Aspergillus fumigatus is a filamentous fungus and the main pathogen responsible for the often fatal respiratory condition, aspergillosis. Airway epithelial cells (AECs) are likely to be the first line of host defence that come into contact with the inhaled conidia of A. fumigatus. Recent evidence strongly suggests that the response of the airway epithelium to inhaled pathogens is pivotal in orchestrating immune responses by inducing phagocytic-like reactions and the secretion of inflammatory cytokines and antimicrobial peptides. However, the majority of previous work investigating A. fumigatus-host interactions has been performed using macrophages and neutrophils, thereby neglecting the epithelium. AECs have been shown to secrete inflammatory cytokines in response to A. fumigatus although these studies predominantly used transformed AEC lines that lack tight junctions and do not fully differentiate. Furthermore, most studies used culture filtrate or extract of A. fumigatus rather than live, whole organism and as a result, the direct interaction of the germinating fungus and the airway epithelium has been overlooked. During the early germination and growth period, the cell wall composition of A. fumigatus is dynamic, with various antigens exposed at different morphological stages. The aim of this thesis was to determine whether AECsare able to alter the germination and growth rate of A. fumigatus, and, conversely, if A. fumigatus affects AECs in terms of the secretion of inflammatory mediators. These studies used live, germinating A. fumigatus, and human primary differentiated AECs to obtain a more realistic in vitro model than those used in previous studies. Data showed that AECs are able to significantly inhibit the germination and growth of A. fumigatus, although this effect was less pronounced in differentiated primary AEC than in transformed AEC lines. A. fumigatus also significantly inducedthe expression and secretion of the inflammatory cytokines, IL-6 and IL-8, probably via the interaction of fungal cell wall β-glucans, and as of yet unidentified AEC receptor. The A1160pyrG+ strain of A. fumigatus secreted factors capable of inducing cytokine secretion whereas Af293 strain did not, highlighting diverse mechanisms of action for different strains. Upregulation of both cytokines was dependent on the stage of A. fumigatus growth with induction synchronous with germination. Despite being associated with fungal sensitisation in asthmatics, AEC-derived cytokines associated with this disease, namely TSLP, IL33 and IL25,did not appear to be upregulated by transformed AECs in response to A. fumigatus. Similarly, A. fumigatus did not seem to induce synthesis and secretion of the acute phase response protein, fibrinogen above baseline levels. The data presented in this thesis confirms the importance of the airway epithelium in directing anti-A. fumigatus immunity and the involvement of complex ligand-receptor interactions.

Sialic acids are a family of 9 carbon acidic sugars that are often part of glycans that decorate glycoproteins and glycolipids. N-acetylneuraminic acid, or Neu5Ac, is the predominant sialic acid in Homo sapiens and is most commonly found on the terminus of glycan chains where it functions as a signalling molecule or providing a negatively-charged mask to cells. Neu5Ac is less commonly found in microbes. A number of pathogens, including the fungus Aspergillus fumigatus and the parasite Trypanosoma cruzi, present Neu5Ac on their surface which aids evasion of the host immune system. A. Fumigatus has no known sialic synthesis genes however a single sialidase, AfS, has been identified. This sialidase is relatively poor at cleaving Neu5Ac in comparison with other members of the sialidase family. Here we present the structure of AfS to 1.8Å, the first fungal sialidase structure published. The overall topology of AfS shares the 6-bladed β-propellor fold common to all known sialidases and has an rmsd of only 1.44 Å over 309 C[sub]αs with the bacterial sialidase from Micromonospora viridifaciens. The active site of AfS also contains all the residues necessary for efficient hydrolysis of sialic acids. Despite repeated attempts. It was not possible to crystallize AfS in complex