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Invasive mycoses remain underdiagnosed and difficult to treat. Hospitalized individuals with compromised immunity increase in number and constitute the main risk group for severe fungal infections. Current antifungal therapy is hampered by slow and insensitive diagnostics and frequent toxic side effects of standard antifungal drugs. Identification of new antifungal compounds with high efficacy and low toxicity is therefore urgently required. We investigated the antifungal activity of tempol, a cell-permeable nitroxide. To narrow down possible mode of action we used RNA-seq technology and metabolomics to probe for pathways specifically disrupted in the human fungal pathogen Candida albicans due to tempol administration. We found genes upregulated which are involved in iron homeostasis, mitochondrial stress, steroid synthesis, and amino acid metabolism. In an ex vivo whole blood infection, tempol treatment reduced C. albicans colony forming units and at the same time increased the release of pro-inflammatory cytokines, such as interleukin 8 (IL-8, monocyte chemoattractant protein-1, and macrophage migration inhibitory factor). In a systemic mouse model, tempol was partially protective with a significant reduction of fungal burden in the kidneys of infected animals during infection onset. The results obtained propose tempol as a promising new antifungal compound and open new opportunities for the future development of novel therapies.

Human colonizers have evolved to sense and adapt environmental cues and nutrient availability. Oxygen is a constantly changing environmental parameter within different host tissues upon different types of infection. We describe how C. albicans, an opportunistic fungal pathogen, can modulate the host response under hypoxia and anoxia. We found that high infiltration of neutrophils to the site of infection contributes to a low oxygen milieu. A persistent low oxygen milieu did not affect viability nor metabolism of polymorphonuclear leukocytes (PMNs), however, disturbed anti-Candida responses. PMNs were not able to efficiently phagocytize, produce ROS or release extracellular DNA traps. This failure to respond was caused by C. albicans β-glucan cell wall masking upon exposure to low oxygen which hindered PAMP sensing by dectin-1. Overall, this contributed to immune evasion which in turn enhanced fungal survival. The effect is prolonged by the accumulation of lactate produced by PMNs under low oxygen condition. Finally, low oxygen adaptation increased the pathogenicity and successful colonization of C. albicans in vivo which we confirmed using a Caenorhabditis elegans infection model. 

Microbial colonizers of humans have evolved to adapt to environmental cues and to sense nutrient availability. Oxygen is a constantly changing environmental parameter in different host tissues and in different types of infection. We describe how Candida albicans, an opportunistic fungal pathogen, can modulate the host response under hypoxia and anoxia. We found that high infiltration of polymorphonuclear leukocytes (PMNs) to the site of infection contributes to a low oxygen milieu in a murine subdermal abscess. A persistent hypoxic environment did not affect viability or metabolism of PMNs. Under oxygen deprivation, however, infection with C. albicans disturbed specific PMN responses. PMNs were not able to efficiently phagocytose, produce ROS, or release extracellular DNA traps. Failure to launch an adequate response was caused by C. albicans cell wall masking of β-glucan upon exposure to low oxygen levels which hindered PAMP sensing by Dectin-1 on the surfaces of PMNs. This in turn contributed to immune evasion and enhanced fungal survival. The cell wall masking effect is prolonged by the accumulation of lactate produced by PMNs under low oxygen conditions. Finally, adaptation to oxygen deprivation increased virulence of C. albicans which we demonstrated using a Caenorhabditis elegans infection model.IMPORTANCE Successful human colonizers have evolved mechanisms to bypass immune surveillance. Infiltration of PMNs to the site of infection led to the generation of a low oxygen niche. Exposure to low oxygen levels induced fungal cell wall masking, which in turn hindered pathogen sensing and antifungal responses by PMNs. The cell wall masking effect was prolonged by increasing lactate amounts produced by neutrophil metabolism under oxygen deprivation. In an invertebrate infection model, C. albicans was able to kill infected C. elegans nematodes within 2 days under low oxygen conditions, whereas the majority of uninfected controls and infected worms under normoxic conditions survived. These results suggest that C. albicans benefited from low oxygen niches to increase virulence. The interplay of C. albicans with innate immune cells under these conditions contributed to the overall outcome of infection. Adaption to low oxygen levels was in addition beneficial for C. albicans by reducing susceptibility to selected antifungal drugs. Hence, immunomodulation of host cells under low oxygen conditions could provide a valuable approach to improve current antifungal therapies.

