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      Malassezia Yeasts: How Many Species Infect Humans and Animals?

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          Abstract

          The Main Significance of Malassezia Yeasts and Their Position in the Tree of Life Malassezia species are lipophilic yeasts that are members of the normal mycobiota of the skin and mucosal sites of a variety of homeothermic animals. They are also among the few basidiomycetous fungi, such as some Cryptococcus spp., Rhodotorula spp., and Trichosporon spp., that can produce disease in man and animals. However, in contrast with these other species, which are quite often involved in disseminated infections in immunosuppressed patients, Malassezia yeasts are associated mainly with certain skin diseases [1]. This special lipophilic group of yeasts is unique among the fungi. Phylogenetically, they form a well-defined cluster of skin-living yeasts, surrounded by plant pathogens and phylloplane-inhabiting fungi (e.g., Ustilago, Tilletiopsis). However, the taxonomic position of the genus Malassezia in the classes of the phylum Basidiomycota is not yet totally well defined. Moreover, the sexual form of these yeasts is still unknown. Recently, a region corresponding to the mating type locus (MAT) has been identified for these yeasts, and it has been suggested that if there is an extant sexual cycle for some of these yeasts that it is more likely to be bipolar, with just two mating types, rather than tetrapolar, with many mating types [2]. In the last higher-level fungal phylogenetic classification revision [3], the monophyletic genus Malassezia was the only genus included in the order Malasseziales, which has an uncertain taxonomic position in the subphylum Ustilagomycotina (e.g., smut fungi). Very recently, the class Malasseziomycetes has been proposed to accommodate these fungi (2013, provided from an anonymous reviewer; unreferenced). They are taxonomically distant to the orders which include the other commented pathogenic basidiomycetous yeasts of the genera Cryptococcus (Filobasidiales) and Trichosporon in Agaricomycotina (e.g., mushrooms) and of the polyphyletic genus Rhodotorula (Sporidiobolales and Cystobasidiales) in Pucciniomycotina (e.g., rust fungi). Spectrum of Malassezia Species That Infect Humans and Animals At present, the genus Malassezia includes 14 species ([4]; Table 1), all of which infect or colonize humans or animals. However, until the late 1980s, this genus remained limited to only to two species; one of these, M. furfur (sensu lato), was considered a heterogeneous group of lipid-dependent yeasts living on human skin and requiring long-chain fatty acids to grow, while the lipophilic but non–lipid-dependent species M. pachydermatis was restricted to animal skin. The latter is the only species in the genus that does not require lipid supplementation for development in culture medium. M. sympodialis, a lipid-dependent species isolated from human skin, was the third species accepted in the genus, a century after the description of M. furfur [5]. Later, the genus Malassezia was revised on the basis of morphological, physiological, and rRNA gene sequencing studies, and four new lipid-dependent species were described [6]. At the same time, different studies [7]–[9] confirmed that the skin of healthy animals could also be colonized by lipid-dependent species, in addition to the non–lipid-dependent species M. pachydermatis. These lipid-dependent species are the major component of the lipophilic mycobiota occurring on the skin of horses and various ruminants [10]. Some of these yeasts isolated from animals were described subsequently as new species, such as M. nana [11], M. equina, or M. caprae [12]. Nowadays, Malassezia yeasts have been isolated from almost all domestic animals, different wild animals held in captivity, and also from wildlife [1]. Despite this, the occurrence of Malassezia yeasts on the skin of most animals remains unknown. The observed host specificity of some of these species made it possible to anticipate an increase in the number of new species in this genus, particularly if other animal species, mainly wild species, were studied. 10.1371/journal.ppat.1003892.t001 Table 1 Current described Malassezia species, authorities, year of the description, and their main hostsa [24]. Malassezia species Main host/others M. furfur, (Robin) Baillon, 1889 Man/cow, elephant, pig, monkey, ostrich, pelican M. pachydermatis, (Weidman) Dodge, 1925 Dog, cat/carnivores, birds M. sympodialis, Simmons & Guého, 1990 Man/horse, pig, sheep M. globosa, Midgley et al., 1996 Man/cheetah, cow M. obtusa, Midgley et al., 1996 Man M. restricta, Guého et al., 1996 Man M. slooffiae, Guillot et al., 1996 Man, pig/goat, sheep M. dermatis, Sugita et al., 2002 Man M. japonica, Sugita et al., 2003 Man M. nana, Hirai et al., 2004 Cat, cow/dog M. yamatoensis, Sugita et al., 2004 Man M. caprae, Cabañes & Boekhout, 2007 Goat/horse M. equina, Cabañes & Boekhout, 2007 Horse/cow M. cuniculi, Cabañes & Castellá, 2011 Rabbit a Cited only those species confirmed by rDNA sequencing analysis. Malassezia Yeasts and Disease The pathogenic role of Malassezia yeasts in skin diseases has always been a matter of controversy. Commensal Malassezia yeasts are clearly implicated in human skin diseases without the presence of inflammation but with heavy fungal load, such as pityriasis versicolor. They are also associated with other skin disorders with characteristic inflammation, such as seborrheic dermatitis, atopic dermatitis, folliculitis, and psoriasis, where their role in the pathogenesis is less clear and, in some cases, speculative [13]. Emerging evidence demonstrates that the interaction of Malassezia yeasts with the skin is multifaceted and entails constituents of the fungal wall, enzymes, and metabolic products, as well as the cellular components of the epidermis. Some skin disorders can be exacerbated by the interactions between Malassezia yeasts and the host immune system [2]. Although M. globosa was initially reported to be the main species associated with pityriasis versicolor, subsequent studies have shown that the distribution of Malassezia species from healthy and diseased skin is equivalent, thus failing to substantiate the existence of a pathogenic species not only in pityriasis versicolor but also for the other Malassezia-associated diseases. M. globosa and M. restricta are the most commonly found species on healthy and diseased human skin [14]. However, other species such as M. sympodialis or M. furfur have been also associated with various human skin disorders [15]. On the other hand, mainly M. furfur and M. pachydermatis have been reported to be the cause of a low percentage of yeast systemic