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Published in: Current Infectious Disease Reports 2/2013

01-04-2013 | GENITOURINARY INFECTIONS (J SOBEL, SECTION EDITOR)

Genetic Basis for Recurrent Vulvo-Vaginal Candidiasis

Authors: Martin Jaeger, Theo S. Plantinga, Leo A. B. Joosten, Bart-Jan Kullberg, Mihai G. Netea

Published in: Current Infectious Disease Reports | Issue 2/2013

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Abstract

Vulvovaginal candidiasis (VVC) is a frequent disease affecting more than 75% of all women at least once in their lifetime. Up to 8% of them suffer from recurrent VVC (RVVC) characterized by at least three episodes each year. Several risk factors, such as antibiotic use, diabetes, or pregnancy, are known, but the vast majority of women with RVVC develop the infection without having any risk factor, implying that a genetic component most likely plays an important role in the susceptibility to RVVC. This review summarizes the immunogenetic alterations that lead to an increased susceptibility to vaginal infections with Candida albicans. Different mutations and polymorphisms in innate immune genes alter the mucosal immune response against fungi and are likely to have an important role in susceptibility to RVVC. A better understanding of the genetic and immunological mechanisms leading to RVVC is important for both the understanding of the pathophysiology of the disease and the design of novel therapeutic strategies.
Literature
2.
go back to reference Sobel JD. Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 1985;152(7 Pt 2):924–35.PubMed Sobel JD. Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 1985;152(7 Pt 2):924–35.PubMed
4.
go back to reference Sobel JD. Pathogenesis and epidemiology of vulvovaginal candidiasis. Ann N Y Acad Sci. 1988;544:547–57.PubMedCrossRef Sobel JD. Pathogenesis and epidemiology of vulvovaginal candidiasis. Ann N Y Acad Sci. 1988;544:547–57.PubMedCrossRef
5.
go back to reference Sobel JD. Pathogenesis and treatment of recurrent vulvovaginal candidiasis. Clin Infect Dis. 1992;14 Suppl 1:S148–53.PubMedCrossRef Sobel JD. Pathogenesis and treatment of recurrent vulvovaginal candidiasis. Clin Infect Dis. 1992;14 Suppl 1:S148–53.PubMedCrossRef
6.
go back to reference Fidel Jr PL. History and update on host defense against vaginal candidiasis. Am J Reprod Immunol. 2007;57(1):2–12.PubMedCrossRef Fidel Jr PL. History and update on host defense against vaginal candidiasis. Am J Reprod Immunol. 2007;57(1):2–12.PubMedCrossRef
7.
go back to reference Cassone A, De Bernardis F, Santoni G. Anticandidal immunity and vaginitis: novel opportunities for immune intervention. Infect Immun. 2007;75(10):4675–86.PubMedCrossRef Cassone A, De Bernardis F, Santoni G. Anticandidal immunity and vaginitis: novel opportunities for immune intervention. Infect Immun. 2007;75(10):4675–86.PubMedCrossRef
8.
go back to reference Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991;165(4 Pt 2):1168–76.PubMed Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991;165(4 Pt 2):1168–76.PubMed
9.
go back to reference Milsom I, Forssman L. Repeated candidiasis: reinfection or recrudescence? A review. Am J Obstet Gynecol. 1985;152(7 Pt 2):956–9.PubMed Milsom I, Forssman L. Repeated candidiasis: reinfection or recrudescence? A review. Am J Obstet Gynecol. 1985;152(7 Pt 2):956–9.PubMed
10.
go back to reference Nawrot U et al. The study of cell-mediated immune response in recurrent vulvovaginal candidiasis. FEMS Immunol Med Microbiol. 2000;29(2):89–94.PubMedCrossRef Nawrot U et al. The study of cell-mediated immune response in recurrent vulvovaginal candidiasis. FEMS Immunol Med Microbiol. 2000;29(2):89–94.PubMedCrossRef
12.
