Candida albicans is a major invasive fungal pathogen of humans and can cause both mucosal and disseminated infections. Infections of the oral mucosa in particular, called oropharyngeal candidiasis (OPC), affect HIV patients (
41), diabetes patients (
51), and head and neck cancer patients receiving radiation therapy (
1,
39,
48). Our goal is to define the attributes of
C. albicans that make it a successful oral pathogen.
Mucosal infections may be considered biofilms, in that the pathogen adheres to a surface and produces an extracellular matrix (
15,
39). This analogy has prompted investigations that test the hypothesis that genes required for biofilm formation
in vitro may be required for mucosal infection as well. Findings from these studies have underscored the utility of this perspective, in that there are several common genetic requirements for the formation of abiotic surface biofilms and mucosal infections (
10,
11,
15,
19).
One of the central regulators of biofilm formation is the zinc finger transcription factor Bcr1. It was identified in screens for mutants defective in biofilm formation on abiotic surfaces (
33–
35) and in adherence to a silicone substrate (
14). Bcr1-dependent genes have been defined under
in vitro growth conditions (
14,
33–
35). Many are cell surface protein genes, including
ALS1,
ALS3, and
HWP1. These three genes are major functional Bcr1 targets, in that they are required for abiotic surface biofilm formation, and their overexpression restores biofilm formation in
bcr1Δ/Δ mutant backgrounds (
33,
34).
Transcription factors like Bcr1 have long been used to define the functional basis of pathogenicity traits (
8,
27,
42). One strength of this approach comes from the fact that virulence potential may arise from expression of gene families or other gene sets with overlapping functions. Because transcription factors often control functionally related target genes, a single transcription factor defect can abolish a function that is carried out by redundant genes. One weakness of this approach comes from the fact that the spectrum of transcription factor target genes may be contingent upon environmental conditions. Thus, the gene expression impact of a transcription factor in an infection setting may be different from its impact
in vitro. In fact, there are now several examples in which a target gene is expressed in colonization or infection samples independently of a transcriptional regulator that was defined by
in vitro assays (
24). Moreover, this limitation is not restricted to transcription factors, since almost any genetic perturbation has gene expression consequences (
22) that may contribute to a mutant phenotype.
Clearly it is critical to assess pathogen gene expression
in vivo during infection, and several prior studies have done so (
2,
18,
21,
29,
36,
38,
47,
49,
52,
54). Relevant to oral
C. albicans infection, there has been a quantitative reverse transcription (QRT)-PCR analysis of
C. albicans gene expression in a gnotobiotic pig OPC model (
50), which revealed that
ECE1 RNA accumulated at very high levels during infection. There have also been microarray analyses of both reconstituted human epithelial (RHE) infection and OPC patient samples (
31,
54). The most highly upregulated genes in these contexts, compared to
in vitro yeast extract-peptone dextrose (YPD)-grown cells, included the cell surface protein genes
ALS3 and
HWP1. All three of these genes—
ECE1,
ALS3, and
HWP—require Bcr1for expression under
in vitro growth conditions (
35). These findings suggested that Bcr1 may be required for OPC. Indeed, a recent analysis in a murine OPC model has shown that Bcr1 is required for infection (
11). In that context, Bcr1 seemed to act through
HWP1, because overexpression of
HWP1 significantly improved virulence of the
bcr1Δ/Δ mutant. These findings were consistent with previous biochemical and functional analysis of Hwp1, which has shown that it is required for OPC in transgenic immunocompromised mouse models and that it is an epithelial adhesin (
44,
45). Overexpression of
ALS3 also improved virulence by qualitative assay (
11), though quantitative measures did not reach significance thresholds. The overall results suggested that Bcr1 is required for both
ALS3 and
HWP1 expression during OPC, a functional relationship similar to that described
in vitro (
35).
Here we have looked at gene expression during OPC to understand the basis for the
bcr1Δ/Δ mutant phenotype. Our study has been aided by new technology, the nanoString nCounter, which has sensitivity on par with that of real-time RT-PCR yet is capable of profiling over 100 genes per sample (
17). We expected that this assay platform may be useful for infected tissue samples, because it enables selective assay of pathogen gene expression despite the presence of abundant host RNA. This issue has previously been recognized as a major impediment to analysis of infection-related gene expression (
2). Our findings indicate that many genes that are Bcr1 dependent
in vitro are still expressed in the mutant during infection. These results suggest that a Bcr1 bypass pathway may function
in vivo to activate shared target genes. In a broader context, our results emphasize the value of mutant gene expression profiling
in vivo as a way to understand gene function during infection.