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Review
. 2021 Sep 22;13(10):1529.
doi: 10.3390/pharmaceutics13101529.

Candida glabrata Antifungal Resistance and Virulence Factors, a Perfect Pathogenic Combination

María Guadalupe Frías-De-León  1 , Rigoberto Hernández-Castro  2 , Esther Conde-Cuevas  3 , Itzel H García-Coronel  3 , Víctor Alfonso Vázquez-Aceituno  2 , Marvin A Soriano-Ursúa  4 , Eunice D Farfán-García  4 , Esther Ocharán-Hernández  4 , Carmen Rodríguez-Cerdeira  5   6   7 , Roberto Arenas  5   8 , Maura Robledo-Cayetano  1 , Tito Ramírez-Lozada  9 , Patricia Meza-Meneses  3   10 , Rodolfo Pinto-Almazán  1   4 , Erick Martínez-Herrera  1   4   5
Affiliations
Review

Candida glabrata Antifungal Resistance and Virulence Factors, a Perfect Pathogenic Combination

María Guadalupe Frías-De-León et al. Pharmaceutics. .

Abstract

In recent years, a progressive increase in the incidence of invasive fungal infections (IFIs) caused by Candida glabrata has been observed. The objective of this literature review was to study the epidemiology, drug resistance, and virulence factors associated with the C. glabrata complex. For this purpose, a systematic review (January 2001-February 2021) was conducted on the PubMed, Scielo, and Cochrane search engines with the following terms: "C. glabrata complex (C. glabrata sensu stricto, C. nivariensis, C. bracarensis)" associated with "pathogenicity" or "epidemiology" or "antibiotics resistance" or "virulence factors" with language restrictions of English and Spanish. One hundred and ninety-nine articles were found during the search. Various mechanisms of drug resistance to azoles, polyenes, and echinocandins were found for the C. glabrata complex, depending on the geographical region. Among the mechanisms found are the overexpression of drug transporters, gene mutations that alter thermotolerance, the generation of hypervirulence due to increased adhesion factors, and modifications in vital enzymes that produce cell wall proteins that prevent the activity of drugs designed for its inhibition. In addition, it was observed that the C. glabrata complex has virulence factors such as the production of proteases, phospholipases, and hemolysins, and the formation of biofilms that allows the complex to evade the host immune response and generate fungal resistance. Because of this, the C. glabrata complex possesses a perfect pathogenetic combination for the invasion of the immunocompromised host.

Keywords: Candida glabrata; adherence mechanisms; antifungal resistance; enzymatic activity; formation of biofilms; variations in drug resistance; virulence factors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the different phases of the systematic review.
Figure 2
Figure 2
Candida glabrata drug resistance and virulence mechanisms.
See this image and copyright information in PMC

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