Amphotericin B (AMB) is the predominant antifungal drug, but the mechanism of resistance is not well understood. We compared the in vivo virulence of an AMB-resistant Aspergillus terreus (ATR) isolate with that of an AMB-susceptible A. terreus isolate (ATS) using a murine model for disseminated aspergillosis. Furthermore, we analyzed the molecular basis of intrinsic AMB resistance in vitro by comparing the ergosterol content, cell-associated AMB levels, AMB-induced intracellular efflux, and prooxidant effects between ATR and ATS. Infection of immunosuppressed mice with ATS or ATR showed that the ATS strain was more lethal than the ATR strain. However, AMB treatment improved the outcome in ATS-infected mice while having no positive effect on the animals infected with ATR. The in vitro data demonstrated that ergosterol content is not the molecular basis for AMB resistance. ATR absorbed less AMB, discharged more intracellular compounds, and had better protection against oxidative damage than the susceptible strain. Our experiments showed that ergosterol content plays a minor role in intrinsic AMB resistance and is not directly associated with intracellular cell-associated AMB content. AMB might exert its antifungal activity by oxidative injury rather than by an increase in membrane permeation.
Invasive mold infections (IMI) are a significant determinant of morbidity and mortality in patients undergoing cancer chemotherapy, hematopoietic stem cell transplantation, or solid organ transplantation (1-3). These infections remain difficult to manage with therapeutic treatments because of a usually late diagnosis and complication of the treatment procedure by toxicity or interactions of drugs (4). The majority of IMI are caused by Aspergillus spp., and the most pathogenic species are Aspergillus fumigatus, Aspergillus terreus, and Aspergillus flavus (5). In particular, A. terreus, a widespread soil saprophyte and producer of several secondary metabolites, is a common cause of infection at the University Hospital of Innsbruck (UHI) in Austria (6-9). In vivo and in vitro data indicate that almost all A. terreus isolates are intrinsically resistant to amphotericin B (AMB), a fungicidal heptaene macrolide antimycotic, and a high mortality rate in patients is associated with this particular mold (10-12).Previous work has shown that AMB binds to ergosterol, the principal sterol in the fungal cell membrane, and forms aqueous pores in the lipid bilayers. Subsequently, proteins and amino acids leak out, which in turn leads to disrupted membrane proton gradients (13-16). AMB resistance is rare, and it has been suggested that for A. flavus and Candida albicans, the ergosterol content (17), the composition of the fungal cell wall (18), and the ability to produce catalase might play a role in AMB resistance (19). SokolAnderson et al. speculated that AMB causes cell death in C. albicans by oxidative damage (19). Despite intensive research for over 50 years, the exact mechanism of action of AMB is still incompletely understood, and the ...