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Candida causes recurrent vulvovaginal candidiasis by forming morphologically disparate biofilms on the human vaginal epithelium

BACKGROUND: Recurrent vulvovaginal candidiasis (RVVC) is a recalcitrant medical condition that affects many women of reproductive age. The importance of biofilm formation by Candida in RVVC has been recently questioned. This study aimed to elucidate the fundamental growth modes of Candida in the vag...

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Autores principales: Pan, Yihong, Sun, Yao, Chen, Lanqian, Cheng, Yali, Jin, Panpan, Zhang, Weidan, Zheng, Lingzhi, Liu, Junyan, Zhou, Tieli, Xu, Zhenbo, Li, Cheng, Kostoulias, Xenia, Watson, Cathy J., McGiffin, David, Peleg, Anton Y., Qu, Yue
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10630605/
https://www.ncbi.nlm.nih.gov/pubmed/37941804
http://dx.doi.org/10.1016/j.bioflm.2023.100162
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author Pan, Yihong
Sun, Yao
Chen, Lanqian
Cheng, Yali
Jin, Panpan
Zhang, Weidan
Zheng, Lingzhi
Liu, Junyan
Zhou, Tieli
Xu, Zhenbo
Li, Cheng
Kostoulias, Xenia
Watson, Cathy J.
McGiffin, David
Peleg, Anton Y.
Qu, Yue
author_facet Pan, Yihong
Sun, Yao
Chen, Lanqian
Cheng, Yali
Jin, Panpan
Zhang, Weidan
Zheng, Lingzhi
Liu, Junyan
Zhou, Tieli
Xu, Zhenbo
Li, Cheng
Kostoulias, Xenia
Watson, Cathy J.
McGiffin, David
Peleg, Anton Y.
Qu, Yue
author_sort Pan, Yihong
collection PubMed
description BACKGROUND: Recurrent vulvovaginal candidiasis (RVVC) is a recalcitrant medical condition that affects many women of reproductive age. The importance of biofilm formation by Candida in RVVC has been recently questioned. This study aimed to elucidate the fundamental growth modes of Candida in the vagina of patients with RVVC or sporadic vulvovaginal candidiasis (VVC) and to assess their roles in the persistence of RVVC. METHODS: Vaginal tissues were sampled from twelve patients clinically and microbiologically diagnosed as RVVC or VVC at a post-antifungal-treatment and asymptomatic period. High-resolution scanning electron microscopy, fluorescence in situ hybridization in combination with Candida-specific 18S rRNA probes and viable fungal burden were used to qualitatively and quantitatively evaluate Candida growth in the human vagina. The presence of Candida biofilm extracellular polymeric substances was examined using confocal laser scanning microscopy and biopsy sections pre-stained with Concanavalin A. Histopathological analysis was carried out on infected vaginal tissues stained with hematoxylin and eosin. Lastly, the susceptibility of epithelium-associated Candida biofilms to fluconazole at the peak serum concentration was evaluated. RESULTS: Candida species grew on the vaginal epithelium of RVVC patients as morphologically disparate biofilms including monolayers, microcolonies, and macro-colonies, in addition to sporadic adherent cells. Candida biofilm growth on the vaginal epithelium was associated with mild lymphocytic infiltration of the vaginal mucosa. These epithelium-based Candida biofilms presented an important characteristic contributing to the persistence of RVVC that is the high tolerance to fluconazole. CONCLUSIONS: In summary, our study provides direct evidence to support the presence of Candida biofilms in RVVC and an important role of biofilm formation in disease persistence.
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spelling pubmed-106306052023-11-07 Candida causes recurrent vulvovaginal candidiasis by forming morphologically disparate biofilms on the human vaginal epithelium Pan, Yihong Sun, Yao Chen, Lanqian Cheng, Yali Jin, Panpan Zhang, Weidan Zheng, Lingzhi Liu, Junyan Zhou, Tieli Xu, Zhenbo Li, Cheng Kostoulias, Xenia Watson, Cathy J. McGiffin, David Peleg, Anton Y. Qu, Yue Biofilm Article BACKGROUND: Recurrent vulvovaginal candidiasis (RVVC) is a recalcitrant medical condition that affects many women of reproductive age. The importance of biofilm formation by Candida in RVVC has been recently questioned. This study aimed to elucidate the fundamental growth modes of Candida in the vagina of patients with RVVC or sporadic vulvovaginal candidiasis (VVC) and to assess their roles in the persistence of RVVC. METHODS: Vaginal tissues were sampled from twelve patients clinically and microbiologically diagnosed as RVVC or VVC at a post-antifungal-treatment and asymptomatic period. High-resolution scanning electron microscopy, fluorescence in situ hybridization in combination with Candida-specific 18S rRNA probes and viable fungal burden were used to qualitatively and quantitatively evaluate Candida growth in the human vagina. The presence of Candida biofilm extracellular polymeric substances was examined using confocal laser scanning microscopy and biopsy sections pre-stained with Concanavalin A. Histopathological analysis was carried out on infected vaginal tissues stained with hematoxylin and eosin. Lastly, the susceptibility of epithelium-associated Candida biofilms to fluconazole at the peak serum concentration was evaluated. RESULTS: Candida species grew on the vaginal epithelium of RVVC patients as morphologically disparate biofilms including monolayers, microcolonies, and macro-colonies, in addition to sporadic adherent cells. Candida biofilm growth on the vaginal epithelium was associated with mild lymphocytic infiltration of the vaginal mucosa. These epithelium-based Candida biofilms presented an important characteristic contributing to the persistence of RVVC that is the high tolerance to fluconazole. CONCLUSIONS: In summary, our study provides direct evidence to support the presence of Candida biofilms in RVVC and an important role of biofilm formation in disease persistence. Elsevier 2023-10-22 /pmc/articles/PMC10630605/ /pubmed/37941804 http://dx.doi.org/10.1016/j.bioflm.2023.100162 Text en © 2023 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pan, Yihong
Sun, Yao
Chen, Lanqian
Cheng, Yali
Jin, Panpan
Zhang, Weidan
Zheng, Lingzhi
Liu, Junyan
Zhou, Tieli
Xu, Zhenbo
Li, Cheng
Kostoulias, Xenia
Watson, Cathy J.
McGiffin, David
Peleg, Anton Y.
Qu, Yue
Candida causes recurrent vulvovaginal candidiasis by forming morphologically disparate biofilms on the human vaginal epithelium
title Candida causes recurrent vulvovaginal candidiasis by forming morphologically disparate biofilms on the human vaginal epithelium
title_full Candida causes recurrent vulvovaginal candidiasis by forming morphologically disparate biofilms on the human vaginal epithelium
title_fullStr Candida causes recurrent vulvovaginal candidiasis by forming morphologically disparate biofilms on the human vaginal epithelium
title_full_unstemmed Candida causes recurrent vulvovaginal candidiasis by forming morphologically disparate biofilms on the human vaginal epithelium
title_short Candida causes recurrent vulvovaginal candidiasis by forming morphologically disparate biofilms on the human vaginal epithelium
title_sort candida causes recurrent vulvovaginal candidiasis by forming morphologically disparate biofilms on the human vaginal epithelium
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10630605/
https://www.ncbi.nlm.nih.gov/pubmed/37941804
http://dx.doi.org/10.1016/j.bioflm.2023.100162
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