Mecanismos de resistencia a fluconazol expresados por Candida glabrata: una situación para considerar en la terapéutica
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jul 22, 2020
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Leidy Yurani Cárdenas Parra
https://orcid.org/0000-0001-7505-8539
Jorge Enrique Perez Cárdenas
https://orcid.org/0000-0002-7829-6505
https://orcid.org/0000-0001-7505-8539
Jorge Enrique Perez Cárdenas
https://orcid.org/0000-0002-7829-6505
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Resumen
Introducción: Los esfuerzos terapéuticos orientados a atender las micosis por Candida spp. se han enfocado en el empleo de azoles; sin embargo, en la literatura científica se discute su beneficio, por los amplios y descritos mecanismos de resistencia. Objetivo: Describir los mecanismos de resistencia al fluconazol expresados por la especie Candida glabrata, con la intención de que sean considerados dentro de las variables de elegibilidad para la intervención. Método: Se realizó una revisión integrativa utilizando la pregunta orientadora: ¿cuáles son los mecanismos de resistencia al fluconazol expresados por la especie Candida glabrata? Veintinueve estudios obtenidos de la base de datos PubMed cumplieron los criterios del análisis crítico propuesto por el instrumento PRISMA, utilizado para la selección de los artículos incluidos para su revisión en este manuscrito. Las categorías bajo las cuales se organizaron los elementos de análisis fueron: sobrexpresión de bombas de eflujo y modificaciones en la enzima lanosterol 14-alfa-desmetilasa. Resultados: Los mecanismos de resistencia al fluconazol expresados por Candida glabrata están determinados principalmente por la regulación a la alza de bombas de adenosina-trifosfato Binding Cassette (ABC) y por la modificación del punto de unión con su blanco farmacológico: la enzima lanosterol 14-alfa-desmetilasa. Conclusión: Los mecanismos de resistencia expresados por Candida glabrata se asocian con la modificación estructural de la diana farmacológica y la sobreexpresión de bombas de eflujo de manera diferencial a otras especies. Se sugiere que Candida glabrata es intrínsecamente menos susceptible al fluconazol.
Keywords
Candida glabrata, Candida, Azole resistant, resistance, Azoles, Fluconazole (MeSH).Candida glabrata, Candida, Resistencia, Azoles, Fluconazol (DeCS)Candida glabrata; Candida; resistência; azóis; fluconazol
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5. Sasso M, Roger C, Sasso M, Poujol H, Barbar S, Lefrant J-Y, et al. Changes in the distribution of colonising and infecting Candida spp. isolates, antifungal drug consumption and susceptibility in a French intensive care unit: A 10-year study. Mycoses. 2017;60(12):770-80. https://doi.org/10.1111/myc.12661
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7. Valle GMM del. Candida glabrata: un patógeno emergente. Biociencias. 2016;10(1):89-102. https://doi.org/10.18041/2390-0512/bioc..1.2859
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12. Sanguinetti M, Posteraro B, Lass-Flörl C. Antifungal drug resistance among Candida species: mechanisms and clinical impact. Mycoses. 2015;58 Suppl 2:2-13. https://doi.org/10.1111/myc.12330
13. Florez J, Armijo JA, De Cost MA. Reacciones adversas a los medicamentos y farmacovigilancia. En: Flórez J, Armijo JA, editores. Farmacología humana. 5.a ed. Barcelona: Masson; 2008. p. 129-46.
14. Isaza G, Fuentes J, Marulanda T, Buriticá O, Machado J, Moncada J. Generalidades de farmacología. En: Isaza G, Fuentes J, Marulanda T, et al., editores. Fundamentos de farmacología en terapéutica. 6.a ed. Bogotá: Celsus; 2014. p. 27-31.
15. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 21 de julio de 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097
16. Deorukhkar SC, Saini S. Virulence factors attributed to pathogenicity of non albicans Candida species isolated from Human Immunodeficiency virus infected patients with oropharyngeal candidiasis. Ann Pathol Lab Med. 2015;2(2):A62-66. https://doi.org/10.1155/2014/456878
17. Ahmad KM, Kokošar J, Guo X, Gu Z, Ishchuk OP, Piškur J. Genome structure and dynamics of the yeast pathogen Candida glabrata. FEMS Yeast Res. 2014;14(4):529-35. https://doi.org/10.1111/1567-1364.12145
18. Muller H, Hennequin C, Gallaud J, Dujon B, Fairhead C. The asexual yeast Candida glabrata maintains distinct a and alpha haploid mating types. Eukaryot Cell. 2008;7(5):848-58. https://doi.org/10.1128/EC.00456-07
19. Bairwa G, Rasheed M, Taigwal R, Sahoo R, Kaur R. GPI (glycosylphosphatidylinositol)-linked aspartyl proteases regulate vacuole homoeostasis in Candida glabrata. Biochem J. 2014;458(2):323-34. https://doi.org/10.1042/BJ20130757
20. Lesage G, Bussey H. Cell Wall Assembly in Saccharomyces cerevisiae. Microbiol Mol Biol Rev. 2006;70(2):317-43. https://doi.org/10.1128/MMBR.00038-05
21. Pontón J. La pared celular de los hongos y el mecanismo de acción de la anidulafungina. Rev Iberoam Micol. 2008;25(2):78-82. https://doi.org/10.1016/S1130-1406(08)70024-X
22. Chaffin WL, López-Ribot JL, Casanova M, Gozalbo D, Martínez JP. Cell wall and secreted proteins of Candida albicans: identification, function, and expression. Microbiol Mol Biol Rev MMBR. 1998;62(1):130-80
23. Okada H, Abe M, Asakawa-Minemura M, Hirata A, Qadota H, Morishita K, et al. Multiple functional domains of the yeast l,3-beta-glucan synthase subunit Fks1p revealed by quantitative phenotypic analysis of temperature-sensitive mutants. Genetics. 2010;184(4):1013-24. https://doi.org/10.1534/genetics.109.109892
24. Spanova M, Czabany T, Zellnig G, Leitner E, Hapala I, Daum G. Effect of lipid particle biogenesis on the subcellular distribution of squalene in the yeast Saccharomyces cerevisiae. J Biol Chem. 2010;285(9):6127-33. https://doi.org/10.1074/jbc.M109.074229
25. Base de datos en farmacología Drugbank. Fluconazole [Internet]. Washington: FDA. 2018 [citado 2018 oct 7]. Disponible en: https://www.drugbank.ca/drugs/DB00196
26. Tuck SF, Patel H, Safi E, Robinson CH. Lanosterol 14 alpha-demethylase (P45014DM): effects of P45014DM inhibitors on sterol biosynthesis downstream of lanosterol. J Lipid Res. 1991;32(6):893-902.
27. Fonseca E, Silva S, Rodrigues CF, Alves CT, Azeredo J, Henriques M. Effects of fluconazole on Candida glabrata biofilms and its relationship with ABC transporter gene expression. Biofouling. 2014;30(4):447-57. https://doi.org/10.1080/08927014.2014.886108
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Cómo citar
Cárdenas Parra, L. Y., & Perez Cárdenas, J. E. (2020). Mecanismos de resistencia a fluconazol expresados por Candida glabrata: una situación para considerar en la terapéutica. Investigación En Enfermería: Imagen Y Desarrollo, 22. https://doi.org/10.11144/Javeriana.ie22.mrfe
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