go back to reference Fidel Jr PL, Sobel JD. Immunopathogenesis of recurrent vulvovaginal candidiasis. Clin Microbiol Rev. 1996;9(3):335–48.PubMed Fidel Jr PL, Sobel JD. Immunopathogenesis of recurrent vulvovaginal candidiasis. Clin Microbiol Rev. 1996;9(3):335–48.PubMed
13.
go back to reference Steele C, Fidel PL. Cytokine and chemokine production by human oral and vaginal epithelial cells in response to Candida albicans. Infect Immun. 2002;70(2):577–83.PubMedCrossRef Steele C, Fidel PL. Cytokine and chemokine production by human oral and vaginal epithelial cells in response to Candida albicans. Infect Immun. 2002;70(2):577–83.PubMedCrossRef
14.
go back to reference Weindl G et al. Human epithelial cells establish direct antifungal defense through TLR4-mediated signaling. J Clin Invest. 2007;117(12):3664–72.PubMed Weindl G et al. Human epithelial cells establish direct antifungal defense through TLR4-mediated signaling. J Clin Invest. 2007;117(12):3664–72.PubMed
15.
go back to reference Hornef MW, Bogdan C. The role of epithelial Toll-like receptor expression in host defense and microbial tolerance. J Endotoxin Res. 2005;11(2):124–8.PubMed Hornef MW, Bogdan C. The role of epithelial Toll-like receptor expression in host defense and microbial tolerance. J Endotoxin Res. 2005;11(2):124–8.PubMed
16.
go back to reference Yano J et al. Epithelial cell-derived S100 calcium-binding proteins as key mediators in the hallmark acute neutrophil response during Candida vaginitis. Infect Immun. 2010;78(12):5126–37.PubMedCrossRef Yano J et al. Epithelial cell-derived S100 calcium-binding proteins as key mediators in the hallmark acute neutrophil response during Candida vaginitis. Infect Immun. 2010;78(12):5126–37.PubMedCrossRef
17.
go back to reference Naglik JR et al. Candida albicans interactions with epithelial cells and mucosal immunity. Microbes Infect. 2011;13(12–13):963–76.PubMedCrossRef Naglik JR et al. Candida albicans interactions with epithelial cells and mucosal immunity. Microbes Infect. 2011;13(12–13):963–76.PubMedCrossRef
18.
go back to reference Barousse MM et al. Growth inhibition of Candida albicans by human vaginal epithelial cells. J Infect Dis. 2001;184(11):1489–93.PubMedCrossRef Barousse MM et al. Growth inhibition of Candida albicans by human vaginal epithelial cells. J Infect Dis. 2001;184(11):1489–93.PubMedCrossRef
19.
go back to reference Steele C et al. Growth inhibition of Candida by human oral epithelial cells. J Infect Dis. 2000;182(5):1479–85.PubMedCrossRef Steele C et al. Growth inhibition of Candida by human oral epithelial cells. J Infect Dis. 2000;182(5):1479–85.PubMedCrossRef
20.
go back to reference Steele C et al. Growth inhibition of Candida albicans by vaginal cells from naive mice. Med Mycol. 1999;37(4):251–9.PubMed Steele C et al. Growth inhibition of Candida albicans by vaginal cells from naive mice. Med Mycol. 1999;37(4):251–9.PubMed
21.
go back to reference Barousse MM et al. Vaginal epithelial cell anti-Candida albicans activity is associated with protection against symptomatic vaginal candidiasis. Infect Immun. 2005;73(11):7765–7.PubMedCrossRef Barousse MM et al. Vaginal epithelial cell anti-Candida albicans activity is associated with protection against symptomatic vaginal candidiasis. Infect Immun. 2005;73(11):7765–7.PubMedCrossRef
22.
go back to reference Netea MG et al. An integrated model of the recognition of Candida albicans by the innate immune system. Nat Rev Microbiol. 2008;6(1):67–78.PubMedCrossRef Netea MG et al. An integrated model of the recognition of Candida albicans by the innate immune system. Nat Rev Microbiol. 2008;6(1):67–78.PubMedCrossRef
23.
