A participação das espécies reativas de oxigênio (ERO) no mecanismo de ação dos antifúngicos azólicos, bem como a relação entre resistência aos antifúngicos e resposta ao estresse oxidativo, têm sido sugeridos. Entretanto, os dados ainda são inconclusivos e diferem entre os micro-organismos. Neste estudo estão apresentados os resultados da geração de ERO pelo fluconazol em isolados de C. glabrata sensíveis e resistentes a esse antifúngico e a resposta antioxidante da levedura. Nesses isolados, tratados e não tratados com fluconazol em concentração subinibitória, de acordo com sua concentração inibitória mínima (CIM), até fase de crescimento estacionário, foi avaliado se o fluconazol geraria ERO. Subsequentemente, foram analisadas as defesas antioxidantes glutationa peroxidase (GPx), superóxido dismutase (SOD), glutationa-S-transferase (GST), consumo de peróxido de hidrogênio e glutationa total, bem como possível dano oxidativo causado pelo fluconazol em lipídeos, proteínas e ácidos nucleicos e os níveis de nitritos e nitratos. Os resultados mostram que nos isolados de C. glabrata sensíveis e resistentes ao fluconazol, na presença do antifúngico, houve um aumento da geração ERO e maior atividade enzimática da GPx e SOD comparada a dos isolados não tratados com fluconazol, não havendo diferença estatística entre isolados sensíveis e resistentes nesses três parâmetros citados. Em relação à enzima GST, os isolados sensíveis mostraram maior atividade enzimática comparada aos resistentes, e quando as células sensíveis foram tratadas com fluconazol, a atividade da GST diminuiu. O fluconazol não induziu dano oxidativo em proteínas e em lipídeos, entretanto foi observado dano oxidativo ao DNA. Diante disso, sugere-se que o fluconazol gera ERO como parte do seu mecanismo antifúngico em C. glabrata em fase de crescimento estacionário, induzindo dano oxidativo no DNA. Como resposta, observa-se aumento na atividade enzimática da SOD e da GPx na levedura. O entendimento da resposta antioxidante de leveduras patogênicas tem importante interesse clínico, uma vez que o desenvolvimento racional de novas drogas antifúngicas requer conhecimento do metabolismo fúngico. / The participation of reactive oxygen species (ROS) in azoles antifungal mechanism of action has been suggested, as well as the relation between antifungal resistance and oxidative stress response. However, data are still inconclusive and differ between microorganisms. This study presents the results of ROS generation by fluconazole in fluconazole-susceptible and resistant C. glabrata strains and their antioxidant response. It was evaluated whether fluconazole generates ROS in those isolates treated and untreated with fluconazole at sub-inhibitory concentration according to their minimal inhibitory concentration (MIC). This treatment was conducted until stationary growth phase was reached. Subsequently, the antioxidant defenses glutathione peroxidase (GPx), superoxide dismutase (SOD), glutathione-S-transferase (GST), consumption of hydrogen peroxide and total glutathione, the possible oxidative damage in lipids, proteins and nucleic acids and the levels of nitrites and nitrates were analyzed. Results showed increased ROS generation in fluconazole-susceptible and resistant C. glabrata strains treated with fluconazole, and also higher GPx and SOD enzymatic activity, compared to untreated cells. No statistical difference of those three parameters was observed between susceptible and resistant strains. In relation to GST, susceptible strains demonstrated higher activity compared to the resistant ones, and when susceptible cells were treated with fluconazole the GST activity decreased compared to untreated. Fluconazole did not induce oxidative damage in proteins and in lipids, however oxidative DNA damage was observed. Therefore, it is suggested that fluconazole generates ROS as part of its antifungal mechanism in C. glabrata at stationary growth phase, inducing oxidative DNA damage. In response, there was increase in the enzymatic activity of SOD and GPx in yeast. The understanding of the pathogenic yeast antioxidant response has important clinical interest, since the rational development of new antifungal drugs requires knowledge about the fungal metabolism.

