Borghi Elisa, Borgo Francesca, Morace Giulia
Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
Adv Exp Med Biol. 2016;931:37-47. doi: 10.1007/5584_2016_7.
Over the past decade, the emergence of biofilm-related invasive fungal diseases has been the subject of numerous studies focused on antifungal resistance and its impact on antifungal therapy in severely ill patients. The majority of the studies investigated the molecular mechanisms involved in antifungal resistance and pathogenicity of biofilm production by Candida albicans and Aspergillus fumigatus, the most common etiologic agents of yeast and mold invasive infections. The main mechanism characterizing biofilm-related antifungal resistance is the production of extracellular matrix, a physical barrier preventing the drugs from entering and expressing their activity. However, over-expression of efflux pumps, genetic changes of drug targets, persister cells, biofilm-host immune system interaction, proteins leading to filamentation, all together contribute to the onset of biofilm antifungal resistance. Some of these mechanisms are shared with planktonic cells and are often related to developmental phases of biofilm formation. All physical and genetic factors leading to biofilm-related antifungal resistance have been briefly discussed.
在过去十年中,生物膜相关的侵袭性真菌疾病的出现一直是众多研究的主题,这些研究聚焦于抗真菌耐药性及其对重症患者抗真菌治疗的影响。大多数研究调查了白色念珠菌和烟曲霉(酵母和霉菌侵袭性感染最常见的病原体)生物膜产生的抗真菌耐药性和致病性所涉及的分子机制。生物膜相关抗真菌耐药性的主要特征机制是细胞外基质的产生,这是一种物理屏障,可阻止药物进入并发挥其活性。然而,外排泵的过度表达、药物靶点的基因变化、持留菌、生物膜与宿主免疫系统的相互作用、导致菌丝形成的蛋白质,都共同促成了生物膜抗真菌耐药性的产生。其中一些机制与浮游细胞共有,并且通常与生物膜形成的发育阶段有关。本文简要讨论了导致生物膜相关抗真菌耐药性的所有物理和遗传因素。