Journal of Clinical Microbiology, December 2003, p. 5709-5717, Vol. 41, No. 12
0095-1137/03/$08.00+0 DOI: 10.1128/JCM.41.12.5709-5717.2003
Copyright © 2003, American
Society for
Microbiology. All Rights Reserved.
Multilocus Sequence Typing of Candida glabrata Reveals Geographically Enriched Clades
Andrew R. Dodgson,1,2 Claude Pujol,2 David W. Denning,1 David R. Soll,2* and Andrew J. Fox3
School
of Medicine, University of
Manchester,1
Manchester Medical
Microbiology Partnership, Manchester Royal
Infirmary, Manchester, United Kingdom,3
Department of Biological
Sciences, University of Iowa, Iowa City,
Iowa2
Received 9 June 2003/
Returned for modification 28 July 2003/
Accepted 31 August 2003
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ABSTRACT
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The
haploid pathogenic yeast Candida glabrata is the second most
common Candida species isolated from cases of bloodstream
infection. The clinical relevance of C. glabrata is enhanced
by its reduced susceptibility to fluconazole. Despite this, little is
known of the epidemiology or population structure of this species. We
developed a multilocus sequence typing (MLST) scheme for C.
glabrata and used it to fingerprint a geographically diverse
collection of 107 clinical isolates and 2 reference strains.
Appropriate loci were identified by amplifying and sequencing fragments
of the coding regions of 11 C. glabrata genes in 10 unrelated
isolates. The 6 most variable loci (FKS, LEU2,
NMT1, TRP1, UGP1, and URA3) were
sequenced in the collection of 109 isolates. From the 3,345 bp
sequenced in each isolate, 81 nucleotide sites were found to be
variable. These defined 30 STs among the 109 strains. The technique was
validated by comparison with random amplified polymorphic DNA and the
complex DNA fingerprinting probes Cg6 and Cg12. MLST identified 5 major
clades among the isolates studied. Three of the clades exhibited
significant geographical bias. Our data demonstrate for the first time,
with such a large geographically diverse strain collection, that
distinct genetic clades of C. glabrata prevail in different
geographical
regions.
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INTRODUCTION
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Candida spp. now represent the fourth most commonly isolated
organisms from nosocomial bloodstream infections
(8). In the past, the
majority of infections were caused by Candida albicans.
However, the proportion of infections caused by non-C.
albicans species is increasing
(1,
14,
29,
37). Though some
geographical variations exist, Candida glabrata is now
considered the most commonly isolated of the non-C.
albicans species
(6,
30), and the incidence of
C. glabrata bloodstream infections is rising
(31,
32). C. glabrata
is also emerging as the second most common cause of vaginitis
(39). This increase in
the incidence of C. glabrata infections is noteworthy because
of its decreased susceptibility to fluconazole
(30,
31) and the high crude
mortality rate of bloodstream infection
(13,
43)
In
spite of its increased prominence, little is known of the population
structure, epidemiology, and basic biology of C. glabrata.
Recently, however, several studies have been reported that shed light
on the developmental capabilities of this organism. These have included
the description of phenotypic switching
(19,
20), the demonstration of
pseudohypha and tube formation
(4,
19), and the
identification and characterization of a mating system that is similar
to that of Saccharomyces cerevisiae
(41,
44). Studies of the
population structure of the organism have also begun to emerge
(5). To facilitate the
latter, we have developed and begun to characterize a fingerprinting
method based upon multilocus sequencing.
A number of different
genetic fingerprinting methods have previously been applied to C.
glabrata (40),
including random amplification of polymorphic DNA (RAPD)
(22,
24), pulsed-field gel
electrophoresis (PFGE) (17,
42), multilocus enzyme electrophoresis (MLEE)
(5), and fingerprinting
with complex DNA probes
(24). To date, there has
only been one example of direct sequence comparison for typing C.
glabrata (38). This
study involved an analysis of variation in the mitochondrial
COX2 gene. To obtain a higher resolution DNA fingerprinting
system based on direct sequence comparison, we developed a multilocus
sequence typing (MLST) system, in which data from alleles at multiple
loci are combined to assess genetic relatedness. Though this system is
based on the same principles as MLEE, MLST has the advantage in that
genetic variation based upon differences in DNA sequences is greater
than that assessed by differences in protein mobility. Hence, fewer
loci are needed to achieve the same level of discrimination as MLEE.
However, the major advantage of MLST over many other typing techniques
is the unambiguous nature of the data generated. This allows
laboratories to easily compare data and allows for the construction of
large international internet-accessible databases such as those for the
bacterial pathogens Neisseria meningitidis and
Streptococcus pneumoniae (available at
www.mlst.net).
MLST schemes now exist for a number of important bacterial pathogens
including N. meningitidis
(26), S.
pneumoniae (10),
Staphylococcus aureus
(11), Streptococcus
pyogenes (9), and
Campylobacter jejuni
(7). The technique has
also been successfully used to assess genetic relatedness among strains
of C. albicans
(3), Aspergillus
flavus (12), and
Coccidioides immitis
(18).
