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. 2023 Nov 15;11(6):e01790-23. doi: 10.1128/spectrum.01790-23

Susceptibility to caspofungin is regulated by temperature and is dependent on calcineurin in Candida albicans

Lijun Zheng 1,#, Yi Xu 2,#, Chen Wang 2, Feng Yang 3, Yubo Dong 2,, Liangsheng Guo 4,
Editor: Gustavo H Goldman5
PMCID: PMC10715083  PMID: 37966204

ABSTRACT

Candida albicans is a prevalent opportunistic human fungal pathogen. Echinocandins are first-line drugs for the treatment of invasive candidiasis. Molecular mechanisms of resistance to echinocandins have been extensively studied; however, the effect of physiological factors on antifungal efficacy of echinocandins is unexplored. Here, we found temperature-modulated susceptibility to caspofungin in medium-independent and strain background-independent manner in C. albicans. Deletions of protein kinase C (PKC) pathway and calcineurin-Crz1 signaling pathway genes conferred hypersensitivity to caspofungin, but only deletion or pharmacological inhibition of calcineurin subunits inverted the temperature effect on susceptibility to caspofungin. Furthermore, the enhanced growth at lower temperature was not due to altered expression of some established genes such as FKS, CHS, or CHT genes; PKC or calcineurin pathway genes; or HSP90. The expressions of other heat shock protein genes, including HSP12 and HSP70, were higher at lower temperature. We posit that the temperature-modulated susceptibility to caspofungin is a non-canonical mechanism that is dependent on heat shock proteins and calcineurin.

IMPORTANCE

Echinocandins are the newest antifungal drugs and are first-line treatment option for life-threatening systemic infections. Due to lack of consensus regarding what temperature should be used when evaluating susceptibility of yeasts to echinocandins, typically either 30°C, 35°C, or 37°C is used. However, the impact of temperature on antifungal efficacy of echinocandins is unexplored. In the current study, we demonstrated that Candida albicans laboratory strain SC5314 was more susceptible to caspofungin at 37°C than at 30°C. We also found that calcineurin was required for temperature-modulated caspofungin susceptibility. Surprisingly, the altered caspofungin susceptibility was not due to differential expression of some canonical genes such as FKS, CHS, or CHT genes. The molecular mechanism of temperature-modulated caspofungin susceptibility is undetermined and deserves further investigations.

KEYWORDS: Candida albicans, caspofungin, temperature, calcineurin

INTRODUCTION

In recent years, due to steady increase of immunocompromised populations, opportunistic fungal infections are emerging as an important public health concern and cost burden (1). Candida spp are the most common human fungal pathogens and are the fourth leading cause of nosocomial bloodstream infections in the United States (2). Among them, Candida albicans is the most common fungal pathogen responsible for nosocomial systemic infections and the most commonly isolated pathogen from clinical samples obtained from mucous membranes (3). C. albicans is a harmless commensal colonizer dwelling in human oral cavity, gastrointestinal tract, and vaginal. However, this fungus is also the leading pathogen causing infections that range from superficial infections of the skin to life-threatening systemic infections, especially in immunocompromised populations (3). In 2022, the World Health Organization released the first-ever list of health-threatening fungi. C. albicans is among the four members of the most dangerous “critical group” (4).

Currently, only four classes of antifungal drugs are available: azoles, polyenes, 5-flucytosine, and echinocandins. Echinocandins are the most optimal first-line antifungal agents for the treatment of invasive candidiasis (5). Three echinocandin drugs are approved by the United States Food and Drug Administration to treat candidemia: caspofungin (CSP), anidulafungin (ANF), and micafungin (MCF). Echinocandins are fungicidal against Candida spp and fungistatic against Aspergillus spp but are inactive against Cryptococcus spp (6). Echinocandins act by non-competitively binding to β-(1,3)-glucan synthase (7). Inhibition of the major fungal cell wall component β-(1,3)-glucan biosynthesis leads to growth inhibition or death owing to imbalance in osmotic pressure (8).

The incidence of CSP resistance is rising in recent years (911). Resistance to CSP is usually due to point mutations in FKS genes, which encode subunits of the β-(1,3)-glucan synthase (12). Mutation usually occurs in two highly conserved hotspot regions of FKS genes encompassing amino acids 641–649 and amino acids 1357–1364 (13). The amino acids of FKS mutation decrease the sensitivity of glucan synthase to echinocandins and cause cross-resistance to various echinocandins (9, 14, 15). About 80% mutation in FKS1/GSC1 of C. albicans occur in Ser645 and Phe641, which brings the most prominent resistance phenotype (16, 17). The roles of FKS2/GSL1 and FKS3/GSL2 in resistance to CSP in C. albicans are largely unknown; however, deletions of FKS2 and FKS3 can upregulate expression of FKS1, increase cell wall glucan content, and decrease susceptibility to echinocandins (18). In glabrata, mutations occur more frequently in FKS2 (19). In auris, S639F mutation of FKS1 is associated with CSP resistance in clinical isolates (20).

In addition to FKS mutations, cell wall salvage mechanism also contributes to CSP resistance. Fungal cell wall consists of glucan, chitin, and glycoproteins. Inhibition of glucan biosynthesis usually results in compensatory increase of chitin synthesis (21, 22). Both in vitro and in vivo, elevated chitin confers CSP resistance in C. albicans (23, 24). Moreover, C. albicans clinical isolates containing FKS1 mutation generally have higher chitin levels (23). Decreased digestion of chitin, due to loss-of-function mutation in chitinase genes CHT2 and CHT3 (25), and decreased copy number of CHT2 also confer CSP resistance in C. albicans (26).

