Mutations in <italic toggle="yes">TAC1B</italic>: a Novel Genetic Determinant of Clinical Fluconazole Resistance in <named-content content-type="genus-species">Candida auris</named-content>

ABSTRACT Candida auris has emerged as a multidrug-resistant pathogen of great clinical concern. Approximately 90% of clinical C. auris isolates are resistant to fluconazole, the most commonly prescribed antifungal agent, and yet it remains unknown what mechanisms underpin this fluconazole resistance...

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Autores principales:	Jeffrey M. Rybak, José F. Muñoz, Katherine S. Barker, Josie E. Parker, Brooke D. Esquivel, Elizabeth L. Berkow, Shawn R. Lockhart, Lalitha Gade, Glen E. Palmer, Theodore C. White, Steve L. Kelly, Christina A. Cuomo, P. David Rogers
Formato:	article
Lenguaje:	EN
Publicado:	American Society for Microbiology 2020
Materias:	Candida triazole resistance efflux CRISPR WGS Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/57743729eb0c454497ebc0dcd700562d
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spelling	oai:doaj.org-article:57743729eb0c454497ebc0dcd700562d2021-11-15T15:56:47ZMutations in <italic toggle="yes">TAC1B</italic>: a Novel Genetic Determinant of Clinical Fluconazole Resistance in <named-content content-type="genus-species">Candida auris</named-content>10.1128/mBio.00365-202150-7511https://doaj.org/article/57743729eb0c454497ebc0dcd700562d2020-06-01T00:00:00Zhttps://journals.asm.org/doi/10.1128/mBio.00365-20https://doaj.org/toc/2150-7511ABSTRACT Candida auris has emerged as a multidrug-resistant pathogen of great clinical concern. Approximately 90% of clinical C. auris isolates are resistant to fluconazole, the most commonly prescribed antifungal agent, and yet it remains unknown what mechanisms underpin this fluconazole resistance. To identify novel mechanisms contributing to fluconazole resistance in C. auris, fluconazole-susceptible C. auris clinical isolate AR0387 was passaged in media supplemented with fluconazole to generate derivative strains which had acquired increased fluconazole resistance in vitro. Comparative analyses of comprehensive sterol profiles, [3H]fluconazole uptake, sequencing of C. auris genes homologous to genes known to contribute to fluconazole resistance in other species of Candida, and relative expression levels of C. auris ERG11, CDR1, and MDR1 were performed. All fluconazole-evolved derivative strains were found to have acquired mutations in the zinc-cluster transcription factor-encoding gene TAC1B and to show a corresponding increase in CDR1 expression relative to the parental clinical isolate, AR0387. Mutations in TAC1B were also identified in a set of 304 globally distributed C. auris clinical isolates representing each of the four major clades. Introduction of the most common mutation found among fluconazole-resistant clinical isolates of C. auris into fluconazole-susceptible isolate AR0387 was confirmed to increase fluconazole resistance by 8-fold, and the correction of the same mutation in a fluconazole-resistant isolate, AR0390, decreased fluconazole MIC by 16-fold. Taken together, these data demonstrate that C. auris can rapidly acquire resistance to fluconazole in vitro and that mutations in TAC1B significantly contribute to clinical fluconazole resistance. IMPORTANCE Candida auris is an emerging multidrug-resistant pathogen of global concern, known to be responsible for outbreaks on six continents and to be commonly resistant to antifungals. While the vast majority of clinical C. auris isolates are highly resistant to fluconazole, an essential part of the available antifungal arsenal, very little is known about the mechanisms contributing to resistance. In this work, we show that mutations in the transcription factor TAC1B significantly contribute to clinical fluconazole resistance. These studies demonstrated that mutations in TAC1B can arise rapidly in vitro upon exposure to fluconazole and that a multitude of resistance-associated TAC1B mutations are present among the majority of fluconazole-resistant C. auris isolates from a global collection and appear specific to a subset of lineages or clades. Thus, identification of this novel genetic determinant of resistance significantly adds to the understanding of clinical antifungal resistance in C. auris.Jeffrey M. RybakJosé F. MuñozKatherine S. BarkerJosie E. ParkerBrooke D. EsquivelElizabeth L. BerkowShawn R. LockhartLalitha GadeGlen E. PalmerTheodore C. WhiteSteve L. KellyChristina A. CuomoP. David RogersAmerican Society for MicrobiologyarticleCandidatriazoleresistanceeffluxCRISPRWGSMicrobiologyQR1-502ENmBio, Vol 11, Iss 3 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Candida triazole resistance efflux CRISPR WGS Microbiology QR1-502
spellingShingle	Candida triazole resistance efflux CRISPR WGS Microbiology QR1-502 Jeffrey M. Rybak José F. Muñoz Katherine S. Barker Josie E. Parker Brooke D. Esquivel Elizabeth L. Berkow Shawn R. Lockhart Lalitha Gade Glen E. Palmer Theodore C. White Steve L. Kelly Christina A. Cuomo P. David Rogers Mutations in <italic toggle="yes">TAC1B</italic>: a Novel Genetic Determinant of Clinical Fluconazole Resistance in <named-content content-type="genus-species">Candida auris</named-content>
