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Antimicrobial Agents and Chemotherapy, June 2004, p. 2305-2307, Vol. 48, No. 6
0066-4804/04/$08.00+0 DOI: 10.1128/AAC.48.6.2305-2307.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
Enhanced Production of Farnesol by Candida albicans Treated with Four Azoles
Jacob M. Hornby* and Kenneth W. Nickerson
School of Biological Sciences, University of Nebraska, Lincoln, Nebraska 68588-0666
Received 8 December 2003/
Returned for modification 21 January 2004/
Accepted 17 February 2004

ABSTRACT
The dimorphic fungus
Candida albicans excretes farnesol, which
is produced enzymatically from the sterol biosynthetic intermediate
farnesyl pyrophosphate. Inhibition of
C. albicans by four azole
antifungals, fluconazole, ketoconazole, miconazole, and clotrimazole,
caused elevated farnesol production (10- to 45-fold). Furthermore,
farnesol production occurs in both laboratory strains and clinical
isolates (J. M. Hornby et al., Appl. Environ. Microbiol. 67:2982-2992,
2001) of
C. albicans.

TEXT
The inoculum size effect in
Candida albicans results from the
natural production and excretion of an extracellular quorum-sensing
molecule (QSM) which our laboratory identified as farnesol (
4).
Exogenous farnesol, purified from spent media or supplied commercially,
prevented mycelial development in both a growth morphology assay
and a differentiation assay. The differentiation assay used
three chemically distinct triggers for germ tube formation:
L-proline,
N-acetylglucosamine, and serum. In all cases, the
presence of farnesol prevented the yeast-to-mycelium conversion,
resulting in actively budding yeasts without influencing cellular
growth rates (
4). We later showed that only the (
E,E)-isomer
of farnesol was biologically active (
11) and that
C. albicans cell extracts contained enzymatic activity to convert [
3H]farnesyl
pyrophosphate (FPP) to [
3H]farnesol (
5).
Because FPP is the biosynthetic precursor of both farnesol (5) and ergosterol (10), we reasoned that drugs which block the sterol biosynthetic pathway after FPP might lead to the accumulation of FPP which would, in turn, lead to enhanced farnesol production. This reasoning proved correct; treatment of C. albicans with 0.5 µM zaragozic acid B, a potent inhibitor of squalene synthase (2), led to an eightfold increase in the amount of farnesol produced by C. albicans (5). At that time our group predicted that all drugs which blocked carbon flow through the sterol pathway would also cause enhanced production of farnesol. The present paper tests that generality by showing that four azole antifungals, fluconazole, clotrimazole, ketoconazole, and miconazole, also boost farnesol production by C. albicans. Additionally, because the farnesol-stimulating activity of zaragozic acid B had only been shown with strain A72, we tested the generality of farnesol production in C. albicans by analyzing five other strains, including recent clinical isolates.
Growth, sample preparation, and determination of extracellular farnesol by gas chromatography-mass spectroscopy were as previously described (4, 5). Table 1 displays the levels of extracellular farnesol produced by seven strains of C. albicans. The four clinical isolates displayed similar levels of farnesol production as the lab strains A72 and CAI-4. No significant differences were observed. In past work (4), our investigators reported quorum-sensing activity in five other laboratory strains (MEN, SC5314, LGH1095, SG3314, and ATCC10261). Thus, this study has shown a general theme of farnesol production by the majority of C. albicans strains used here. At this time we also clarified the distinction between our work, showing that farnesol is the QSM in C. albicans, and that of Oh et al. (9), who described the production of farnesoic acid as the QSM in C. albicans 10231. C. albicans 10231 produced no detectable farnesol (Table 1), thereby revealing a significant metabolic modification in this strain. To date, C. albicans 10231 is the only strain tested that does not produce farnesol. Direct comparison of the quorum-sensing activity of farnesoic acid and farnesol showed that farnesoic acid displays only 3.3% of the activity exhibited by (E,E)-farnesol (11).
Following our group's work showing increased farnesol production
after treatment of
C. albicans with the squalene synthase inhibitor
zaragozic acid B (
5), additional sterol inhibitors were studied.
Treatment with fluconazole resulted in the dose-response curve