Compensatory increase of chitin in response to CSP treatment is dependent on the regulatory circuit composed of PKC pathway, calcineurin pathway, high-osmolarity glycerol pathway, and heat shock protein 90 (Hsp90) (22, 27). Deletion of PKC pathway genes, including PKC1, BCK1, MKK2, and MKC1, or genes encoding downstream transcription factors, including SWI4, SWI6 and RLM1, causes hypersensitivity to echinocandins (28, 29). Pharmacological inhibition of calcineurin is synergistic with echinocandins against clinical isolates harboring FKS1 mutations (30). Genetic deletion of CMP1 and CNB1, which encodes the catalytic subunit and regulatory subunit of calcineurin, respectively, or CRZ1, which encodes the major downstream transcription factor of the calcineurin pathway, can enhance sensitivity of C. albicans to echinocandins (29, 30). Calcineurin is the client protein of Hsp90, a highly conserved molecular chaperone. Hsp90 plays a pivotal role in activation and stabilization of calcineurin (30).

Although genes and regulatory networks required for CSP resistance have been studied extensively, physiological factors affecting antifungal efficacy of CSP are largely unexplored. Recent studies indicate that temperature affects antifungal potency of azoles against C. albicans (31, 32); however, the impact of different temperatures on the antifungal effect of CSP is still unknown. There is no consensus among researchers regarding what temperature should be used in yeast studies. Usually either 30°C or 37°C is used. In the current study, we found that C. albicans was less susceptible to CSP at 30°C than at 37°C. The temperature effect was independent on medium composition, or genetic backgrounds of test strains, and was independent on the PKC pathway, albeit deletion of PKC pathway genes that caused hypersensitivity to CSP. Pharmacological inhibition or genetic knockdown of calcineurin subunits inverted temperature effect on CSP susceptibility; however, the transcription factor of the calcineurin pathway, Crz1, was not involved. Comparison of transcriptomes of cells grown at 30°C and 37°C indicated that several genes encoding chaperone proteins were more abundant at 30°C. We posit that heat shock proteins and the client protein calcineurin are required for temperature-modulated CSP susceptibility in C. albicans.

MATERIALS AND METHODS

Strains and growth conditions

The strains used in this study are listed in Table S1. The stock culture was preserved in 25% of glycerol and maintained at −80°C. Cells were routinely grown in the yeast extract–peptone–dextrose (YPD) media [1% (wt/vol) yeast extract, 2% (wt/vol) peptone, and 2% (wt/vol) D-glucose] at 37°C in a shaking incubator at 150–200 rpm. For solid medium, 2% [wt/vol] agar was added. SD agar plates [0.67% (wt/vol) yeast nitrogen base without amino acids, 2% (wt/vol) D-glucose, and 2% (wt/vol) agar] and SDC agar plates [0.67% (wt/vol) yeast nitrogen base without amino acids, 0.2% of all amino acids mixture, 2% (wt/vol) D-glucose, and 2% (wt/vol) agar] were used. The same medium was used for growing cells and doing tests. The medium and temperature used in each experiment are specified in the figure legends. Drugs were dissolved in dimethyl sulfoxide (DMSO) and stored at −20°C. For the selection of gene knockout strains, YPD agar containing 400 µg/mL nourseothricin (NAT; Werner BioAgents) medium was used (YPD + NAT). To evict the disruption cassette, we used yeast nitrogen base (YNB)–bovine serum albumin (BSA) [0.17% (wt/vol) YNB, 2% (wt/vol) D-glucose, 0.02% (wt/vol) BSA, and 2% (wt/vol) agar] plates.

Spot assay

Cells were suspended in distilled water and adjusted to 1 × 107 cells/mL. A total of 3 µL of 10-fold serial dilutions were spotted on YPD, SD, or SDC plates with or without drugs (control) at 30°C or 37°C and photographed after 2 days. Medium and temperature were indicated in the figures.

Deletions

Gene deletions were performed as described previously (31). Primers are the same as described previously (31). Plasmid pJK863 (33) was used as template for amplifying the NAT1 flipper gene deletion cassette. Approximately 500 bp regions flanking the CDS of the target gene to be deleted were amplified using the genomic DNA of YJB-T490 as the template. The upstream region of the gene was fused by PCR to the 5′ region of the cassette, and the downstream region of the gene was fused to the 3′ region of the cassette. The upstream and downstream fusion products for each gene were then simultaneously transformed in C. albicans by following the lithium acetate method (34). Transformants were selected on YPD plates supplemented with 400 µg/mL NAT. Diagnostic PCR using primers that annealed outside the flanking homologous regions of the gene was performed to confirm the replacement of the gene with the NAT1 flipper cassette. The NAT1 flipper was evicted by streaking the clones on YNB–BSA plates.

Growth curve

Approximately 1 × 103 cells/mL of each strain were suspended in YPD broth and 150 µL was transferred to a 96-well plate. Optical density at 595 nm (OD595) was measured every 15 min for 24 h at 30°C using a Tecan plate reader (Infinite F200 PRO; Tecan, Switzerland).

