Elevated Cell Wall Chitin in Candida albicans Confers Echinocandin Resistance In Vivo

Keunsook K. Lee, Donna M Maccallum, Mette D Jacobsen, Louise A Walker, Frank C Odds, Neil A R Gow, Carol A Munro

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Candida albicans cells with increased cell wall chitin have reduced echinocandin susceptibility in vitro. The aim of this study was to investigate whether C. albicans cells with elevated chitin levels have reduced echinocandin susceptibility in vivo. BALB/c mice were infected with C. albicans cells with normal chitin levels and compared to mice infected with high-chitin cells. Caspofungin therapy was initiated at 24 h postinfection. Mice infected with chitin-normal cells were successfully treated with caspofungin, as indicated by reduced kidney fungal burdens, reduced weight loss, and decreased C. albicans density in kidney lesions. In contrast, mice infected with high-chitin C. albicans cells were less susceptible to caspofungin, as they had higher kidney fungal burdens and greater weight loss during early infection. Cells recovered from mouse kidneys at 24 h postinfection with high-chitin cells had 1.6-fold higher chitin levels than cells from mice infected with chitin-normal cells and maintained a significantly reduced susceptibility to caspofungin when tested in vitro. At 48 h postinfection, caspofungin treatment induced a further increase in chitin content of C. albicans cells harvested from kidneys compared to saline treatment. Some of the recovered clones had acquired, at a low frequency, a point mutation in FKS1 resulting in a S645Y amino acid substitution, a mutation known to confer echinocandin resistance. This occurred even in cells that had not been exposed to caspofungin. Our results suggest that the efficacy of caspofungin against C. albicans was reduced in vivo due to either elevation of chitin levels in the cell wall or acquisition of FKS1 point mutations.

Original languageEnglish
Pages (from-to)208-217
Number of pages10
JournalAntimicrobial Agents and Chemotherapy
Issue number1
Early online date10 Oct 2011
Publication statusPublished - Jan 2012

Bibliographical note

PMID: 21986821 [PubMed - indexed for MEDLINE] PMCID: PMC3256049 Free PMC Article

We thank Gillian Milne from the University of Aberdeen EM and histology facility and Luis Castillo for assistance with the histological analysis. We thank Cameron Douglas for helpful comments on the manuscript. We also thank Gilead Sciences Ltd. (Cambridge, United Kingdom), the Wellcome Trust (080088 and 086827), and the EC (ALLFUN and Ariadne) consortia for financial support and Merck Research Laboratories (NJ) for provision of caspofungin.


  • Amino Acid Substitution
  • Animals
  • Antifungal Agents
  • Candida albicans
  • Candidiasis
  • Cell Wall
  • Chitin
  • DNA Mutational Analysis
  • Drug Resistance, Fungal
  • Echinocandins
  • Female
  • Fungal Proteins
  • Glucosyltransferases
  • Kidney
  • Mice
  • Mice, Inbred BALB C
  • Microbial Sensitivity Tests
  • Microscopy, Fluorescence
  • Mutation
  • Survival Rate


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