infections. However, fungemia produced by these yeasts may be underdiagnosed by modern automated blood systems for fungal detection if culture media with lipids are not included in the diagnostic protocol [16]. The majority of published case reports and miniepidemics have involved infants, children, and adults with profound immunosuppression, serious concurrent health problems, and the infusion of total parenteral nutrition with lipid supplementation through central vascular catheters. The main ingredients of this nutrition system (i.e., linoleic, oleic, and palmitic acids) are potent growth stimulants for Malassezia species [15]. Skin colonization by Malassezia species of healthy human neonates does not include M. pachydermatis, whereas the occurrence of other species such as M. sympodialis and M. globosa begins at birth and increases in the first weeks of life. [17]. This fact corroborates the animal origin of M. pachydermatis in human infections. Furthermore, it should be noted that zoonotic transfer of M. pachydermatis has been documented from dogs to neonates by healthcare workers who own dogs [18]. M. pachydermatis, the only species in the genus that does not require lipid supplementation for development in culture medium, is considered to be zoophilic, and is frequently found on wild and domestic carnivores. This species is usually associated with otitis externa and different kinds of dermatitis in domestic animals, especially in dogs (Figure 1). This species is more frequently isolated from dogs than cats and appears to be a relatively infrequent pathogen in other animals. This yeast seems to have an opportunistic nature, and it may become pathogenic with any detected alteration in the skin surface microclimate or in the host defense. In some canine breeds, hypersensitivity conditions such as flea allergy dermatitis, food hypersensitivity or atopy, and antimicrobial or corticosteroid therapy may be factors favoring proliferation of these yeasts. Lipid-dependent species seem to be found more frequently in cats than in dogs, but very little is known about their pathogenic role in animal skin [19]. 10.1371/journal.ppat.1003892.g001 Figure 1 Gram stain of a smear (A) and culture (B) from an otic swab of a dog with otitis externa, showing numerous M. pachydermatis cells (A) and colonies (B). This species is a controversial pathogen that is now recognized as an important cause of dermatitis and otitis externa in dogs. Author: F. Javier Cabañes. Difficulties in Determining the Biodiversity and Significance of Malassezia Yeasts The study of some Malassezia yeasts continues to be difficult, due mainly to their low viability and lack of suitable methods for their isolation and preservation. The majority of yeasts can be stored at temperatures between 4 and 12°C and subcultured at intervals of 6 to 8 months. However, Malassezia spp. do not fit this pattern. Freezing at −80°C is the only successful method to maintain viable all Malassezia spp., particularly M. globosa, M. restricta, and M. obtusa, which have been reported as difficult species to maintain in vitro [20]. In most surveys, these yeasts have been identified only on the basis of phenotypic characteristics without confirmation through molecular analysis. Difficulties remain in obtaining a high level of certainty in the identification of some lipid-dependent strains by means of physiological tests (e.g., Tween physiological tests) without molecular characterization. Although some Malassezia yeasts may be distinguished using these tests, sequencing of some genes (e.g., ITS-5.8S and D1D2 26S rRNA, β-tubulin) [4] or the use of new tools such as MALDI-TOF mass spectrometry [21] are necessary for a proper identification. Recently, the spectrum of fungal species in the human skin has been explored using culture and culture-independent methods [22]. In this study, Malassezia yeasts predominated on most of the sampled body sites. Moreover, 11 of the 14 species (all of them, with the exception of M. caprae, M. cuniculi, and M. equina) (2013 letter from K. Findley to me; unreferenced) were directly identified by rRNA gene sequencing from different clinical samples of ten healthy volunteers. Other DNA sequences that may represent unidentified Malassezia spp. were also detected. Some species predominated in certain body sites (e.g., M. globosa on the back). Using culturing methods, apparently the most abundant Malassezia species on human skin (e.g., M. globosa, M. restricta, and M. sympodialis) were isolated in this study. These authors [22] used only Sabouraud glucose agar (SGA) with olive oil containing chloramphenicol and cycloheximide for recovering Malassezia species from different body sites. The use of SGA overlaid with olive oil has been used frequently in the past, but only some Malassezia species grow well on this medium [23], [24]. For an exhaustive survey, the samples must be inoculated onto more complex culture media, such as modified Dixon agar (mDA) or Leeming and Notman agar (LNA), which facilitate the recovery of the more fastidious Malassezia species from the skin. These culture media include, among other ingredients, a mixture of fatty acids such as oleic acid, whole-fat cow milk, and some polyoxyethylene sorbitanesters (e.g., Tween 40, Tween 60). However, the exact nutritional requirements of Malassezia species in culture are yet to be fully determined, and this hinders the study of these yeasts. Moreover, it is difficult and expensive to obtain fatty acids of sufficient purity to fully establish the fatty-acid requirements of each Malassezia species [25]. A recent example of the difficulties inherent to the recovery of these fastidious yeasts from the skin is M. cuniculi. In the description of this species [26], only a few lipid- dependent Malassezia yeasts were recovered from two of the 11 rabbits investigated. They grew scarcely on LNA and no growth was obtained either on mDA or SGA. They were also not able to grow on glucose peptone agar supplemented with Tweens (20, 40, 60, and 80) and Cremophor EL as sole sources of lipids, which are used to phenotypically characterize these species [6], [27]. This inhibition of growth may be related to the toxic effects of these mixtures of fatty acids at higher concentrations. LNA contains, among other components, Tween 60 at a 10-fold lower concentration (0.05%) than that used in the Tween physiological tests [6]. In other recent surveys performed in soil nematodes [28], marine sponges [29], and coral colonies [30], Malassezia yeasts have been tentatively identified exclusively on the basis of some genotypic characteristics by culture-independent methods. However, although other habitats for Malassezia yeasts may exist, their significance and the real identity of these yeasts still remain unknown.