We describe
here the development of an MLST scheme for the haploid pathogenic yeast
C. glabrata by using sequences from 6 genes to type a diverse
collection of 109 isolates. We compared this MLST method with current
typing techniques to validate the system
(40). We have also used
the MLST method to examine the genetic relatedness of isolates from
different geographical locales and isolates with different levels of
fluconazole resistance.
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MATERIALS AND
METHODS
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Isolates.
A total of 107 clinical isolates and
two reference strains were used (Table
1). The clinical isolates were geographically diverse, comprising 63 from
Europe (29 from the United Kingdom, 16 from Spain, 8 from Belgium, 7
from Germany, 2 from Switzerland, and 1 from The Netherlands), 28 from
the United States, 14 from Japan, and 2 from Chile. Isolates from a
wide variety of clinical sites, including the bloodstream and the
genitourinary and gastrointestinal tracts, were represented in the
collection. Twenty-six isolates had previously been typed by RAPD and
Southern blotting with the complex C. glabrata-specific DNA
probes Cg6 and Cg12 (24).
Twenty-one isolates had previously been analyzed for MICs of
fluconazole by published methods
(21). Eight isolates were
fluconazole resistant (MIC
64 µg/ml) by the criteria
of Rex et al.
(36).
DNA
extraction and PCR amplification.
DNA was extracted by using the Qiagen
DNA tissue kit (Qiagen, Crawley, United Kingdom) according to the
manufacturer's instructions. Oligonucleotide primers (Table
2) were designed by using GenBank sequences of C. glabrata genes
as templates. PCRs were performed in 25-µl volumes containing
2.5 ng of C. glabrata DNA, 1 U of Taq DNA polymerase
(Q-Biogene, Harefield, United Kingdom), 2.5 µl of 10x
PCR buffer plus 1.5 mM MgCl2 (provided with Taq DNA
polymerase), 0.2 mM concentrations of combined deoxynucleoside
triphosphates (Amersham Pharmacia Biotech, Little Chalfont, United
Kingdom), and 0.2 µM concentrations of each primer (Table
2). The reaction
conditions were as follows: 7 min at 94°C, 30 cycles of 1 min
at 94°C, 1 min at the relevant annealing temperature (Table
2), and 1 min at
74°C, followed by 10 min at 74°C. The reactions were
performed on a Perkin Elmer GeneAmp PCR system 2400 thermal cycler
(Perkin Elmer, Norwalk, Conn.). Purification of the PCR product was
done with the Genelute PCR clean-up kit (Sigma-Aldrich Life Sciences,
Poole, United Kingdom) according to the manufacturer's
instructions.
Sequencing.
All loci were sequenced in both the
forward and reverse directions with the same primers as those used for
the PCRs. Sequencing reactions were performed in a 20-µl volume
with 3 pmol of oligonucleotide primer, 25 ng of template, 4 µl
of BigDye terminator cycle sequencing ready reaction mix (version 1;
ABI, Warrington, United Kingdom), and 2 µl of 5x
sequencing buffer (80 mM Tris-Cl [lpH 9.0], 2 mM
MgCl2 [final concentrations]). Excess chromophore
was removed by ethanol precipitation. The reaction products were
analyzed with an ABI Prism 377 DNA
sequencer.
Selection of suitable
loci.
Comparisons were made
of the sequence variation of DNA fragments of the coding regions of
ADE2, ERG11, FKS, HEM2,
LEU2, NEP1, NMT1, PSA1,
TRP1, UGP1, and URA3 in 10 unrelated
isolates. Nucleotide sequences were determined by alignment of the
forward and reverse sequences with the Genebuilder program of the
Bionumerics package (Applied Maths, Sint-Martens-Latem, Belgium). All
novel polymorphisms were confirmed visually by examination of the
sequencing traces. Single base pair differences were considered
significant. Therefore, each allele was defined by a unique sequence.
Unique alleles were assigned arbitrary numbers as they were identified.
Sequence types (STs) were defined by combining the allelic data
obtained from a number of loci. The combination of the alleles gave an
allelic profile, which was used to assign a ST. Therefore, each ST was
described by a unique combination of alleles. STs were numbered in
order of their identification, with no reference to relatedness. Those
loci showing the most variation, and combinations of which generated
the most STs, were chosen for use in the MLST scheme. The six genes
selected for the MLST scheme to analyze the collection of 109 isolates
were FKS, LEU2, NMT1, TRP1,
UGP1, and URA3. To determine whether the addition of
further loci could increase the discrimination of the scheme, the loci
ERG11, NEP1, and PSA1 (which had shown a
degree of variability in initial screening) and a further 6 loci
(MSH4, CCA1, RAP1, HIS3,
SNF1, and RRN1) were sequenced from 24 selected
isolates representing 4 STs. For all of the loci studied, only coding
regions were considered for
analysis.
Data analysis.
The dendrogram of the whole
collection was constructed from the matrix of pairwise similarity from
the 3,345-bp concatenated DNA sequence (a composite of the sequences
from all 6 loci) by using the unweighted pair group method with
arithmetic averages (UPGMA) computed by the Bionumerics package.
