Hypoxic conditions promote Candida glabrata colonization in the intestinal tract and EPA6 plays a significant role in hypoxic adhesion to intestinal cells

Candida glabrata , a fungal pathogen colonizing mucocutaneous membranes and indwelling medical devices, is associated with invasive infections, especially in immunocompromised individuals. Candidiasis could be of endogenous and exogenous origins. Endogenous infections are considered to derive from the invasion of Candida species colonizing the digestive mucosa. Investigations of the gut-to-bloodstream translocation mechanisms of Candida species remain limited, although environmental oxygen levels have been recently suggested to alter the human fungal pathogen phenotypes. Moreover, human fungal pathogens, including Candida , colonizing or invading less oxygenated tissues encounter altered oxygen circumstances. Therefore, phenotype investigation under hypoxic conditions could provide valuable novel insights into the host-pathogen interaction mechanisms. This study aimed to elucidate the adhesion capabilities and mechanisms of C. glabrata depending on various oxygen levels. We performed C. glabrata adhesion assays to Caco-2 cells under aerobic, microaerobic (5 vol% oxygen), and anaerobic conditions, conducted RNA-seq to identify candidate genes functioning on hypoxic adhesion. We then generated deletants of these genes and evaluated both their adhesion to Caco-2 cells under anaerobic conditions and their colonization ability in the hypoxic intestinal tract in a mouse model. We observed significant differences in Caco-2 cell adhesion in response to different oxygen levels. Under hypoxic conditions, the C. glabrata adhesion capability increased and the expression levels of seven adhesion-related genes were up-regulated. Among these mutants, the adhesion capability of epa6 Δ decreased the most. The epa6 Δ mutant exhibited significantly lower intestinal colonization in mice than the wild-type. To the best of our knowledge, this study first describes the hypoxic adjustment of C. glabrata to intestinal cell adhesion, in which EPA6 plays the most significant role. If Epa6p function could be inhibited, it may contribute to reducing endogenous infection. Phenotype investigation under hypoxic conditions could provide valuable novel insights into the host-pathogen interaction mechanisms. Author Summary Candida glabrata is the second most common pathogen of Candida infections (i.e., candidiasis), colonizing mucocutaneous membranes, indwelling medical devices, thereby causing bloodstream- and medical device-related infections and often leading to high morbidity and mortality. Candidiasis could be of endogenous and exogenous origins. Endogenous infections are considered to derive from the invasion of Candida species colonizing the digestive mucosa. Investigations of the gut-to-bloodstream colonizing and translocation mechanisms of Candida species remain limited. Interestingly, recent studies suggest that environmental oxygen levels could alter the human fungal pathogen phenotypes. This study thus focused on the relationship between the colonization and adhesion capability of C. glabrata in the gastrointestinal tract depending on the environmental oxygen level to address the underlying mechanisms. Our results suggest that anaerobic conditions promote C. glabrata adhesion and EPA6 plays a significant role in hypoxic adhesion, opening new perspectives in various affiliated fields and related research domains. If Epa6p function could be inhibited, it may contribute to control the colonization in the gut and following translocation. C. glabrata is known to be low-susceptible to azole antifungals. A novel antifungal agent type, such as one targeting these adhesive molecules, should thus be considered and further related studies would be necessary. ### Competing Interest Statement The authors have declared no competing interest.