Excessive use of antifungal agents has been implicated in the emergence of antifungal resistance in
C. albicans and constitutes a serious clinical problem in hospitals by affecting the natural balance of the intestinal microflora in these individuals
[15]. The non-pathogenic yeast, Sb, which is widely prescribed for the treatment of antibiotic-induced gastrointestinal disorders and
Clostridium difficile-associated enteropathies, has been shown to be an alternative approach to counterbalance the equilibrium of the intestinal microflora and modulate the innate immune defence
[16],
[17]. Orally administered Sb was successful in both the treatment of inflammatory bowel disease (IBD) and the elimination of
C. albicans colonization
[7],
[8],
[18]–
[21].
Recently, it has been shown that Sb decreases both
C. albicans colonization and intestinal inflammation in a mouse model of DSS-induced colitis
[6]. Following this study,
S. cerevisiae strains, MP and β-glucan fractions were screened in a mouse model of DSS-induced colitis. As Sb is considered taxonomically to be a strain of
S. cerevisiae
[12],
[13], strain Sc1-1 was compared to Sb in the DSS model. Sc1-1 is a gastro-resistant strain that reacts rapidly to its environment and is widely used in the food industry. Incidentally, it was observed that both Sc1-1 and Sb strains reduced
C. albicans filamentation
in vitro and
C. albicans adhesion to plastic-plate wells (data not shown). In the present study, we did not chose a prophylactic but a curative model in which the animals develop colitis with histological features that are similar to those seen in patients with IBD before starting their treatment.
In this model low doses of DSS were used in order to establish C. albicans colonization, followed by S. cerevisiae or yeast extracts administration to assess their effects on the inflamed colon and colonic epithelium restitution.
Two weeks of DSS administration were scheduled to induce moderate colonic inflammation in mice, with low mortality rates. A recent study by Samonis et al. showed that mice receiving a high daily oral dose of
C. albicans (around 10
8 CFU/day) for 2 weeks did not respond to Sb treatment
[22]. In our model, a single inoculum of
C. albicans was used and
Candida colonization was maintained naturally in the mouse gastrointestinal tract by the DSS-induced colitis since a high
C. albicans dose could dramatically hide the beneficial effect of Sb. In the present study, and similar to the Sb strain, Sc1-1 decreased both
C. albicans colonization and intestinal inflammation in terms of clinical and histological score and mortality. Another notable finding was the acceleration of colonic epithelium restoration in mice treated with these dietary yeasts leading to the absence of submucosal oedema and epithelial erosion. Mechanistically, a recent report on intestinal inflammation showed that Sb secretes motogenic factors that enhance intestinal epithelial cell restitution
[23].
Regarding the RT-PCR results, both Sb and Sc1-1 reduced the expression levels of pro-inflammatory cytokine TNF-α mRNA in the colonic mucosa with subsequent enhancement of IL-10 mRNA expression that inhibits intestinal injury
[24]. Additionally, different pro-inflammatory cytokines were investigated in this set of experiments and were consistent with TNF-α expression. Further investigation is required to determine the role of Th17/Treg responses in different sets of experiments
[25],
[26]. A recent study in patients with IBD showed that Sb reduced TNF-α production and significantly inhibited T-cell proliferation induced by intestinal inflammation
[19]. Generally, the biological activities of
S. cerevisiae in gastrointestinal inflammatory conditions are mediated through modulation of host pro-inflammatory responses not only by the whole yeast, but also by secreted factors able to interfere with host signalling molecules that control inflammation at different levels such as NF-κB
[27],
[28]. Sb produces a soluble anti-inflammatory factor that inhibits NF-κB activation and attenuates pro-inflammatory signalling in host cells. In addition, Sb stimulates IL-10 secretion from intraepithelial lymphocytes infected by
C. albicans and
Escherichia coli
[29]. As Sc1-1 was shown to be comparable to Sb and presents the same beneficial features against
C. albicans and intestinal inflammation, Sc1-1 was considered as the reference strain in the DSS model. To assess if the observed anti-inflammatory properties were strain-dependent, other
S. cerevisiae strains were selected deliberately for their high phenotypic diversity. The possible influence of yeast preparation process on anti-
C. albicans activity was also studied. Surprisingly, some strains had a dramatic effect in the DSS mouse model and the process of yeast preparation also had an influence on the yeast's biological properties
[30]. Each strain selected in this study was well characterized
in vitro in terms of cell growth, osmostress, fermentation, viability and metabolites. However, different factors could influence the biological activity of the strains when introduced by gavage in the DSS mouse model: (i) the resistance of the cell wall related to the yeast preparation process
[30]; (ii) the viability of the strain in the stomach, ileum and colon; (iii) its interaction with the microflora and intestinal mucosa
[31]; and (iv) its ability to produce soluble anti-inflammatory factors in the milieu triggering expression of mediators in the intestinal epithelium and cells of monocyte lineage present in the submucosae
[27]. Altogether, each strain has its own unique properties and supports specific activities within the host. The
in vitro findings, together with the results for all
S. cerevisiae strains analyzed in this study, suggest that Sc1-1 has beneficial biological activities reversing all aspects of colitis, including histological damage, diarrhoea and mucosal levels of the pro-inflammatory mediator TNF-α.
