The impact of the Fungus-Host-Microbiota interplay upon Candida albicans infections: current knowledge and new perspectives

Christophe d'Enfert* (Corresponding Author), Ann-Kristin Kaune, Leovigildo Rey Alaban, Sayoni Chakraborty, Nathaniel Cole, Margot Delavy, Daria Kosmala, Benoît Marsaux, Ricardo FróisMartins, Moran Morelli, Diletta Rosati, Marisa Valentine, Zixuan Xie, Yoan Emritloll, Peter A Warn, Frédéric Bequet, Marie-Elisabeth Bougnoux, Stephanie Bornes, Mark S. Gresnigt , Bernard Hubelse D. Jacobsen, Melanie Legrand, Salomé Leibundgut-Landmann, Chaysavanh Manichanh, Carol Munro, Mihai G. Netea, Karla Queiroz, Karine Roget, Vincent Thomas, Claudia Thora, Pieter Van den Abbeele, Alan W Walker, Alistair J.P. Brown*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Candida albicans is a major fungal pathogen of humans. It exists as a commensal in the oral cavity, gut or genital tract of most individuals, constrained by the local microbiota, epithelial barriers and immune defences. Their perturbation can lead to fungal outgrowth and the development of mucosal infections such as oropharyngeal or vulvovaginal candidiasis, and patients with compromised immunity are susceptible to life-threatening systemic infections. The importance of the interplay between fungus, host and microbiota in driving the transition from C. albicans commensalism to pathogenicity is widely appreciated. However, the complexity of these interactions, and the significant impact of fungal, host and microbiota variability upon disease severity and outcome, are less well understood. Therefore, we summarise the features of the fungus that promote infection, and how genetic variation between clinical isolates influences pathogenicity. We discuss antifungal immunity, how this differs between mucosae, and how individual variation influences a person's susceptibility to infection. Also, we describe factors that influence the composition of gut, oral and vaginal microbiotas, and how these affect fungal colonisation and antifungal immunity. We argue that a detailed understanding of these variables, which underlie fungal-host-microbiota interactions, will present opportunities for directed antifungal therapies that benefit vulnerable patients.
Original languageEnglish
Article number fuaa060
JournalFEMS Microbiology Reviews
Early online date24 Nov 2020
DOIs
Publication statusE-pub ahead of print - 24 Nov 2020

Keywords

  • Candida
  • candida infections
  • antifungal immunity
  • microbiota
  • mycobiota
  • fungus-host-microbiota interactions
  • patients variability
  • fungal variability
  • microbiota variability

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