with Neu5Ac. Closer inspection of the AfS active site revealed that the pocket that usually accommodates the N-acetyl moiety of Neu5Ac contained more polar residues and was shallower than that of other sialidases. The apo structure suggested that substitution of the N-acetyl group on C5 of Neu5Ac with a smaller group may be accommodated better in the active site of AfS. 2-Keto-3-deoxy-D-galactononulosonic acid (KDN), which has a hydroxyl group at this position, is capable of binding in the active site and is the preferred substrate of AfS. The structure of AfS in complex with KDN was determined to 1.45 Å and is the first KDN specific sialidase structure determined. Crystal complexes with either a di-fluoro-KDN or KDN2en allowed atomic snapshots to be obtained of the catalytic cycle from Michaelis complex, through transition state to covalent intermediate. Several KDN binding sites on the surface of the enzyme were discovered suggesting that the enzyme may be specific for polyKDN, which intruigingly has been found in the human lung. Mutations were made to AfS to enlarge the cavity around C5 to see if the enzyme could accommodate Neu5Ac-related substrates. Identification and mutation of arginine 171 in the active site to leucine increased the depth and hydrophobicity of the cavity and improved the ability of AfS to utilize Neu5Ac, albeit poorly. The structure AfS[sub](R171L) in complex with Neu5Ac2en was solved to 1.8 Å. Trypanosoma cruzi is the etiological agent of Chagas disease. The trans sialidase from T. cruzi, TcTs, is a verified virulence factor. Here we detail a fragment-based search for novel inhibitors of TcTs using a fluorogenic assay, STD-NMR and WaterLOGSY-NMR, in silico screening and X-ray crystallography. There was poor agreement between the techniques used and only fragment hits validated by X-ray crystallography were pursued. All protein-ligand complexes shared two common interactions. The verified compounds interacted with the arginine triad via a carboxylic acid, as is the case with the sialic acid substrate. Secondly, all compiunds possessed an amine that was within hydrogen bonding distance of the TcTs catalytic aspartic acid. One of these compunds, 3-piperidinic acid, was capable of binding in the TcTs active site in both of its anomeric forms. Interestingly, each anomer binds in 2 similar but distinct positions in the active site. In one of these conformations Tyr119 moves into the active site and hydrogen bonds with the fragment's amine. In an attempt to combine the interaction seen in both the R and S anomers of 3-piperidinic acid, (R)-2-piperazine carboxylic acid was soaked into TcTs crystals. This compound made additional interactions with the protein and demonstrated a 4-fold improvement in the IC50. A known sialidase inhibitor, Siastatin B, based on a 3-piperidinic acid frame was also investigated and we present a TcTs-siastatin B complex structure to 2.1 Å, the first structure of Siastatin B in complex with a glycoside hydrolase. There is much work to be done to these preliminary inhibitors however here we have identified 3 druggable sites within the TcTs active site. The research presented herein provides a platform for future drug design studies on TcTs.

The lung was recently identified to consist of a complex microenvironment made up of microorganisms that interact with one another and the host cells via direct and indirect interactions. As a result, understanding the dynamic of the microbiome in chronic respiratory diseases has become the focus of pulmonary researches. In cystic fibrosis (CF), chronic infections are a comorbidity associated with the genetic disorder. Recently, it was noted that the interactions of the fungus, Aspergillus fumigatus, and the bacterium, Pseudomonas aeruginosa together contribute to more severe disease outcomes in CF patients. In vitro co-cultures show that P. aeruginosa and A. fumigatus can affect one another’s growth and pathogenicity, but very few studies have attempted to model interactions of these microorganisms in vivo. Based on clinical and basic research, we developed a co-exposure model in which we could compare non-allergic and allergic animals co-exposed to Pseudomonas aeruginosa and Aspergillus fumigatus. While