Assessment of the significance of the nodes was done by bootstrapping
with 1,000 randomizations. Only the polymorphic sites were used for the
bootstrap analysis. STs were also grouped based upon allelic profiles
by using the BURST program (available at
www.mlst.net),
defining a group as those STs sharing alleles at 4 or more of the 6
analyzed loci. Assessment of the likelihood of selective pressure at
each of the loci was calculated by the ratio of nonsynonymous to
synonymous nucleotide substitutions
(dN/dS) by using the method of
Nei and Gojobori (28)
implemented in the START program (available at
http://outbreak.ceid.ox.ac.uk/software.shtml).
Dendrograms for the isolates typed by RAPD and Southern blotting with
the probes Cg6 and Cg12 were produced by using previously published
methods (24). To enable
comparison, dendrograms were generated from MLST data with DENDRON
software (40), with the
nucleotides at polymorphic sites used to represent
bands.
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RESULTS
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Sequence
variability.
For MLST
analysis, sequences from 6 loci were analyzed in 109 isolates of C.
glabrata. A total of 3,345 bp were sequenced in the 6 loci in each
isolate. The sizes of the 6 fragments ranged between 419 bp
(TRP1) and 616 bp (UGP1), as shown in Table
3. No insertions, deletions, or heterozygosities were detected in any of
the sequenced DNA fragments. Eighty-one (2.5%) polymorphic sites
were identified among the 6 loci (Fig.
1). The number of variable nucleotide sites per locus ranged between 6
(1.3%, UGP1) and 21 (3.5%, NMT1). Data
for all 6 loci are shown in Table
3 and Fig.
1. The polymorphisms
defined between 8 (UGP1) and 17 (NMT1) alleles per locus. The ratio of
synonymous to nonsynonymous nucleotide substitutions
(dN/dS) as calculated by the
method of Nei and Gojobori
(28) was below 1 for all
6 loci (Table 3),
suggesting that none were under positive selective pressure. The three
loci with the highest dN/dS
ratios (NMT1, TRP1, and URA3) were also the
three that exhibited the greatest percentage of variable
sites.

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FIG. 1. Polymorphic
sites of the 6 loci used in the MLST scheme. The polymorphisms
comprising each of the 30 STs found in the 109 isolates tested are
shown. The STs are arranged in the 5 groups defined in the study,
followed by the pairs of STs differing at only one allele, followed
finally by the STs not fitting these criteria. The allelic profiles and
groups of the STs are also shown. The allelic profiles are given in the
order FKS, LEU2, NMT1, TRP1,
UGP1, and URA3. Synaptomorphic alleles are indicated
in boldface type. The letters under the figure indicate whether the
polymorphism is synonymous (S) or nonsynonymous (N). The
position of the polymorphism in the coding sequence is given by reading
the numbers
vertically.
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Sequence typing and grouping of
isolates.
STs were assigned
by combining the data from each of the 6 loci sequenced per isolate.
Each ST represents a unique combination of alleles. STs were named as
they were described, with no reference to relatedness. A total of 30
STs could be defined by using the 6 loci (Fig.
1). It was necessary to
include all 6 loci to differentiate all 30 STs. The number of isolates
with each ST varied widely, from 26 with ST3, to 17 STs represented by
a single isolate (Fig.
2).
Eight pairs of STs were separated by differences at only one locus
(Fig. 1). Of these, 5 were
different by only one base (Fig.
1). Pairwise similarities
were calculated between each pair of concatenated DNA sequences. The
similarities were used to generate a UPGMA dendrogram. In the
dendrogram generated for the whole collection of isolates (Fig.
2), 12 nodes presented
greater than 60% confidence in bootstrap analysis. These nodes
were all found above a DNA sequence similarity threshold of
99.6%. Thus, we used this arbitrary threshold to distinguish 5
major groups (I to V) in the collection of isolates analyzed. Four of
the five groups had bootstrap values of 98% or higher. However,
the value of 64% for group III was relatively low. To better
assess the integrity of group III, the maximum-parsimony method was
applied. It confirmed the integrity of this group (data not shown).
Partitioning of STs based on the alleles themselves (with the BURST
program) defined the same groups, with the exception of group III,
which was subdivided into 2 smaller groups by this method (designated
IIIA and IIIB), again suggesting this group to be less homogeneous than
the others. In addition, a number of synaptomorphic alleles were
associated with each of the five groups (Fig.
1). Alleles were deemed
synaptomorphic when they were shared by all members of a given group
and were not present in any other isolates in the collection analyzed
(35). The alleles
FKS-5, NMT1-8, and
URA3-6 were group I specific and were identified in
all members of group I. Group II members were the only isolates with
LEU2-2 or NMT1-2.
NMT1-3 was found only in group III isolates. Group IV
isolates shared three synaptomorphic alleles, FKS-3,
NMT1-4, and TRP1-3.
NMT1-7 was synaptomorphic for group V isolates. It
should be noted that each of the five groups had an NMT1
synaptomorphic allele and that in this collection the NMT1
data alone were sufficient to distinguish the groups. Together, these
data suggest that the five groups described represent genuine clades,
even if group III shows higher
heterogeneity.

