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Antimicrobial Agents and Chemotherapy, November 2004, p. 4337-4341, Vol. 48, No. 11
0066-4804/04/$08.00+0 DOI: 10.1128/AAC.48.11.4337-4341.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
Inhibition of Adherence and Killing of Candida albicans with a 23-Mer Peptide (Fn/23) with Dual Antifungal Properties
Stephen A. Klotz,1,2*
Nand K. Gaur,2
Jason Rauceo,3
Douglas F. Lake,4
Y. Park,5
K. S. Hahm,5 and
Peter N. Lipke3
Department of Medicine, University of Arizona,1
Research Service, Southern Arizona VA Health Care Systems,2
Arizona Cancer Center, Tucson, Arizona,4
Research Center for Proteineous Materials, Chosun University, Kwangju, Korea,5
Hunter College of the City University of New York, New York, New York3
Received 12 January 2004/
Returned for modification 26 April 2004/
Accepted 30 June 2004

ABSTRACT
Candida albicans adheres to host tissue and then proliferates
in order to establish a commensal as well as a pathogenic state.
Specific adherence to proteins is provided by several surface
adhesins of
Candida. Two well-studied proteins, Als1p and Als5p,
do not require energy for adherence to occur (dead as well as
living cells adhere) and have a multiplier effect of cell-cell
aggregation that mediates the formation of microcolonies of
Candida cells. The entire process is spontaneous, reversible,
and stable for physiologically relevant chemical and physical
forces. This adherence process is inhibited by the addition
of free peptide ligands, including a 23-mer derived from fibronectin
(Fn/23) that binds to the adhesins through H bond formation.
Adherence was measured by determining the number of yeast cells
that adhered to 90-µm-diameter polyethylene glycol (PEG)
beads with a 7-mer peptide (KLRIPSV) synthesized on the surfaces
of the beads. The concentration of the Fn/23 peptide that inhibited
the adherence of cells to the peptide-coated beads by 50% was
4 to 5 µM, and the magnitudes of adherence were similar
regardless of the presence or absence of physiologic salt concentrations.
The minimum fungicidal concentration of Fn/23 was 2 to 4 µM
in water, but there was no killing in physiologic salt concentrations.
Peptides from the C and N termini or the center sequence of
Fn/23 had no effect on inhibition of adherence and little effect
on fungal viability. The fungicidal effect was similar to that
seen with 23-, 19-, and 18-mer peptides derived from porcine
myeloid cells, a
Helicobacter pylori ribosomal protein, and
a hybrid of cecropin and magainin, respectively. However, these
fungicidal peptides did not inhibit
C. albicans adherence to
the peptide-coated PEG beads. This dual property of Fn/23, i.e.,
inhibition of adherence and killing of
C. albicans, may provide
important adjuvant effects in the treatment of disease caused
by this fungus.

