, 1990; Beggs, 1994). In vitro exposure of planktonic cells to amphotericin B often leads to a repression of ERG3 and ERG11 expression and a

concomitant decrease in ergosterol levels in the membrane, indicating that changes in the sterol composition are important for amphotericin B resistance in C. albicans (Liu et al., 2005). Furthermore, changes in the expression of genes involved in β-1,6-glucan EPZ-6438 nmr biosynthesis (including SKN1 and KRE1) have also been proposed as a resistance mechanism against polyene antifungals (Gale, 1986; Mio et al., 1997; Liu et al., 2005). Antifungal resistance in C. albicans biofilms is a complex phenomenon, and like in planktonic cells, multiple mechanisms appear to be involved (Kuhn & Ghannoum, 2004). It was reported that efflux pumps are highly expressed in young biofilms (Ramage et al., 2002; Mukherjee et al., 2003; Mateus et al., 2004), even in the absence of an antifungal agent. However, the expression of genes encoding efflux pumps (CDR and MDR family) seems to be model system and/or strain dependent as CDR and MDR genes were not found to be overexpressed in the transcriptome studies of Garcia-Sanchez et al. (2004) and Murillo et al. (2005).

Nevertheless, some genes (including QDR1 and CDR4) appeared to be overexpressed in the study by Yeater et al. (2007) and other genes (including CDR2 at 12 h and MDR1 at 12 and at 24 h) were overexpressed in the in vivo model described by Nett et al. (2009). Reduced ergosterol levels (combined with Selleckchem Ponatinib increased levels of other sterols) also provide a possible resistance mechanism in biofilms (Mukherjee

et al., 2003) and changes in the expression levels of ERG genes were observed in several studies (Yeater et al., 2007; Nett et al., 2009). These changes probably lead to changes in the sterol composition of the cell membrane and may have a profound impact on antifungal resistance. Khot et al. (2006) and LaFleur et al. (2006) showed that resistant subpopulations (persisters) are present in C. albicans biofilms. Using untreated biofilms, Khot et al. (2006) compared the less-resistant, crotamiton shear-removed, fraction of the biofilm with the basal blastospore subpopulation. In the latter, a marked downregulation of the ERG1 gene was observed, probably resulting in an overall downregulation of the ergosterol biosynthesis (remarkably, the expression of ERG11 was not altered). SKN1 and KRE1 were markedly upregulated in this resistant subpopulation. These changes in gene expression likely contributed to the observed amphotericin B resistance. When C. albicans biofilms in various stages of growth were treated with very high doses of fluconazole, an overexpression of genes involved in the ergosterol biosynthesis (ERG1, 3, 11 and 25) was observed, whereas after exposure to amphotericin B, an upregulation of SKN1 and KRE1 was observed. The transcriptional changes in sessile C.