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FIG. 2. Dendrogram
showing the relationships of all 109 isolates typed by MLST. The
dendrogram was generated by using the UPGMA method from the
concatenated sequence obtained from all 6 loci used in the MLST scheme.
Bootstrap values of >60% are shown. The STs to which the
isolates belong are shown. Groups defined by a sequence similarity of
>99.6% (shown by a dashed line) are also shown. Isolates
from Europe are shown in blue, those from Japan are shown in red, and
those from the United States are shown in green. All other isolates are
shown in black. The 8 isolates known to be fluconazole resistant (MIC
64 µg/ml) are
underlined.
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Analysis of additional
loci.
To test whether the
discriminatory power of the MLST scheme could be improved by the
addition of other loci, fragments of the genes CCA1,
ERG11, HIS3, MSH4, NEP1,
PSA1, RAP1, RRN1, and SNF1 were
sequenced in 24 selected isolates. The loci ERG11,
NEP1, and PSA1 had previously been discarded
following the initial screen for loci appropriate for the MLST scheme.
They nevertheless exhibited a degree of variability warranting further
evaluation. The isolates selected for further sequencing were taken
from 4 frequently occurring STs (5 from ST2, 11 from ST3, 4 from ST7,
and 4 from ST18). The sequence variability of the 9 loci and a
comparison with the variability of the 6 loci used in the MLST scheme
are shown in Table
4. In the 24 isolates sequenced, the percentage of variable sites in the
additional loci ranged between 0.1 and 2.3%, which was similar
to the variability of the original 6 MLST loci in these isolates of 0.5
to 1.5%. Overall, taking all of the 9 additional loci into
account, 0.9% of the 5,894 nucleotide sites sequenced were
variable, in comparison to 1% of the 3,345 sites sequenced for
the 6 MLST loci. This resulted in 53 polymorphic sites analyzed with
the additional loci versus 34 polymorphic sites analyzed for the
original 6 MLST loci. In the 24 isolates, there were between 2 and 4
alleles per locus with both sets of loci. The distribution of the
alleles was such that even with a greater number of polymorphic sites
analyzed for the additional loci, none of the loci were able to further
subdivide any of the STs identified by using the original 6 MLST loci.
This suggests that the genetic variability obtained through the
analysis of the original 6 loci used in the MLST scheme was close to
the limit of discrimination that could be
achieved.
Comparison of the clustering
ability of MLST and other DNA fingerprinting methods.
To verify the ability of a typing
technique to correctly cluster related isolates, it is necessary to
compare the clusters obtained by the scheme in question with those
generated by other unrelated typing techniques
(40). Of the 109 isolates
typed in this study, 26 formed a representative subset of the 39 used
by Lockhart et al. (24)
to develop and verify DNA fingerprinting probes for C.
glabrata. Dendrograms constructed for these 26 isolates generated
from MLST and the results of previous typing with RAPD
(24) and DNA
fingerprinting with the combined results of the complex probes Cg6 and
Cg12 (24) are presented
for comparison in Fig. 3a, b, and
c, respectively. An SAB threshold of 0.9 defined the
groups described from the MLST data. Arbitrary thresholds of 0.75 and
0.47 were used to cluster the isolates typed by RAPD and by combined
Cg6 and Cg12 fingerprinting, respectively. Eight of the nine group I
isolates clustered in the RAPD and Cg6/Cg12 dendrograms, with the one
exception being isolate US-26 (Fig.
3). The two isolates in
group II (US-12 and US-15) did not cluster in the RAPD or Cg6/Cg12
dendrogram (Fig. 3). All
four isolates in group IIIA of the MLST dendrogram also clustered in
the RAPD and Cg6/Cg12 dendrograms (Fig.
3). The two isolates in
group IV of the MLST dendrogram clustered in the RAPD dendrogram but
not in the Cg6/Cg12 dendrogram (Fig.
3). Finally, all three
isolates in group V of the MLST dendrogram appear in the same clusters
in the RAPD and Cg6/Cg12 dendrograms. Of the isolates that did not
cluster in the RAPD and Cg6/Cg12 dendrograms, three isolates clustered
differently with each of the three typing techniques (US-12, US-15, and
US-26). Strains CE-09 and CE-15, both from group IV, clustered with
RAPD but not with Cg6/Cg12, whereas US-25 clustered with other isolates
of group III when typed with Cg6/Cg12 but not with RAPD. The similar
grouping of the majority of the isolates by RAPD and Cg6/Cg12
fingerprinting, which can be assumed to involve different DNA markers,
supported the ability of the MLST scheme developed to
cluster genetically related
isolates.

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FIG. 3. Dendrograms
based on the computed SABs between the 26 isolates
typed by MLST (a), RAPD (b), and combined data obtained by Southern
blotting with the DNA probes Cg6 and Cg12 (c). The arbitrary
SAB thresholds used to define clusters are shown by
dashed
lines.
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Geographical
distribution.
Table
5 shows the geographical distribution of the 103 clinical isolates from
individual patients from Europe, Japan, and the United States with
respect to the 5 groups. Fisher's exact tests were used to
statistically assess differences in distribution of the groups among
the three populations. Despite the relatively small numbers of isolates
in these geographical groupings, significant (P <
0.05) differences were observed in the distribution of three of the
groups. Group I was significantly overrepresented in the European
population with respect to the Japanese and United States populations.