RNA-Seq

RNA-seq was performed as described previously (29). SC5314 was inoculated to a starting OD600 of 0.2 in 50 mL of YPD broth. The culture was incubated in a shaker at 30°C and 37°C until the OD600 reached 1.0. Cultures were collected by centrifugation (comparison between 30°C and 37°C) or divided into two batches: one batch was supplemented with 100 ng/mL CSP, and the other batch was supplemented with an equal volume of DMSO. Three hours later, the cultures were collected by centrifugation, washed, and flash frozen in liquid nitrogen. The total RNA was extracted for six independent samples, corresponding to two conditions and three biological replicates. Total RNA extraction and purification, library construction, and sequencing were performed as described in Yang et al. (35). Raw sequence files (.fastq files) underwent quality control analysis using the FastQC tool (http://www.bioinformatics.babraham.ac.uk/projects/fastqc). Reads were mapped to the C. albicans SC5314 reference genome (http://www.candidagenome.org/download/sequence/C_albicans_SC5314/Assembly22/current/). Differential gene expression profiling was carried out using DESeq2 (36) with standard parameters. Genes with false discovery rate-adjusted P-value (<0.05) and expression fold changes of more than 1.5 or less than −1.5 were considered differentially expressed.

RESULTS

Temperature modulates echinocandins susceptibility

Susceptibility of the C. albicans reference strain SC5314 to CSP and MCF was measured at two different temperatures using different media. On YPD, the growth was not inhibited by 100 ng/mL CSP (Fig. 1, top panel) or 25 ng/mL MCF (Fig. 1, bottom panel) at 30°C, but the growth was completely inhibited at these drug concentrations at 37°C. On SD and SDC, the inhibition of growth by 200 ng/mL of CSP (Fig. 1, top panel) or 25 ng/mL MCF (Fig. 1, bottom panel) was more obvious at 37°C than at 30°C. Thus, independent on medium composition, SC5314 is generally less susceptible to CSP and MCF at 30°C than at 37°C.

Fig 1.

Fig 1

Temperature modulates resistance to echinocandins. Spot assays were performed using YPD, SD, and SDC media. Cells were suspended in distilled water and adjusted to 1 × 107 cells/mL; 3 µL of 10-fold serial dilutions was spotted on the plates. The plates were supplemented with caspofungin (CSP, top panel) or micafungin (MCF, bottom panel). Drug concentrations are indicated in the figure. The plates were incubated for 48 h at 30°C and 37°C, as indicated in the figure.

Temperature effect on CSP susceptibility is independent on PKC

We asked if intact PKC pathway was required for temperature-modulated CSP susceptibility. Knockouts of PKC pathway genes MKK2 and MKC1 were evaluated at 30°C and 37°C using three different media. As shown previously in Fig. 1, at 30°C, on YPD, SD, and SDC, wild-type strain could grow in the presence of 100 ng/mL, 200 ng/mL, and 200 ng/mL of CSP, respectively (Fig. 1, top panel), while growths of mkk2 Δ/Δ strain (Fig. 2, top panel) and mkc1 Δ/Δ strain (Fig. 2, bottom panel) were completely inhibited by 30 ng/mL, 200 ng/mL, and 200 ng/mL of CSP, respectively. At 37°C, on YPD, SD, and SDC, wild-type strain could grow in the presence of 50 ng/mL, 100 ng/mL, and 100 ng/mL of CSP, respectively (Fig. 1, top panel), while growths of mkk2 Δ/Δ strain (Fig. 2, top panel) and mkc1 Δ/Δ strain (Fig. 2, bottom panel) were completely inhibited by 15 ng/mL, 100 ng/mL, and 100 ng/mL of CSP, respectively.

Fig 2.

Fig 2

Role of PKC pathway in temperature-modulated caspofungin resistance. SC5314-derived strains with deletions of MKK2 (top panel) and MKC1 (bottom panel) were evaluated with spot assay. The media, temperatures, and drug concentrations are indicated in the figure. For each strain, the cell densities spotted on the plates were 1 × 107, 1 × 106, 1 × 105, and 1 × 104 cells/mL. The plates were incubated for 48 h then photographed.

Comparing between 30°C and 37°C, on YPD, SD and SDC, both mkk2 Δ/Δ and mkc1 Δ/Δ strains were less susceptible to CSP at 30°C than at 37°C (Fig. 2). Therefore, deletion of MKK2 or MKC1 caused hypersensitivity to CSP at both 30°C and 37°C; however, in deletion strains, lower temperature (30°C) still enables better adaptation to CSP than higher temperature (37°C).

Temperature effect on susceptibility to CSP is dependent on calcineurin

The calcineurin-Crz1 signaling pathway is conserved across multiple pathogenic fungi. Calcineurin is a major player in calcium2+-dependent signal transduction pathways of eukaryotes. The transcription factor Crz1 is the major effector of calcineurin (37). Calcineurin consists of a catalytic subunit and a regulatory unit, which is encoded by CMP1 and CNB1, respectively, in C. albicans genome (37).

In this study, the role of calcineurin-Crz1 signaling pathway in temperature-modulated CSP susceptibility was evaluated in two genetic backgrounds: SC5314 and YJB-T490. Two methods were employed: genetic deletions of CMP1, CNB1, and CRZ1 and pharmacological inhibition of calcineurin.

In SC5314 background, at 30°C, the wild type was not inhibited by 90 ng/mL CSP, while cmp1Δ/Δ and cnb1Δ/Δ strains were completely inhibited by 30 ng/mL CSP. However, crz1Δ/Δ strain was not inhibited by 90 ng/mL CSP. At 37°C, the wild type was not inhibited by 50 ng/mL CSP, while cmp1Δ/Δ and cnb1Δ/Δ strains were obviously inhibited by 50 ng/mL CSP, but the crz1Δ/Δ strain was also not inhibited by 50 ng/mL. Comparing between 30°C and 37°C, interestingly, both cmp1Δ/Δ and cnb1Δ/Δ strains were less susceptible at 37°C than at 30°C; however, similar to wild type, the crz1Δ/Δ strain was still more susceptible at 37°C than at 30°C (Fig. 3A).