description	ABSTRACT Candida auris has emerged as a multidrug-resistant pathogen of great clinical concern. Approximately 90% of clinical C. auris isolates are resistant to fluconazole, the most commonly prescribed antifungal agent, and yet it remains unknown what mechanisms underpin this fluconazole resistance. To identify novel mechanisms contributing to fluconazole resistance in C. auris, fluconazole-susceptible C. auris clinical isolate AR0387 was passaged in media supplemented with fluconazole to generate derivative strains which had acquired increased fluconazole resistance in vitro. Comparative analyses of comprehensive sterol profiles, [3H]fluconazole uptake, sequencing of C. auris genes homologous to genes known to contribute to fluconazole resistance in other species of Candida, and relative expression levels of C. auris ERG11, CDR1, and MDR1 were performed. All fluconazole-evolved derivative strains were found to have acquired mutations in the zinc-cluster transcription factor-encoding gene TAC1B and to show a corresponding increase in CDR1 expression relative to the parental clinical isolate, AR0387. Mutations in TAC1B were also identified in a set of 304 globally distributed C. auris clinical isolates representing each of the four major clades. Introduction of the most common mutation found among fluconazole-resistant clinical isolates of C. auris into fluconazole-susceptible isolate AR0387 was confirmed to increase fluconazole resistance by 8-fold, and the correction of the same mutation in a fluconazole-resistant isolate, AR0390, decreased fluconazole MIC by 16-fold. Taken together, these data demonstrate that C. auris can rapidly acquire resistance to fluconazole in vitro and that mutations in TAC1B significantly contribute to clinical fluconazole resistance. IMPORTANCE Candida auris is an emerging multidrug-resistant pathogen of global concern, known to be responsible for outbreaks on six continents and to be commonly resistant to antifungals. While the vast majority of clinical C. auris isolates are highly resistant to fluconazole, an essential part of the available antifungal arsenal, very little is known about the mechanisms contributing to resistance. In this work, we show that mutations in the transcription factor TAC1B significantly contribute to clinical fluconazole resistance. These studies demonstrated that mutations in TAC1B can arise rapidly in vitro upon exposure to fluconazole and that a multitude of resistance-associated TAC1B mutations are present among the majority of fluconazole-resistant C. auris isolates from a global collection and appear specific to a subset of lineages or clades. Thus, identification of this novel genetic determinant of resistance significantly adds to the understanding of clinical antifungal resistance in C. auris.
format	article
author	Jeffrey M. Rybak José F. Muñoz Katherine S. Barker Josie E. Parker Brooke D. Esquivel Elizabeth L. Berkow Shawn R. Lockhart Lalitha Gade Glen E. Palmer Theodore C. White Steve L. Kelly Christina A. Cuomo P. David Rogers
author_facet	Jeffrey M. Rybak José F. Muñoz Katherine S. Barker Josie E. Parker Brooke D. Esquivel Elizabeth L. Berkow Shawn R. Lockhart Lalitha Gade Glen E. Palmer Theodore C. White Steve L. Kelly Christina A. Cuomo P. David Rogers
author_sort	Jeffrey M. Rybak
title	Mutations in <italic toggle="yes">TAC1B</italic>: a Novel Genetic Determinant of Clinical Fluconazole Resistance in <named-content content-type="genus-species">Candida auris</named-content>
title_short	Mutations in <italic toggle="yes">TAC1B</italic>: a Novel Genetic Determinant of Clinical Fluconazole Resistance in <named-content content-type="genus-species">Candida auris</named-content>
title_full	Mutations in <italic toggle="yes">TAC1B</italic>: a Novel Genetic Determinant of Clinical Fluconazole Resistance in <named-content content-type="genus-species">Candida auris</named-content>
title_fullStr	Mutations in <italic toggle="yes">TAC1B</italic>: a Novel Genetic Determinant of Clinical Fluconazole Resistance in <named-content content-type="genus-species">Candida auris</named-content>
title_full_unstemmed	Mutations in <italic toggle="yes">TAC1B</italic>: a Novel Genetic Determinant of Clinical Fluconazole Resistance in <named-content content-type="genus-species">Candida auris</named-content>
title_sort	mutations in <italic toggle="yes">tac1b</italic>: a novel genetic determinant of clinical fluconazole resistance in <named-content content-type="genus-species">candida auris</named-content>
publisher	American Society for Microbiology
publishDate	2020
url	https://doaj.org/article/57743729eb0c454497ebc0dcd700562d
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Mutations in <italic toggle="yes">TAC1B</italic>: a Novel Genetic Determinant of Clinical Fluconazole Resistance in <named-content content-type="genus-species">Candida auris</named-content>

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