Hgc1 Mediates Dynamic Candida albicans-Endothelium Adhesion Events during Circulation

Common iatrogenic procedures can result in translocation of the human pathogenic fungus Candida albicans from mucosal surfaces to the bloodstream. Subsequent disseminated candidiasis and infection of deep-seated organs may occur if the fungus is not eliminated by blood cells. In these cases, fungal cells adhere to the endothelial cells of blood vessels, penetrate through endothelial layers, and invade deeper tissue. In this scenario, endothelial adhesion events must occur during circulation under conditions of physiological blood pressure. To investigate the fungal and host factors which contribute to this essential step of disseminated candidiasis, we have developed an in vitro circulatory C. albicans-endothelium interaction model. We demonstrate that both C. albicans yeast and hyphae can adhere under flow at a pressure similar to capillary blood pressure. Serum factors significantly enhanced the adhesion potential of viable but not killed C. albicans cells to endothelial cells. During circulation, C. albicans cells produced hyphae and the adhesion potential first increased, then decreased with time. We provide evidence that a specific temporal event in the yeast-to-hyphal transition, regulated by the G₁ cyclin Hgc1, is critical for C. albicans-endothelium adhesion during circulation.Candida albicans is one of only a few fungal species which belong to the normal microbial flora of human beings and, under normal circumstances, exists as a commensal of the skin, gastrointestinal tract, oral cavity, or vagina. Alterations in the host environment, however, can result in the transition from a commensal to a pathogenic relationship. Even relatively mild immune suppression or antibiotic treatment can result in mucosal infections, and these superficial infections are extremely common (24). Candida species are also the most frequent cause of invasive fungal infections in humans, and C. albicans accounts for around 50% of disseminated candidiasis (23). These infections are extremely serious, with attributable mortality rates of 40 to 50%, even with first-line antifungal therapy. Although severe immune suppression—in particular defects in innate immunity, such as neutropenia—is associated with disseminated candidiasis, the major risk factors are common iatrogenic procedures and/or nosocomial conditions such as placement of a central venous catheter and disruption of normal skin barriers or gut mucosa.In these situations, C. albicans can gain access to the bloodstream and, from there, disseminate throughout the body and colonize organs, which may ultimately result in sepsis and multiorgan failure. In order to exit the bloodstream and infect internal organs, however, the fungus must first adhere to and traverse the endothelial lining of blood vessels. Although this critical step in disseminated candidiasis has been the subject of several studies (reviewed in reference 13), the detailed mechanisms underlying it remain poorly understood, and it is likely that C. albicans-endothelium adhesion is mediated by numerous different host and fungal activities. While mostly uncharacterized at the molecular level, C. albicans has been shown to possess integrin-like molecules which mediate the adhesion of yeast cells to the endothelium (15). In addition, the hydrophobicity of the yeast cell surface was also demonstrated to influence adhesion under conditions which mimic the physical pressure of the circulatory system (11) and the glycosylation state of cell wall proteins is likely to play a major role, as a pmt6Δ mutant with defective O-glycosylation of secreted proteins displays attenuated endothelial adhesion (26).The genome of C. albicans contains numerous genes encoding both putative and characterized adhesins (6, 21, 25). Of these, only a small number have been tested for involvement in endothelial interactions and only certain members of the ALS gene family have been demonstrated to play a role in endothelial attachment events. Als2 and Als3 represent multifunctional adhesins with roles in adherence to both endothelial and epithelial cells, while Als1, Als4, and Als9 appear to specifically mediate adhesion to endothelial cells (30, 31).The aims of this study were to develop a circulatory blood vessel model and to characterize factors necessary for C. albicans-endothelium adhesion under physical pressure. A similar model has recently been described by Grubb et al. (14). These authors utilized a novel flow system to determine the relative adhesiveness of different C. albicans morphologies to endothelial cells. The authors found that yeast cells were more adherent under conditions of shear stress, which mimic the physical environment of postcapillary venules.The experimental design of the current study, however, features several differences. Most importantly, we have developed a circulation system, as opposed to linear perfusion, which permitted fungal adaptation within the system and allowed us to monitor morphological and adhesion kinetics during circulation. Furthermore, we have used a pressure which is similar to that found in capillary networks, have quantified the orientation of fungal hyphae relative to flow, and have analyzed the importance of fungal viability, the role of serum factors, and the importance of hypha-associated genes by using mutants lacking regulators of morphogenesis. Similar to Grubb et al. (14), we found that C. albicans yeast and hyphae can rapidly adhere under flow. However, we also found that an adaptation event associated with the yeast-to-hypha transition can greatly enhance C. albicans-endothelium adhesion during circulation. In fact, C. albicans adhered most efficiently at a distinct stage during dimorphism. Furthermore, we found that C. albicans can adhere under relatively high pressure, above 3 dynes/cm², and that serum factors are important for this process. Finally, we provide molecular evidence that adhesion to endothelial cells under these conditions requires hyphal formation and is specifically mediated by the G₁ cyclin encoded by HGC1.