24.
go back to reference Eisen DP, Minchinton RM. Impact of mannose-binding lectin on susceptibility to infectious diseases. Clin Infect Dis. 2003;37(11):1496–505.PubMedCrossRef Eisen DP, Minchinton RM. Impact of mannose-binding lectin on susceptibility to infectious diseases. Clin Infect Dis. 2003;37(11):1496–505.PubMedCrossRef
25.
go back to reference Chaim W, Foxman B, Sobel JD. Association of recurrent vaginal candidiasis and secretory ABO and Lewis phenotype. J Infect Dis. 1997;176(3):828–30.PubMedCrossRef Chaim W, Foxman B, Sobel JD. Association of recurrent vaginal candidiasis and secretory ABO and Lewis phenotype. J Infect Dis. 1997;176(3):828–30.PubMedCrossRef
26.
go back to reference •• Ferwerda B et al. Human dectin-1 deficiency and mucocutaneous fungal infections. N Engl J Med. 2009;361(18):1760–7. This study showed that a mutaion in the β-glucan receptor dectin-1 lead to a defect in the antifungal defense. Reduced receptor expression and ligand binding, as well as decreased cytokine (IL-17,IL-6, and TNF-α), are the consequences of this mutation.PubMedCrossRef •• Ferwerda B et al. Human dectin-1 deficiency and mucocutaneous fungal infections. N Engl J Med. 2009;361(18):1760–7. This study showed that a mutaion in the β-glucan receptor dectin-1 lead to a defect in the antifungal defense. Reduced receptor expression and ligand binding, as well as decreased cytokine (IL-17,IL-6, and TNF-α), are the consequences of this mutation.PubMedCrossRef
27.
go back to reference Rosentul DC et al. Genetic variation in the dectin-1/CARD9 recognition pathway and susceptibility to candidemia. J Infect Dis. 2011;204(7):1138–45.PubMedCrossRef Rosentul DC et al. Genetic variation in the dectin-1/CARD9 recognition pathway and susceptibility to candidemia. J Infect Dis. 2011;204(7):1138–45.PubMedCrossRef
28.
go back to reference Filler SG. Insights from human studies into the host defense against candidiasis. Cytokine. 2012;58(1):129–32.PubMedCrossRef Filler SG. Insights from human studies into the host defense against candidiasis. Cytokine. 2012;58(1):129–32.PubMedCrossRef
29.
go back to reference Taylor PR et al. Dectin-1 is required for beta-glucan recognition and control of fungal infection. Nat Immunol. 2007;8(1):31–8.PubMedCrossRef Taylor PR et al. Dectin-1 is required for beta-glucan recognition and control of fungal infection. Nat Immunol. 2007;8(1):31–8.PubMedCrossRef
30.
go back to reference Gow NA et al. Immune recognition of Candida albicans beta-glucan by dectin-1. J Infect Dis. 2007;196(10):1565–71.PubMedCrossRef Gow NA et al. Immune recognition of Candida albicans beta-glucan by dectin-1. J Infect Dis. 2007;196(10):1565–71.PubMedCrossRef
31.
go back to reference •• Glocker EO et al. A Homozygous CARD9 Mutation in a Family with Susceptibility to Fungal Infections. N Engl J Med. 2009;361(18):1727–35. This study showed that homozygous mutations in the intracellular adapter molecule CARD9 lead to an increased susceptibility to fungal infections. CARD9 signals downstream to dectin-1, a receptor with great importance in the fungal defense.PubMedCrossRef •• Glocker EO et al. A Homozygous CARD9 Mutation in a Family with Susceptibility to Fungal Infections. N Engl J Med. 2009;361(18):1727–35. This study showed that homozygous mutations in the intracellular adapter molecule CARD9 lead to an increased susceptibility to fungal infections. CARD9 signals downstream to dectin-1, a receptor with great importance in the fungal defense.PubMedCrossRef
32.
go back to reference Glocker EO et al. Susceptibility to fungal infections due to a homozygous mutation in CARD9. Clin Exp Immunol. 2010;160:4–5. Glocker EO et al. Susceptibility to fungal infections due to a homozygous mutation in CARD9. Clin Exp Immunol. 2010;160:4–5.