This situation was reversed in group III, which was significantly
underrepresented among European isolates with respect to those from the
United States, although with respect to Japan, the distribution just
failed to reach significance (P = 0.0509). Japanese
isolates, when compared to either the United States or European
populations, had a significant bias toward group IV. Seven (54%)
of the Japanese isolates were group IV in comparison to none from the
United States and only 4 (6%) from Europe. Group II consisted of
19 isolates, none of which were Japanese. While this distribution just
failed to reach significance, with P values of 0.057 and 0.077
for the distribution of Japanese isolates versus European and United
States isolates, respectively, it suggested a trend. Together, these
results suggest geographical specificity in some of the
clades.
Association of genotype with
clinical site and fluconazole resistance.
Of the 109 isolates typed, 21 had been
analyzed for fluconazole resistance. Eight isolates had a MIC of
fluconazole of
64 µg/ml and, hence, were deemed
fluconazole resistant
(36). These resistant
isolates fell into 6 different STs (Fig.
2). Two STs contained two
resistant isolates each (ST 3 and ST6). When analyzed as groups,
resistant isolates were found in four of the five groups. Two isolates
belonged to STs not associated with a group. The most common ST, ST3,
contained five isolates for which the MICs ranged from 6.25 to 128
µg/ml. Though the numbers were too small to perform any
meaningful statistical analysis, it appeared that fluconazole
resistance was not related to ST or group. The data on the clinical
site of origin of the isolates were incomplete. Thus, no statistical
analysis was attempted, though there seemed to be no obvious
association between clinical site and
genotype.
 |
DISCUSSION
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MLST is considered
a highly effective method for DNA fingerprinting microorganisms, since
it fulfills the requirement set forth by some population geneticists
that a method must be based on the identification of discrete alleles
for each analyzed locus. Here, we have developed for the first time an
MLST scheme for the yeast pathogen C. glabrata. We chose 6
loci that defined 30 STs among the 109 isolates analyzed. In an attempt
to improve resolution, we tested nine additional loci. The addition of
these loci did not increase discrimination, suggesting that we were
approaching the limit of resolution for this method. The MLST system
developed for C. albicans
(3) revealed similar
ranges for the percentage of variable sites (1.5 to 4.0% for
C. albicans compared to 1.5 to 3.5% for C.
glabrata). The MLST system developed for C. albicans
(3), however, appears to
be more discriminating than the system developed for C.
glabrata, even though more polymorphic sites were analyzed in the
C. glabrata system (81 in C. glabrata versus 68 in
C. albicans). This is probably due to heterozygosity at the
tested loci of C. albicans, which, in contrast to haploid
C. glabrata, is diploid.
To verify the efficacy of the
MLST system we developed for C. glabrata, we compared its
capacity to cluster isolates in a test collection of 26 isolates with
that of two other independent DNA fingerprinting methods. We found that
the majority (80%) of isolates that formed clusters defined by
an arbitrary threshold in the MLST dendrogram also formed similar
clusters in the RAPD and Cg6/Cg12 dendrograms. One group (group II) in
the MLST dendrogram did not remain intact in either the RAPD or
Cg6/Cg12 dendrogram. These results demonstrated that the MLST method
was effective in distinguishing deep-rooted clusters and, in fact, may
be more effective than the other two methods in examining population
structure. However, the MLST method did not, for the most part,
discriminate between isolates in a group. The RAPD method exhibited a
higher degree of discrimination, but neither the MLST method nor the
RAPD method discriminated between the great majority of group I
isolates. In contrast, the Cg6/Cg12 method discriminated between all
isolates in all groups, including group I isolates. Therefore, for
analyzing microevolution and studies of nosocomial transmission,
Southern blot hybridization with Cg6/Cg12
(24) is the superior
method.
An analysis of the 103 test isolates according to
geographical origin revealed that a degree of geographical specificity
existed for the different clades, as has recently been demonstrated for
C. albicans (2,
34). We found that the
most representative C. glabrata groups in Europe, the United
States, and Japan were groups I and II, groups II and III, and groups
III and IV, respectively. The population structure of C.
glabrata is believed to be predominantly clonal
(5). The results we have
obtained on geographical specificity tend to support the conclusion
that mixing between clades is depressed. This is also suggested by the
robustness of the MLST clades and the presence of synapomorphic alleles
associated with each of the groups. It is also believed that the
population structure of C. albicans is predominantly clonal
(33), but the discovery
of mating type loci (15)
and the demonstration of fusion and mating
(16,
25,
23,
27) has refocused
attention to the possibility of low levels of recombination, which was
suggested in most studies of population structure. Similarly, the
mating type loci of C. glabrata were recently identified and
characterized (41,
44), suggesting that
recombination also takes place in this species. Detailed studies of the
population structure of C. glabrata are, therefore,
warranted.
Finally, we found no association between fluconazole
resistance and either ST or group. de Meeûs et al.
