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Mechanisms of Resistance

Resistance Mechanisms in Clinical Isolates of Candida albicans

Theodore C. White, Scott Holleman, Francis Dy, Laurence F. Mirels, David A. Stevens
Theodore C. White
1Department of Pathobiology, School of Public Health and Community Medicine, University of Washington
2Seattle Biomedical Research Institute, Seattle, Washington
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  • For correspondence: tedwhite@u.washington.edu
Scott Holleman
2Seattle Biomedical Research Institute, Seattle, Washington
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Francis Dy
2Seattle Biomedical Research Institute, Seattle, Washington
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Laurence F. Mirels
3Department of Medicine, Santa Clara Valley Medical Center and California Institute for Medical Research, San Jose
4Stanford University, Stanford, California
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David A. Stevens
3Department of Medicine, Santa Clara Valley Medical Center and California Institute for Medical Research, San Jose
4Stanford University, Stanford, California
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DOI: 10.1128/AAC.46.6.1704-1713.2002
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ABSTRACT

Resistance to azole antifungals continues to be a significant problem in the common fungal pathogen Candida albicans. Many of the molecular mechanisms of resistance have been defined with matched sets of susceptible and resistant clinical isolates from the same strain. Mechanisms that have been identified include alterations in the gene encoding the target enzyme ERG11 or overexpression of efflux pump genes including CDR1, CDR2, and MDR1. In the present study, a collection of unmatched clinical isolates of C. albicans was analyzed for the known molecular mechanisms of resistance by standard methods. The collection was assembled so that approximately half of the isolates were resistant to azole drugs. Extensive cross-resistance was observed for fluconazole, clotrimazole, itraconazole, and ketoconazole. Northern blotting analyses indicated that overexpression of CDR1 and CDR2 correlates with resistance, suggesting that the two genes may be coregulated. MDR1 overexpression was observed infrequently in some resistant isolates. Overexpression of FLU1, an efflux pump gene related to MDR1, did not correlate with resistance, nor did overexpression of ERG11. Limited analysis of the ERG11 gene sequence identified several point mutations in resistant isolates; these mutations have been described previously. Two of the most common point mutations in ERG11 associated with resistance, D116E and E266D, were tested by restriction fragment length polymorphism analysis of the isolates from this collection. The results indicated that the two mutations occur frequently in different isolates of C. albicans and are not reliably associated with resistance. These analyses emphasize the diversity of mechanisms that result in a phenotype of azole resistance. They suggest that the resistance mechanisms identified in matched sets of susceptible and resistant isolates are not sufficient to explain resistance in a collection of unmatched clinical isolates and that additional mechanisms have yet to be discovered.

  • Copyright © 2002 American Society for Microbiology
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Resistance Mechanisms in Clinical Isolates of Candida albicans
Theodore C. White, Scott Holleman, Francis Dy, Laurence F. Mirels, David A. Stevens
Antimicrobial Agents and Chemotherapy Jun 2002, 46 (6) 1704-1713; DOI: 10.1128/AAC.46.6.1704-1713.2002

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Resistance Mechanisms in Clinical Isolates of Candida albicans
Theodore C. White, Scott Holleman, Francis Dy, Laurence F. Mirels, David A. Stevens
Antimicrobial Agents and Chemotherapy Jun 2002, 46 (6) 1704-1713; DOI: 10.1128/AAC.46.6.1704-1713.2002
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KEYWORDS

antifungal agents
Candida albicans
candidiasis
Drug Resistance, Multiple
Fungal Proteins

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