Investigation of the relationship between fluconazol sensitivity, proteinase activity and ERG11-SAP2 expression in candida albicans strains isolated from clinical samples

Background: Our aim in this study is to examine the relationship between fluconazole resistance in Candida albicans strains, their proteinase activities and ERG11/ SAP2 genes. Material and Method: Strains isolated from 127 samples with C. albicans growth were included in our study, from samples sent to Düzce University Faculty of Medicine Medical Microbiology Laboratory between 01.08.2021 and 01.08.2022. Fluconazole MIC values of the isolates were determined by the broth microdilution method according to EUCAST recommendations. The increase in fluconazole MIC values at the 48th hour and proteinase activities were examined. ERG11 and SAP2 gene expression levels of 44 strains included in the study were measured by real time qPCR. Relative expression levels were calculated by the ΔΔCT method. The relationships of these levels with each other, fluconazole resistance, 48th hour MIC elevation and proteinase production were examined. Results: The fluconazole resistance rate in C. albicans detected in our study is similar to recent studies conducted around the world (3.14%). A positive linear correlation was detected between ERG11 AND SAP2 gene expression levels (p<0.001). No relationship was found between the SAP2 and ERG11 expression levels of the isolates and their fluconazole resistance. While there was a statistically significant relationship between ERG11 expression levels and the 48th hour MIC increase (p=0.037), there was no statistically significant relationship between SAP2 levels and the 48th hour MIC increase. Likewise, there is no statistically significant relationship between the proteinase activities of the isolates and SAP2/ERG11 expression levels. It was determined that the increase in fluconazole 48th hour MIC values was unrelated to proteinase activity. Our study can be repeated by increasing the number of strains for which PCR is performed and ensuring the equality of resistant-susceptible strains. In the future, prevention and control of Candida infections may be achieved by pharmacological or immunological tools specifically modulated to inhibit virulence factors such as the SAP family.