both groups had significant neutrophilia and production of acute phase response cytokines and chemokines, the allergic co-exposed group had a greater mortality with 34.8% of the animals expiring by 24h in comparison to 12.5% for the non-allergic co-exposed animals and 100% survival in the controls. A contributing factor to the more severe disease outcomes in the allergic co-exposed group is the increase in eosinophilic inflammation and IL-17A production, which only occurs when both microorganisms are viable. In addition, it was found that viable P. aeruginosa but not A. fumigatus causes interstitial inflammation, significant neutrophilia, and even death during co-exposures. The decline in health of animals co-exposed to the fungus and bacteria could be attributed not only to the host’s inflammatory response, but also to the spatial and temporal co-localization in the lung. To address this, we performed in vitro studies finding an aggregation of the microorganisms that could also be identified in vivo. This current research emphasizes the need for in vivo studies on polymicrobial interactions. / ND Agricultural Experiment Station; National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number R155AI137886

Ziel der vorliegenden Arbeit war die Charakterisierung von Punktmutationen in ifng und ncam1 in Hinblick auf eine veränderte Funktionalität von NK-Zellen bei der Interaktion mit A. fumigatus. Die gewonnenen Erkenntnisse sollen langfristig zur Verbesserung der Diagnostik, Prophylaxe und Therapie einer Invasiven Aspergillose, die zum Beispiel im Rahmen einer Stammzelltransplantation auftreten könnte, beitragen. In dieser Arbeit wurde die DNA von zwanzig gesunden Spendern auf einen ifng-SNP (rs2069705) und einen ncam1-SNP (rs10502171) untersucht. Von je drei ausgewählten Spendern mit SNP und sechs Kontrollspendern wurden NK-Zellen isoliert. Diese wurden unstimuliert belassen, mit Interleukin 2/15 oder A. fumigatus stimuliert. Bei der Versuchsreihe zum ifng-SNP wurde eine qPCR zur Ermittlung der relativen Expression von ifng und ccl4, bei den Versuchen zum ncam1-SNP eine durchflusszytometrische Analyse zur Messung der Expression verschiedener Oberflächenmarker durchgeführt. Bei beiden wurde mittels ELISA die Freisetzung von IFN-gamma bzw. CCL4/MIP-1ß bestimmt. Die in dieser Arbeit gewonnenen Ergebnisse zum ifng-SNP lassen vermuten, dass das Vorliegen dieses ifng-SNP keine durch NK-Zellen vermittelten Auswirkungen auf das Risiko der Patienten, an einer Invasiven Aspergillose zu erkranken, hat. In Bezug auf den ncam1-SNP konnte die Hypothese bestätigt werden, dass der SNP die Interaktion zwischen der NK-Zelle und A. fumigatus verändert. Der SNP korreliert zwar mit einer erhöhten Grundaktivierung von NK-Zellen, jedoch auch mit einem schwächeren Aktivierungspotential bei Stimulation mit dem Pilz. / The aim of this thesis was the characterization of point mutations in ifng and ncam1 with respect to an altered functionality of NK cells during interaction with A. fumigatus. In the long term, the findings should contribute to the improvement of the diagnosis, prophylaxis and therapy of invasive aspergillosis, which can occur, for example, after stem cell transplantation. In this work, the DNA of twenty healthy donors was examined for one ifng-SNP (rs2069705) and one ncam1-SNP (rs10502171). NK cells were isolated from three donors for each SNP and six control donors. These were left unstimulated, stimulated with interleukin 2/15 or A. fumigatus. In the ifng-SNP series qPCR was performed to determine the relative expression of ifng and ccl4, in the ncam1-SNP series flow cytometric analysis was performed to measure the expression of different surface markers. In both cases the release of IFN-gamma and CCL4/MIP-1ß was determined by ELISA. The results obtained in this study on ifng-SNP suggest that the presence of this ifng-SNP has no NK cell mediated effects on the risk of patients suffering from invasive aspergillosis. With regard to the ncam1-SNP, the hypothesis that the SNP alters the interaction between the NK cell and A. fumigatus was confirmed. The SNP correlates with an increased basic activation of NK cells, but also with a weaker activation potential when stimulated with the fungus.

