre-incubated in YPD medium at 25degreesC and released into HFM7 medium containing 4% serum at 37degreesC, germ tubes emerged within 0.5 h. To determine whether mRNA or protein synthesis was necessary for germ tube formation, we examined the effects of mRNA and protein syntheses inhibitors on this formation. In the presence of cycloheximide, cells were unbudded and no germ tube was observed. However, in the presence of actinomycin D, germ tube formation was observed while budding growth and true hyphae elongation were blocked. Next, we measured mRNA or protein accumulation during induction of germ tube formation in the presence of the inhibitors. In the presence of cycloheximide, protein was not synthesized, while in the presence of actinomycin D, mRNA synthesis decreased to 6.3% and protein synthesis to 37.7%. The condition we found which allows only germination but not budding or filamentation might be convenient to use in screening genes involved in the initial stage of morphological change in C. albicans.     

Comparison of cream of rice agar and horse serum for differentiating germ tubes of Candida albicans from filaments of Candida tropicalis.

Simple cream of rice agar was superior to horse serum for the demonstration of germ tubes by Candida albicans and in the differentiation of pseudohyphae of Candida tropicalis from germ tubes at 37 degrees C. Mycelium and chlamydospores were also produced on this medium.     

Variable expression of a surface determinant during proliferation of Candida albicans.

The surface expression of an antigenic determinant that is present in the cell wall of Candida albicans was investigated with monoclonal antibody 24 (MAb24), an immunoglobulin M MAb. The proportion of the cell population that expressed the epitope under different growing conditions was determined by indirect immunofluorescence microscopy. More than 90% of stationary-phase yeast cells of strain B311 grown at 28 degrees C expressed the antigen. Less than 50% of yeast cells grown exponentially at 28 degrees C or either growing or stationary-phase yeast cells cultivated at 37 degrees C expressed the epitope. Germ tubes, which were induced at 37 degrees C from stationary-phase yeast cells grown at 28 degrees C, expressed the determinant on the parent yeast but not the hyphal portion of the germ tube. The change in antigen expression by stationary-phase cells grown at 28 degrees C, when they resumed growth by bud formation, suggested that antigen expression was lost by cells in the inoculum prior to the first cell division. By using the same assay, strong positive reactions were observed in stationary-phase cultures of other isolates of C. albicans, C. guilliermondii, C. stellatoidea, and C. tropicalis, but not with isolates of C. krusei, C. parapsilosis, or Torulopsis glabrata. The identification of the antigenic determinant as a carbohydrate was based on three observations: (i) interaction with a mannan preparation from the same organism, (ii) sensitivity of the antigen to periodate but not proteases, and (iii) coincidence of the migration of antigen during electrophoresis with material which stained intensely with carbohydrate but not with protein reagents. These observations suggest that the expression of the antigenic determinant of MAb24 is dependent on the growth conditions, growth state, and morphology of the cell and that the topography of the cell surface is dynamic.     

The effect of oral bacteria on Candida albicans germ-tube formation

A total of eight bacterial isolates belonging to six species, and a select group of 12 oral Candida albicans isolates, were used to study the effect of bacteria on germ-tube formation. Briefly, each bacterial suspension (10(5-6) cells/ml) was mixed with a C. albicans suspension (10(7) cells/ml) and incubated at 37 degrees C for 90 min with bovine serum, and the percentage germ-tube-positive Candida cells was quantified using a haemocytometer, under light microscopy. In general, out of eight bacteria, Streptococcus sanguis SK21A, Streptococcus salivarius SK56, Escherichia coli ATCC 25922, and S. salivarius OBU3 suppressed germ-tube formation to varying degrees, with different C albicans isolates. Porphyromonas gingivalis Pg 50, Lactobacillus casei ATCC 7469 and Prevotella intermedia OBU4 elicited significant enhancement of germ-tube formation, whereas S. sanguis OBU 2 had no effect. E. coli ATCC 25922 was the only organism to show statistically significant suppression of germ-tube formation (p=0.0312). A significant increase in the germ tube production of C. albicans isolated from HIV-infected compared with HIV-free individuals was also noted. The current results tend to suggest that commensal and transient oral bacterial populations may selectively influence the differential expression of germ-tube-forming ability of C. albicans isolates.     