Immunosuppressed patients are frequently afflicted with severe mycoses caused by opportunistic fungal pathogens. Besides being a commensal, colonizing predominantly skin and mucosal surfaces, Candida albicans is the most common human fungal pathogen. Mast cells are present in tissues prone to fungal colonization being expectedly among the first immune cells to get into contact with C. albicans. However, mast cell-fungus interaction remains a neglected area of study. Here we show that human mast cells mounted specific responses towards C. albicans. Collectively, mast cell responses included the launch of initial, intermediate and late phase components determined by the secretion of granular proteins and cytokines. Initially mast cells reduced fungal viability and occasionally internalized yeasts. C. albicans could evade ingestion by intracellular growth leading to cellular death. Furthermore, secreted factors in the supernatants of infected cells recruited neutrophils, but not monocytes. Late stages were marked by the release of cytokines that are known to be anti-inflammatory suggesting a modulation of initial responses. C. albicans-infected mast cells formed extracellular DNA traps, which ensnared but did not kill the fungus. Our results suggest that mast cells serve as tissue sentinels modulating antifungal immune responses during C. albicans infection. Consequently, these findings open new doors for understanding fungal pathogenicity.

Candida albicans is a leading human fungal pathogen that uses several metabolic adaptations to escape immune cells and causes systemic disease. Here, we describe a protocol for measuring one of these adaptations, the ability to thrive in hypoxic niches. Hypoxia was generated after successful subdermal infection with C. albicans in a murine infection model. Hypoxia was measured using a fluorescent dye for carbonic anhydrase 9, a host enzyme active under hypoxic conditions. Emitted fluorescence was subsequently quantified using an IVIS system. This protocol was optimized for the use in subdermal infection in mice but has the potential to be adapted to other models of fungal infection.

Den mänskliga kroppen är ständigt utsatt för angrepp från mikrober i vår miljö. Varje dag träffar vår kropp på organismer som potentiellt kan infektera oss, så kallade patogener så som bakterier, virus, parasiter och svampar. Det är immunsystemets uppgift att befria oss från oönskade mikroorganismer. Vårt immunförsvar är mycket effektivt vilket framgår av att trots den ständiga närvaron av mikroorganismer så blir vi sällan allvarligt sjuka. Men, människor med nedsatt immunförsvar kan utveckla allvarliga infektioner från opportunister patogener så som svampen Candida albicans. C. albicans är en viktig orsak till sjukdom och död över hela världen. Syftet med denna avhandling är att bättre förstå samspelet mellan dessa svampar och vårt immunförsvar. Vi fokuserar på det medfödda immunförsvaret och försöker identifiera de delar som är nödvändiga för kontroll under en infektion. Vi studerar också hur svamparna utvecklar mekanismer för att möta värdorganismens försvar och vad som reglerar dessa mekanismer. Det medfödda immunförsvaret finns i hela kroppen och består bland annat av vävnader - huden och slemhinnorna - och en mängd olika celltyper. Mastcellerna är en del av det medfödda immunförsvaret och finns utspridda på kroppens ytor mot omvärlden. Främst finns de i huden, tarmens slemhinnor och luftvägarna och det är också här som patogena svampar förekommer i kroppen. Mastcellerna är därför strategiskt placerade för att snabbt kunna möta infekterande mikroorganismer. Här har vi visat att mastceller är kroppens vaktposter och mycket viktiga vid svampinfektioner, men de kan bara tillfälligt kontrollera C. albicans. Mastcellerna aktiveras när de möter C. albicans och släpper omedelbart ut inflammatoriska mediatorer som är lagrade i cellernas granula. Denna degranulering kan också rekrytera fler immunceller så som neutrofiler. De kan även släppa ut strukturer som kallas extracellulära fällor (MCETs), som fångar in inkräktarna för nedbrytning. Med dessa metoder kan Mastcellerna ta upp och oskadliggöra invaderande mikroorganismer, men här har även C. albicans utvecklat ett eget försvar mot Mastcellerna. När C. albicans tas upp av mastcellerna kan de undkomma avdödning och utnyttjar då istället den skyddade intracellulära miljön för döda mastcellerna inifrån.

