Kaaren G. Vargas

Natural Defenses against Candida Colonization Breakdown in the Oral Cavities of the Elderly

Candida colonization of the oral cavity increases in the elderly. A major predisposing condition is denture use, which also increases in the elderly. To test whether the increase in colonization is age-related in a fashion independent of denture use, we analyzed the frequency (incidence) of carriage, the intensity of carriage, the multiplicity of species, and the genetic relatedness of strains in the oral cavities of 93 test subjects separated into the three age groups: 60 to 69 yr, 70 to 79 yr, and ≥ 80 yr. Each age group was further subdivided into subjects with and without dentures, and into males and females. The results demonstrate that the frequency of carriage, the intensity of carriage, and multispecies carriage all increase as a function of age and differ according to gender, in both cases independent of denture use, suggesting that the natural suppression of yeast carriage in the oral cavity breaks down in the elderly. In addition, it is demonstrated that Candida glabrata colonizes the oral cavities of elderly individuals without dentures only after 80 yr of age, suggesting that there are age-related compromising conditions other than denture use in this most elderly age group.

Carriage Frequency, Intensity of Carriage, and Strains of Oral Yeast Species Vary in the Progression to Oral Candidiasis in Human Immunodeficiency Virus-Positive Individuals

ABSTRACT Candida samples were taken over a period of 2 years from 54 human immunodeficiency virus (HIV)-positive asymptomatic subjects to evaluate changes in yeast carriage, intensity of carriage, and genotype over time. Overall, we found that HIV-positive patients with CD4+-cell counts of between 200 and 400/μl had significantly more yeast colonization than healthy control subjects. Of the 54 patients, 11 developed thrush. We found that intensity of carriage in these 11 patients increased significantly in the progression from asymptomatic yeast carrier to an episode of oral thrush. Also, the most common yeast species isolated was Candidaalbicans; however, we did see a number of patients harboring multiple species at the same time. Using the C. albicans-specific probe Ca3, we found that 54% (n = 6) of the 11 patients who developed thrush maintained genetically similar strains throughout the study period, with minor genetic variations in all patients except one. Forty-six percent of these patients had either multiple strains throughout the study period (n = 2), strain replacement (n = 1), or species replacement (n = 2). Of the patients who had multiple strains, one (I4) was infected by two different strains of Candidadubliniensis distinguished by a recently developed species-specific probe. These results suggest that commensal strains colonizing HIV-positive individuals can undergo alterations prior to producing an episode of thrush.

Susceptibilities of Oral Bacteria and Yeast to Mammalian Cathelicidins

ABSTRACT The effects of cathelicidins against oral bacteria and clinically important oral yeasts are not known. We tested the susceptibilities of Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum,Porphyromonas gingivalis, Streptococcus sanguis, Candida krusei, Candida tropicalis and Candida albicans to the following cathelicidins: FALL39, SMAP29, and CAP18. SMAP29 and CAP18 were antimicrobial, whereas FALL39 did not exhibit antimicrobial activity. Future studies are needed to determine the potential use of these antimicrobial peptides in prevention and treatment of oral infections.

Developmental and molecular biology of switching in Candida albicans

Candida albicans and related species switch frequently and reversibly between a number of general phenotypes usually discriminated by colony morphology and in some cases by cellular morphology. Switching has been demonstrated to affect a number of physiologic and architectural characteristics of single cells including most of the putative virulence factors of C.albicans. In the past few years, we have cloned several genes regulated by switching in the white-opaque transition of C.albicans strain WO-1. Two of the genes, PEP1 and Op4, are transcribed only in the opaque phase, and one of the genes, Wh11, is transcribed only in the white phase. These coordinately regulated genes are unlinked in the genome and do not undergo sequence reorganization in switching. With the identification of a cis-acting regulatory sequence in the five-prime flanking sequence of Wh11, we now believe that phase-specific genes are regulated by transacting factors and that these factors may be coded for or under the direct regulation of a single master regulatory gene at which site the basic switch event occurs.