33.
go back to reference Plantinga TS et al. Early stop polymorphism in human DECTIN-1 is associated with increased candida colonization in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2009;49(5):724–32.PubMedCrossRef Plantinga TS et al. Early stop polymorphism in human DECTIN-1 is associated with increased candida colonization in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2009;49(5):724–32.PubMedCrossRef
34.
go back to reference Gross O et al. Card9 controls a non-TLR signalling pathway for innate anti-fungal immunity. Nature. 2006;442(7103):651–6.PubMedCrossRef Gross O et al. Card9 controls a non-TLR signalling pathway for innate anti-fungal immunity. Nature. 2006;442(7103):651–6.PubMedCrossRef
35.
go back to reference LeibundGut-Landmann S et al. Syk- and CARD9-dependent coupling of innate immunity to the induction of T helper cells that produce interleukin 17. Nat Immunol. 2007;8(6):630–8.PubMedCrossRef LeibundGut-Landmann S et al. Syk- and CARD9-dependent coupling of innate immunity to the induction of T helper cells that produce interleukin 17. Nat Immunol. 2007;8(6):630–8.PubMedCrossRef
36.
go back to reference Sutterwala FS, Ogura Y, Flavell RA. The inflammasome in pathogen recognition and inflammation. J Leukoc Biol. 2007;82(2):259–64.PubMedCrossRef Sutterwala FS, Ogura Y, Flavell RA. The inflammasome in pathogen recognition and inflammation. J Leukoc Biol. 2007;82(2):259–64.PubMedCrossRef
37.
go back to reference • Lev-Sagie A et al. Polymorphism in a gene coding for the inflammasome component NALP3 and recurrent vulvovaginal candidiasis in women with vulvar vestibulitis syndrome. Am J Obstet Gynecol. 2009;200(3):303 e1–6. This research article showed that inflammasome-mediated IL-1β production was decreased in women with polymorpisms in the CIAS1 gene. Women postive for the risk allele were more frequently found in VVC and RVVC cohorts.CrossRef • Lev-Sagie A et al. Polymorphism in a gene coding for the inflammasome component NALP3 and recurrent vulvovaginal candidiasis in women with vulvar vestibulitis syndrome. Am J Obstet Gynecol. 2009;200(3):303 e1–6. This research article showed that inflammasome-mediated IL-1β production was decreased in women with polymorpisms in the CIAS1 gene. Women postive for the risk allele were more frequently found in VVC and RVVC cohorts.CrossRef
38.
go back to reference Omi T et al. An intronic variable number of tandem repeat polymorphisms of the cold-induced autoinflammatory syndrome 1 (CIAS1) gene modifies gene expression and is associated with essential hypertension. Eur J Hum Genet. 2006;14(12):1295–305.PubMedCrossRef Omi T et al. An intronic variable number of tandem repeat polymorphisms of the cold-induced autoinflammatory syndrome 1 (CIAS1) gene modifies gene expression and is associated with essential hypertension. Eur J Hum Genet. 2006;14(12):1295–305.PubMedCrossRef
39.
go back to reference Babula O et al. Relation between recurrent vulvovaginal candidiasis, vaginal concentrations of mannose-binding lectin, and a mannose-binding lectin gene polymorphism in Latvian women. Clin Infect Dis. 2003;37(5):733–7.PubMedCrossRef Babula O et al. Relation between recurrent vulvovaginal candidiasis, vaginal concentrations of mannose-binding lectin, and a mannose-binding lectin gene polymorphism in Latvian women. Clin Infect Dis. 2003;37(5):733–7.PubMedCrossRef
40.
