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. 2006 Nov;50(11):3839-46.
doi: 10.1128/AAC.00684-06. Epub 2006 Aug 21.

Candida albicans biofilms produce antifungal-tolerant persister cells

Affiliations

Candida albicans biofilms produce antifungal-tolerant persister cells

Michael D LaFleur et al. Antimicrob Agents Chemother. 2006 Nov.

Abstract

Fungal pathogens form biofilms that are highly recalcitrant to antimicrobial therapy. The expression of multidrug resistance pumps in young biofilms has been linked to increased resistance to azoles, but this mechanism does not seem to underlie the resistance of mature biofilms that is a model of in vivo infection. The mechanism of drug resistance of mature biofilms remains largely unknown. We report that biofilms formed by the major human pathogen Candida albicans exhibited a strikingly biphasic killing pattern in response to two microbicidal agents, amphotericin B, a polyene antifungal, and chlorhexidine, an antiseptic, indicating that a subpopulation of highly tolerant cells, termed persisters, existed. The extent of killing with a combination of amphotericin B and chlorhexidine was similar to that observed with individually added antimicrobials. Thus, surviving persisters form a multidrug-tolerant subpopulation. Interestingly, surviving C. albicans persisters were detected only in biofilms and not in exponentially growing or stationary-phase planktonic populations. Reinoculation of cells that survived killing of the biofilm by amphotericin B produced a new biofilm with a new subpopulation of persisters. This suggests that C. albicans persisters are not mutants but phenotypic variants of the wild type. Using a stain for dead cells, rare dark cells were visible in a biofilm after amphotericin B treatment, and a bright and a dim population were physically sorted from this biofilm. Only the dim cells produced colonies, showing that this method allows the isolation of yeast persisters. Given that persisters formed only in biofilms, mutants defective in biofilm formation were examined for tolerance of amphotericin B. All of the known mutants affected in biofilm formation were able to produce normal levels of persisters. This finding indicates that attachment rather than formation of a complex biofilm architecture initiates persister formation. Bacteria produce multidrug-tolerant persister cells in both planktonic and biofilm populations, and it appears that yeasts and bacteria have evolved analogous strategies that assign the function of survival to a small part of the population. In bacteria, persisters are dormant cells. It remains to be seen whether attachment initiates dormancy that leads to the formation of fungal persisters. This study suggests that persisters may be largely responsible for the multidrug tolerance of fungal biofilms.

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Figures

FIG. 1.
FIG. 1.
Survival of C. albicans 3153A biofilm and exponential- and stationary-phase cells. Biofilms were cultured in RPMI medium for 48 h, scraped, vortexed, resuspended in 100 μl PBS, and plated for CFU determination. Exponential- and stationary-phase cultures were obtained by growth in the same medium. The experiment was performed in triplicate, and the error bars represent standard deviations. (A) Amphotericin B. (B) Chlorhexidine.
FIG. 2.
FIG. 2.
Survival of C. albicans biofilms challenged with amphotericin B and chlorhexidine. Biofilms were treated with 100 μg/ml amphotericin B, 100 μg/ml chlorhexidine, or a combination of the two antifungals for 24 h. The biofilms were washed and sampled for CFU determination before and after antibiotic treatment. The experiment was performed in triplicate, and the error bars indicate standard deviations.
FIG. 3.
FIG. 3.
Heritability of persister formation. Biofilms were treated with 100 μg/ml amphotericin B or 100 μg/ml chlorhexidine for 24 h, after which they were disrupted by being vortexed, washed, and reinoculated in order to form new biofilms. The biofilms were sampled for CFU determination before and after antibiotic treatment. The procedure was repeated a total of three times. The experiment was performed in triplicate, and the error bars indicate standard deviations.
FIG. 4.
FIG. 4.
Live-dead staining of C. albicans with fluorescein diacetate. Planktonic or biofilm cells were stained with 100 μg/ml fluorescein diacetate and examined by fluorescence microscopy. (A) Live planktonic cells. (B) Dead planktonic cells after treatment with 100 μg/ml amphotericin B (×400 magnification). (C, D, and E) Biofilms (×1,000 magnification) of untreated control and after 18 and 48 h of amphotericin B treatment (100 μg/ml), respectively.
FIG. 5.
FIG. 5.
Isolation of persister cells from a biofilm. C. albicans MC191 was grown as a biofilm for 48 h in RPMI 1640 medium in microtiter plate wells. A homogenous population of cells from disrupted biofilms was obtained by applying a forward scatter and a side scatter gate, as shown in panel A, for all subsequent analyses. (B) A biofilm was stained with 100 μg/ml fluorescein diacetate for 24 h, disrupted, washed three times with PBS, and analyzed with a MoFlo cell sorter. Single events representing individual cells were physically sorted directly on YPD medium and incubated for 48 h (D). (C) A biofilm was treated with 100 μg/ml amphotericin B, stained with fluorescein diacetate, and similarly analyzed with the cell sorter. Two distinct populations were separated based on green fluorescence intensity, as shown. (E) Particles representing 96 events from the dim population, R4, were sorted onto YPD agar and incubated for 48 h. (F) Particles representing over 6,000 events from R2 were sorted onto YPD agar and incubated for 48 h.

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