INTRODUCTION
Candida albicans is a commensal microorganism of healthy human
mucosal surfaces that, in the event of impairment of normal
host immunity, can cause trivial to life-threatening opportunistic
infections (
2,
18). Adherence to host tissue is a prerequisite
for establishment of a commensal as well as a pathogenic relationship.
The Als proteins are cell surface adhesins capable of forming
rapid and extremely stable H bond-dependent associations with
host proteins and peptides (
5). These associations have been
termed stable, reversible, and specific (SRS) adherence and
are a property of both Als proteins studied to date, Als1p and
Als5p (
5). Recognition of ligands by Als1p and Als5p is degenerate
(i.e., not highly specific); hence, there is a multitude of
potential ligand targets for these adhesins (
9). Adherence of
C. albicans to a protein target is a spontaneous property of
these adhesins. Following adherence, there is a global surface
conformational shift of the microorganism, which leads to the
spontaneous aggregation of nearby cells into microcolonies (
19).
This process occurs without expenditure of energy and is a property
shared by live as well as dead fungi (
5,
19). The aggregation
and adherence of cells are reversible upon the addition of formamide
or urea or an increase in the pH to 9 or greater, all of which
are factors that break hydrogen bonds (
4).
Previous work established that an
20-mer peptide (formerly available commercially as PepTite 2000 [Telios Corporation, San Diego, Calif.]) is an extremely effective inhibitor of the adherence of C. albicans to immobilized extracellular matrix proteins in vitro (11). This peptide was developed from the cell-binding domain of fibronectin (containing arginine-glycine-aspartic acid [RGD]) and possessed features that allowed for effective adsorption on plastic and other nonbiological surfaces (i.e., it possessed a hydrophobic domain and other sequences to enhance adsorption to charged surfaces). Paradoxically, when PepTite 2000 was placed on plastic, C. albicans could not adhere to the surface (8). In addition, this peptide was shown to be an effective adjuvant in the treatment of disseminated candidiasis in rabbits (11), which was attributed to inhibition of the adherence of yeast cells to host tissue, likely by binding to C. albicans cells and blocking their ability to adhere to proteins or peptides. In those studies, PepTite 2000 was diluted in physiologic salt solutions and had no detectable effect on C. albicans growth or viability.
Once C. albicans adherence has occurred, survival and reproduction become important determinants in maintaining the commensal or pathogenic state. Part of the host defense includes naturally occurring antimicrobial peptides, such as defensins and cathelicidins, which may have potential for use in the treatment of the many presentations of candidiasis (1). These molecules are attractive due to their small size, their simplicity, and the speed with which they kill microorganisms. Killing occurs on contact in low- or no-salt concentrations. One such candidacidal peptide is PMAP-23, derived from porcine myeloid cells (12). This is a 23-mer peptide with several well-characterized derivatives that is broadly microbicidal (14). In this report, we compare the activities of Fn/23 (similar in composition to PepTite 2000, as reported in previous publications [8, 11]), which inhibits Candida adherence as well as kills the microorganism, with the properties of PMAP-23 and other fungicidal peptides that have no measurable effect upon adherence of fungi to proteins or peptides.

MATERIALS AND METHODS
Microorganisms, plasmids, and growth media.
A wild-type
C. albicans strain (CA1) originally isolated from
a human source was used in these studies and grown in liquid
yeast extract-peptone-dextrose (YPD) (
6,
10).
Saccharomyces cerevisiae YPH499 (
MATa ura3-
52 lys2-
801amber ade2-
101ochre trp1-d63 his3-d200 leu2-d1) was obtained from the American Type
Culture Collection and used as a heterologous host for the expression
of a
C. albicans adhesin, Als5p.
S. cerevisiae YPH499 or
S. cerevisiae YPH499 expressing Als5p were grown in liquid YP-raffinose-galactose
media at 28°C prior to adherence assays, as described before
(
4). The vector of Als5p is a low-copy-number vector, and the
gene is expressed from a GAL1 promoter. Cells were thoroughly
washed with Tris-EDTA (TE) buffer by centrifugation and suspended
at a concentration of