go back to reference Kilpatrick DC. Mannan-binding lectin and its role in innate immunity. Transfus Med. 2002;12(6):335–52.PubMedCrossRef Kilpatrick DC. Mannan-binding lectin and its role in innate immunity. Transfus Med. 2002;12(6):335–52.PubMedCrossRef
41.
go back to reference Turner MW. The role of mannose-binding lectin in health and disease. Mol Immunol. 2003;40(7):423–9.PubMedCrossRef Turner MW. The role of mannose-binding lectin in health and disease. Mol Immunol. 2003;40(7):423–9.PubMedCrossRef
42.
go back to reference Herpers BL et al. Acute-phase responsiveness of mannose-binding lectin in community-acquired pneumonia is highly dependent upon MBL2 genotypes. Clin Exp Immunol. 2009;156(3):488–94.PubMedCrossRef Herpers BL et al. Acute-phase responsiveness of mannose-binding lectin in community-acquired pneumonia is highly dependent upon MBL2 genotypes. Clin Exp Immunol. 2009;156(3):488–94.PubMedCrossRef
43.
go back to reference Babovic-Vuksanovic D, Snow K, Ten RM. Mannose-binding lectin (MBL) deficiency. Variant alleles in a midwestern population of the United States. Ann Allergy Asthma Immunol. 1999;82(2):134–8. 141; quiz 142-3.PubMedCrossRef Babovic-Vuksanovic D, Snow K, Ten RM. Mannose-binding lectin (MBL) deficiency. Variant alleles in a midwestern population of the United States. Ann Allergy Asthma Immunol. 1999;82(2):134–8. 141; quiz 142-3.PubMedCrossRef
44.
go back to reference Milanese M et al. MBL2 genetic screening in patients with recurrent vaginal infections. Am J Reprod Immunol. 2008;59(2):146–51.PubMedCrossRef Milanese M et al. MBL2 genetic screening in patients with recurrent vaginal infections. Am J Reprod Immunol. 2008;59(2):146–51.PubMedCrossRef
45.
go back to reference • Donders GG et al. Mannose-binding lectin gene polymorphism and resistance to therapy in women with recurrent vulvovaginal candidiasis. BJOG. 2008;115(10):1225–31. This article confirms the previous hypothesis that the MBL2 polymorphism in codon 54 is more frequently found in women with RVVC. The result of this polymorphism is reduced levels of MBL.PubMedCrossRef • Donders GG et al. Mannose-binding lectin gene polymorphism and resistance to therapy in women with recurrent vulvovaginal candidiasis. BJOG. 2008;115(10):1225–31. This article confirms the previous hypothesis that the MBL2 polymorphism in codon 54 is more frequently found in women with RVVC. The result of this polymorphism is reduced levels of MBL.PubMedCrossRef
46.
go back to reference Liu F, Liao Q, Liu Z. Mannose-binding lectin and vulvovaginal candidiasis. Int J Gynaecol Obstet. 2006;92(1):43–7.PubMedCrossRef Liu F, Liao Q, Liu Z. Mannose-binding lectin and vulvovaginal candidiasis. Int J Gynaecol Obstet. 2006;92(1):43–7.PubMedCrossRef
47.
go back to reference Giraldo PC et al. Mannose-binding lectin gene polymorphism, vulvovaginal candidiasis, and bacterial vaginosis. Obstet Gynecol. 2007;109(5):1123–8.PubMedCrossRef Giraldo PC et al. Mannose-binding lectin gene polymorphism, vulvovaginal candidiasis, and bacterial vaginosis. Obstet Gynecol. 2007;109(5):1123–8.PubMedCrossRef
48.