Characterization of antigens specific to the surface of germ tubes of Candida albicans by immunofluorescence

To characterize germ tube-specific antigens of Candida albicans, rabbit antiserum prepared to Formalin-treated yeast possessing germ tubes was adsorbed with stationary-phase blastospores. By immunofluorescence and enzyme-linked immunosorbent assay, this antibody did not react with blastospores but detected germ tube-specific antigens in hyphal forms. Germ tube-specific antigens appeared 30 min after placing blastospores in appropriate conditions for germ tube formation. Hyphae, formed by allowing yeast to germinate for 24 h, still retained germ tube-specific antigens, but blastospores budding off these hyphae were unstained, as were log-phase blastospores. Germ tube-specific antigens were sensitive to heat, sodium metaperiodate oxidation, dithiothreitol reduction, and proteolysis with pronase, trypsin, or chymotrypsin, whereas antigens common to blastospores and germ tubes were stable to boiling, treatment with proteolytic enzymes, and dithiothreitol reduction. Thus, surfaces of germ tubes can be distinguished from those of blastospores not only immunologically, but also by the sensitivity of germ tube-specific antigens to proteolytic treatments.     

In vitro effect of fibrinogen on Candida albicans germ tube formation

Pseudohyphae formation by Candida albicans blastoconidia, as seen in vaginal smears, is a phenotypical change commonly assumed to mean fungal invasiveness, i.e. not mere colonization. C. albicans forms germ tubes in vitro in the presence of serum. In our search for inhibitory components of germ tube formation, we decided to study fibrinogen. The inhibition of germ tube formation by clinical isolates of C. albicans was evaluated in the presence of serial concentrations of fraction I, type IV and fraction I, type Is of fibrinogen from bovine plasma. Fibrinogen showed a dose-dependent, pH-independent inhibitory effect on the germ tube formation by C. albicans.     

Role of yeast cell growth temperature on Candida albicans virulence in mice.

Previous studies have suggested that yeast cell growth temperature may influence the relative virulence of the opportunistic dimorphic fungus Candida albicans. To test this possibility, mice were challenged with C. albicans yeast cells which were grown at either room temperature or 37 degrees C, and their survival was monitored daily. Mice which received room temperature-grown cells died faster. The interaction of glycogen-elicited polymorphonucleated neutrophils (PMNs) with C. albicans yeast cells grown at the two temperatures was examined, because PMNs have been shown to have a critical role in preventing development of candidiasis in normal individuals. In the absence of serum (i.e., nonopsonic conditions), more PMNs conjugated and engulfed C. albicans cells grown at room temperature than those grown at 37 degrees C. However, PMNs were less able to kill cells grown at room temperature than cells grown at 37 degrees C. Cells grown at room temperature also produced abundant germ tubes after engulfment and were thus more likely to escape killing by phagocytes. These results suggest that cells grown at room temperature are more virulent because they are less likely to be killed by phagocytes and are more likely to disseminate. The possibility that expression of cell surface hydrophobicity is involved in these events is discussed.     

Phagocytosis measured as inhibition of uridine uptake by Candida albicans.

Inhibition of 3H-uridine incorporation into Candida albicans can be used as a sensitive index of phagocytic function because: 1) there is a linear correlation between uridine incorporation and yeast number; 2) phagocytic cells do not incorporate significant amounts of uridine in short term cultures; and 3) C. albicans replicating inside phagocytic cells does not take up uridine from culture medium. Appropriate conditions for measuring phagocytic capacity of human polymorphonuclear cells (PMN's) were 5 x 10(5) C. albicans and 5 x 10(4) PMNs in 0.5 ml of medium containing 2.5% AB serum. This mixture was incubated for 30 min at 37 degrees C. Aliquots were then transferred into microtiter wells and incubated for a further 60 min in the presence of 3H-uridine. Under these conditions PMN leucocytes from 25 healthy individuals caused suppression of uridine incorporation ranging from 33 to 75% (50 +/- 12).     

The morphological identification of pathogenic yeasts using carbohydrate media.