Fig 3.

Fig 3

Role of calcineurin-Crz1 pathway in temperature-modulated caspofungin resistance. In SC5314 (top panel) and YJB-T490 (middle panel), CMP1, CNB1, and CRZ1 were deleted. Wild-type and deletion strains were tested with spot assay on YPD-agar medium supplemented with caspofungin (CSP). The wild-type strains were also tested with spot assay using YPD-agar supplemented with calcineurin inhibitor cyclosporin A (CsA, 0.5 µg/mL) (bottom panel). The temperatures and drug concentrations are indicated in the figure. The plates were incubated for 48 h then photographed.

In YJB-T490 background, at 30°C, the wild type was not inhibited by 70 ng/mL CSP, while the cmp1Δ/Δ and cnb1Δ/Δ strains were completely inhibited by 30 ng/mL and 50 ng/mL CSP, respectively. At 37°C, the wild type was not inhibited by 50 ng/mL CSP and was completely inhibited by 70 ng/mL CSP, while the cmp1Δ/Δ and cnb1Δ/Δ strains were all completely inhibited by 50 ng/mL CSP. However, crz1Δ/Δ strain had similar extent of CSP susceptibility to wild type at both 30°C and 37°C. Compared between 30°C and 37°C, both cmp1Δ/Δ and cnb1Δ/Δ strains were less susceptible to CSP at 37°C than at 30°C, while the crz1Δ/Δ strain was still more susceptible at 37°C than at 30°C (Fig. 3B). We also measured growth curves of deletion strains and the wild types in YPD broth without CSP. We found that all strains had similar growth curves (Fig. S1); thus, altered CSP susceptibility in the deletion strains was not due to change of growth caused by deletions.

Requirement of calcineurin for temperature-modulated CSP susceptibility was also evaluated by using calcineurin inhibitor cyclosporin A (CsA). In the YPD medium supplemented with 0.5 µg/mL CsA, both SC5314 and YJB-T490 were less susceptible to CSP at 37°C than at 30°C (Fig. 3C). As a control, CsA at 0.5 µg/mL was not inhibitory to the strains (Fig. S2).

Taken together, in both SC5314 and YJB-T490 backgrounds, calcineurin is required for temperature-modulated CSP susceptibility. Genetic deletion or pharmacological inhibition of calcineurin inverted extent of CSP susceptibility at 30°C and 37°C.

Canonical genes associated with CSP susceptibility are not involved in temperature-modulated CSP susceptibility

We asked why susceptibility to CSP was lower at 30°C than at 37°C. Transcriptome analysis indicated that some genes were regulated by CSP similarly 30°C and 37°C. For example, the FKS gene GSC1; the CHS genes CHS2, CHS3, CHS4, and CHS7; and the calcineurin-Crz1 signal pathway genes CMP1 and CRZ1 were upregulated by CSP at both temperatures. The CHT gene CHT3 and the HSP genes HSP21, HSP70, HSP104, and HSP12 were downregulated by CSP at both temperatures. Some genes were differentially regulated by CSP at 30°C and 37°C. For example, the PKC pathway genes BCK1 and RLM1 were upregulated by CSP at 30°C but not at 37°C, while the HSP genes HSP31 and HSP104 were downregulated by CSP at 30°C but not at 37°C (Table S2).

We compared transcriptomes of log phase cells of SC5314 incubated at 30°C and at 37°C. Genes with ratios of transcripts at 30°C vs 37°C higher than 1.5 and lower than 0.67 were considered higher and lower expressed, respectively. We found that cells did not have altered expression of FKS genes, including GSC1, GSL1, and GSL2, or of CHS genes, including CHS1, CHS2, CHS3, CHS4, CHS5, CHS6, CHS7, and CHS8. Among the four CHT genes, CHT2 and CHT3 had higher expressions (Fig. 4, top panel). Among the calcineurin-Crz1 signal pathway genes, CMP1 and CNB1 were not differentially expressed. Expression of CRZ1 was not detected. Among the PKC pathway genes, RLM1 was downregulated. The other genes were not differentially expressed, including PKC1, BCK1, MKK2, MKC1, SWI4, and SWI6 (Fig. 4, middle panel). Among the heat shock protein genes, HSP12, HSP70, HSP78, and HSP104 had higher expressions at 30°C than at 37°C, while the other heat shock protein genes were not differentially expressed, including HSP21, HSP30, HSP31, HSP60, and HSP90 (Fig. 4, bottom panel).

Fig 4.

Fig 4

Transcriptomes of cells growing at different temperatures. SC5314 was grown in YPD broth to log phase at 30°C and 37°C. Ratios of gene expression levels were calculated by dividing the transcript abundance under 30°C by that under 37°C. For each gene, ratios of both alleles (allele A and allele B) were calculated.

We also compared proteomes of log phase cells of SC5314 incubated at 30°C and at 37°C. Unexpectedly, cells did not exhibit significantly different abundance of proteins encoded by the abovementioned FKS, CHS, CHT, calcineurin-Crz1 signal pathway, or PKC pathway genes. Among the Hsp proteins, Hsp106, Hsp60, Hsp90, Hsp21, and Hsp78 were significantly more abundant in cells grown at 37°C than at 30°C (Table S3).

Taken together, lower CSP susceptibility at 30°C than at 37°C is not due to elevated expressions of FKS or CHS genes or to decreased expression of CHT genes. It is also not due to activation of PKC and calcineurin-Crz1 signaling pathways or higher expression of HSP90. It is probably due to altered expression and abundance of other heat shock protein genes such as HSP12, HSP70, HSP78, and HSP104.