L'espèce Candida glabrata, qui se situe au deuxième rang parmi les agents des candidoses toutes formes cliniques confondues, possède des caractéristiques singulières et engendre notamment une plus grande mortalité chez les patients atteints de candidoses profondes ou systémiques. Cette espèce présente notamment la particularité d'être peu sensible aux azolés, les antifongiques les plus couramment utilisés en clinique. De plus, il semble que le développement d'une résistance aux antifongiques aussi bien azolés, que polyéniques ou pyrimidiques, soit plus fréquent chez C. glabrata. Nous nous sommes donc proposé d'étudier des isolats cliniques ou des mutants induits de cette espèce résistants à ces trois classes d'antifongiques et de déterminer les mécanismes moléculaires à l'origine de leur résistance. Les outils de biologie moléculaire classique ont mis en évidence dans chaque cas une dérégulation de l'expression de certains gènes impliqués dans le métabolisme de ces molécules antifongiques ou de leur cible, ainsi que des mutations sur ces mêmes gènes. Le génome haploïde de C. glabrata, et donc la plus forte probabilité d'exprimer un gène muté, ainsi que le contexte médical actuel, prônant la prophylaxie dans nombre de pathologies où l'immunité des patients est touchée, représentent un terrain favorable au développement d'une candidose et à la sélection simultanée d'isolats résistants.

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Made available in DSpace on 2014-06-11T19:28:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-03-16Bitstream added on 2014-06-13T20:18:33Z : No. of bitstreams: 1 dovigo_ln_me_arafo.pdf: 987871 bytes, checksum: 23bc47899d421f6557ae321ff6536498 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O surgimento da resistência antifúngica aos tratamentos convencionais tem proporcionado o desenvolvimento de novas modalidades terapêuticas para o tratamento da candidose bucal. Nesse contexto, a utilização da PDT vem sendo sugerida como método alternativo para a inativação de microrganismos patogênicos. Este estudo avaliou a efetividade da PDT na inativação de C. albicans e C. glabrata, ATCC e resistente a fluconazol, por meio da utilização do e da iluminação com LEDs de agente fotossensibilizador Photogem® comprimento de onda azul. Inicialmente, os microrganismos avaliados foram inoculados em tubos de ensaio contendo meio de cultura líquido e incubados overnight a 37ºC. Em seguida, foram obtidas suspensões celulares das espécies de Candida avaliadas. Essas suspensões foram transferidas para placas de 96 orifícios, tratadas com cinco diferentes concentrações de Photogem® (2,5; 5; 10; 25 e 50mg/L) e expostas a quatro doses de luz (10,5; 18; 25,5 e 37,5J/cmø). Suspensões adicionais foram tratadas somente com as cinco concentrações do fotossensibilizador ou apenas com as quatro doses de luz. Cada condição experimental foi realizada três vezes. Após a realização desses experimentos, foram obtidas diluições seriadas de cada amostra (10-1 a 10-3 ), e alíquotas de 25 æL dessas diluições foram plaqueadas, em triplicatas, em Sabouraud Dextrose Agar. Adicionalmente, alíquotas de 25 æL foram removidas das cavidades das placas de orifícios e transferidas diretamente para um quadrante da placa de Petri, sem a realização de diluição. As placas foram incubadas a 37ºC por 48 horas. Após a incubação, foi realizada a contagem das colônias viáveis (ufc/mL), e os valores obtidos foram analisados com o teste t de Student (p < 0,05). / Oral candidosis is an opportunistic infection that affects a significant percentage of the population. The oral infection caused by Candida spp. is usually treated with topical and systemic antifungal drugs. However, the widespread use of these agents has resulted in an alarming increase in the rate of antifungal resistance. Recently, the photodynamic therapy (PDT) has been studied as an alternative modality of killing microorganisms, including viruses, fungi and bacteria. The aim of this study was to determine whether Candida albicans and C. glabrata, ATCC and fluconazole-resistant strains, could be photosensitized by Photogem® in combination with blue Light Emitted Diode (LED). Suspensions of each Candida strain, containing 106 viable cells per milliliter, were treated with five concentrations of Photogem® (2.5, 5, 10, 25 and 50 mg/l), followed by LED irradiation in four light doses (10.5, 18, 25.5 and 37.5 J/cm2). Each experimental condition was carried out in triplicate and repeated tree times. From each sample, serial dilutions were obtained and aliquots of 25 æl of each dilution were plated on Sabouraud Dextrose Agar. All plates were incubated at 37°C for 48 hours. After incubation, colonies were counted (CFU/ml) and the data were statistically analyzed by the Student's t test (p < 0.05). The results demonstrated a concentration/dose-dependent pattern of inactivation, that resulted in complete elimination of all Candida evaluated. The minimal light dose for the complete inactivation of both C. albicans source was 18 J/cmø, in conjunction with 50 mg/l of Photogem®. After 25.5 and 37.5 J/cmø, a lower concentration of Photogem® was required to totally inactivate C. albicans ATCC (5 and 2.5 mg/l) in comparison with C. albicans luconazole-resistant (10 and 5 mg/l). (Complete abstract, clik electronic access below)