Synthetic biology is an emerging field which has led to development of many useful applications of engineered biological networks and systems. One of the exciting advancements of the field are living cells which can serve as molecular factories, diagnostics or therapeutics. A widely used chassis in synthetic biology is yeast due to simple and inexpensive culturing conditions and the ability to heterologously express eukaryotic proteins. In this thesis, we present work exploring and expanding biosensing and responding capabilities of engineered lab strain yeast. Chapter 1 gives background information related to synthetic biology, living engineered biosensors, theranostics and more specifically on Saccharomyces cerevisiae general overview and applications in synthetic biology. Chapter 2 describes progress on establishing redox active peptides as a modular electrochemical interfacing language between electronics and engineered yeast. Chapter 3 covers yeast engineering as a heavy metal and metalloid biosensor, as well as the exploration of peptide-containing hydrobeads in conjunction with peptide-responsive yeast as a physical damage biosensor. In Chapter 4, we establish living yeast biosensor for detection of pathogenic fungus Aspergillus fumigatus and expanded biosensing of other Aspergillus species, as well as additional optimization of the biosensing yeast’s signal-to-noise ratio, sensitivity and readout time. Chapter 5 demonstrates the utility of specific peptide proteases in combination with promiscuous GPCRs in living yeast biosensor for detection and differentiation of peptide variants differing in single amino acid. Lastly, in Chapter 6 we implement yeast sense-and-respond community which is activated by pheromone-secreting fungi and as a response secretes a toxin which kills sensed fungi.

Evalúa la actividad antimicrobiana de metabolitos secundarios de Aspergillus fumigatus sobre cepas clínicas de Staphylococcus aureus y Streptococcus pneumoniae. La fermentación líquida de un aislamiento clínico de Aspergillus fumigatus fue realizada en un caldo líquido Sulfato, Papa y Dextrosa (SPG). La extracción de metabolitos del caldo de cultivo fermentado fue realizada usando acetato de etilo. Se evaluó la actividad antimicrobiana sobre cepas clínicas de cocos Gram positivos mediante los métodos de disco y pozo difusión. Se obtuvo una media de 24 y 23 mm sobre Staphylococcus aureus sensible y resistente respectivamente por disco difusión. Para las cepas sensibles y resistentes de Streptococcus pneumoniae las medias fueron de 26 mm según disco difusión. Existe diferencia significativa entre la metodología de difusión de disco y pozo (p < 0.05) Se concluye que el extracto crudo de Aspergillus fumigatus posee metabolitos secundarios de naturaleza alcaloide, esteroles insaturados y terpenos; con efectiva actividad antimicrobiana sobre cepas clínicas de Staphylococcus aureus y Streptococcus pneumoniae sensibles y resistentes. / Tesis

Aspergillus fumigatus is a filamentous saprophytic mold that is found abundantly in the biosphere. A. fumigatus is also an airborne human pathogen and is considered the major cause of aspergillosis, infections caused by inhalation of conidia. In immunocompetent individuals, the spores rarely cause any harm as they are cleared by innate pulmonary defences; however, in immunocompromised patients, the host immune system can fail to clear the inhaled conidia and aspergillosis may develop. Indeed, aspergillosis represents a major cause of morbidity and mortality in these populations. Aspergillosis is commonly treated using triazole and amphotericin B (AMB) antifungal agents. However, the increasing prevalence of triazole resistant strains and emergence of AMB resistance has become a challenge in treatment. To further expand our knowledge on the mechanisms of antifungal resistance in the species, we tested previously known or associated genes for antifungal resistance as well as investigated novel mechanisms via