10
9/ml prior to use.
Peptides.
Fn/23 (GRGDSPASSKGGGGSRLLLLLLR) and its derivatives (RGDSPASSKP, SPASSKGGGGSRL, and GGGGSRLLLLLLR) were synthesized using 9-fluorenylmethoxy carbonyl (Fmoc) chemistry on a 72-column synthesizer, and quality assurance was provided by mass spectroscopy and high-performance liquid chromatography (Invitrogen, Carlsbad, Calif.). The PMAP-23 peptide (12, 14), RIIDLLWRVRRPQKPKFVTVWVR-NH2; an 18-mer hybrid of cecropin and magainin, KWKKLLKKPLLKKLLKKL-NH2 (17); and a 19-mer derived from Helicobacter pylori ribosomal protein L1, AKKVFKRLEKLFSKIWNWK-NH2 (13), were synthesized by one author (K. S. Hahm) by the solid-phase method using Fmoc chemistry. An amide 4-methyl benzhydrylamine resin was used as the support to obtain a C-terminal amidate peptide (14). The peptide KLRIPSV was synthesized on 90-µm-diameter polyethylene glycol (PEG) beads using Fmoc chemistry (9). Sequence analysis of peptides attached to the beads confirmed the identity of the peptide (Laboratory for Protein Sequencing and Analyses, Department of Chemistry, University of Arizona, Tucson).
Adherence assay.
For adherence assay purposes, 1 µl of culture concentrate containing
106 yeast cells was mixed with approximately 1,000 PEG beads (
90 µm in diameter) in 1.5 ml of water, TE buffer (10 mM Tris-HCl, 1 mM EDTA [pH 7.0]), or Earle's balanced salt solution without Ca2+, Mg2+, or phenol red (EBSS) and placed in the wells of a six-well culture tray. The PEG beads had the adherent ligand KLRIPSV synthesized on their surfaces. KLRIPSV is a heptamer recognized by Als1p and Als5p as well as by C. albicans (9) and leads to adherence and aggregation of yeast cells on the beads. The tray was agitated horizontally at 150 rpm for 30 min. The tray was removed and examined microscopically, and counts were made of yeast cells that had adhered to PEG beads or an estimate of adherence was made and scored as follows: a score of 0 indicated no adherence, + indicated some adherence of yeast cells (20 to 25/bead), ++ indicated that the bead was almost covered by yeast cells (80 to 150/ bead), and +++ indicated adherence with cell-cell aggregation. Experiments were always done in triplicate and repeated a minimum of three times. In some of the experiments, all ingredients were added simultaneously, whereas in other assays, we were interested in desorption and reagents were added following adherence of the yeast cells to a bead surface.
Determination of killing.
Yeast cells were placed with the peptide of interest in a chosen buffer and mixed by placing the solution on a rocking platform for 30 min. The microbicidal action of the peptides was determined by staining cells with the vital dye methylene blue (0.05 mg/ml) (live cells exclude the dye [15]). Dye results were confirmed by culture on YPD agar. Mean numbers of CFU of treated yeast cells cultured on YPD agar (expressed as percentages of live cells) were as follows: 100% with no Fn/23 peptide (control), 100% with 0.04 µM Fn/23, 11% with 0.4 µM Fn/23, 4% with 2 µM Fn/23, and 0% with 4 and 8 µM Fn/23. Thus, the minimum fungicidal concentration is between 2 and 4 µM. The dye method is rapid, accurate, and easy to perform; therefore, viability results shown are those obtained by dye study only. Thus, adherence and viability could be monitored simultaneously by microscopy.
Statistical analysis.
The quantitative adherence and viability assays for each variable were performed a minimum of three times. Results are presented as means ± standard deviations and were analyzed by using a paired Student t test, with a P value of <0.05 being considered significant.