DISCUSSION

Echinocandins are the newest antifungal drugs licensed for clinical use. Molecular mechanism of development of resistance to echinocandins has been extensively studied. However, little is known about the impact physiological factors on antifungal efficacy of echinocandins. The normal human body temperature ranges from 36.5°C to 37.5°C. Studies evaluating antifungal activities of echinocandins in Candida spp typically use either 30°C (38) or 37°C (39, 40). To the best of our knowledge, our study is the first to investigate the effect of different temperature on the extent of CSP resistance in C. albicans.

Consistent with previous studies, deletions of PKC pathway genes MKK2 and MKC1 and calcineurin-Crz1 signaling pathway genes CMP1 and CNB1 caused hypersensitivity to CSP (29, 30, 41, 42). Furthermore, we demonstrated that PKC pathway was not required for temperature-modulated CSP resistance. Like the wild type, both mkk2Δ/Δ and mkc1Δ/Δ strains were still more resistant to CSP at 30°C than at 37°C. We further demonstrated that both pharmacological inhibition and genetic deletion of calcineurin subunits abolished the temperature-modulated CSP resistance; however, strains with deletion of CRZ1 were still more resistant to CSP at 30°C than at 37°C, indicating that CSP resistance modulated by temperature is dependent on calcineurin but is independent on Crz1.

Unexpectedly, cells grown at 30°C and 37°C do not have altered expression of some canonical genes associated with CSP resistance, such as FKS, CHS, or CHT genes, or the PKC and calcineurin pathway genes, or HSP90. Several other genes encoding heat shock proteins were highly expressed (1.7–6.4 fold), including HSP12, HSP70, HSP78, and HSP104. Heat shock proteins exist in most organisms and have multiple broad functions. In C. albicans, there are nine kinds of heat shock proteins with varying molecular sizes: HSP12, HSP21, HSP30, HSP31, HSP60, HSP70, HSP78, HSP90, and HSP104. Calcineurin is a client protein of Hsp90. Requirement of calcineurin in resistance to azoles and echinocandins is dependent on Hsp90 (30, 43). Hsp70 is involved in the transfer of client proteins to Hsp90 for their subsequent activation via the Hsp90 chaperone cycle (44). Hsp12 is a small heat shock protein. Hsp12 usually binds denatured proteins with high affinity until Hsp70 reactivates them (45). In C. albicans, overexpression of HSP12 causes hypersensitivity to azoles (46). In Cryptococcus neoformans, deletion of HSP12 confers hypersensitivity to amphotericin B but not to azoles (47). In Saccharomyces cerevisiae, HSP12 is involved in response to multiple stresses including antifungal drugs (48), and deletion of HSP12 results in reduced plasticity and flexibility of cell wall (49). HSP12 and HSP70 are promising potential targets for antifungal drug development (50). The function of Hsp104 is similar to Hsp70 (51). Hsp78 is a mitochondrial heat shock protein. Hsp78 is implicated in the proteolysis required for the efficient degradation of substrate proteins in mitochondria (52). We posit differential expressions of Hsp12 and Hsp70 at 30°C and 37°C and potentiated calcineurin-dependent CSP resistance.

In conclusion, this study demonstrated a temperature-modulated, non-canonical mechanism of CSP susceptibility in C. albicans. Coordinated actions of Hsp12 and Hsp70 probably underlay the essentiality of calcineurin in this novel mechanism.

ACKNOWLEDGMENTS

This study was supported by the Science and Technology Development Plan of Suzhou (SLJ2022018), Scientific Research Project of Suzhou Commission of Health (GSWS2020028) to L.G., Natural Science Foundation of Shandong Province (ZR2023MH227) and the National Natural Science Foundation of China (81402978) to Y.X.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Contributor Information

Yubo Dong, Email: ddr1997@sohu.com.

Liangsheng Guo, Email: gls2135@sina.com.

Gustavo H. Goldman, Universidade de Sao Paulo, Sao Paulo, Brazil

DATA AVAILABILITY

Sequence data are available in the ArrayExpress database at EMBL-EBI (www.ebi.ac.uk/arrayexpress) under accession number E-MTAB-11924.

SUPPLEMENTAL MATERIAL

The following material is available online at https://doi.org/10.1128/spectrum.01790-23.

Fig. S1. spectrum.01790-23-s0001.tif.

Growth curves of strains with deletions of the calcineurin-Crz1 pathway genes.

DOI: 10.1128/spectrum.01790-23.SuF1
Fig. S2. spectrum.01790-23-s0002.tif.

Control experiment of cyclosporin A dosage effect.

DOI: 10.1128/spectrum.01790-23.SuF2
Supplemental legends. spectrum.01790-23-s0003.docx.

Legends for supplemental figures and tables.

DOI: 10.1128/spectrum.01790-23.SuF3
Table S1. spectrum.01790-23-s0004.docx.

Strains used in this study.

DOI: 10.1128/spectrum.01790-23.SuF4
Table S2. spectrum.01790-23-s0005.docx.

Expression of genes induced by CSP at 30°C and 37°C.

DOI: 10.1128/spectrum.01790-23.SuF5
Table S3. spectrum.01790-23-s0006.csv.

Differential proteins at 30°C and 37°C.