Eight isolates of C. albicans were used to determine the frequency with which germ tube formation occurred: on rice extract -Tween 80 agar, on its components, and on 1% bactopeptone agar after three hr at 37 degrees C; in 0.5% aqueous solution of various carbohydrates; in various concentrations of glucose; on 0.5 and 0.1% glucose agar and on various types of agar alone. Subsequently 250 isolates of yeast of the genera Candida, Torulopsis, Trichosporon, Cryptococcus, and Saccharomyces, which were obtained from a clinical laboratory, were spread on rice extract -Tween 80 agar and on 0.1% glucose agar and covered with coverslips. Direct microscopic examination after incubation for three hours at 37 degrees C demonstrated germ tube formation by all 140 isolates of C. albicans, but by none of the other yeasts. The characteristic features of the pseudomycelia of isolates of Candida and Trichosporon were evident on reexamination after a further 45 to 69 hours at room temperature (22 degrees C). These morphological observations suggested the identity of the isolates of Torulopsis, Cryptococcus, and Saccharomyces but identified virtually all (98.2%) of those of the genera which formed pseudomycelia. Of the latter group only four isolates required fermentation and assimilation tests to determine whether they were C. parapsilosis (1) or C. guilliermondii (3).     

Investigation of Candida dubliniensis in Candida spp.-positive hemocultures

Candida dubliniensis is one of the Candida species which was first recognized in 1995. The yeast was misidentified because of its phenotypic similarities with Candida albicans. In this study, blood samples of patients from various departments at Ankara University Medical Faculty between January 1996 and September 2000 were investigated for distribution of Candida spp. and presence of C. dubliniensis. Ninety-eight culture positive fungi were included in the study. Phenotypic tests for identification of C. dubliniensis and tests for differentiation of the yeast from C. albicans, such as colony morphology on Staib agar, growth at 42 degrees C and 45 degrees C, beta-glucosidase activity and carbohydrate assimilation, were carried out. Sixty-four of the isolates produced germ tubes and chlamydospores, and none of them had the phenotypic characteristics of C. dubliniensis. Further large-scale studies of specific patient groups are necessary to reveal the etiologic importance of this yeast.     

Germ-tube formation by oral strains of Candida tropicalis.

Candida species isolated from the mouths of healthy children and of patients with denture stomatitis included strains of Candida tropicalis that formed germ tubes when incubated in serum. Twenty-six germ-tube-forming strains of C. albicans and of C. tropicalis were subcultured weekly for 9 wk on blood agar and on Sabouraud's agar and the ability of each subculture to form germ tubes was measured. All the strains of C. albicans formed almost as many germ tubes after nine weekly subcultures as they did when first isolated. By contrast, although all 26 strains of C. tropicalis formed germ tubes when first isolated, all had lost the ability to do so after six serial weekly subcultures. Germ-tube formation should not be the sole criterion for the identification of oral C. albicans strains.     

Comparison of rapid testing methods for enzyme production with the germ tube method for presumptive identification of Candida albicans.

The observation of germ tube production as a method for the presumptive identification of Candida albicans has been in use for many years. Methods have recently been developed for detecting the production of the enzymes L-proline aminopeptidase and beta-galactosaminidase by yeast isolates grown in culture. Both enzymes are produced by C. albicans; other yeasts may produce either L-proline aminopeptidase or beta-galactosaminidase but not both enzymes. One hundred thirty-three clinical yeast isolates, including 55 C. albicans, 27 Candida tropicalis, 22 Torulopsis (Candida) glabrata, and 29 other yeast isolates were tested by the germ tube production method and three tests for enzyme production, with the API 20C method used as a "gold standard." All three enzymatic methods evaluated provided more objective and rapid nonmicroscopic alternatives to the germ tube test and may be used to accurately distinguish C. albicans from other yeasts.     

Isolation of Vibrio parahaemolyticus from fecal specimens on mannitol salt agar.

Normal sera and sera from burned patients were examined for Candida agglutinin titers, precipitin titers, and the ability to disperse germ tubes of Candida albicans in an attempt to determine whether germ tube dispersion is correlated with Candida infection as animal models have indicated. Other investigators have reported that immunoglobulin G antibody to Candida interferes with a serum clumping factor resulting in germ tube dispersion. Germ tube dispersion in sera from burned patients with varying degrees of Candida infection is significantly greater than that found in uninfected controls. In addition, the germ tube dispersion test indicated the presence of Candida infection in several patients who had clinical evidence of infection but no detectable agglutinins or precipitins.     

