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Biofilm Formation and Aspartyl Proteinase Activity and Their Association with Azole Resistance Among Candida albicans

Marian A Gerges1, Yasmin Ahmed Fahmy1, Thoraya Hosny2

  • 1Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Infection and Drug Resistance
|August 21, 2023
PubMed
Abstract

Insights

Azole resistance in Candida albicans causing vulvovaginal candidiasis is linked to biofilm formation and proteinase production in Egyptian women. New therapies targeting these virulence factors are needed.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Candida albicans is a primary cause of vulvovaginal candidiasis (VVC).
  • Azole agents are common VVC treatments.
  • Biofilm formation and aspartyl proteinase production are virulence factors potentially linked to azole resistance in C. albicans.

Purpose of the Study:

  • To investigate the association between biofilm formation, proteinase production, and azole resistance in C. albicans isolates from Egyptian women with VVC.

Main Methods:

  • Cross-sectional study of 204 C. albicans isolates from nonpregnant women with VVC.
  • Azole susceptibility testing using disc diffusion.
  • Phenotypic assessment of biofilm formation and proteinase production.
  • PCR screening for biofilm-related genes (ALS1, HWP1) and proteinase genes (SAP2, SAP4, SAP6).

Main Results:

  • High azole resistance rates observed: voriconazole (30.4%), itraconazole (17.6%), fluconazole (11.3%), econazole (6.4%).
  • 63.2% of isolates exhibited biofilm-producing capacity and 63.2% were proteinase producers.
  • Significant association found between biofilm formation and azole resistance (P < 0.001).
  • Significant association found between proteinase production and resistance to fluconazole, voriconazole, econazole (P < 0.001), and itraconazole (P = 0.047).

Conclusions:

  • Azole resistance in C. albicans causing VVC in nonpregnant Egyptian women is significantly associated with biofilm formation and proteinase production.
  • These findings highlight the clinical relevance of these virulence factors in treatment failure.
  • Development of novel therapeutic strategies targeting biofilm and proteinase may be beneficial.
Keywords:
Candida albicansaspartyl proteinaseazole resistancebiofilm formationvulvovaginal candidiasis

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