Moderate levels of 5-fluorocytosine cause the emergence of high frequency resistance in cryptococci

Nat Commun. 2021 Jun 8;12(1):3418. doi: 10.1038/s41467-021-23745-1.

Abstract

The antifungal agent 5-fluorocytosine (5-FC) is used for the treatment of several mycoses, but is unsuitable for monotherapy due to the rapid development of resistance. Here, we show that cryptococci develop resistance to 5-FC at a high frequency when exposed to concentrations several fold above the minimal inhibitory concentration. The genomes of resistant clones contain alterations in genes relevant as well as irrelevant for 5-FC resistance, suggesting that 5-FC may be mutagenic at moderate concentrations. Mutations in FCY2 (encoding a known permease for 5-FC uptake), FCY1, FUR1, UXS1 (encoding an enzyme that converts UDP-glucuronic acid to UDP-xylose) and URA6 contribute to 5-FC resistance. The uxs1 mutants accumulate UDP-glucuronic acid, which appears to down-regulate expression of permease FCY2 and reduce cellular uptake of the drug. Additional mutations in genes known to be required for UDP-glucuronic acid synthesis (UGD1) or a transcriptional factor NRG1 suppress UDP-glucuronic acid accumulation and 5-FC resistance in the uxs1 mutants.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Chromosomes, Fungal / genetics
  • Clone Cells
  • Cryptococcus / drug effects*
  • Cryptococcus / genetics
  • Cryptococcus / growth & development
  • Drug Resistance, Fungal* / drug effects
  • Drug Resistance, Fungal* / genetics
  • Flucytosine / pharmacology*
  • Fungal Proteins / genetics
  • Fungal Proteins / metabolism
  • Gene Dosage
  • Gene Duplication
  • Gene Expression Regulation, Fungal / drug effects
  • Genes, Suppressor
  • Genetic Variation
  • Genome, Fungal
  • Intracellular Space / metabolism
  • Microbial Sensitivity Tests
  • Mutation / genetics
  • Reproducibility of Results
  • Uridine Diphosphate Glucuronic Acid / metabolism

Substances

  • Fungal Proteins
  • Uridine Diphosphate Glucuronic Acid
  • Flucytosine