go back to reference Wojitani MD et al. Association between mannose-binding lectin and interleukin-1 receptor antagonist gene polymorphisms and recurrent vulvovaginal candidiasis. Arch Gynecol Obstet. 2012;285(1):149–53.PubMedCrossRef Wojitani MD et al. Association between mannose-binding lectin and interleukin-1 receptor antagonist gene polymorphisms and recurrent vulvovaginal candidiasis. Arch Gynecol Obstet. 2012;285(1):149–53.PubMedCrossRef
49.
go back to reference Wink DA et al. DNA deaminating ability and genotoxicity of nitric oxide and its progenitors. Science. 1991;254(5034):1001–3.PubMedCrossRef Wink DA et al. DNA deaminating ability and genotoxicity of nitric oxide and its progenitors. Science. 1991;254(5034):1001–3.PubMedCrossRef
50.
go back to reference Cenci E et al. Interleukin-4 and interleukin-10 inhibit nitric oxide-dependent macrophage killing of Candida albicans. Eur J Immunol. 1993;23(5):1034–8.PubMedCrossRef Cenci E et al. Interleukin-4 and interleukin-10 inhibit nitric oxide-dependent macrophage killing of Candida albicans. Eur J Immunol. 1993;23(5):1034–8.PubMedCrossRef
51.
go back to reference Babula O et al. Frequency of interleukin-4 (IL-4) -589 gene polymorphism and vaginal concentrations of IL-4, nitric oxide, and mannose-binding lectin in women with recurrent vulvovaginal candidiasis. Clin Infect Dis. 2005;40(9):1258–62.PubMedCrossRef Babula O et al. Frequency of interleukin-4 (IL-4) -589 gene polymorphism and vaginal concentrations of IL-4, nitric oxide, and mannose-binding lectin in women with recurrent vulvovaginal candidiasis. Clin Infect Dis. 2005;40(9):1258–62.PubMedCrossRef
52.
go back to reference Sampaio P et al. Highly polymorphic microsatellite for identification of Candida albicans strains. J Clin Microbiol. 2003;41(2):552–7.PubMedCrossRef Sampaio P et al. Highly polymorphic microsatellite for identification of Candida albicans strains. J Clin Microbiol. 2003;41(2):552–7.PubMedCrossRef
53.
go back to reference Sampaio P et al. New microsatellite multiplex PCR for Candida albicans strain typing reveals microevolutionary changes. J Clin Microbiol. 2005;43(8):3869–76.PubMedCrossRef Sampaio P et al. New microsatellite multiplex PCR for Candida albicans strain typing reveals microevolutionary changes. J Clin Microbiol. 2005;43(8):3869–76.PubMedCrossRef
54.
go back to reference • Fan SR et al. Genotype distribution of Candida albicans strains associated with different conditions of vulvovaginal candidiasis, as revealed by microsatellite typing. Sex Transm Infect. 2008;84(2):103–6. This study compares different Candida albicans strains in RVVC, as well as in control, cohorts. It is shown that particular C. albicans strains are more frequently present in patients suffering form (R)VVC. This implies a correlation of different C.albicans genotypes and the severity of (R)VVC.PubMedCrossRef • Fan SR et al. Genotype distribution of Candida albicans strains associated with different conditions of vulvovaginal candidiasis, as revealed by microsatellite typing. Sex Transm Infect. 2008;84(2):103–6. This study compares different Candida albicans strains in RVVC, as well as in control, cohorts. It is shown that particular C. albicans strains are more frequently present in patients suffering form (R)VVC. This implies a correlation of different C.albicans genotypes and the severity of (R)VVC.PubMedCrossRef
Metadata
Title
Genetic Basis for Recurrent Vulvo-Vaginal Candidiasis
Authors
Martin Jaeger
Theo S. Plantinga
Leo A. B. Joosten
Bart-Jan Kullberg
Mihai G. Netea
Publication date
01-04-2013
Publisher
Current Science Inc.
Published in
Current Infectious Disease Reports / Issue 2/2013
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI
https://doi.org/10.1007/s11908-013-0319-3

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