Made available in DSpace on 2014-06-11T19:35:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-07-28Bitstream added on 2014-06-13T19:44:49Z : No. of bitstreams: 1 dovigo_ln_dr_arafo.pdf: 3524091 bytes, checksum: bd9c194e1468a342205c6be45f7e5d62 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Esta investigação teve como objetivo avaliar: 1. a viabilidade de utilização da curcumina como agente fotossensibilizador (PS) em Terapia Fotodinâmica (PDT) para inativação de uma cepa padrão de Candida albicans e seu efeito tóxico sobre culturas celulares de macrófagos; 2. a efetividade da PDT mediada pela curcumina para inativação de suspensões planctônicas e biofilmes formados por diferentes isolados clínicos de C. albicans, Candida tropicalis e Candida glabrata; 3. a fotoinativação de C. albicans, presente em candidose induzida em camundongos, por meio da utilização de diferentes concentrações de curcumina. No primeiro estudo, suspensões planctônicas de C. albicans (ATCC 90028) foram expostas a nove concentrações de curcumina (0,005; 0,01; 0,05; 0,1; 0,5; 1, 5, 10 e 20μM) e oito doses de luz (1,32; 2,64; 3,96; 5,28; 6,60; 13,20 e 26,4J/cm2). O efeito de diferentes tempos de pré-irradiação (PIT), a possível captação de curcumina pelas células fúngicas e participação do oxigênio singlete na fotoinativação também foram avaliados. Adicionalmente, a PDT mediada pela curcumina foi avaliada em biofilmes formados pela cepa de referência de C. albicans e sobre culturas celulares de macrófagos. Além disso, as características ópticas da solução de curcumina foram investigadas em função da dose de luz utilizada. Os resultados foram submetidos à análise descritiva, Análise de Variância (ANOVA) e Kruskal-Wallis (α= 5%). As suspensões planctônicas de C. albicans foram completamente inativadas com a utilização de 20μM de curcumina e 5,28J/cm2. Além disso, foi observada redução significativa na viabilidade celular dos biofilmes de C. albicans. O efeito fotodinâmico foi acentuado pela presença da curcumina durante a iluminação... / The aim of this investigation was to evaluate: 1. the Photodynamic Therapy (PDT) mediated by curcumin for in vitro inactivation of a reference strain of Candida albicans and its citotoxic effects against a macrofage cell line; 2. the effectiveness of PDT mediated by curcumin to inactivate clinical isolates of C. albicans, Candida tropicalis and Candida glabrata, both in planktonic and biofilm phases; 3. the photoinactivation of C. albicans in a murine model of oral candidiasis using different curcumin concentrations. In the first study, suspensions of C. albicans were treated with nine curcumin concentrations (0.005; 0.01; 0.05; 0.1; 0.5; 1, 5, 10 and 20μM) and exposed to LED light at different fluences (1.32; 2.64; 3.96; 5.28; 6.60; 13.20 and 26.4J/cm2). The effect of the pre-irradiation time (PIT) on PDT effectiveness, the uptake of curcumin by C. albicans cells and the possible involvement of singlet oxygen in the photodynamic action was also evaluated. In addition, curcumin-mediated PDT was assessed against biofilms. Similar protocols were tested on a macrophage cell line and the effect was evaluated by MTT and SEM analysis. The optical properties of curcumin were investigated as a function of illumination fluence. Data were analyzed with Analysis of Variance (ANOVA), and Kruskal-Wallis test (α= 5%). The results showed a statistically significant reduction in C. albicans viability after PDT (p<0.05), for both planktonic and biofilm cultures. Photodynamic effect was greatly increased with the presence of curcumin in the surrounding media and the PIT of 20 minutes improved PDT effectiveness. Although PDT was phototoxic to macrophages, the therapy was more effective in inactivating the yeast cell than the defense cell. The spectral changes showed a high photobleaching rate of curcumin. In the second study, planktonic... (Complete abstract click electronic access below)