Neutrofiler är också en del av det medfödda immunförsvaret och de är den vanligaste typen av vita blodkroppar. Dessa celler cirkulerar i blodet men reagerar snabbt på hot och migrerar då från blodet in i vävnaden där bekämpandet av svamparna sker. De är oftast först på plats vid en infektion.

I det andra projektet har vi tittat närmare på neutrofilers försvar mot C. albicans infektioner och hur detta skiljer sig mellan syrerika och syrefattiga miljöer. Vi fann att neutrofilernas försvarsförmåga är kraftigt minskad under syrefattiga förhållanden. Både formationen av neutrofila extracellulära fällor (NETs) och även fagocytering, eller förtäring är kraftigt nedsatta under dessa förhållanden och detta kan ha en stor betydelse för immunförsvarets förmåga att bekämpa C. albicans infektioner. Bekämpandet av mikroorganismer är en aktiv process, driven av neutrofilernas snabba migration från blodet ut till vävnaden där mycket av syret förbrukas. I syrefattiga miljöer kan C. albicans också ändra cellväggens komposition och det ändrar i sin tur hur immunförsvaret reagerar mot dem.

Produktion av reaktiva syreradikaler är en av de mest påverkade försvarsmekanismerna i syrefattig miljö. Neutrofilerna använder reaktiva syreradikaler som en robust och effektiv kontroll-mekanism mot svamppatogener. I det tredje projektet undersöker vi om vi kan förhindra spridning av svampceller genom att påverka redoxpotentialen. Vi använder Tempol som är ett ämne med bevisad påverkan på metabolism och cellväggens komposition och har även inflammatorisk effekt. Behandling av svampcellerna med Tempol gav en framgångsrik anti-Candida effekt som karakteriserades med hjälp av RNA-sekvensering och metaboliska tester.

Idag finns det ett mycket stort behov av nya och bättre läkemedel mot systemisk svampinfektion. Opportunistiska svampinfektioner är ett stort hot mot patienter med nedsatt immunförsvar e.g patienter med leukemi eller som fått organtransplantationer. I projekt nummer fyra tänker vi oss att dessa patienter kanske skulle kunna får endast ett läkemedel mot både sjukdomarna. Därför har vi undersökt 844 godkänt-FDA läkemedlen för effekt mot C. albicans. Vi identifierat 7 nya molekyler med god effekt mot C. albicans. Vi har karakteriserad dessa läkemedlen och visat att de är lika effektiva som kommersiellt tillgängliga läkemedel.

Sammanfattningsvis visar våra resultat nödvändigheten till en fördjupad förståelse om immunceller och svampars samspel i mikromiljöer, så som de syrefattiga. En mer detaljerad förståelse kan därmed bidra till att utveckla bättre diagnostiska och terapeutiska verktyg för svampinfektioner.

Cryptococcosis, caused by the basidiomycete Cryptococcus neoformans, is a life-threatening disease affecting approximately one million people per year worldwide. Infection can occur when C. neoformans cells are inhaled by immunocompromised people. In order to establish infection, the yeast must bypass recognition and clearance by immune cells guarding the tissue. Using in vitro infections, we characterized the role of mast cells (MCs) in cryptococcosis. We found that MCs recognize C. neoformans and release inflammatory mediators such as tryptase and cytokines. From the latter group MCs released mainly CCL-2/MCP-1, a strong chemoattractant for monocytic cells. We demonstrated that supernatants of infected MCs recruit monocytes but not neutrophils. During infection with C. neoformans, MCs have a limited ability to kill the yeast depending on the serotype. C. neoformans, in turn, modulates the lifespan of MCs both, by presence of its polysaccharide capsule and by secreting soluble modulators. Taken together, MCs might have important contributions to fungal clearance during early stages of cryptocococis where these cells regulate recruitment of monocytes to mucosal tissues.

