Antagonism of the azoles to olorofim and cross-resistance are governed by linked transcriptional networks in Aspergillus fumigatus

Abstract

Aspergillosis, in its various manifestations, is a major cause of morbidity and mortality. Very few classes of antifungal have been approved for clinical use to treat these diseases and resistance to the first line therapeutics is increasing. A new class of antifungals, the orotomides, are currently in development with the first compound in this class olorofim in late-stage clinical trials. In this study, we characterise a network of genes that govern olorofim response in A. fumigatus. We reveal that the number of transcription factors that regulate olorofim susceptibility are far fewer than we have previously observed for the azoles and the change in sensitivity observed in these isolates is less extreme. Intriguingly, loss of function in two higher order transcriptional regulators, HapB a member of the heterotrimeric HapB/C/E (CBC) complex or the regulator of nitrogen metabolic genes AreA, leads to cross resistance to both the azoles and olorofim. However, a clinical azole resistant isolate with a point mutation in HapE (hapEP88L) retains sensitivity to olorofim. Our transcriptomic analysis suggests that altered sensitivity to olorofim may emerge via modification of genes involved in the production of pyrimidine biosynthetic precursors. Finally, we also show that the action of the azoles are antagonistic to olorofim in vitro.