DOI: 10.1128/spectrum.01790-23.SuF6

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REFERENCES

  • 1. Benedict K, Jackson BR, Chiller T, Beer KD. 2019. Estimation of direct healthcare costs of fungal diseases in the United States. Clin Infect Dis 68:1791–1797. doi: 10.1093/cid/ciy776 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Horn DL, Neofytos D, Anaissie EJ, Fishman JA, Steinbach WJ, Olyaei AJ, Marr KA, Pfaller MA, Chang CH, Webster KM. 2009. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis 48:1695–1703. doi: 10.1086/599039 [DOI] [PubMed] [Google Scholar]
  • 3. Ruhnke M. 2006. Epidemiology of Candida albicans infections and role of non-Candida-albicans yeasts. Curr Drug Targets 7:495–504. doi: 10.2174/138945006776359421 [DOI] [PubMed] [Google Scholar]
  • 4. WHO . 2022. WHO fungal priority pathogens list to guide research, development and public health action. World Health Organization, Geneva. [Google Scholar]
  • 5. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. 2016. Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America. Clin Infect Dis 62:e1–e50. doi: 10.1093/cid/civ933 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Mroczyńska M, Brillowska-Dąbrowska A. 2020. Review on current status of echinocandins use. Antibiotics (Basel) 9:227. doi: 10.3390/antibiotics9050227 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. Douglas CM, D’Ippolito JA, Shei GJ, Meinz M, Onishi J, Marrinan JA, Li W, Abruzzo GK, Flattery A, Bartizal K, Mitchell A, Kurtz MB. 1997. Identification of the FKS1 gene of Candida albicans as the essential target of 1,3-beta-D-glucan synthase inhibitors. Antimicrob Agents Chemother 41:2471–2479. doi: 10.1128/AAC.41.11.2471 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Letscher-Bru V, Herbrecht R. 2003. Caspofungin: the first representative of a new antifungal class. J Antimicrob Chemother 51:513–521. doi: 10.1093/jac/dkg117 [DOI] [PubMed] [Google Scholar]
  • 9. Garcia-Effron G, Lee S, Park S, Cleary JD, Perlin DS. 2009. Effect of Candida glabrata FKS1 and FKS2 mutations on echinocandin sensitivity and kinetics of 1,3-beta-D-glucan synthase: implication for the existing susceptibility breakpoint. Antimicrob Agents Chemother 53:3690–3699. doi: 10.1128/AAC.00443-09 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10. Cleary JD, Garcia-Effron G, Chapman SW, Perlin DS. 2008. Reduced Candida glabrata susceptibility secondary to an FKS1 mutation developed during candidemia treatment. Antimicrob Agents Chemother 52:2263–2265. doi: 10.1128/AAC.01568-07 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Garcia-Effron G, Chua DJ, Tomada JR, DiPersio J, Perlin DS, Ghannoum M, Bonilla H. 2010. Novel FKS mutations associated with echinocandin resistance in Candida species. Antimicrob Agents Chemother 54:2225–2227. doi: 10.1128/AAC.00998-09 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Perlin DS. 2015. Mechanisms of echinocandin antifungal drug resistance. Ann N Y Acad Sci 1354:1–11. doi: 10.1111/nyas.12831 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13. Perlin DS. 2007. Resistance to echinocandin-class antifungal drugs. Drug Resist Updat 10:121–130. doi: 10.1016/j.drup.2007.04.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14. Park S, Kelly R, Kahn JN, Robles J, Hsu M-J, Register E, Li W, Vyas V, Fan H, Abruzzo G, Flattery A, Gill C, Chrebet G, Parent SA, Kurtz M, Teppler H, Douglas CM, Perlin DS. 2005. Specific substitutions in the echinocandin target Fks1p account for reduced susceptibility of rare laboratory and clinical Candida sp. isolates. Antimicrob Agents Chemother 49:3264–3273. doi: 10.1128/AAC.49.8.3264-3273.2005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Garcia-Effron G, Park S, Perlin DS. 2009. Correlating echinocandin MIC and kinetic inhibition of fks1 mutant glucan synthases for Candida albicans: implications for interpretive breakpoints. Antimicrob Agents Chemother 53:112–122. doi: 10.1128/AAC.01162-08 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16. Perlin DS. 2014. Echinocandin resistance, susceptibility testing and prophylaxis: implications for patient management. Drugs 74:1573–1585. doi: 10.1007/s40265-014-0286-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17. Shields RK, Nguyen MH, Press EG, Cumbie R, Driscoll E, Pasculle AW, Clancy CJ. 2015. Rate of FKS mutations among consecutive Candida isolates causing bloodstream infection. Antimicrob Agents Chemother 59:7465–7470. doi: 10.1128/AAC.01973-15 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18. Suwunnakorn S, Wakabayashi H, Kordalewska M, Perlin DS, Rustchenko E. 2018. FKS2 and FKS3 genes of opportunistic human pathogen Candida albicans influence echinocandin susceptibility. Antimicrob Agents Chemother 62:e02299-17. doi: 10.1128/AAC.02299-17 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Katiyar S, Pfaller M, Edlind T. 2006. Candida albicans and Candida glabrata clinical isolates exhibiting reduced echinocandin susceptibility. Antimicrob Agents Chemother 50:2892–2894. doi: 10.1128/AAC.00349-06 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20. Chowdhary A, Prakash A, Sharma C, Kordalewska M, Kumar A, Sarma S, Tarai B, Singh A, Upadhyaya G, Upadhyay S, Yadav P, Singh PK, Khillan V, Sachdeva N, Perlin DS, Meis JF. 2018. A multicentre study of antifungal susceptibility patterns among 350 Candida auris isolates (2009-17) in India: role of the ERG11 and FKS1 genes in azole and echinocandin resistance. J Antimicrob Chemother 73:891–899. doi: 10.1093/jac/dkx480 [DOI] [PubMed] [Google Scholar]