Orientador: Luciane Dias de Oliveira / Banca: Célia Regina Gonçalves e Silva / Banca: Antonio Olavo Cardoso Jorge / Resumo: A técnica da espectroscopia infravermelha por transformada de Fourier (FT-IR) vem sendo largamente empregada como uma abordagem rápida e simples para a identificação de microrganismos, incluindo a do gênero Candida. A proposta deste estudo foi avaliar o emprego da microespectroscopia FT-IR na identificação e discriminação de 5 cepas clínicas de Candida albicans e 3 de Candida glabrata, as quais foram identificadas previamente por meio de métodos convencionais, e mais duas cepas ATCC de cada espécie. As amostras foram analisadas em triplicata, a partir de culturas independentes, por meio de filmes finos obtidos da suspensão em solução salina estéril a 0,85% da biomassa da colônia que ficou incubada por 24 horas em placas com ágar Saboraud Dextrose. Dez espectros com 32 varreduras foram obtidos na forma de ponto em 10 regiões selecionadas aleatoriamente nas amostras. A média foi obtida dos dez espectros de cada amostra para a análise estatística multivariada, dada pela análise de cluster. Além disso os espectros foram transformados em primeira derivada e três janelas espectrais foram determinadas (900-1250 cm-1, 1300-1600 cm-1, 2800-3000 cm-1). A representação dos resultados foi dada pela construção de um dendograma. Nesse, foi possível separar em dois grupos distintos as duas espécies de Candida estudadas. Dessa forma, pode-se concluir que a microespectroscopia FT-IR foi capaz de identificar e discriminar cepas clínicas de Candida albicans e de Candida glabrata, sendo um método promissor para identificação de leveduras / Abstract: The technique of infrared spectroscopy Fourier transform (FT-IR) has been widely used as a new approach for rapid identification and simple micro-organisms, including the genus Candida. The purpose of this study was to evaluate the use of FT-IR microspectroscopy for the identification and discrimination of 5 clinical strains of Candida albicans and Candida glabrata 3, which were previously identified by conventional methods, and two-standard strains of each species. The samples were analyzed in triplicate from independent cultures by means of thin films obtained from a suspension in sterile saline and 0.85% of the biomass of the colony that was incubated for 24 hours in Sabouraud dextrose agar plates. Ten spectra with 32 scans were obtained in 10 randomly selected regions in the samples.The average of ten spectra was obtained from each sample for the multivariate analysis, given by cluster analysis. In addition, three windows were determined spectral (900-1250 cm-1, 1300-1600 cm-1, 2800-3000 cm-1) and the spectra were transformed into first derivative. The representation of the results was given by the construction of a dendrogram. In this, we separated into two groups of two Candida species studied. Thus, one can conclude that the FT-IR microspectroscopy was able to identify and distinguish clinical isolates of Candida albicans and Candida glabrata is an important method for identification of yeasts / Mestre

A participação das espécies reativas de oxigênio (ERO) no mecanismo de ação dos antifúngicos azólicos, bem como a relação entre resistência aos antifúngicos e resposta ao estresse oxidativo, têm sido sugeridos. Entretanto, os dados ainda são inconclusivos e diferem entre os micro-organismos. Neste estudo estão apresentados os resultados da geração de ERO pelo fluconazol em isolados de C. glabrata sensíveis e resistentes a esse antifúngico e a resposta antioxidante da levedura. Nesses isolados, tratados e não tratados com fluconazol em concentração subinibitória, de acordo com sua concentração inibitória mínima (CIM), até fase de crescimento estacionário, foi avaliado se o fluconazol geraria ERO. Subsequentemente, foram analisadas as defesas antioxidantes glutationa peroxidase (GPx), superóxido dismutase (SOD), glutationa-S-transferase (GST), consumo de peróxido de hidrogênio e glutationa total, bem como possível dano oxidativo causado pelo fluconazol em lipídeos, proteínas e ácidos nucleicos e os níveis de nitritos e nitratos. Os resultados mostram que nos isolados de C. glabrata sensíveis e resistentes ao fluconazol, na presença do antifúngico, houve um aumento da geração ERO e maior atividade enzimática da GPx e SOD comparada a dos isolados não tratados com fluconazol, não havendo diferença estatística entre isolados sensíveis e resistentes nesses três parâmetros citados. Em relação à enzima GST, os isolados sensíveis mostraram maior atividade enzimática comparada aos resistentes, e quando as células sensíveis foram tratadas com fluconazol, a atividade da GST diminuiu. O fluconazol não induziu dano oxidativo em proteínas e em lipídeos, entretanto foi observado dano oxidativo ao DNA. Diante disso, sugere-se que o fluconazol gera ERO como parte do seu mecanismo antifúngico em C. glabrata em fase de crescimento estacionário, induzindo dano oxidativo no DNA. Como resposta, observa-se aumento na atividade enzimática da SOD e da GPx na levedura. O entendimento da resposta antioxidante de leveduras patogênicas tem importante interesse clínico, uma vez que o desenvolvimento racional de novas drogas antifúngicas requer conhecimento do metabolismo fúngico. / The participation of reactive oxygen species (ROS) in azoles antifungal mechanism of action has