multiple genome-wide association studies (GWAS), which used a total of 211 genomes from A. fumigatus strains in 12 countries. Our results identified many novel mutations related to triazole and AMB resistance. Specifically, using stepwise GWAS analyses, we identified 6 and 18 missense variants to be significantly associated with itraconazole and voriconazole resistance, respectively. A linkage disequilibrium analysis identified six additional missense variants associated with triazole resistance, with two of these six being consistently associated with pan-azole resistance across subsets of samples. Furthermore, examination of known mutation sites and genes overexpressed with triazole exposure found a total of 65 SNPs implicated in triazole resistance. For the AMB study, we identified a total of 34 mutations associated with AMB tolerance using a GWAS. Subsequent analysis with 143 progeny strains, generated from a laboratory cross and genotyped with PCR-RFLP, identified epistatic interactions between five of these SNP sites that impacted growth in different concentrations of AMB. With the expanding immunocompromised population and increasing frequency of antifungal resistance, our results will help in investigating novel resistance mechanisms in A. fumigatus and in expanding the molecular diagnostic toolset in resistance screening, to enable rapid and accurate diagnosis and treatment decision-making. / Thesis / Master of Science (MSc)

The human pathogen Aspergillus (A.) fumigatus is a fungal mold that can cause severe infections in immunocompromised hosts. Pathogen recognition and immune cell cross-talk are essential for clearing fungal infections efficiently. Immune cell interactions in particular may enhance individual cell activation and cytotoxicity towards invading pathogens. This study analyzed the reciprocal cell activation of natural killer (NK) cells and monocyte-derived dendritic cells (moDCs) after stimulation with A. fumigatus cell wall fractions and whole-cell lysates. Furthermore, the impact of the on moDCs expressed fungal receptors Dectin-1 and TLR-2 on NK cell activation was analyzed. Stimulation of moDCs with ligands for Dectin-1 and TLR-2 and transfer of soluble factors on autologous NK cells showed that moDCs could induce NK cell activation solely by secreting factors. In summary, both cell types could induce reciprocal cell activation if the stimulated cell type recognized fungal morphologies and ligands. However, moDCs displayed a broader set of A. fumigatus receptors and, therefore, could induce NK cell activation when those were not activated by the stimulus directly. Consequently, new fungal receptors should be identified on NK cells. The NK cell characterization marker CD56 was reduced detected in flow cytometry after fungal co-culture. Notably, this decreased detection was not associated with NK cell apoptosis, protein degradation, internalization, or secretion of CD56 molecules. CD56 was shown to tightly attach to hyphal structures, followed by its concentration at the NK-A. fumigatus interaction site. Actin polymerization was necessary for CD56 relocalization, as pre-treatment of NK cells with actin-inhibitory reagents abolished CD56 binding to the fungus. Blocking of CD56 suppressed fungal mediated NK cell activation and secretion of the immune-recruiting chemokines MIP-1α, MIP-1β, and RANTES, concluding that CD56 is functionally involved in fungal recognition by NK cells. CD56 binding to fungal hyphae was inhibited in NK cells obtained from patients during immune-suppressing therapy after allogeneic stem cell transplantation (alloSCT). Additionally, reduced binding of CD56 correlated with decreased actin polymerization of reconstituting NK cells challenged with the fungus. The immune-suppressing therapy with corticosteroids negatively influenced the secretion of MIP-1α, MIP-1β, and RANTES in NK cells after fungal stimulation ex vivo. Similar results were obtained when NK cells from healthy donors were