  • 21. Plaine A, Walker L, Da Costa G, Mora-Montes HM, McKinnon A, Gow NAR, Gaillardin C, Munro CA, Richard ML. 2008. Functional analysis of Candida albicans GPI-anchored proteins: roles in cell wall integrity and caspofungin sensitivity. Fungal Genet Biol 45:1404–1414. doi: 10.1016/j.fgb.2008.08.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22. Walker LA, Munro CA, de Bruijn I, Lenardon MD, McKinnon A, Gow NAR. 2008. Stimulation of chitin synthesis rescues Candida albicans from echinocandins. PLoS Pathog 4:e1000040. doi: 10.1371/journal.ppat.1000040 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. Walker LA, Gow NAR, Munro CA. 2013. Elevated chitin content reduces the susceptibility of Candida species to caspofungin. Antimicrob Agents Chemother 57:146–154. doi: 10.1128/AAC.01486-12 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24. Lee KK, Maccallum DM, Jacobsen MD, Walker LA, Odds FC, Gow NAR, Munro CA. 2012. Elevated cell wall chitin in Candida albicans confers echinocandin resistance in vivo. Antimicrob Agents Chemother 56:208–217. doi: 10.1128/AAC.00683-11 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. Drakulovski P, Dunyach C, Bertout S, Reynes J, Mallié M. 2011. A Candida albicans strain with high MIC for caspofungin and no FKS1 mutations exhibits a high chitin content and mutations in two chitinase genes. Med Mycol 49:467–474. doi: 10.3109/13693786.2010.538732 [DOI] [PubMed] [Google Scholar]
  • 26. Suwunnakorn S, Wakabayashi H, Rustchenko E. 2016. Chromosome 5 of human pathogen Candida albicans carries multiple genes for negative control of caspofungin and anidulafungin susceptibility. Antimicrob Agents Chemother 60:7457–7467. doi: 10.1128/AAC.01888-16 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27. Munro CA, Selvaggini S, de Bruijn I, Walker L, Lenardon MD, Gerssen B, Milne S, Brown AJP, Gow NAR. 2007. The PKC, HOG and Ca2+ signalling pathways co-ordinately regulate chitin synthesis in Candida albicans. Mol Microbiol 63:1399–1413. doi: 10.1111/j.1365-2958.2007.05588.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28. Caplan T, Polvi EJ, Xie JL, Buckhalter S, Leach MD, Robbins N, Cowen LE. 2018. Functional genomic screening reveals core modulators of echinocandin stress responses in Candida albicans. Cell Rep 23:2292–2298. doi: 10.1016/j.celrep.2018.04.084 [DOI] [PubMed] [Google Scholar]
  • 29. Yang F, Gritsenko V, Slor Futterman Y, Gao L, Zhen C, Lu H, Jiang Y-Y, Berman J. 2021. Tunicamycin potentiates antifungal drug tolerance via aneuploidy in Candida albicans. mBio 12:e0227221. doi: 10.1128/mBio.02272-21 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30. Singh SD, Robbins N, Zaas AK, Schell WA, Perfect JR, Cowen LE. 2009. Hsp90 governs echinocandin resistance in the pathogenic yeast Candida albicans via calcineurin. PLoS Pathog 5:e1000532. doi: 10.1371/journal.ppat.1000532 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Xu Y, Lu H, Zhu S, Li WQ, Jiang YY, Berman J, Yang F. 2021. Multifactorial mechanisms of tolerance to ketoconazole in Candida albicans. Microbiol Spectr 9:e0032121. doi: 10.1128/Spectrum.00321-21 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Yang F., Scopel EFC, Li H, Sun LL, Kawar N, Cao YB, Jiang YY, Berman J. 2023. Antifungal tolerance and resistance emerge at distinct drug concentrations and rely upon different aneuploid chromosomes. mBio 14:e0022723. doi: 10.1128/mbio.00227-23 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33. Shen J, Guo W, Köhler JR. 2005. CaNAT1, a heterologous dominant selectable marker for transformation of Candida albicans and other pathogenic Candida species. Infect Immun 73:1239–1242. doi: 10.1128/IAI.73.2.1239-1242.2005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34. Wilson RB, Davis D, Enloe BM, Mitchell AP. 2000. A recyclable Candida albicans URA3 cassette for PCR product-directed gene disruptions. Yeast 16:65–70. doi: [DOI] [PubMed] [Google Scholar]
  • 35. Yang F, Kravets A, Bethlendy G, Welle S, Rustchenko E. 2013. Chromosome 5 monosomy of Candida albicans controls susceptibility to various toxic agents, including major antifungals. Antimicrob Agents Chemother 57:5026–5036. doi: 10.1128/AAC.00516-13 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36. Love MI, Huber W, Anders S. 2014. Moderated estimation of fold change and dispersion for RNA-seq data with DESeq2. Genome Biol 15:550. doi: 10.1186/s13059-014-0550-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37. Karababa M, Valentino E, Pardini G, Coste AT, Bille J, Sanglard D. 2006. CRZ1, a target of the calcineurin pathway in Candida albicans. Mol Microbiol 59:1429–1451. doi: 10.1111/j.1365-2958.2005.05037.x [DOI] [PubMed] [Google Scholar]