been suggested, as well as the relation between antifungal resistance and oxidative stress response. However, data are still inconclusive and differ between microorganisms. This study presents the results of ROS generation by fluconazole in fluconazole-susceptible and resistant C. glabrata strains and their antioxidant response. It was evaluated whether fluconazole generates ROS in those isolates treated and untreated with fluconazole at sub-inhibitory concentration according to their minimal inhibitory concentration (MIC). This treatment was conducted until stationary growth phase was reached. Subsequently, the antioxidant defenses glutathione peroxidase (GPx), superoxide dismutase (SOD), glutathione-S-transferase (GST), consumption of hydrogen peroxide and total glutathione, the possible oxidative damage in lipids, proteins and nucleic acids and the levels of nitrites and nitrates were analyzed. Results showed increased ROS generation in fluconazole-susceptible and resistant C. glabrata strains treated with fluconazole, and also higher GPx and SOD enzymatic activity, compared to untreated cells. No statistical difference of those three parameters was observed between susceptible and resistant strains. In relation to GST, susceptible strains demonstrated higher activity compared to the resistant ones, and when susceptible cells were treated with fluconazole the GST activity decreased compared to untreated. Fluconazole did not induce oxidative damage in proteins and in lipids, however oxidative DNA damage was observed. Therefore, it is suggested that fluconazole generates ROS as part of its antifungal mechanism in C. glabrata at stationary growth phase, inducing oxidative DNA damage. In response, there was increase in the enzymatic activity of SOD and GPx in yeast. The understanding of the pathogenic yeast antioxidant response has important clinical interest, since the rational development of new antifungal drugs requires knowledge about the fungal metabolism.

A participação das espécies reativas de oxigênio (ERO) no mecanismo de ação dos antifúngicos azólicos, bem como a relação entre resistência aos antifúngicos e resposta ao estresse oxidativo, têm sido sugeridos. Entretanto, os dados ainda são inconclusivos e diferem entre os micro-organismos. Neste estudo estão apresentados os resultados da geração de ERO pelo fluconazol em isolados de C. glabrata sensíveis e resistentes a esse antifúngico e a resposta antioxidante da levedura. Nesses isolados, tratados e não tratados com fluconazol em concentração subinibitória, de acordo com sua concentração inibitória mínima (CIM), até fase de crescimento estacionário, foi avaliado se o fluconazol geraria ERO. Subsequentemente, foram analisadas as defesas antioxidantes glutationa peroxidase (GPx), superóxido dismutase (SOD), glutationa-S-transferase (GST), consumo de peróxido de hidrogênio e glutationa total, bem como possível dano oxidativo causado pelo fluconazol em lipídeos, proteínas e ácidos nucleicos e os níveis de nitritos e nitratos. Os resultados mostram que nos isolados de C. glabrata sensíveis e resistentes ao fluconazol, na presença do antifúngico, houve um aumento da geração ERO e maior atividade enzimática da GPx e SOD comparada a dos isolados não tratados com fluconazol, não havendo diferença estatística entre isolados sensíveis e resistentes nesses três parâmetros citados. Em relação à enzima GST, os isolados sensíveis mostraram maior atividade enzimática comparada aos resistentes, e quando as células sensíveis foram tratadas com fluconazol, a atividade da GST diminuiu. O fluconazol não induziu dano oxidativo em proteínas e em lipídeos, entretanto foi observado dano oxidativo ao DNA. Diante disso, sugere-se que o fluconazol gera ERO como parte do seu mecanismo antifúngico em C. glabrata em fase de crescimento estacionário, induzindo dano oxidativo no DNA. Como resposta, observa-se aumento na atividade enzimática da SOD e da GPx na levedura. O entendimento da resposta antioxidante de leveduras patogênicas tem importante interesse clínico, uma vez que o desenvolvimento racional de novas drogas antifúngicas requer conhecimento do metabolismo fúngico. / The participation of reactive oxygen species (ROS) in azoles antifungal mechanism of action has been suggested, as well as the relation between antifungal resistance and oxidative stress response. However, data are still inconclusive and differ between microorganisms. This study presents the results of ROS generation by fluconazole in fluconazole-susceptible and resistant C. glabrata strains and their antioxidant response. It was evaluated whether fluconazole generates ROS in those isolates treated and untreated with fluconazole at sub-inhibitory concentration according to their minimal inhibitory concentration (MIC). This treatment was conducted until stationary growth phase was reached. Subsequently, the