bCandida species cause a variety of mucosal and invasive infections and are, collectively, the most important human fungal pathogens in the developed world. The majority of these infections result from a few related species within the "CUG clade," so named because they use a nonstandard translation for that codon. Some members of the CUG clade, such as Candida albicans, present significant clinical problems, whereas others, such as Candida (Meyerozyma) guilliermondii, are uncommon in patients. The differences in incidence rates are imperfectly correlated with virulence in animal models of infection, but comparative analyses that might provide an explanation for why some species are effective pathogens and others are not have been rare or incomplete. To better understand the phenotypic basis for these differences, we characterized eight CUG clade species-C. albicans, C. dubliniensis, C. tropicalis, C. parapsilosis, Clavispora lusitaniae, M. guilliermondii, Debaryomyces hansenii, and Lodderomyces elongisporus-for host-relevant phenotypes, including nutrient utilization, stress tolerance, morphogenesis, interactions with phagocytes, and biofilm formation. Two species deviated from expectations based on animal studies and human incidence. C. dubliniensis was quite robust, grouping in nearly all assays with the most virulent species, C. albicans and C. tropicalis, whereas C. parapsilosis was substantially less fit than might be expected from its clinical importance. These findings confirm the utility of in vitro measures of virulence and provide insight into the evolution of virulence in the CUG clade.
Candida species are the most important fungal pathogens of humans and are collectively responsible for a vast number of infections. These range from superficial mucosal infections such as vulvovaginal candidiasis, and oropharyngeal thrush, to lifethreatening infections such as disseminated hematogenous and invasive candidiasis. These latter infections have steadily increased in incidence in the last 30 years and are associated with a stubbornly high mortality rate as a result of the underlying immunodeficiency of the patients and inadequate diagnostics and treatments (1).Of the approximately 150 species in the genus, 95% of infections are caused by just four species: C. albicans, C. tropicalis, C. parapsilosis, and C. glabrata (2-4). C. albicans is the dominant species, representing about half of disseminated disease and an even greater percentage of mucosal infections. Other clinically relevant species include Clavispora lusitaniae (anamorph: Candida lusitaniae), M. guilliermondii (anamorph: Candida guilliermondii), C. krusei, and C. dubliniensis, while D. hansenii (synonym: Candida famata) and Lodderomyces elongisporus are subjects of rare clinical reports. Because the genus Candida is polyphyletic, a better sense of evolutionary relationships comes in the "CUG clade," a grouping of species that use an alternative genetic code in which that codon specifies serine rather than leucine (5, 6). The CUG clade encompasses ...