treated with corticosteroids prior to fungal co-culture. Thus, corticosteroids were identified to have detrimental effects on NK cell function during infection with A. fumigatus. / Der humanpathogene Pilz Aspergillus (A.) fumigatus kann lebensbedrohliche Infek-tionen in immunsupprimierten Patienten verursachen. Die Immunerkennung von Patho-genen sowie die Wechselwirkungen zwischen Immunzellen sind essentiell für die erfolg-reiche Bekämpfung von Pilzinfektionen. Zell-Zell-Interaktionen tragen zur gegenseitigen Aktivierung bei und können somit die Zytotoxizität gegenüber eindringenden Pathogenen steigern. In dieser Arbeit wurde die gegenseitige Zellaktivierung von natürlichen Killerzellen (NK-Zellen) und die aus Monozyten generierten, dendritischen Zellen (DZ) nach Stimula-tion mit Zellwandfraktionen und Zelllysaten des Pilzes A. fumigatus analysiert. Des Weite-ren wurde der Einfluss dendritischer Rezeptoren auf die NK-Zellaktivierung untersucht. Die Stimulation mit Liganden für Dectin-1 und TLR-2 induzierte die Freisetzung löslicher Faktoren, welche ausreichend waren, um autologe NK-Zellen zu stimulieren. Zusammen-fassend ist zu sagen, dass DZ mehr Rezeptoren zur Pilzerkennung exprimieren und so-mit NK-Zellen auch dann aktivieren konnten, wenn diese, aufgrund fehlender Rezepto-ren, nicht stimuliert wurden. Basierend auf diesen Ergebnissen sollten neue Pathogen-Erkennungsrezeptoren auf NK-Zellen identifiziert werden. Der Charakterisierungsmarker CD56 zeigte nach fun-galer Kokultur eine reduzierte Detektion in durchflusszytometrischen Analysen. Die ver-minderte Proteindetektion von CD56 war nicht assoziiert mit Apoptose, Internalisation, Sekretion oder Proteindegradierung. Weitere Analysen bestätigten eine starke CD56-Bindung zu Pilzhyphen, gefolgt von einer Konzentration des Proteins an der NK-A. fumi-gatus Interaktionsstelle. Diese Relokalisation zeigte eine Abhängigkeit zu Aktin, da Zytos-kelett-Inhibitoren die CD56-Bindung am Pilz verhinderten. Eine spezifische Blockade von CD56 Rezeptoren reduzierte die Freisetzung der immun-rekrutierenden Chemokine MIP-1α, MIP-1β und RANTES, was folgern ließ, dass CD56 eine funktionelle Rolle in der Pil-zerkennung der NK-Zellen hat. NK-Zellen, die während einer Immunsuppressionstherapie aus Empfängern einer al-logenen Stammzelltransplantation (alloSZT) gewonnen wurden, zeigten eine inhibierte Bindung von CD56 an Pilzhyphen. Diese korrelierte mit einer reduzierten Aktinpolymeri-sation nach fungaler Stimulation. Weiterhin hemmte eine Immunsuppressionstherapie mit Corticosteroiden die Sekretion von MIP-1α, MIP-1β und RANTES in NK-Zellen, die mit Pilz ex vivo stimuliert wurden. Ähnliches war zu beobachten, wenn NK-Zellen von ge-sunden Spendern vor Pilzstimulation mit Corticosteroiden vorbehandelt wurden. Daraus folgend wurde den Corticosteroiden ein negativer Einfluss auf die NK-Zellfunktion bei Pilzinfektionen zugesprochen.

Although the field of fungal infections advanced tremendously, diagnosis of invasive pulmonary aspergillosis (IPA) in immunocompromised patients continues to be a challenge. Since IPA is a multifactorial disease, investigation from different aspects may provide new insights, helpful for improving IPA diagnosis. This work aimed to characterize the human immune response to Aspergillus fumigatus in a multilevel manner to identify characteristic molecular candidates and risk factors indicating IPA, which may in the future support already established diagnostic assays. We combined in vitro studies using myeloid cells infected with A. fumigatus and longitudinal case-control studies investigating patients post allogeneic stem cell transplantation (alloSCT) suffering from IPA and their match controls. Characteristic miRNA and mRNA signatures indicating A. fumigatus-infected monocyte-derived dendritic cells (moDCs) demonstrated the potential to differentiate between A. fumigatus and Escherichia coli infection. Transcriptome and protein profiling of alloSCT patients suffering from IPA