High-frequency switching in Candida strains isolated from vaginitis patients.

High-frequency switching and strain variability at the site of infection was assessed in 11 patients with acute Candida albicans vaginitis. By cloning cells directly from the site of infection, it was demonstrated that 4 of the 11 isolates contained multiple-switch phenotypes at the site of infection and that 9 of the 11 isolates were in a high-frequency mode of switching (10(-2) to 10(-3)). Isolates could be separated into four general categories of switching repertoires. To demonstrate that multiple phenotypes at the site of a single infection represented the same strain, EcoRI digests of total cell DNA were separated on agarose gels, and Southern hybridization patterns with two cloned midrepeat sequences were compared.     

Increased phenotypic switching in strains of Candida albicans associated with invasive infections.

This study reports the rates of phenotypic switching in strains of Candida albicans isolated from superficial and invasive infections. Of 19 invasive strains, 68% showed switching activity, often at very high rates, compared with only 28% of 40 strains isolated from superficial sites (P = 0.004).     

Candida albicans strain delineation.

Candida albicans is a major opportunistic pathogen causing a wide spectrum of disease in human beings. Methods for strain delineation of this species to assess or predict virulence or to conduct epidemiologic or pathogenetic investigations have been developed. Although factors associated with virulence have been identified, there is no rapid system to quantitate them in a clinical laboratory. Therefore, many typing methods are based on variable phenotypic characteristics within this species including morphotyping, serotyping, antibiogram, resistogram typing, biotyping, biotyping based on commercial carbon assimilation patterns, enzyme profiles, sensitivity to yeast killer toxins, and typing based on protein variability. Phenotypically defined strains generally do not correlate with the pathogenic potential of a strain with the exception of morphotyping. However, these methods can be useful in epidemiologic investigations; for example, they have revealed that most individuals harbor one strain and that infections are frequently due to an endogenous strain. Problems with these methods usually relate to their discriminatory power. When this is maximized, reproducibility (especially between laboratories) suffers. Recently, methods based on differences in DNA structure (genotyping) for strain delineation have been developed, including electrophoretic karyotyping and restriction enzyme fragment length polymorphisms. The development of a computer-assisted data bank and analysis for these genotypic strain delineators will open investigations into the pathogenesis of this infection and permit epidemiologic studies previously not possible with this important human pathogen.     

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.     

Lymphocyte adhesion to Candida albicans.

Adherence of lymphocytes to the fungus is the first step in the direct lymphocyte-mediated antifungal effect against Candida albicans. In this study we identified macrophage-1 antigen (Mac-1) (CD11b/CD18, alpha(M)/beta(2)) as the lymphocyte surface structure responsible for the adhesion of activated lymphocytes to the hyphal form of the fungus. Antibodies specific for epitopes of the alpha-subunit (CD11b) and the beta(2)-subunit (CD18) of Mac-1 were shown to completely eliminate lymphocyte adhesion to C. albicans hyphae. Lymphocyte adhesion to C. albicans was also inhibited significantly by known ligands of Mac-1, including the extracellular matrix proteins laminin and fibrinogen, as well as engineered peptides containing arginine-glycine-aspartic acid sequences and the disintegrin echistatin. N-Acetyl-D-glucosamine and beta-glucan, which inhibit Mac-1-mediated adhesion to the yeast, blocked lymphocyte adhesion to hyphae. NIH 3T3 fibroblast transfectants expressing human CD11b/CD18 bound to C. albicans, and their binding was inhibited by antibodies specific for CD11b/CD18. Finally, antibodies specific for CD11b/CD18 effectively inhibited the capacity of activated lymphocytes to have an antifungal effect against hyphae. Our results clearly identify Mac-1 (CD11b/CD18) as the lymphocyte surface structure that mediates activated lymphocyte adhesion to C. albicans and the resultant antifungal effect of the lymphocytes.     

Morphogenesis in Candida albicans

This review will survey environmental controls on the morphology of Candida albicans, describe the cellular and ultrastructural events associated with morphological transitions in this fungus, and attempt to relate biochemical phenomena that have been reported to be associated with dimorphic change to C. albicans cell biology. The synthesis of the cell wall of C. albicans and its control remain largely undiscovered, but it is clear that the cell wall is the principal component involved in shape determination. Possible models for C. albicans dimorphism will be critically reviewed.     

Factors affecting filamentation in Candida albicans: changes in respiratory activity of Candida albicans during filamentation.

