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. 2008 Dec;52(12):4274-80.
doi: 10.1128/AAC.00740-08. Epub 2008 Sep 22.

Gain-of-function mutations in the transcription factor MRR1 are responsible for overexpression of the MDR1 efflux pump in fluconazole-resistant Candida dubliniensis strains

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Gain-of-function mutations in the transcription factor MRR1 are responsible for overexpression of the MDR1 efflux pump in fluconazole-resistant Candida dubliniensis strains

Sabrina Schubert et al. Antimicrob Agents Chemother. 2008 Dec.

Abstract

Candida dubliniensis, a yeast that is closely related to Candida albicans, can rapidly develop resistance to the commonly used antifungal agent fluconazole in vitro and in vivo during antimycotic therapy. Fluconazole resistance in C. dubliniensis is usually caused by constitutive overexpression of the MDR1 gene, which encodes a multidrug efflux pump of the major facilitator superfamily. The zinc cluster transcription factor Mrr1p has recently been shown to control MDR1 expression in C. albicans in response to inducing stimuli, and gain-of-function mutations in the MRR1 gene result in constitutive upregulation of the MDR1 efflux pump. We identified a gene with a high degree of similarity to C. albicans MRR1 (CaMRR1) in the C. dubliniensis genome sequence. When C. dubliniensis MRR1 (CdMRR1) was expressed in C. albicans mrr1Delta mutants, it restored benomyl-inducible MDR1 expression, demonstrating that CdMRR1 is the ortholog of CaMRR1. To investigate whether MDR1 overexpression in C. dubliniensis is caused by mutations in MRR1, we sequenced the MRR1 alleles from a fluconazole-resistant, clinical C. dubliniensis isolate and a matched, fluconazole-susceptible isolate from the same patient as well as those from four in vitro-generated, fluconazole-resistant C. dubliniensis strains derived from two different C. dubliniensis isolates. We found that all five resistant strains contained single nucleotide substitutions or small in-frame deletions that resulted in amino acid changes in Mrr1p. Expression of these mutated alleles in C. albicans resulted in the constitutive activation of the MDR1 promoter and multidrug resistance. Therefore, mutations in MRR1 are the major cause of MDR1 upregulation in both C. albicans and C. dubliniensis, demonstrating that the transcription factor Mrr1p plays a central role in the development of drug resistance in these human fungal pathogens.

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Figures

FIG. 1.
FIG. 1.
CdMRR1 complements the defect in inducible MDR1 expression of a C. albicans mrr1Δ mutant. (A) Structure of the cassette that was used to express CdMRR1 or CaMRR1 (white arrow) from the ADH1 promoter (PADH1, bent arrow) after integration into the C. albicans genome with the help of the caSAT1 marker (gray arrow). TACT1, transcription termination sequence of the ACT1 gene (filled circle). (B) Fluorescence of C. albicans strains carrying a PMDR1-GFP reporter fusion in an mrr1Δ background and expressing either CaMRR1 or CdMRR1 from the ADH1 promoter. Two independent transformants of parental strain CAG48MRR1M4B (mrr1Δ) were used in each case. Strain SC5314 (control), which does not contain the GFP gene, was included to control for background fluorescence. The strains were grown in the presence (+) or the absence (−) of benomyl, and the mean fluorescence of the cells was determined by flow cytometry, as detailed in Materials and Methods.
FIG. 2.
FIG. 2.
The mutated CdMRR1 alleles constitutively activate the MDR1 promoter. The indicated CaMRR1 and CdMRR1 alleles were expressed under the control of the ADH1 promoter in a C. albicans mrr1Δ mutant carrying a PMDR1-GFP reporter fusion (mrr1Δ). Strains were grown to log phase in YPD medium, and the mean fluorescence of the cells was determined by flow cytometry. Two independent transformants expressing the various MRR1 alleles were used in each case.
FIG. 3.
FIG. 3.
MICs (in μg ml−1) of fluconazole, cerulenin, and brefeldin A for wild-type parental strain SC5314, two independently constructed homozygous mrr1Δ mutants, and transformants expressing the indicated MRR1 alleles under the control of the ADH1 promoter.
FIG. 4.
FIG. 4.
Location of the gain-of-function mutations identified in CdMrr1p. The CdMrr1p protein is represented as a linear bar. The DNA-binding domain at the N terminus is indicated by black shading. The five mutations found in fluconazole-resistant C. dubliniensis strains in the present study are shown above the bar. Positions at which gain-of-function mutations have previously been identified in fluconazole-resistant C. albicans strains are indicated below the bar, and the corresponding positions in CaMrr1p are given in parentheses.

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