Yihong Pan , Yao Sun , Lanqian Chen , Yali Cheng , Panpan Jin , Weidan Zhang , Lingzhi Zheng , Junyan Liu , Tieli Zhou , Zhenbo Xu , Cheng Li , Xenia Kostoulias , Cathy J. Watson , David McGiffin , Anton Y. Peleg , Yue Qu
{"title":"念珠菌通过在人阴道上皮上形成形态不同的生物膜而引起复发性外阴阴道念珠菌病","authors":"Yihong Pan , Yao Sun , Lanqian Chen , Yali Cheng , Panpan Jin , Weidan Zhang , Lingzhi Zheng , Junyan Liu , Tieli Zhou , Zhenbo Xu , Cheng Li , Xenia Kostoulias , Cathy J. Watson , David McGiffin , Anton Y. Peleg , Yue Qu","doi":"10.1016/j.bioflm.2023.100162","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Recurrent vulvovaginal candidiasis (RVVC) is a recalcitrant medical condition that affects many women of reproductive age. The importance of biofilm formation by <em>Candida</em> in RVVC has been recently questioned. This study aimed to elucidate the fundamental growth modes of <em>Candida</em> in the vagina of patients with RVVC or sporadic vulvovaginal candidiasis (VVC) and to assess their roles in the persistence of RVVC.</p></div><div><h3>Methods</h3><p>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 <em>Candida</em>-specific 18S rRNA probes and viable fungal burden were used to qualitatively and quantitatively evaluate <em>Candida</em> growth in the human vagina. The presence of <em>Candida</em> 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 <em>Candida</em> biofilms to fluconazole at the peak serum concentration was evaluated.</p></div><div><h3>Results</h3><p><em>Candida</em> 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. <em>Candida</em> biofilm growth on the vaginal epithelium was associated with mild lymphocytic infiltration of the vaginal mucosa. These epithelium-based <em>Candida</em> biofilms presented an important characteristic contributing to the persistence of RVVC that is the high tolerance to fluconazole.</p></div><div><h3>Conclusions</h3><p>In summary, our study provides direct evidence to support the presence of <em>Candida</em> biofilms in RVVC and an important role of biofilm formation in disease persistence.</p></div>","PeriodicalId":55844,"journal":{"name":"Biofilm","volume":null,"pages":null},"PeriodicalIF":5.9000,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259020752300059X/pdfft?md5=76948a01969b74a6adf6661c7a3940da&pid=1-s2.0-S259020752300059X-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Candida causes recurrent vulvovaginal candidiasis by forming morphologically disparate biofilms on the human vaginal epithelium\",\"authors\":\"Yihong Pan , Yao Sun , Lanqian Chen , Yali Cheng , Panpan Jin , Weidan Zhang , Lingzhi Zheng , Junyan Liu , Tieli Zhou , Zhenbo Xu , Cheng Li , Xenia Kostoulias , Cathy J. Watson , David McGiffin , Anton Y. Peleg , Yue Qu\",\"doi\":\"10.1016/j.bioflm.2023.100162\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Recurrent vulvovaginal candidiasis (RVVC) is a recalcitrant medical condition that affects many women of reproductive age. The importance of biofilm formation by <em>Candida</em> in RVVC has been recently questioned. This study aimed to elucidate the fundamental growth modes of <em>Candida</em> in the vagina of patients with RVVC or sporadic vulvovaginal candidiasis (VVC) and to assess their roles in the persistence of RVVC.</p></div><div><h3>Methods</h3><p>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 <em>Candida</em>-specific 18S rRNA probes and viable fungal burden were used to qualitatively and quantitatively evaluate <em>Candida</em> growth in the human vagina. The presence of <em>Candida</em> 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 <em>Candida</em> biofilms to fluconazole at the peak serum concentration was evaluated.</p></div><div><h3>Results</h3><p><em>Candida</em> 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. <em>Candida</em> biofilm growth on the vaginal epithelium was associated with mild lymphocytic infiltration of the vaginal mucosa. These epithelium-based <em>Candida</em> biofilms presented an important characteristic contributing to the persistence of RVVC that is the high tolerance to fluconazole.</p></div><div><h3>Conclusions</h3><p>In summary, our study provides direct evidence to support the presence of <em>Candida</em> biofilms in RVVC and an important role of biofilm formation in disease persistence.</p></div>\",\"PeriodicalId\":55844,\"journal\":{\"name\":\"Biofilm\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.9000,\"publicationDate\":\"2023-10-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S259020752300059X/pdfft?md5=76948a01969b74a6adf6661c7a3940da&pid=1-s2.0-S259020752300059X-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Biofilm\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S259020752300059X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MICROBIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Biofilm","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S259020752300059X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MICROBIOLOGY","Score":null,"Total":0}
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 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.