Resistance Mechanisms in Clinical Isolates of Candida albicans

White, Theodore C.; Holleman, Scott; Dy, Francis; Mirels, Laurence F.; Stevens, David A.

doi:10.1128/aac.46.6.1704-1713.2002

Cited by 461Antifungal resistance and susceptibilityFungal and yeast genetics researchFungal Plant Pathogen Control

Resistance Mechanisms in Clinical Isolates of Candida albicans

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White, Theodore C., Holleman, Scott, Dy, Francis, Mirels, Laurence F., Stevens, David A.·2002·Antimicrobial Agents and Chemotherapy

DOI 10.1128/aac.46.6.1704-1713.2002PMC PMC127245

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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.

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Over the past 20 years, these strains have been extensively investigated at the genomic and transcriptomic levels to elucidate the mechanisms of resistance, revealing a combination of various resistance mechanisms among the resistant strains.
“Over the past 20 years, these strains have been extensively investigated at the genomic and transcriptomic levels to elucidate the mechanisms of resistance (25–35), revealing a combination of various resistance mechanisms among the resistant strains (Table 1).”
From Potential role of lysine acetylation in the stepwise adaptation of Candida albicans to fluconazole (2025) · cites this paper as [30]

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Authors: White, T. C., Holleman, S., Dy, F., Mirels, L. F., & Stevens, D. A.
Affiliations: Center for Infectious Disease Research (US)
Santa Clara Valley Medical Center (US)
Corresponding author: White, Theodore C.
ORCID: White, Theodore C.
Stevens, David A.
Venue: Antimicrobial Agents and Chemotherapy
Publisher: American Society for Microbiology
Published: 2002-06
Volume: 46
Issue: 6
Pages: 1704-1713
ISSN: 0066-4804 (ISSN-L)
1098-6596
DOI: 10.1128/aac.46.6.1704-1713.2002
PMC: PMC127245
OpenAlex: W2117461892
Cited by: 461
References: 42
Citations by year: 2026: 8 · 2025: 9 · 2024: 14 · 2023: 15 · 2022: 24 · 2021: 9 · 2020: 16 · 2019: 28 · 2018: 16 · 2017: 23 · 2016: 22 · 2015: 31 · 2014: 28 · 2013: 19 · 2012: 12
FWCI: 13.35
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: journals.asm.org/non-commercial-tdm-license (tdm)
Locations: Antimicrobial Agents and Chemotherapy (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Burroughs Wellcome Fund
M.J. Murdock Charitable Trust
National Institutes of Health
National Institute of Dental and Craniofacial Research (R01DE011367, R01 DE-11367)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fungal and yeast genetics research
Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
Keywords: Candida albicans, azole resistance, drug resistance mechanisms, ERG11 mutations, CDR1, CDR2, MDR1, efflux pump overexpression, cross-resistance, fluconazole, clotrimazole, itraconazole, ketoconazole, clinical isolates
MeSH terms: Antifungal Agents, Candida albicans, Candidiasis, DNA, Fungal, Drug Resistance, Microbial, Fungal Proteins, Microbial Sensitivity Tests, Phenotype, Polymorphism, Restriction Fragment Length, RNA, Fungal, Blotting, Southern, Blotting, Northern, DNA Probes, Gene Expression Regulation, Fungal, Drug Resistance, Multiple, ATP-Binding Cassette Transporters, Genes, MDR, Reverse Transcriptase Polymerase Chain Reaction

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Resistance Mechanisms in Clinical Isolates of Candida albicans

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