(5) also found no
correlation between fluconazole resistance and genotypes derived by
MLEE. However, our results do not exclude the possibility that the
capacity to become resistant through drug exposure is a function of ST
or group.
In summary, we have developed an MLST system for DNA
fingerprinting of the yeast pathogen C. glabrata. This system
is highly effective in cluster analysis directed at population
structure but is not suited for studies of nosocomial infection or
microevolution. Our results further suggest specificity of particular
clades to particular geographical locales. We have also shown that
NMT1 data alone may be sufficient to ascertain groups.
Therefore, a reduced number of loci may provide a straightforward
method for further study of the geographical distribution of C.
glabrata.
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ACKNOWLEDGMENTS
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This work was funded by
Wellcome Trust Medical Microbiology Research Fellowship 064466 to
A.R.D. and National Institutes of Health grant DE014219 to
D.R.S.
We thank C. B. Moore, S. R. Lockhart,
J. Bille, J. L. Rodriguez-Tudela, and S. Kohno for the
strains used in this study; M. J. Anderson for help with the
manuscript; and M. Bond and P. Fullwood from the University of
Manchester Sequencing Facility for help with
sequencing.
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FOOTNOTES
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* Corresponding
author. Mailing address: Department of Biological Sciences, University
of Iowa, Iowa City, IA 52242. Phone: (319) 335-1117. Fax: (319)
335-2772. E-mail:
david-soll{at}uiowa.edu. 
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REFERENCES
|
|---|
- Abi-Said,
D., E. Anaissie, O. Uzun, I. Raad, H. Pinzcowski, and S.
Vartivarian. 1997. The epidemiology of hematogenous
candidiasis caused by different Candida species. Clin. Infect.
Dis.
24:1122-1128.[Medline]
- Blignaut,
E., C. Pujol, S. Lockhart, S. Joly, and D. R. Soll.2002
. Ca3 fingerprinting of Candida albicans
isolates from human immunodeficiency virus-positive and healthy
individuals reveals a new clade in South Africa. J.
Clin. Microbiol.
40:826-836.[Abstract/Free Full Text]
- Bougnoux,
M. E., S. Morand, and C. d'Enfert.2002
. Usefulness of multilocus sequence typing for
characterization of clinical isolates of Candida albicans.J. Clin. Microbiol.
40:1290-1297.[Abstract/Free Full Text]
- Csank,
C., and K. Haynes. 2000. Candida glabrata
displays pseudohyphal growth. FEMS Microbiol. Lett.
189:115-120.[CrossRef][Medline]
- de
Meeûs, T., F. Renaud, E. Mouveroux, J. Reynes, G. Galeazzi, M.
Mallie, and J. M. Bastide. 2002. Genetic
structure of Candida glabrata populations in AIDS and non-AIDS
patients. J. Clin. Microbiol.
40:2199-2206.[Abstract/Free Full Text]
- Diekema,
D. J., S. A. Messer, A. B. Brueggemann,
S. L. Coffman, G. V. Doern, L. A.
Herwaldt, and M. A. Pfaller. 2002.
Epidemiology of candidemia: 3-year results from the emerging infections
and the epidemiology of Iowa organisms study. J. Clin.
Microbiol.
40:1298-1302.[Abstract/Free Full Text]
- Dingle,
K. E., F. M. Colles, D. R. A.
Wareing, R. Ure, A. J. Fox, F. E. Bolton,
H. J. Bootsma, R. J. L. Willems, R.
Urwin, and M. C. J. Maiden. 2001.
Multilocus sequence typing system for Campylobacter jejuni.J. Clin. Microbiol.
39:14-23.[Abstract/Free Full Text]
- Edmond,
M. B., S. E. Wallace, D. K. McClish,
M. A. Pfaller, R. N. Jones, and R. P.
Wenzel. 1999. Nosocomial bloodstream infections in
United States hospitals: a three-year analysis. Clin. Infect.
Dis.
29:239-244.[Medline]
- Enright,
M. C., B. G. Spratt, A. Kalia, J. H.
Cross, and D. E. Bessen. 2001. Multilocus
sequence typing of Streptococcus pyogenes and the
relationships between emm type and clone. Infect.
Immun.
69:2416-2427.[Abstract/Free Full Text]
- Enright,
M. C., and B. G. Spratt. 1998. A
multilocus sequence typing scheme for Streptococcus
pneumoniae: identification of clones associated with serious
invasive disease. Microbiology
144:3049-3060.[Abstract]
- Enright,
M. C., N. P. J. Day, C. E.
Davies, and S. J. Peacock. 2000. Multilocus
sequence typing for characterization of methicillin-resistant and
methicillin-susceptible clones of Staphylococcus aureus.J. Clin. Microbiol.
38:1008-1015.[Abstract/Free Full Text]
- Geiser,
D. M., J. I. Pitt, and J. W. Taylor.1998
. Cryptic speciation and recombination in the
aflatoxin-producing fungus Aspergillus flavus. Proc.
Natl. Acad. Sci. USA
95:388-393.[Abstract/Free Full Text]
- Gumbo,
T., C. M. Isada, G. Hall, M. T. Karafa, and
S. M. Gordon. 1999. Candida
glabrata fungemia. Clinical features of 139 patients.Medicine (Baltimore)
78:220-227.[CrossRef][Medline]
- Hazen,
K. C. 1995. New and emerging yeast
pathogens. Clin. Microbiol. Rev.