RESULTS
Peptides and adherence.
C. albicans (Fig.
1) and
S. cerevisiae expressing Als5p readily
adhered to and aggregated upon the surfaces of PEG beads coated
with the heptamer KLRIPSV. Aggregation occurs through SRS adherence
as described above. Prerequisites for SRS adherence include
the presence of a sterically accessible peptide backbone in
the target peptide or protein with at least five peptide bonds
(
7).
S. cerevisiae not expressing Als proteins (Als1p and Als5p)
does not adhere to the peptide-coated PEG beads, and neither
C. albicans nor
S. cerevisiae expressing Als proteins adhere
to beads that lack the peptide. KLRIPSV was chosen as the target
peptide because it is recognized by both Als proteins and elicits
adherence followed by cell-to-cell aggregation by
C. albicans and
S. cerevisiae expressing the two Als proteins (
9).
Previous work with magnetic beads coated with proteins or peptides
has demonstrated that SRS adherence is not affected by the addition
of saccharides and nonionic detergent, and thus lectin-like
and hydrophobic interactions are not the predominant forces
in this form of adherence. On the contrary, SRS adherence is
reversed only upon the addition of factors which are known to
break hydrogen bonds, such as formamide, high pH, and urea (
4).
We tested whether Fn/23 could inhibit
C. albicans adhesive interactions.
Table
1 shows that this peptide inhibited both adherence to
beads and cell-to-cell aggregation when it was added with the
ligand beads and also reversed aggregate formation to a large
extent if it was added after the interactions had already formed.
Formamide was similarly a very effective inhibitor of adherence,
completely abrogating the interaction and displaying desorptive
activity as well. The addition of formamide results in a dissociation
of yeasts from the peptide-coated PEG beads, and if the formamide
is washed away from the yeasts, then the same yeast will then
readily adhere and aggregate on the peptide-coated PEG beads
when resuspended with the beads, which demonstrates that adherence
is reversible (
9). Inhibition of adherence with the Fn/23 peptide
occurred with
S. cerevisiae expressing Als5p as well (Table
1).
View this table:
[in this window]
[in a new window]
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TABLE 1. Effects of different treatments on the adherence of C. albicans and S. cerevisiae expressing Als5p to PEG beads with KLRIPSV synthesized on their surfaces
|
We then asked the question of whether other oligomers, even
some derived from Fn/23, could inhibit the adherence of
C. albicans to KLRIPSV-coated PEG beads. We divided Fn/23 into sequences
possessing only the N and C termini and the central sequence
of the peptide and compared the inhibitory actions of these
peptides to that of Fn/23 as well as to those of PMAP-23, a
well-characterized microbicidal peptide (
12), a peptide derived
from a hybrid of cecropin and magainin, and a peptide from an
H. pylori ribosomal protein (Table
2). Only the intact parent
Fn/23 molecule possessed the property of inhibition of adherence.
Even peptides derived from Fn/23 did not share this property.
The concentration of Fn/23 that inhibited adherence by 50% was
determined to be about 4 to 5 µM (Fig.
2).
View this table:
[in this window]
[in a new window]
|
TABLE 2. Adherence of C. albicans to PEG beads coated with KLRIPSV in the presence or absence of various peptides
|
Killing of fungi.
We had noticed that
C. albicans yeast cells mixed with the Fn/23
peptide, when suspended in TE buffer or water, aggregate in
pairs and in small clusters and appear to have extruded part
of their contents. We therefore tested for fungicidal activity.
C. albicans yeast cells mixed with the peptide could not be
cultured and took up methylene blue dye avidly. The concentration-dependent
nature of the fungicidal action of Fn/23 was then determined
by incubating cells treated with Fn/23 for 15 to 30 min with
methylene blue dye (Fig.
3). All yeast cells were killed by
a concentration of 4 to 8 µM Fn/23. The dye method allowed
one to observe microscopically cell death and the presence or
absence of adherence simultaneously. However, the method was
not as sensitive as a CFU-counting technique for detecting cell
death. For example, the mean numbers of CFU of Fn/23-treated
yeast cells cultured on YPD agar (expressed as percentages of
live cells) were as follows: 100% with no Fn/23 peptide (control),
100% with 0.04 µM Fn/23, 11% with 0.4 µM Fn/23,
4% with 2 µM Fn/23, and 0% with 4 and 8 µM Fn/23.
Thus, the minimum fungicidal concentration, as determined by
the CFU-counting technique, was between 2 and 4 µM.
The killing action of Fn/23 was, however, abolished in the presence
of physiologic salt concentrations (Table
3), a feature common
to other microbicidal peptides. However, washing
C. albicans cells exposed to the Fn/23 peptide in physiologic salts in water
or TE buffer led to their immediate deaths as determined by
their inability to exclude methylene blue.
To see if the fungicidal activity of Fn/23 was independent of
its antiadhesion properties, we conducted a series of washing
experiments.
C. albicans cells expressing several Als adhesins
or Als-expressing
S. cerevisiae cells were treated with Fn/23
in EBSS under conditions leading to complete inhibition of adherence
and aggregation. The peptide was then removed from the adhesins
by incubation at pH 11 to dissociate the peptide. The cells
regained adhesiveness to ligand-coated beads when washed cells
were added to beads; however, the
C. albicans yeast cells were
killed. Thus, Fn/23 binds to the Als adhesins as well as to
other components of the cell. Exposure of
C. albicans cells
to Fn/23 leads to an irreversible commitment to killing in low-ionic-strength
media.
We then compared the killing activity of Fn/23 to the killing activities of components of Fn/23 and other known fungicidal peptides. The N or C terminus sequence of amino acids or the sequence from the middle of the peptide had modest effects on the viability of the fungi (Table 4). On the other hand, the 23-mer PMAP-23, peptides derived from cecropin and magainin, and an H. pylori ribosomal protein sequence were fungicidal at concentrations equivalent to that of Fn/23. However, it should be recalled that these other peptides had no effect on the adherence of C. albicans (Table 2) or S. cerevisiae expressing Als5p.