Background: Neutrophils are traditionally considered transcriptionally inactive. Compared to other immune cells, little is known about their transcriptional profile during interaction with pathogens. Methods: We analyzed the meta-transcriptome of the neutrophil-Candida albicans interplay and the transcriptome of C. albicans challenged with neutrophil extracellular traps (NETs) by RNA-Seq, considering yeast and hypha individually in each approach. Results: The neutrophil response to C. albicans yeast and hyphae was dominated by a morphotype-independent core response. However, 11 % of all differentially expressed genes were regulated in a specific manner when neutrophils encountered the hyphal form of C. albicans. While involving genes for transcriptional regulators, receptors, and cytokines, the neutrophil core response lacked typical antimicrobial effectors genes. Genes of the NOD-like receptor pathway, including NLRP3, were enriched. Neutrophil-and NET-provoked responses in C. albicans differed. At the same time, the Candida transcriptome upon neutrophil encounter and upon NET challenge included genes from various metabolic processes and indicate a mutual role of the regulators Tup1p, Efg1p, Hap43p, and Cap1p. Upon challenge with neutrophils and NETs, the overall Candida response was partially morphotype-specific. Yet again, actual oppositional regulation in yeasts and hyphae was only detected for the arginine metabolism in neutrophil-infecting C. albicans. Conclusions: Taken together, our study provides a comprehensive and quantitative transcript profile of the neutrophil-C. albicans interaction. By considering the two major appearances of both, neutrophils and C. albicans, our study reveals yet undescribed insights into this medically relevant encounter. Hence, our findings will facilitate future research and potentially inspire novel therapy developments.

Candida species are the cause of 60% of all mycoses in immunosuppressed individuals, leading to similar to 150,000 deaths annually due to systemic infections, whereas the current antifungal therapies either have toxic side effects or are insufficiently efficient. We performed a screening of two compound libraries, the Enzo and the Institute for Molecular Medicine Finland (FIMM) oncology collection library, for anti-Candida activity based on the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. From a total of 844 drugs, 26 agents showed activity against Candida albicans. Of those, 12 were standard antifungal drugs (SADs) and 7 were off-target drugs previously reported to be active against Candida spp. The remaining 7 off-target drugs, amonafide, tosedostat, megestrol acetate, melengestrol acetate, stanozolol, trifluperidol, and haloperidol, were identified with this screen. The anti-Candida activities of the new agents were investigated by three individual assays using optical density, ATP levels, and microscopy. The antifungal activities of these drugs were comparable to those of the SADs found in the screen. The aminopeptidase inhibitor tosedostat, which is currently in a clinical trial phase for anticancer therapy, displayed a broad antifungal activity against different Candida spp., including Candida glabrata. Thus, this screen reveals agents that were previously unknown to be anti-Candida agents, which allows for the design of novel therapies against invasive candidiasis.

Invasive mycoses have been increasing worldwide, with Candida spp. being the most prevalent fungal pathogen causing high morbidity and mortality in immunocompromised individuals. Only few antimycotics exist, often with severe side effects. Therefore, new antifungal drugs are urgently needed. Because the identification of antifungal compounds depends on fast and reliable assays, we present a new approach based on high-throughput image analysis to define cell morphology. Candida albicans and other fungi of the Candida clade switch between different growth morphologies, from budding yeast to filamentous hyphae. Yeasts are considered proliferative, whereas hyphae are required for invasion and dissemination. Thus, morphotype switching in many Candida spp. is connected to virulence and pathogenesis. It is, consequently, reasonable to presume that morphotype blockers interfere with the virulence, thereby preventing hazardous colonization. Our method efficiently differentiates yeast from hyphal cells using a combination of automated microscopy and image analysis. We selected the parameters length/width ratio and mean object shape to quantitatively discriminate yeasts and hyphae. Notably, Z' factor calculations for these parameters confirmed the suitability of our method for high-throughput screening. As a second stage, we determined cell viability to discriminate morphotype-switching inhibitors from those that are fungicidal. Thus, our method serves as a basis for the identification of candidates for next-generation antimycotics.