8:462-478.[Abstract]
- Hull,
C. M., and A. D. Johnson. 1999.
Identification of a mating type-like locus in the asexual pathogenic
yeast Candida albicans. Science
285:1271-1275.[Abstract/Free Full Text]
- Hull,
C. M., R. M. Raisner, and A. D.
Johnson. 2000. Evidence for mating of the
"asexual" yeast Candida albicans in a
mammalian host. Science
289:307-310.[Abstract/Free Full Text]
- Kaufmann,
C. S., and W. G. Merz. 1989.
Electrophoretic karyotypes of Torulopsis glabrata.J. Clin. Microbiol.
27:2165-2168.[Abstract/Free Full Text]
- Koufopanou,
V., A. Burt, and J. W. Taylor. 1997.
Concordance of gene genealogies reveals reproductive isolation in the
pathogenic fungus Coccidioides immitis. Proc. Natl.
Acad. Sci. USA
94:5478-5482.[Abstract/Free Full Text]
- Lachke,
S. A., S. Joly, K. Daniels, and D. R. Soll.2002
. Phenotypic switching and filamentation in
Candida glabrata. Microbiology
148:2661-2674.[Abstract/Free Full Text]
- Lachke,
S. A., T. Srikantha, L. K. Tsai, K. Daniels, and
D. R. Soll. 2000. Phenotypic switching in
Candida glabrata involves phase-specific regulation of the
metallothionein gene MT-II and the newly discovered hemolysin gene HLP.Infect. Immun.
68:884-895.[Abstract/Free Full Text]
- Law,
D., C. B. Moore, H. M. Wardle, L. A.
Ganguli, M. G. Keaney, and D. W. Denning.1994
. High prevalence of antifungal resistance in
Candida spp. from patients with AIDS. J. Antimicrob.
Chemother.
34:659-668.[Abstract/Free Full Text]
- Lehmann,
P. F., D. Lin, and B. A. Lasker.1992
. Genotypic identification and characterization of
species and strains within the genus Candida by using random
amplified polymorphic DNA. J. Clin. Microbiol.
30:3249-3254.[Abstract/Free Full Text]
- Lockhart,
S. R., K. J. Daniels, R. Zhao, D. Wessels, and
D. R. Soll. 2003. Cell biology of mating in
Candida albicans. Eukaryotic Cell
2:49-61.[Abstract/Free Full Text]
- Lockhart,
S. R., S. Joly, C. Pujol, J. D. Sobel, M.
A. Pfaller, and D. R. Soll. 1997.
Development and verification of fingerprinting probes for Candida
glabrata. Microbiology
143:3733-3746.[Abstract]
- Magee,
B. B., and P. T. Magee. 2000.
Induction of mating in Candida albicans by construction of
MTLa and MTLalpha strains. Science
289:310-313.[Abstract/Free Full Text]
- Maiden,
M. C. J., J. A. Bygraves, E. Feil, G.
Morelli, J. E. Russell, R. Urwin, Q. Zhang, J. Zhou, K.
Zurth, D. A. Caugant, I. M. Feavers, M. Achtman,
and B. G. Spratt. 1998. Multilocus sequence
typing: a portable approach to the identification of clones within
populations of pathogenic microorganisms. Proc. Natl. Acad. Sci.
USA
95:3140-3145.[Abstract/Free Full Text]
- Miller,
M. G., and A. D. Johnson. 2002.
White-opaque switching in Candida albicans is controlled by
mating-type locus homeodomain proteins and allows efficient mating.Cell
110:293-302.[CrossRef][Medline]
- Nei,
M., and T. Gojobori. 1986. Simple methods for
estimating the numbers of synonymous and nonsynonymous nucleotide
substitutions. Mol. Biol. Evol.
3:418-426.[Abstract]
- Nguyen,
M. H., J. E. Peacock, Jr., A. J. Morris,
D. C. Tanner, M. L. Nguyen, D. R.
Snydman, M. M. Wagener, M. G. Rinaldi, and
V. L. Yu. 1996. The changing face of
candidemia: emergence of non-Candida albicans species and
antifungal resistance. Am. J. Med.
100:617-623.[CrossRef][Medline]
- Pfaller,
M. A., D. J. Diekema, R. N. Jones,
H. S. Sader, A. C. Fluit, R. J. Hollis,
S. A. Messer, and the SENTRY Participant Group.2001
. International surveillance of bloodstream infections
due to Candida species: frequency of occurrence and in vitro
susceptibilities to fluconazole, ravuconazole, and voriconazole of
isolates collected from 1997 through 1999 in the SENTRY antimicrobial
surveillance program. J. Clin. Microbiol.
39:3254-3259.[Abstract/Free Full Text]
- Pfaller,
M. A., R. N. Jones, G. V. Doern,
H. S. Sader, S. A. Messer, A. Houston, S. Coffman,
R. J. Hollis, and the SENTRY Participant Group.2000
. Bloodstream infections due to Candida
species: SENTRY antimicrobial surveillance program in North America and
Latin America, 1997-1998. Antimicrob. Agents
Chemother.
