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Tolérance et résistance aux antifongiques chez Candida spp. : caractérisation de nouvelles cibles thérapeutiques

Abstract : The incidence of invasive candidiasis (IC) has dramatically increased over the past decades, partly due to the increasing number of at-risk patients. IC is associated with high mortality rates: however, its prognosis can be improved by early treatment. Four antifungal classes are available today for the prevention and treatment of IC: echinocandins, azoles, polyenes and pyrimidines. Due to their high efficacy and interesting safety profile, echinocandins and azoles are more commonly used. Massive use of these compounds has led to epidemiological changes in IC, with the emergence of non-albicans species which are intrinsically less susceptible to these antifungals, such as C. glabrata or C. parapsilosis. In addition, Candida spp. strains resistant, or even multiresistant, to azoles and echinocandins are increasingly isolated and associated with therapeutic failures. Antifungal activity is also limited by tolerance, a reversible phenomenon resulting from the yeast's adaptation to membrane and cell wall stresses caused by these molecules.For these reasons, identification and development of new antifungal strategies are needed. This work aimed at studying antifungal resistance and tolerance in Candida spp. and characterizing new therapeutic targets involved in these process.First, this work showed the interest of next-generation sequencing and multigene approaches to study mechanisms involved in resistance to echinocandins and azoles antifungals in Candida spp. It notably allowed to identify new mechanisms involved in antifungal resistance, which still need to be confirmed.In a second part, this work allowed to show that all the proteins of the pH-signaling pathway, known as the Rim pathway in yeasts, are involved in antifungal tolerance in C. albicans, the most frequent species responsible for IC in humans. In addition, new Rim-dependent genes were identified through RNA-sequencing, such as HSP90, coding for a major chaperone involved in the regulation of multiple cellular process, as well as IPT1, responsible for the synthesis of the main membrane sphingolipid.Both genes were previously shown to be involved in azoles and echinocandins tolerance in C. albicans, and could therefore play a role in antifungal tolerance mediated by the Rim pathway. These results offer great perspectives. Indeed, targeting the Rim pathway would allow to enhance the activity of commercially available antifungals and to indirectly target Hsp90, with no or limited toxicity as this signaling pathway is fungal-specific.Thirdly, a last part of this work performed in the context of the ANR FungiBET consortium, allowed to show that the BET protein Bdf1 in C. glabrata, which is involved in epigenetic regulation of transcription, is required for in vitro growth. More precisely, the integrity of both BD1 and BD2 Bdf1 bromodomains are essential in this species, which ranks second among causes of IC. This result confirms the first data obtained in C. albicans and the interest of inhibiting fungal BET proteins as a new antifungal strategy
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Cécile Garnaud. Tolérance et résistance aux antifongiques chez Candida spp. : caractérisation de nouvelles cibles thérapeutiques. Médecine humaine et pathologie. Université Grenoble Alpes, 2017. Français. ⟨NNT : 2017GREAS004⟩. ⟨tel-02092298⟩

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