Chitosan Ameliorates Candida auris Virulence in a Galleria mellonella Infection Model

Abstract

<i>Candida auris</i> has emerged as a multidrug-resistant nosocomial pathogen over the last decade. Outbreaks of the organism in health care facilities have resulted in life-threatening invasive candidiasis in over 40 countries worldwide. Resistance by <i>C. auris</i> to conventional antifungal drugs such as fluconazole and amphotericin B means that alternative therapeutics must be explored. As such, this study served to investigate the efficacy of a naturally derived polysaccharide called chitosan against aggregative (Agg) and nonaggregative (non-Agg) isolates of <i>C. auris</i><i>in vitro</i> and <i>in vivo. In vitro</i> results indicated that chitosan was effective against planktonic and sessile forms of Agg and non-Agg <i>C. auris</i> In a <i>Galleria mellonella</i> model to assess <i>C. auris</i> virulence, chitosan treatment was shown to ameliorate killing effects of both <i>C. auris</i> phenotypes (NCPF 8973 and NCPF 8978, respectively) <i>in vivo</i> Specifically, chitosan reduced the fungal load and increased survival rates of infected <i>Galleria</i>, while treatment alone was nontoxic to the larvae. Finally, chitosan treatment appeared to induce a stress-like gene expression response in NCPF 8973 in the larvae likely arising from a protective response by the organism to resist antifungal activity of the compound. Taken together, results from this study demonstrate that naturally derived compounds such as chitosan may be useful alternatives to conventional antifungals against <i>C. auris</i>.