44:747-751.[Abstract/Free Full Text]
- Pfaller,
M. A., S. A. Messer, R. J. Hollis,
R. N. Jones, G. V. Doern, M. E. Brandt,
and R. A. Hajjeh. 1999. Trends in species
distribution and susceptibility to fluconazole among blood stream
isolates of Candida species in the United States.Diagn. Microbiol. Infect. Dis.
33:217-222.[CrossRef][Medline]
- Pujol,
C., J. Reynes, F. Renaud, M. Raymond, M. Tibayrenc, F. J.
Ayala, F. Janbon, M. Mallie, and J. M. Bastide.1993
. The yeast Candida albicans has a clonal
mode of reproduction in a population of infected human immunodeficiency
virus-positive patients. Proc. Natl. Acad. Sci. USA
90:9456-9459.[Abstract/Free Full Text]
- Pujol,
C., M. Pfaller, and D. R. Soll. 2002. Ca3
fingerprinting of Candida albicans bloodstream isolates from
the United States, Canada, South America, and Europe reveals a European
clade. J. Clin. Microbiol.
40:2729-2740.[Abstract/Free Full Text]
- Pujol,
C., S. Joly, S. R. Lockhart, S. Noel, M. Tibayrenc, and
D. R. Soll. 1997. Parity among the randomly
amplified polymorphic DNA method, multilocus enzyme electrophoresis,
and Southern blot hybridization with the moderately repetitive DNA
probe Ca3 for fingerprinting Candida albicans.J. Clin. Microbiol.
35:2348-2358.[Abstract]
- Rex,
J. H., M. A. Pfaller, J. N. Galgiani,
M. S. Bartlett, A. Espinel-Ingroff, M. A. Ghannoum,
M. Lancaster, F. C. Odds, M. G. Rinaldi,
T. J. Walsh, and A. L. Barry.1997
. Development of interpretive breakpoints for
antifungal susceptibility testing: conceptual framework and analysis of
in vitro-in vivo correlation data for fluconazole, itraconazole, and
Candida infections. Subcommittee on Antifungal Susceptibility
Testing of the National Committee for Clinical Laboratory Standards.Clin. Infect. Dis.
24:235-247.[Medline]
- Samra,
Z., J. Bishara, S. Ashkenazi, S. Pitlik, M. Weinberger, M. Lapidoth, M.
Yardeni, and I. Levy. 2002. Changing distribution of
Candida species isolated from sterile and nonsterile sites in
Israel. Eur. J. Clin. Microbiol. Infect. Dis.
21:542-545.[CrossRef][Medline]
- Sanson,
G. F., and M. R. Briones. 2000.
Typing of Candida glabrata in clinical isolates by comparative
sequence analysis of the cytochrome c oxidase subunit 2 gene
distinguishes two clusters of strains associated with geographical
sequence polymorphisms. J. Clin. Microbiol.
38:227-235.[Abstract/Free Full Text]
- Sobel,
J. D., and W. Chaim. 1997. Treatment of
Torulopsis glabrata vaginitis: retrospective review of boric
acid therapy. Clin. Infect. Dis.
24:649-652.[Medline]
- Soll,
D. R. 2000. The ins and outs of DNA
fingerprinting the infectious fungi. Clin. Microbiol.
Rev.
13:332-370.[Abstract/Free Full Text]
- Srikantha,
T. A., S. A. Lachke, and D. R. Soll.2003
. Three mating type-like loci of Candida
glabrata. Eukaryotic Cell.
2:328-340.[Abstract/Free Full Text]
- Vazquez,
J. A., A. Beckley, S. Donabedian, J. D. Sobel, and
M. J. Zervos. 1993. Comparison of
restriction enzyme analysis versus pulsed-field gradient gel
electrophoresis as a typing system for Torulopsis glabrata and
Candida species other than C. albicans.J. Clin. Microbiol.
31:202120-202130.
- Viscoli,
C., C. Girmenia, A. Marinus, L. Collette, P. Martino, B. Vandercam, C.
Doyen, B. Lebeau, D. Spence, V. Krcmery, B. De Pauw, and F.
Meunier. 1999. Candidemia in cancer patients: a
prospective, multicenter surveillance study by the Invasive Fungal
Infection Group (IFIG) of the European Organization for Research and
Treatment of Cancer (EORTC). Clin. Infect. Dis.
28:1071-1079.[Medline]
- Wong,
S., M. A. Fares, W. Zimmermann, G. Butler, and K.
H. Wolfe. 23 January 2003, posting date. Evidence from
comparative genomics for a complete sexual cycle in the
asexual pathogenic yeast Candida glabrata.Genome Biol.
4:R10.
[Online.]
http://www.genomebiology.com.
Journal of Clinical Microbiology, December 2003, p. 5709-5717, Vol. 41, No. 12
0095-1137/03/$08.00+0 DOI: 10.1128/JCM.41.12.5709-5717.2003
Copyright © 2003, American
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Microbiology. All Rights Reserved.
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