| Literature DB >> 33173866 |
Jacob L Steenwyk1, Matthew E Mead1, Patrícia Alves de Castro2, Clara Valero2, André Damasio3,4, Renato A C Dos Santos2, Abigail L Labella1, Yuanning Li1, Sonja L Knowles5, Huzefa A Raja5, Nicholas H Oberlies5, Xiaofan Zhou6, Oliver A Cornely7,8,9,10, Frieder Fuchs11, Philipp Koehler7,8, Gustavo H Goldman2, Antonis Rokas1.
Abstract
The ongoing global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) first described from Wuhan, China. A subset of COVID-19 patients has been reported to have acquired secondary infections by microbial pathogens, such as fungal opportunistic pathogens from the genus Aspergillus . To gain insight into COVID-19 associated pulmonary aspergillosis (CAPA), we analyzed the genomes and characterized the phenotypic profiles of four CAPA isolates of Aspergillus fumigatus obtained from patients treated in the area of North Rhine-Westphalia, Germany. By examining the mutational spectrum of single nucleotide polymorphisms, insertion-deletion polymorphisms, and copy number variants among 206 genes known to modulate A. fumigatus virulence, we found that CAPA isolate genomes do not exhibit major differences from the genome of the Af293 reference strain. By examining virulence in an invertebrate moth model, growth in the presence of osmotic, cell wall, and oxidative stressors, and the minimum inhibitory concentration of antifungal drugs, we found that CAPA isolates were generally, but not always, similar to A. fumigatus reference strains Af293 and CEA17. Notably, CAPA isolate D had more putative loss of function mutations in genes known to increase virulence when deleted (e.g., in the FLEA gene, which encodes a lectin recognized by macrophages). Moreover, CAPA isolate D was significantly more virulent than the other three CAPA isolates and the A. fumigatus reference strains tested. These findings expand our understanding of the genomic and phenotypic characteristics of isolates that cause CAPA.Entities:
Year: 2020 PMID: 33173866 PMCID: PMC7654854 DOI: 10.1101/2020.11.06.371971
Source DB: PubMed Journal: bioRxiv
Figure 1.Inhalation of Aspergillus spores can result in fungal infection.
Inhalation of Aspergillus spores from the environment can travel to the lung and then grow vegetatively and spread to other parts of the body.
Metainformation and NCBI Accessions for CAPA isolates
| Isolate | Patient Identifier | Patient Outcome | Patient Age | Patient Sex | Patient immunocompromising condition | Antifungal treatment | Antiviral treatment | NCBI BioSample/Sequence Read Archive Accessions |
|---|---|---|---|---|---|---|---|---|
| CAPA A | Patient from this study | Deceased | 57 | Male | None | Caspofungin (70/50 mg once daily) | Supportive only | SAMN16591136; SRR12949929 |
| CAPA B | Patient #4 | Deceased | 73 | Male | Inhalational steroids for medical history of chronic obstructive pulmonary disease | Voriconazole iv (6/4 mg/kg BW twice daily) | Supportive only | SAMN16591179; SRR12949928 |
| CAPA C | Patient #3 | Alive | 54 | Male | IV corticosteroid therapy 0.4 mg/kg/day, total of 13 days | Caspofungin (70/50 mg once daily) followed by IV voriconazole (6/4 mg/kg BW twice daily) | Hydroxychloroquine, darunavir and cobicistat at external hospital, in house changed to supportive only | SAMN16591190; SRR12949927 |
| CAPA D | Patient #1 | Deceased | 62 | Female | Inhalational steroids for medical history of chronic obstructive pulmonary disease | IV Voriconazole (6/4 mg/kg BW twice daily) | Supportive only | SAMN16591200; SRR12949926 |
Information on CAPA isolates B, C, and D is from (Koehler et al., 2020), where the isolates were first described. CAPA isolate A is being reported for the first time. Supportive only antiviral treatment indicates no specific antiviral treatment was given. Abbreviations are as follows: BW: body weight; IV: Intravenous; kg: kilogram; mg: milligram.
