One Population, Multiple Lifestyles: Commensalism and Pathogenesis in the Human Mycobiome

Authors

Diana M Proctor
Rebecca A Drummond
Michail S Lionakis
Julia A Segre

Publication Date

4-12-2023

Journal

Cell Host & Microbe

Abstract

Candida auris and Candida albicans can result in invasive fungal diseases. And yet, these species can stably and asymptomatically colonize human skin and gastrointestinal tracts. To consider these disparate microbial lifestyles, we first review factors shown to influence the underlying microbiome. Structured by the damage response framework, we then consider the molecular mechanisms deployed by C. albicans to switch between commensal and pathogenic lifestyles. Next, we explore this framework with C. auris to highlight how host physiology, immunity, and/or antibiotic receipt are associated with progression from colonization to infection. While treatment with antibiotics increases the risk an individual will succumb to invasive candidiasis, the underlying mechanisms remain unclear. Here, we describe several hypotheses that may explain this phenomenon. We conclude by highlighting future directions integrating genomics with immunology to advance our understanding of invasive candidiasis and human fungal disease.

Keywords

Candida, mycobiome, antibiotics, damage response framework, commensal, pathogen, medical mycology, microbiome, antibiotic stewardship