Trehalose hydrolysis is not required for human serum-induced dimorphic transition in Candida albicans: evidence from a tps1/tps1 mutant deficient in trehalose synthesis

Exponential yeast-like cells of a Candida albicans wild-type strain exhibited strong capacity for germ tube formation in a glucose-containing medium (YPD) after induction with human serum at 37 degrees C, whereas the isogenic double disruptant tps1/tps1 mutant, which is deficient in trehalose synthesis, failed to produce germ tubes. In a medium without glucose (YP), the morphological transition fraction was roughly equivalent in both strains. Substitution of glucose by galactose or glycerol increased the number of wild-type proliferating cells able to enter the dimorphic program with no noticeable change in their trehalose content, while stationary cells, which accumulate a large amount of trehalose, did not form germ tubes. When fresh medium was added, a high proportion of these resting cells recovered their ability to carry out dimorphic transition. The tps1/tps1 mutant followed the same pattern of hyphae formation, despite the fact that it was unable to accumulate trehalose either during dimorphism induction or after several stress challenges. Furthermore, trehalose-6-phosphate synthase activity was barely detectable in the mutant. These results strongly suggest that serum-induced dimorphic transition does not require trehalose mobilization; they also support the idea that TPS1 is the only activity involved in trehalose biosynthesis in C. albicans.     

Assessment of Germ Tube Dispersion Activity of Serum from Experimental Candidiasis: a New Procedure for Serodiagnosis

Germ tubes of Candida albicans and C. stellatoidea clump in normal serum but disperse in serum from animals infected with either species of Candida. A new procedure for the assessment of grades of germ tube dispersion activity of serum is presented; this procedure is to count the number of freely dispersed germ tubes in test serum into which a definite number of yeast-type C. albicans has been inoculated. The relationship between the serum activity and macroscopic lesions caused by candidal infection is observed, indicating the possibility of applying the phenomenon to the serodiagnosis of deep-seated candidiasis. The specificity and sensitivity of the test are also examined.     

Cytological aspects of dimorphism in Candida albicans

From a comparison of the growth of yeast and hyphal cells of Candida albicans at 37 degrees C, the present authors suggest that the formation of hyphae is a response to nutrient stress. The major cytological evidence for this is that the formation of a germ tube is chiefly the result of the migration of cytoplasm out of the parent yeast cell, with little biosynthesis occurring other than DNA replication and wall assembly. This explains the linear outgrowth of the germ tube rather than an autocatalytic outgrowth. It is accompanied by the enlargement of the vacuole in the parent cell. Subsequent elongation of the hyphae is accompanied by vacuolation of subapical compartments, and branching only occurs from some of the subapical compartments after they have reformed sufficient cytoplasm.     

Autoregulation of germ tube formation by Candida albicans.

Germ tube formation by Candida albicans is at least partially controlled by a product(s) of the yeast phase of the organism which is released from cells upon incubation at 37 degrees C in tissue culture medium or fetal calf serum. This germination regulatory substance is stable under conditions of lyophilization and heating of 70 degrees C, but becomes inactivated at pH values of 4.0 and 9.5. A germination regulatory substance was produced by both strains of C. albicans tested and by a strain of C. tropicalis. Production does not appear to be a universal characteristic of yeasts because the factor could not be recovered from either Cryptococcus laurentii or Candida parapsilosis. Previously described C. albicans germination inhibitors such as cysteine, tryptophol, and phenylethyl alcohol appear not to be the substance described here. Because of the ability of the factor to influence C. albicans morphology, we have designated it morphogenic autoregulatory substance.     

Pathogenicity and virulence of Candida dubliniensis: comparison with C. albicans.

Candida dubliniensis is a newly described fungus that is frequently isolated from the oral cavities of HIV-positive patients. Although extensive studies have been performed on the phylogeny of C. dubliniensis, little is known about the pathogenic ecology of this yeast. Here we examined aspects related to C. dubliniensis in comparison with those of C. albicans. When injected intravenously into mice, C. dubliniensis had a higher survival rate than C. albicans. Histopathological analysis disclosed that C. dubliniensis remained mostly in the yeast form in the infected organs, whereas C. albicans changed into the mycelial form. The host inflammatory reaction was aggressive with C. dubliniensis infection and mild with C. albicans infection. Co-culture of the yeasts with human polymorphonuclear leukocytes disclosed that C. dubliniensis is more vulnerable to the fungicidal activity of leukocytes than C. albicans. C. dubliniensis was also more susceptible to the toxic effect of hydrogen peroxide. When cultured in vitro, C. dubliniensis grew more slowly than C. albicans, but the formation of germ tubes was faster. When the fungi were cultured in RPMI 1640, a fetal bovine serum supplement suppressed the growth of C. dubliniensis but enhanced that of C. albicans. These results clearly indicated that C. dubliniensis is less virulence than C. albicans.