journal article·2026-06-28Open access

Calcineurin‐Dependent Stress Adaptation Enables Caspofungin Heteroresistance Leading to Stable Resistance in Candida Glabrata

Yanyu Su, Yi Li, Meng Xiao, Dan Guo, David S. Perlin, Erika Shor, Yingchun Xu, Yingxing Li

Abstract

ABSTRACT Antifungal heteroresistance has emerged as a clinical challenge across diverse species. In Candida glabrata , however, it has rarely been reported. Here, we characterized heteroresistance in a multicenter collection of 156 C. glabrata isolates, revealing a 25% prevalence with caspofungin specificity and 37°C dependent phenotypes. Transcriptomic profiling of the heteroresistant subpopulation under escalating drug pressure revealed an adaptive program centered on cell cycle and cell wall integrity, including several members of the calcineurin pathway. Mechanically, we identified that the phenotype was abolished by pharmacological inhibition or Δ cnb1 , Δ crz1 genetic deletion, confirming the regulatory role of calcineurin. Crucially, heteroresistance functioned as a reservoir for resistance, with in vitro descendant strains spanning a spectrum of MIC alterations. Mechanistically, we found the heteroresistance phenotype mostly independent of aneuploidy. To decipher the genetic basis, we applied an unbiased machine‐learning framework to genomic data, which not only identified the canonical FKS2_F659del mutation but also prioritized novel candidate PIR2_G149_I167del , demonstrating its power to uncover drivers of resistance from complex datasets. In summary, our study established a stepwise model of heteroresistance in C. glabrata , wherein calcineurin serves as a master regulator that promotes a resistance reservoir, revealing a potential vulnerability that could be exploited to prevent treatment failure.
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Research context

OpenAlex topics: Antifungal resistance and susceptibility · Signaling Pathways in Disease · Fungal and yeast genetics research

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Laboratory Medicine State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

Graduate School Chinese Academy of Medical Science and Peking Union Medical College Beijing China

National Infrastructures for Translational Medicine Institute of Clinical Medicine Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

State Key Laboratory of Complex Severe, and Rare Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

Clinical Biobank Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

Center For Discovery and Innovation Hackensack Meridian Health 111 Ideation Way Nutley New Jersey USA

Biomedical Engineering Facility of National Infrastructures for Translational Medicine Institute of Clinical Medicine Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China

Funding

National Science and Technology Major Project

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