Changes of Gene Expression in Candida albicans Isolates from Vaginal Infections by Effects of Zinc Oxide Nanoparticles and Fluconazole

Background: There are serious challenges of drug resistance in Candida albicans infection. Therefore, it is essential to identify new antifungal agents against resistant species to effectively treat patients affected by these species. Objectives: The present study aimed to study how zinc oxide nanoparticles (ZnO-NPs) and fluconazole affected the genes encoding resistance to fluconazole (i.e., CDR2 and ERG11) and those encoding adhesins (i.e., ALS1 and HWP1) in C. albicans isolates. Methods: In this descriptive-analytic study, samples of 120 patients with vaginitis were obtained using sterile swabs. After the identification of C. albicans strains, the fluconazole-resistant candida isolates were treated with various sub-minimum inhibitory concentrations of ZnO-NPs, fluconazole, and a combination of ZnO-NPs and fluconazole. Then, the effects of ZnO-NPs and fluconazole on the expression levels of ALS1, HWP1, CDR2, and ERG11 genes were evaluated by real-time polymerase chain reaction. Results: In this study, 50 out (41.6%) of 120 species with C. albicans were isolated, and 13 (26%) of 50 species were resistant to fluconazole. The expression analysis of fluconazole-resistant C. albicans strains showed that the expression of HWP1 and ALS1 genes was decreased by 2.84 and 1.62 times (P 0.05), respectively. Nevertheless, the expression of CDR2 increased 1.42 - fold after the treatment with fluconazole. The expression of ERG11, CDR2, HWP1, and ALS1 in isolates treated with the combination of ZnO-NPs and fluconazole was downregulated by 2.1, 5.9, 3, and 5.5 times, respectively, compared to that of the control group. Conclusions: Based on the results, ZnO-NPs are helpful for the treatment of vaginitis-related C. albicans isolates in combination with fluconazole.