The cell wall is an essential structural component of yeast cells playing a central role in the interaction of yeasts with their environment. Unfortunately, the biological activities of S. cerevisiae cell wall components are still unclear in terms of C. albicans colonization and intestinal inflammation. Two components (MP and β-glucans) produced industrially were explored in our experimental model. With MP fraction administration, C. albicans colonization was not consistent with intestinal inflammation parameters, suggesting that MP fractions have differential effects on C. albicans colonization and intestinal inflammation. In contrast to MP fractions, GP fraction administration decreased the number of C. albicans CFUs concomitantly to all intestinal inflammation parameters.
Both of these components are known to be potent immunological activators, but their mechanisms of action are different and controversial
[32]–
[34]. As an example, both MP and β-glucans act positively on tumour cells and several microbial infections
[34],
[35]. Conversely, administration of β-glucans derived from
C. albicans has been shown to exacerbate arthritis in mice
[36]. Structurally, MP have extensive
N-and
O-linked mannosylation which serve as ligands for galectin-3 (Gal-3), mannose receptor and DC-SIGN on macrophages and dendritic cells
[37]. Different MP express β-Man epitopes, which have been identified as the principal ligand for Gal-3
[38]. In a previous study using the DSS model with
C. albicans, Gal-3 knock-out mice were less affected by intestinal inflammation and
C. albicans colonization than wild-type animals
[39]. Recently, it was shown that
C. glabrata deficient in β-Man was less virulent in DSS-treated mice as revealed by low clinical and histological scores and reduction of
C. glabrata colonization
[40]. β-glucans have affinities towards different receptors such as CD11b/CD18
[41], located on neutrophils, or Dectin-1 on macrophages
[42]. This results in β-glucan activation of cytokine production and in turn activation of adaptive immunity. Thus, β-glucans attenuate the impact of colitis compared to MP
[43].
As our results also showed a beneficial effect of β-glucans on inflammation/colonization, insoluble ghost yeast cells derived from
C. albicans containing β-glucans were prepared and compared to zymosan which is widely used in β-glucan studies where many investigators refer to it as β-glucan
[44],
[45]. Zymosan stimulates the production and activity of pro-inflammatory cytokines
[45]. Additionally, when chemically characterized zymosan containing only β-(1–3)-glucans was added to macrophage cells, the production of IL-10, reactive oxygen species (ROS) and TNF-α increased in a dose-dependent way
[46]. Bonifazi et al. demonstrated the capacity of zymosan to activate both inflammatory and tolerogenic dendritic cells (DCs) leading to the triggering of both Th17 and Treg cells
in vivo
[47]. Our observations showed that zymosan contains both mannans and β-glucans exposed together on the cell wall surface in comparison to
C. albicans ghosts that contain only β-glucans. This evidence prevented us from further studies on zymosan. Different observations showed that the biological activities of soluble β-glucans differ from those of cell-associated β-glucans
[32],
[48],
[49]. Ishibashi et al. showed that insoluble cell wall β-glucans induced intensive inflammatory and immunomodulating activities compared to soluble β-glucans
[49]. Following the β-glucan analysis, the chemical structure of the soluble β-glucan fraction derived from
C. albicans ghosts was characterized and its biological activities were tested in the DSS mouse model. Interestingly, orally administered β-glucans from
C. albicans decreased intestinal inflammation and
C. albicans colonization.Several reports show that β-glucan enhances the immune response and improves the clearance of pathogenic bacteria in animal models
[50]–
[52]; this supports our findings that smaller oligoglucosides derived from
C. albicans showed beneficial activities against
C. albicans and these results are comparable to β-glucans derived from
S. cerevisiae. However, it may also be hypothesized that these individual oligoglucosides could block receptors such as dectin-1 and CD11b/CD18 and prevent multivalent binding necessary for strong triggering of the inflammatory responses
[53]. Besides the importance of yeast molecules sensing for immune response, a third player may also possibly act in the general interplay. This is the mouse microbiota. Oligosaccharides are well known prebiotics active on the intestinal flora
[54],
[55], and although such a role has not been investigated for
C. albicans derived oligoglucosides it cannot be ruled out. Altogether, these results demonstrate that oligoglucosides behave differently from the original
C. albicans whole yeast cells in the DSS mouse model.
In summary, Sc1-1 was found to be comparable to Sb and had beneficial biological activities against C. albicans and intestinal inflammation. Clinical trials are currently being conducted with Sc1-1 and promising results have been seen in patients with IBD. In the second part of this study, we focused on cell wall components involved in direct contact with the host and demonstrated that, in contrast to MP, β-glucan fractions from either S. cerevisiae or C. albicans have a more potent anti-inflammatory effect against colonic colitis induced by DSS in mice. In conclusion, this study generated some progress in deciphering the nature of the yeast molecular components differentially favouring inflammation and/or C. albicans clearance. Future studies will include experiments on oligosaccharide administration to mice in order to determine how these glycans stimulate the growth of beneficial bacteria in the gut and boost the immune system providing therapeutic perspectives for digestive disorders and life-threatening fungal infections of endogenous origin.