Figure 2.Phylogenomics confirms CAPA isolates are Aspergillus fumigatus and mutational spectra among genetic determinants of virulence.
(A) Phylogenomic analysis of a concatenated matrix of 4,525 single-copy orthologous groups genes (sites: 7,133,367) confirmed CAPA isolates are A. fumigatus. Furthermore, CAPA isolates are closely related to reference strains A1163 and Af293. Bipartitions with less than 85% ultrafast bootstrap approximation support were collapsed. (B) Genome-wide SNPs, indels, and CN variants were filtered for those present in genetic determinants of virulence. Thereafter, the number of genetic determinants of virulence with high impact polymorphisms were identified. The number known to increase or decrease virulence in null mutants was determined thereafter.
Biosynthetic gene clusters that produce secondary metabolites implicated in modulating host biology in A. fumigatus
| Function | Reference(s) | Evidence of Biosynthetic Gene Cluster | ||||
|---|---|---|---|---|---|---|
| CAPA A | CAPA B | CAPA C | CAPA D | |||
| Gliotoxin | Inhibits host immune response | ( | + | + | + | + |
| Fumitremorgin | Inhibits the breast cancer resistance protein | ( | + | + | + | + |
| Trypacidin | Damages lung cell tissues | ( | + | + | + | + |
| Pseurotin | Inhibits immunoglobulin E | ( | + | + | + | + |
| Fumagillin | Inhibits neutrophil function | ( | + | + | + | + |
‘+’ and ‘−’ indicates the presence and absence of a BGC, respectively.
Figure 3.CAPA isolates have BGCs encoding the toxic small molecule gliotoxin.
Gliotoxin is known to contribute to virulence of A. fumigatus. The genomes of CAPA isolates of A. fumigatus contain biosynthetic gene clusters known to encode gliotoxin. Note, the BGC of CAPA A was split between two contigs and therefore the BGC is hypothesized to be present.
Figure 4.Strain heterogeneity among CAPA isolates.
CAPA isolates and reference strains Af293 and CEA17 virulence significantly varied in the Galleria moth model of disease (p < 0.001; log-rank test). Pairwise examinations revealed CAPA D was significantly more virulent than all other strains (Benjamini-Hochberg adjusted p-value < 0.01 when comparing CAPA isolate D to another isolate; log-rank test). Growth of CAPA isolates and references strains Af293 and CEA17 in the presence of (B) osmotic, (C) cell wall, and (D) oxidative stressors. Growth differences between CAPA isolates and reference strains Af293 and CEA17 were observed across all growth conditions (p < 0.001; multi-factor ANOVA). Pairwise differences were assessed using the post-hoc Tukey Honest Significant Differences test and were only observed for growth in the presence of CFW at 25 μg/mL (p < 0.001; Tukey Honest Significant Differences test) in which the CAPA isolates did not grow as well as the reference isolates. To correct for strain heterogeneity in growth rates, radial growth in centimeters in the presence of stressors was divided by radial growth in centimeters in the absence of the stressor (MM only). Abbreviations of cell wall stressors are as follows: CFW: calcofluor white; CR: congo red; CSP: caspofungin. Growth in the presence of other stressors is summarized in Supplementary Figure 4.
Antifungal drug susceptibility of CAPA clinical isolates grown in minimal media
| Af293 | CEA17 | CAPA A | CAPA B | CAPA C | CAPA D | |
|---|---|---|---|---|---|---|
| Amphotericin B | 2 | 2 | 2–4 | 2 | 2 | 2 |
| Voriconazole | 1 | 0.25–0.50 | 0.5 | 0.5 | 0.25–0.50 | 0.5 |
| Itraconazole | 0.5 | 0.5 | 0.5 | 0.5 | 0.5 | 0.5 |
| Posaconazole | 1 | 1 | 1 | 1 | 1 | 1 |
Minimum inhibitory concentrations are reported as micrograms (μg) per milliliter (mL).