Glucose metabolism and respiration of Candida albicans were compared under conditions which permitted either maximal filamentous or maximal yeast growth. Changes in metabolism were monitored by comparing the quantities of ethanol produced, CO2 evolved, and oxygen consumed. Filamenting cultures produced more ethanol and less CO2 than yeasts, with oxygen consumption in the former concomitantly slower than that of the latter. Studies involving cofactors and inhibitors associated with electron transport imply that a transfer of electrons away from flavoprotein is required for maintenance of yeast morphology. Conditions consistent with a buildup of reduced flavoprotein, however, favored filament formation. These changes were expressed metabolically as a shift from an aerobic to a fermentative metabolism. The results presented are consistent with hypotheses correlating filament production with changes in carbohydrate metabolism and an interruption of electron transfer within the cell.     

Effects of neutrophils and in vitro oxidants on survival and phenotypic switching of Candida albicans WO-1.

The relationship to pathogenesis of the spontaneous phenotypic switching of Candida albicans is uncertain. Since neutrophils are critical in containment of disseminated candidiasis, we used these cells and some of their potentially microbicidal oxidative products to define effects on a C. albicans strain (WO-1) that exhibits characteristic, easily recognized switching between the white and opaque phenotypes. Blastoconidia of the opaque phenotypes were more susceptible than those of the white to killing by either intact neutrophils or cell-free oxidants, including reagent hydrogen peroxide or the myeloperoxidase-H2O2-Cl- system. Paralleling these findings, opaque blastoconidia were 2.8- to 3.6-fold more potent stimuli of neutrophil superoxide generation than were the white cells. In addition, both neutrophils and oxidants (reagent H2O2 or hypochlorous acid as well as the myeloperoxidase-H2O2-Cl- system) induced unidirectional increases in spontaneous rates of switching from white to opaque phenotypes. Differences in expression of C. albicans phenotypes therefore may determine relative susceptibility to neutrophil fungicidal mechanisms, and neutrophils themselves appear to be capable of selectively augmenting the switching process.     

Fingerprinting Candida albicans

A new method of typing Candida albicans based on immunoblotting is described. Isolates were disrupted by a mixture of enzymic pretreatment with alpha-mannosidase followed by sonication. They were then stained using a modified ELISA system by a rabbit hyperimmune serum raised against a single isolate, C. albicans NCTC 3153. The 190 isolates examined from the London Hospital produced 16 different types. Type 1 accounted for 43% of the isolates and was the commonest type outside the intensive care unit. Type 2 caused an outbreak of systemic candidosis on the intensive care unit. The technique was much more sensitive than the serotyping and morphotyping methods and lacked the phenotypic variability of the biotyping procedure previously used to define the outbreak. The gel-to-gel variation precludes its use in large scale epidemiological work. Its value lies in identification of outbreaks so that they can be controlled by the introduction of measures to prevent cross-infection.     

Isoenzyme changes in Candida albicans during domestication.

Isoenzyme analysis was performed on multiple strains of two commonly used reference cultures of Candida albicans (B311 and NCPF3153). Whereas strains originating from C. albicans B311 showed no variation in isoenzyme profiles, some strains derived from NCPF3153 were identical to B311 strains but others showed variation in their glucose-6-phosphate dehydrogenase isoenzymes. The results are compared with those from previous analyses with these strains and show that C. albicans can undergo genetic alterations during prolonged maintenance in laboratories.     

Hepatic clearance of Candida albicans in rats.

The initial clearance of Candida albicans from the blood stream of rats and from perfusion medium by perfused rat livers was characterized. Normal rats cleared over 90% of large doses of intravenously injected yeast cells in 5 min. All were recovered as viable cells among various reticulendothelial organs after 30 min. The perfused rat liver trapped an average of 85% of the yeast cells in a single pass. No significant killing occurred, even in the presence of 10% whole rat blood. Scanning electron microscopy of cryofractured livers revealed that the cells were trapped in liver sinusoids but outside phagocytic cells.     