and their matched controls revealed a distinctive IPA signature consisting of MMP1 induction and LGAL2 repression in combination with elevated IL-8 and caspase-3 levels. Both, in vitro and case-control studies, suggested cytokines, matrix-metallopeptidases and galectins are important in the immune response to A. fumigatus. Identified IPA characteristic molecular candidates are involved in numerous processes, thus a combination of these in a distinctive signature may increase the specificity. Finally, low monocyte counts, severe GvHD of the gut (grade ≥ 2) and etanercept administration were significantly associated with IPA diagnosis post alloSCT. Etanercept in monocyte-derived macrophages (MDM) infected with A. fumigatus downregulates genes involved in the NF-κB and TNF-α pathway and affects the secretion of CXCL10. Taken together, identified characteristic molecular signatures and risk factors indicating IPA may in the future in combination with established fungal biomarkers overcome current diagnostic challenges and help to establish tailored antifungal therapy. Therefore, further multicentre studies are encouraged to evaluate reported findings. / Obwohl im Bereich der Erforschung invasiver Pilzinfektionen aktuell enorme Fortschritte erzielt wurden, stellt die Diagnose der Invasiven Pulmonalen Aspergillose (IPA) bei immunsupprimierten Patienten weiterhin eine grosse Herausforderung dar. Da es sich bei der IPA um eine multifaktorielle Erkrankung handelt, können Untersuchungen unter verschiedenen Fragestellungen neue Erkenntnisse liefern, die zur Verbesserung der IPA Diagnose beitragen. In dieser Arbeit wurde die humane Immunantwort auf Aspergillus fumigatus auf mehreren Ebenen untersucht, um charakteristische molekulare Kandidaten und Risikofaktoren zu identifizieren, die auf eine IPA hinweisen um so in Zukunft bereits etablierte diagnostische Tests unterstützen zu können. Wir kombinierten in vitro Studien mit A. fumigatus infizierten, myeloischen Zellen mit longitudinalen Case-Control-Studien, in denen an IPA erkrankte Patienten und ihre passenden Kontrollpatienten nach allogener Stammzelltransplantation (alloSZT) untersucht wurden. Charakteristische miRNA und mRNA Signaturen von A. fumigatus-infizierten Monozyten-abgeleiteten dendritischen Zellen (moDCs) zeigten das Potenzial, zwischen A. fumigatus und Escherichia coli Infektionen zu unterscheiden. Transkriptom- und Protein- Analysen von alloSZT Patienten, die an einer IPA erkrankten, und den passenden Kontrollpatienten ergaben charakteristische IPA Signaturen, bestehend aus einer MMP1 Induktion und einer LGALS2 Repression, in Kombination mit erhöhten IL-8 und Caspase-3 Konzentrationen. Sowohl die in vitro Daten als auch die Fall-Kontroll- Studien zeigten, dass Zytokine, Matrix-Metallopeptidasen und Galectine eine wichtige Rolle bei der Immunantwort auf A. fumigatus spielen. Die in IPA identifizierten charakteristischen molekularen Kandidaten sind an mehreren Prozessen beteiligt, so dass eine Kombination dieser molekularen Kandidaten die Spezifität mittels charakteristischer Signatur erhöhen könnte. Schließlich waren niedrige Monozytenzahlen, eine schwere GvHD des Darms (Grad ≥ 2) und die Anwendung von Etanercept signifikant mit einer IPA Diagnose nach alloSZT assoziiert. Etanercept in Makrophagen, die mit A. fumigatus ko-kultiviert wurden, reguliert Gene herunter, die am NF-κB- und TNF-α-Signalweg beteiligt sind, und beeinflusst die Sekretion von CXCL10. Zusammenfassend lässt sich festhalten, dass die identifizierten charakteristischen molekularen Signaturen und Risikofaktoren, die auf eine IPA hinweisen, in Zukunft in Kombination mit etablierten Pilz-Biomarkern die derzeitigen diagnostischen Limitationen überwinden könnten und dazu beitragen könnten, eine patientenindividuelle antimykotische Therapie zu etablieren. Es werden jedoch weitere multizentrische Studien notwendig sein, um diese Ergebnisse umfassend zu bewerten.

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