Calcineurin Controls Drug Tolerance, Hyphal Growth, and Virulence in Candida dubliniensis
ABSTRACTCandida dubliniensisis an emerging pathogenic yeast species closely related toCandida albicansand frequently found colonizing or infecting the oral cavities of HIV/AIDS patients. Drug resistance duringC. dubliniensisinfection is common and constitutes a significant therapeutic challenge. The calcineurin inhibitor FK506 exhibits synergistic fungicidal activity with azoles or echinocandins in the fungal pathogensC. albicans,Cryptococcus neoformans, andAspergillus fumigatus. In this study, we show that calcineurin is required for cell wall integrity and wild-type tolerance ofC. dubliniensisto azoles and echinocandins; hence, these drugs are candidates for combination therapy with calcineurin inhibitors. In contrast toC. albicans, in which the roles of calcineurin and Crz1 in hyphal growth are unclear, here we show that calcineurin and Crz1 play a clearly demonstrable role in hyphal growth in response to nutrient limitation inC. dubliniensis. We further demonstrate that thigmotropism is controlled by Crz1, but not calcineurin, inC. dubliniensis. Similar toC. albicans,C. dubliniensiscalcineurin enhances survival in serum.C. dubliniensiscalcineurin andcrz1/crz1mutants exhibit attenuated virulence in a murine systemic infection model, likely attributable to defects in cell wall integrity, hyphal growth, and serum survival. Furthermore, we show thatC. dubliniensiscalcineurin mutants are unable to establish murine ocular infection or form biofilms in a rat denture model. That calcineurin is required for drug tolerance and virulence makes fungus-specific calcineurin inhibitors attractive candidates for combination therapy with azoles or echinocandins against emergingC. dubliniensisinfections.