Release of a potent polymorphonuclear leukocyte chemoattractant is regulated by white-opaque switching in Candida albicans

Previous studies employing transmembrane assays suggested that Candida albicans and related species, as well as Saccharomyces cerevisiae, release chemoattractants for human polymorphonuclear leukocytes (PMNs). Because transmembrane assays do not definitively distinguish between chemokinesis and chemotaxis, single-cell chemotaxis assays were used to confirm these findings and test whether mating-type or white-opaque switching affects the release of attractant. Our results demonstrate that C. albicans, C. dubliniensis, C. tropicalis, C. parapsilosis, and C. glabrata release bona fide chemoattractants for PMNs. S. cerevisiae, however, releases a chemokinetic factor but not a chemoattractant. Characterization of the C. albicans chemoattractant revealed that it is a peptide of approximately 1 kDa. Whereas the mating type of C. albicans did not affect the release of chemoattractant, switching did. White-phase cells released chemoattractant, but opaque-phase cells did not. Since the opaque phase of C. albicans represents the mating-competent phenotype, it may be that opaque-phase cells selectively suppress the release of chemoattractant to facilitate mating.     

Preliminary investigation of Candida albicans biovars.

A total of 126 Candida albicans strains were enzymatically evaluated by the API ZYM system. Four enzymatically based groups of C. albicans are recognized.     

Chemotactic factor produced by Candida albicans.

Candida albicans was found to produce a substance that was chemotactically active for guinea pig polymorphonuclear neutrophils. The chemotactic factor was detected in culture filtrates of organisms grown under aeration and incubated at 37 degrees C for at least 12 h. Nutrients found to be essential for the production of chemotactic factor included glucose, yeast extract, and a mixture of amino acids. Several strains of C. albicans isolated from humans were tested, and varying degrees of chemotactic activity were found to be associated with the culture filtrates. Only one of the eight isolates did not produce a measurable amount of chemotactic activity. Culture filtrates remained chemotactically active after several cycles of freezing and thawing and after heating at 90 degrees C for 10 min. Substantial evidence is presented that the chemotactic activity is not dependent upon activation of complement.     

Misexpression of the white-phase-specific gene WH11 in the opaque phase of Candida albicans affects switching and virulence.

Candida albicans WO-1 switches between a white- and an opaque-colony-forming phenotype. The gene WH11 is expressed differentially in the white phase. The WH11 open reading frame was inserted downstream of the promoter of the opaque-phase-specific gene OP4 in the transforming vector pCWOP16, and resulting transformants were demonstrated to misexpress WH11 in the opaque phase. Misexpression had no effect on the ability to switch from the white to the opaque or the opaque to the white phase, and it had no effect on the genesis of the unique opaque-phase cellular phenotype, even though the Wh11 protein was distributed throughout the cytoplasm in a manner similar to that observed for the endogenous gene product in the white phase. Misexpression did, however, increase the frequency of the opaque-to-white transition 330-fold and markedly increased the virulence of cells in the opaque phase in a mouse tail injection model.     

The fibronectin adhesin of Candida albicans.

Candida albicans possesses on its cell surface an adhesin which binds the whole viable fungus to subendothelial extracellular matrix and matrix proteins. The adhesin is composed of 75 to 80% carbohydrate and approximately 20 to 25% protein by weight. High-performance liquid chromatography of material eluted from a fibronectin-agarose affinity column demonstrates the presence of three peaks, all of which on sodium dodecyl sulfate-polyacrylamide gel electrophoresis show the presence of one protein of approximately 60 kDa. Molecular weight sizing column chromatography, however, demonstrates that the adhesin elutes with an apparent molecular mass of 42 kDa. The N terminus of the 60-kDa glycoprotein is blocked to Edman degradation. The fibronectin adhesin of C. albicans is a glycoprotein that may be present and functional as an aggregate or multimer of a 60-kDa protein.     

Immunological relatedness among Candida albicans and other pathogenic Candida species.

Membrane-mitochondrial (butanol-hot phosphate-buffered saline) and cytosol (soluble cytoplasmic substances) extracts from seven pathogenic species of Candida were used in in vivo and in vitro immunological assays to study antigenic similarities among the strains with respect to C. albicans. Mice were sensitized with C. albicans serotype A for footpad testing or to provide cells for lymphocyte stimulation assays, and guinea pigs were immunized with whole cells or butanol-hot phosphate-buffered saline extracts of C. albicans to obtain antisera for immunodiffusion assays. When extracts from each of the seven species were used in the assays, they consistently segregated, as determined by statistical or subjective analyses, into three groups. Extracts of C. albicans serotype A or B and C. stellatoidea were the most immunologically reactive in all assays, indicating close similarities between those two species, whereas extracts of C. tropicalis and C. parapsilosis elicited only moderate responses. Extracts from C. krusei, C. guilliermondii, and C. pseudotropicalis were hypo- or nonreactive in the assays, indicating a low level of antigenic relatedness to C. albicans.