  • 38. Duxbury SJN, Bates S, Beardmore RE, Gudelj I. 2020. Evolution of drug-resistant and virulent small colonies in phenotypically diverse populations of the human fungal pathogen Candida glabrata. Proc Biol Sci 287:20200761. doi: 10.1098/rspb.2020.0761 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39. Ksiezopolska E, Schikora-Tamarit MÀ, Beyer R, Nunez-Rodriguez JC, Schüller C, Gabaldón T. 2021. Narrow mutational signatures drive acquisition of multidrug resistance in the fungal pathogen Candida glabrata. Curr Biol 31:5314–5326. doi: 10.1016/j.cub.2021.09.084 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40. Carolus H, Pierson S, Muñoz JF, Subotić A, Cruz RB, Cuomo CA, Van Dijck P. 2021. Genome-wide analysis of experimentally evolved Candida auris reveals multiple novel mechanisms of multidrug resistance. mBio 12:e03333-20. doi: 10.1128/mBio.03333-20 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41. LaFayette SL, Collins C, Zaas AK, Schell WA, Betancourt-Quiroz M, Gunatilaka AAL, Perfect JR, Cowen LE. 2010. PKC signaling regulates drug resistance of the fungal pathogen Candida albicans via circuitry comprised of Mkc1, calcineurin, and Hsp90. PLoS Pathog 6:e1001069. doi: 10.1371/journal.ppat.1001069 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42. Reinoso-Martín C, Schüller C, Schuetzer-Muehlbauer M, Kuchler K. 2003. The yeast protein kinase C cell integrity pathway mediates tolerance to the antifungal drug caspofungin through activation of Slt2p mitogen-activated protein kinase signaling. Eukaryot Cell 2:1200–1210. doi: 10.1128/EC.2.6.1200-1210.2003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43. Cowen LE, Carpenter AE, Matangkasombut O, Fink GR, Lindquist S. 2006. Genetic architecture of Hsp90-dependent drug resistance. Eukaryot Cell 5:2184–2188. doi: 10.1128/EC.00274-06 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44. Jackson SE. 2013. Hsp90: structure and function. Top Curr Chem 328:155–240. doi: 10.1007/128_2012_356 [DOI] [PubMed] [Google Scholar]
  • 45. Friedrich KL, Giese KC, Buan NR, Vierling E. 2004. Interactions between small heat shock protein subunits and substrate in small heat shock protein-substrate complexes. J Biol Chem 279:1080–1089. doi: 10.1074/jbc.M311104200 [DOI] [PubMed] [Google Scholar]
  • 46. Fu M-S, De Sordi L, Mühlschlegel FA. 2012. Functional characterization of the small heat shock protein Hsp12p from Candida albicans. PLoS One 7:e42894. doi: 10.1371/journal.pone.0042894 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47. Maeng S, Ko YJ, Kim GB, Jung KW, Floyd A, Heitman J, Bahn YS. 2010. Comparative transcriptome analysis reveals novel roles of the Ras and cyclic AMP signaling pathways in environmental stress response and antifungal drug sensitivity in Cryptococcus neoformans. Eukaryot Cell 9:360–378. doi: 10.1128/EC.00309-09 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48. Nisamedtinov I, Lindsey GG, Karreman R, Orumets K, Koplimaa M, Kevvai K, Paalme T. 2008. The response of the yeast Saccharomyces cerevisiae to sudden vs. gradual changes in environmental stress monitored by expression of the stress response protein Hsp12p. FEMS Yeast Res 8:829–838. doi: 10.1111/j.1567-1364.2008.00391.x [DOI] [PubMed] [Google Scholar]
  • 49. Karreman RJ, Dague E, Gaboriaud F, Quilès F, Duval JFL, Lindsey GG. 2007. The stress response protein Hsp12p increases the flexibility of the yeast Saccharomyces cerevisiae cell wall. Biochim Biophys Acta 1774:131–137. doi: 10.1016/j.bbapap.2006.10.009 [DOI] [PubMed] [Google Scholar]
  • 50. Ancuceanu R, Hovaneț MV, Cojocaru-Toma M, Anghel A-I, Dinu M. 2022. Potential antifungal targets for Aspergillus sp. from the calcineurin and heat shock protein pathways. Int J Mol Sci 23:12543. doi: 10.3390/ijms232012543 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51. Sanchez Y, Parsell DA, Taulien J, Vogel JL, Craig EA, Lindquist S. 1993. Genetic evidence for a functional relationship between Hsp104 and Hsp70. J Bacteriol 175:6484–6491. doi: 10.1128/jb.175.20.6484-6491.1993 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52. Rottgers K, Zufall N, Guiard B, Voos W. 2002. The ClpB homolog Hsp78 is required for the efficient degradation of proteins in the mitochondrial matrix. J Biol Chem 277:45829–45837. doi: 10.1074/jbc.M207152200 [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Fig. S1. spectrum.01790-23-s0001.tif.

Growth curves of strains with deletions of the calcineurin-Crz1 pathway genes.

DOI: 10.1128/spectrum.01790-23.SuF1
Fig. S2. spectrum.01790-23-s0002.tif.

Control experiment of cyclosporin A dosage effect.

DOI: 10.1128/spectrum.01790-23.SuF2
Supplemental legends. spectrum.01790-23-s0003.docx.

Legends for supplemental figures and tables.

DOI: 10.1128/spectrum.01790-23.SuF3
Table S1. spectrum.01790-23-s0004.docx.

Strains used in this study.

DOI: 10.1128/spectrum.01790-23.SuF4
Table S2. spectrum.01790-23-s0005.docx.

Expression of genes induced by CSP at 30°C and 37°C.

DOI: 10.1128/spectrum.01790-23.SuF5
Table S3. spectrum.01790-23-s0006.csv.

Differential proteins at 30°C and 37°C.

DOI: 10.1128/spectrum.01790-23.SuF6

Data Availability Statement

Sequence data are available in the ArrayExpress database at EMBL-EBI (www.ebi.ac.uk/arrayexpress) under accession number E-MTAB-11924.


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