antioxidant defenses glutathione peroxidase (GPx), superoxide dismutase (SOD), glutathione-S-transferase (GST), consumption of hydrogen peroxide and total glutathione, the possible oxidative damage in lipids, proteins and nucleic acids and the levels of nitrites and nitrates were analyzed. Results showed increased ROS generation in fluconazole-susceptible and resistant C. glabrata strains treated with fluconazole, and also higher GPx and SOD enzymatic activity, compared to untreated cells. No statistical difference of those three parameters was observed between susceptible and resistant strains. In relation to GST, susceptible strains demonstrated higher activity compared to the resistant ones, and when susceptible cells were treated with fluconazole the GST activity decreased compared to untreated. Fluconazole did not induce oxidative damage in proteins and in lipids, however oxidative DNA damage was observed. Therefore, it is suggested that fluconazole generates ROS as part of its antifungal mechanism in C. glabrata at stationary growth phase, inducing oxidative DNA damage. In response, there was increase in the enzymatic activity of SOD and GPx in yeast. The understanding of the pathogenic yeast antioxidant response has important clinical interest, since the rational development of new antifungal drugs requires knowledge about the fungal metabolism.

Magister Scientiae Dentium - MSc(Dent) / Candida glabrata (C. glabrata/ Cg) is a pathogenic organism that is increasingly developing frank innate and acquired resistance to the most commonly used antifungal agents, namely, azole group of antifungals. Furthermore, C. glabrata-associated oropharyngeal infections affecting immunocompromised patients, are more difficult to treat and the development of resistance worsen the prognosis. Molecular studies related the emergence of resistance in C. glabrata to the upregulation of ATP-binding cassette (ABC) transporter genes, which work by reducing drug concentration within the cell via drug efflux mechanism, and among these genes, CgCDR1 is considered to play a major role in resistance development. Thus, in order to overcome this problem, several combinations of antifungal agents are being studied. Aim: To evaluate the effect of a combination therapy of fluconazole and amphotericin B on the growth and CDR1 gene expression of C. glabrata. Research design and methodology: This in-vitro study evaluated the effect of a combination therapy of fluconazole and amphotericin B on the growth of C. glabrata and related it to the expression of CgCDR1 resistance gene. C. glabrata was revived in brain heart infusion (BHI) broth and later inoculated onto agar plates. Following overnight incubation, 5 colonies were transferred using a sterile loop into 2 ml of phosphate buffered saline (PBS) solution to establish McFarland (Mcf) standard. Later, the solution was diluted by transferring 200 μL to 400 ml of yeast peptone dextrose (YPD) agar (flask 1). From (flask 1), 90 ml, 99 ml and 89 ml of inoculum were allocated into 3 separate flasks, into which 10 ml fluconazole, 1 ml amphotericin B and 11 ml combination (10 ml fluconazole + 1 ml amphotericin B) were added, respectively. The inoculums were left to settle for 20 minutes, then incubated at 37oC with serial dilutions carried after 30 minutes, 2, 4, 6 and 24 hours. From the 96-microtiter plate, 10 μL for each treatment arm and time interval were transferred from selected wells and onto 30 Casein-peptone Soymeal-peptone (CASO) agar plates, and incubated for 24 hours. After incubation, the number of colonies were counted using an automated colony counter, to establish colony forming unit (CFU)/ml. CgCDR1 gene expression was analyzed using real time polymerase chain reaction. After 6 hours of incubation, a sample was taken from each treatment arm, transferred into CASO agar plates and incubated for 24 hours at 37oC. After establishing Mcf, gene extraction and gene expression were carried out according to manufacturer’s instructions. Results and discussion: No significant difference between the effect of the combination and amphotericin B was evident regarding C. glabrata growth. However, the combination therapy was more effective against C. glabrata than fluconazole, with a marked decrease in candidal growth at 30 minutes and 6 hours. Furthermore, the expression of CgCDR1 gene at 6 hours contact time was more pronounced in the samples of C. glabrata treated with the combination therapy, compared to that of the monotherapy. Conclusion: The combination therapy had better effect on the growth of C. glabrata than fluconazole monotherapy. On the other hand, the expression of CgCDR1 was detected in the samples of C. glabrata treated with the combination therapy, suggesting the ability of the yeast to adapt and develop resistance in such environment.

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