DISCUSSION
Antimicrobial peptides are part of the innate host defenses
in plants, insects, amphibians, and mammals (
16). They have
a broad spectrum of activity against bacteria, fungi, and even
viruses. The fungicidal action of one of these peptides is believed
to occur by the binding of the peptide to the plasma membrane
(
16,
20), possibly to ergosterol, and in so doing, disrupting
the integrity of the membrane and hence the internal homeostasis
(
3). Macroscopic damage to fungi is a property of several cathelicidin
antimicrobial peptides, linear peptides of 23 to 37 amino acids
(
20) that are larger than defensins and lack cysteine, which
confers a ß pleat conformation to such peptides. These
peptides fold into

helices that are amphipathic (
20). The Fn/23
peptide described herein most resembles the cathelicidin antimicrobial
peptides in sequence and composition. Exposure of
C. albicans to 12.5 µM melittin or PMAP-23 causes gross destruction
and rupture of cell membranes and cell walls (
14). Similar gross
destruction of
C. albicans yeast cells led to the serendipitous
discovery of the antifungal activity of the Fn/23 peptide, since
cells in TE buffer or water exposed to the peptide were misshapen
and appeared to extrude cell contents when viewed by light microscopy.
Fn/23 was compared to the activities of other well-characterized antifungal peptides. A peptide derived from an H. pylori ribosomal protein (13), a hybrid of cecropin and magainin (17), and a porcine myeloid cell line (PMAP-23) were chosen for their similarity in number of amino acids to Fn/23. These three peptides have been studied in depth for their broad spectra of activity, modes of killing, and relative antifungal activities (12). Further fungicidal peptides have been synthesized on the basis of the sequence and stereochemistry of PMAP-23 (14). Although these peptides were potent killers, they did not display any antiadhesive qualities.
The cathelicidins, particularly those derived from bovine and porcine myeloid cells, possess other properties besides antimicrobial killing, such as wound healing and angiogenesis (19). It is interesting that Fn/23 not only kills but also inhibits the adherence of C. albicans, two unrelated properties apparently targeting different parts of the fungal cell, i.e., in one case, targeting the Als adhesin cell surface proteins, and in the other case, targeting the cell membrane. These dual properties may prove to be helpful adjuvants in the treatment of some forms of candidiasis, particularly mucosal disease, where a temporary aqueous environment could conceivably be achieved by therapeutic intervention.

ACKNOWLEDGMENTS
We thank Min Hahn of the Arizona Cancer Center for the synthesis
of the peptide-coated PEG beads.
This research was supported by a grant from the Southeastern Arizona Biomedical Research Foundation, Tucson.

FOOTNOTES
* Corresponding author. Mailing address: Section of Infectious Diseases, Department of Medicine, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724. Phone: (520) 626-6887. Fax: (520) 626-5183. E-mail:
sklotz{at}u.arizona.edu.


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Antimicrobial Agents and Chemotherapy, November 2004, p. 4337-4341, Vol. 48, No. 11
0066-4804/04/$08.00+0 DOI: 10.1128/AAC.48.11.4337-4341.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
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