High glucose-mediated overexpression of ICAM-1 in human vaginal epithelial cells increases adhesion of Candida albicans

J Obstet Gynaecol. 2018 Feb;38(2):226-230. doi: 10.1080/01443615.2017.1343810. Epub 2017 Sep 18.


To investigate the involvement of ICAM-1 in the adhesion of Candida to the genitourinary epithelial cells in high glucose, we examined the adhesion of Candida albicans or Candida glabrata to human vaginal epithelial cells (VK2/E6E7) or human vulvovaginal epidermal cells (A431). These cells were cultured in 100, 500 or 3000 mg/dL glucose for three days and inoculated with Candida for 60 minutes. Followed by, adhering of Candida to the cells, which were counted. While the adhesion of Candida albicans to VK2/E6E7 significantly increased in the high glucose, A431 did not. We next examined the expression of ICAM-1 as a ligand on the epithelial cells. ICAM-1 expression was increased in VK2/E6E7 cultured in the high glucose; however, the expression level in A431 was not high compared with VK2/E6E7. This data suggested that ICAM-1 functions as one of ligands in the adhesion of Candida albicans to the vaginal epithelial cells in a high glucose environment. Impact statement What is already known on the subject: Candida's complement receptor is involved in the adhesion to epithelial cells. The expression of this receptor has been reported to increase as glucose concentration increases. This is considered as a contributing factor to the high risk for vulvovaginal candidiasis (VVC) in diabetes. On the host side, diabetic patients have a factor that facilitates adhesion of Candida to epithelial cells. This factor has been unknown until recently. What the results of this study add: In this study, we used a vaginal epithelial cell line and showed that the adhesion of C. albicans to cells increased at higher glucose concentrations. At the same time, ICAM-1 expression of cells also increased. Thereby, it is suggested that the expression of ICAM-1 in vaginal epithelial cells is increased by glucose such as urinary sugar in diabetic patients and is a condition for facilitating adhesion of Candida. What the implications are of these findings for clinical practice and/or further research: We expect not only host immune dysfunction but also alteration in epithelial cells will be focussed on as a cause of VVC in diabetic patients.

Keywords: Candida adhesion; Diabetes; ICAM-1; complement receptor; high glucose; vaginal epithelial cells.

MeSH terms

  • Blotting, Western
  • Candida albicans / isolation & purification
  • Candida albicans / metabolism*
  • Candida glabrata / isolation & purification
  • Candida glabrata / metabolism*
  • Candidiasis, Vulvovaginal / etiology
  • Candidiasis, Vulvovaginal / genetics
  • Candidiasis, Vulvovaginal / microbiology*
  • Cell Culture Techniques
  • Diabetes Complications / genetics
  • Diabetes Complications / microbiology
  • Epithelial Cells / microbiology*
  • Female
  • Gene Expression Regulation
  • Glucose / metabolism
  • Glucose / pharmacology*
  • Humans
  • Intercellular Adhesion Molecule-1 / metabolism*
  • Risk Factors
  • Tissue Adhesions / metabolism
  • Vagina / microbiology*


  • Intercellular Adhesion Molecule-1
  • Glucose