Rhesus Theta Defensin 1 Promotes Long Term Survival in Systemic Candidiasis by Host Directed Mechanisms

Sci Rep. 2019 Nov 15;9(1):16905. doi: 10.1038/s41598-019-53402-z.

Abstract

Invasive candidiasis is an increasingly frequent cause of serious and often fatal infections in hospitalized and immunosuppressed patients. Mortality rates associated with these infections have risen sharply due to the emergence of multidrug resistant (MDR) strains of C. albicans and other Candida spp., highlighting the urgent need of new antifungal therapies. Rhesus theta (θ) defensin-1 (RTD-1), a natural macrocyclic antimicrobial peptide, was recently shown to be rapidly fungicidal against clinical isolates of MDR C. albicans in vitro. Here we found that RTD-1 was rapidly fungicidal against blastospores of fluconazole/caspofungin resistant C. albicans strains, and was active against established C. albicans biofilms in vitro. In vivo, systemic administration of RTD-1, initiated at the time of infection or 24 h post-infection, promoted long term survival in candidemic mice whether infected with drug-sensitive or MDR strains of C. albicans. RTD-1 induced an early (4 h post treatment) increase in neutrophils in naive and infected mice. In vivo efficacy was associated with fungal clearance, restoration of dysregulated inflammatory cytokines including TNF-α, IL-1β, IL-6, IL-10, and IL-17, and homeostatic reduction in numbers of circulating neutrophils and monocytes. Because these effects occurred using peptide doses that produced maximal plasma concentrations (Cmax) of less than 1% of RTD-1 levels required for in vitro antifungal activity in 50% mouse serum, while inducing a transient neutrophilia, we suggest that RTD-1 mediates its antifungal effects in vivo by host directed mechanisms rather than direct fungicidal activity. Results of this study suggest that θ-defensins represent a new class of host-directed compounds for treatment of disseminated candidiasis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • Biofilms / drug effects
  • Candida albicans / drug effects
  • Candida albicans / physiology
  • Candidiasis / drug therapy*
  • Candidiasis / immunology
  • Candidiasis / metabolism
  • Candidiasis / mortality*
  • Defensins / pharmacokinetics
  • Defensins / therapeutic use*
  • Drug Resistance, Multiple / drug effects
  • Drug Resistance, Multiple, Fungal / drug effects
  • Female
  • Host-Pathogen Interactions / drug effects
  • Host-Pathogen Interactions / immunology
  • Macaca mulatta / immunology
  • Mice
  • Mice, Inbred BALB C
  • Microbial Sensitivity Tests
  • Signal Transduction / drug effects
  • Signal Transduction / immunology
  • Survival Analysis

Substances

  • Defensins
  • theta-defensin

Supplementary concepts

  • Systemic candidiasis