shown in Fig.
1. The farnesol excreted increased roughly 13-fold,
reaching a maximum of ca. 1.24 mg of farnesol per gram (cell
dry weight) at 1 µM fluconazole (Fig.
1 and Table
2).
Intracellular farnesol increased in a proportional manner (data
not shown). The fluconazole concentration needed for maximal
farnesol production (1 µM) corresponded well with the
MIC of fluconazole which, for
C. albicans A72, is ca. 1 µM,
although even at 10 µM fluconazole complete inhibition
of growth is not achieved. This effect, known as trailing growth,
is common in many strains of
C. albicans (
6).
Table
2 illustrates the commonality of increased farnesol production
due to sterol inhibition by azole antifungals. Treatment with
1 µM ketoconazole, 1 µM clotrimazole, or 0.5 µM
miconazole led to farnesol production increases of 45-, 45-,
and 44-fold, respectively. Dose-response curves were not conducted
for these three azoles. With the doses chosen, very little growth
was observed over 24 h (cell dry weights were ca. 2% of those
of the untreated controls). Therefore, the higher levels of
farnesol produced with clotrimazole, ketoconazole, and miconazole
(Table
2) probably reflected how little growth occurred rather
than any mechanistic differences between fluconazole and the
other azoles. Significantly, tolnaftate, an inhibitor of squalene
epoxidation added as a control because it is known to be inactive
versus
C. albicans (
1), did not increase farnesol production
above wild-type levels (Table
2).
Our investigators previously proposed the general theme that inhibition of the sterol pathway would lead to increased production of farnesol (5). This idea was based on our work with squalene synthase inhibition by zaragozic acid B (5). This theme has now been confirmed for the inhibition of lanosterol 14
-demethylase by four cytochrome P450-inhibitory azoles (Table 2). For most strains of C. albicans, any drug that inhibits a step in the sterol biosynthetic pathway, thus inhibiting carbon flow to ergosterol, may also increase farnesol production.
Increased farnesol could also be used to screen drugs that target the sterol biosynthetic pathway and to examine the sensitivity of clinical isolates to known sterol-inhibitory drugs. While the hypothesis that azoles promote farnesol production via inhibition of the ergosterol pathway is attractive, at this time we cannot exclude the possibility that pleiotropic effects of the azole family affect farnesol independently of sterol biosynthesis.
Elevated production of farnesol at sublethal levels of fluconazole (Fig. 1), coupled with the known ability of farnesol to cause a shift from mycelia to yeast in C. albicans (4), provides an attractive explanation for past work which noted that subinhibitory concentrations of azole drugs inhibited hyphal development and maintained the cells in the yeast morphology. Interestingly, this inhibitory effect was independent of any inhibition on growth of the fungus (3, 8). Odds (7) also mentioned in his comprehensive review of Candida that "most azoles are able to prevent or greatly perturb hyphal growth of C. albicans. The drugs retard or annul the initial outgrowth of germ tubes and entirely prevent hyphal branching, thus leading to cultures of largely or entirely yeast-form cells, even on media that normally support development of long hyphae."

ACKNOWLEDGMENTS
We thank Sara Basiaga for her assistance with gas chromatography-mass
spectroscopy, Thomas Stalder for providing the clinical isolates
used in this study, and Ted White for his scientific commentary
related to the history of sublethal concentrations of azoles
inhibiting hyphal development in
C. albicans. We also thank
Pfizer Pharmaceuticals, Sandwich, United Kingdom, for providing
the fluconazole used in this study.
This work was supported by grants from the National Science Foundation (MCB-0110999) and the University of Nebraska Tobacco Settlement Biomedical Research Enhancement Fund.

FOOTNOTES
* Corresponding author. Present address: Division of Natural Sciences, Lewis-Clark State College, Lewiston, ID 83501. Phone: (208) 792-2441. Fax: (208) 792-2064. E-mail:
jmhornby{at}lcsc.edu.


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Antimicrobial Agents and Chemotherapy, June 2004, p. 2305-2307, Vol. 48, No. 6
0066-4804/04/$08.00+0 DOI: 10.1128/AAC.48.6.2305-2307.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
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