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          The genus Malassezia with description of four new species.

          The genus Malassezia has been revised using morphology, ultrastructure, physiology and molecular biology. As a result the genus has been enlarged to include seven species comprising the three former taxa M. furfur, M. pachydermatis and M. sympodialis, and four new taxa M. globosa, M. obtusa, M. restricta and M. slooffiae. The descriptions of all the species include morphology of the colonies and of the cells, together with ultrastructural details. The physiological properties studied were the presence of catalase, the tolerance of 37 degrees C and the ability to utilize certain concentrations of Tween 20, 40, 60 and 80 as a source of lipid in a simple medium. Information is given for each of the taxa on mole% GC and also the rRNA sequence from the comparison previously described for the genus.
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            Malassezia Fungi Are Specialized to Live on Skin and Associated with Dandruff, Eczema, and Other Skin Diseases

            Introduction Malassezia is a monophyletic genus of fungi found on the skin of 7 billion humans and associated with a variety of conditions, including dandruff, atopic eczema (AE)/dermatitis, pityriasis versicolor, seborrheic dermatitis, and folliculitis ([1], [2]; Figure 1). In immunocompromised hosts Malassezia can also cause systemic infections. There are 14 currently recognized species of Malassezia, eight of which have been associated with humans, four of these commonly [3]. Malassezia spp. are Basidiomycetous fungi, as are most species of fungi readily seen on a walk through the forest. Among the Basidiomycota, only Malassezia and Cryptococcus are frequent human pathogens. However, their adaptations to humans are presumed to be independent: Malassezia's closest relatives are plant pathogens: the smuts and rusts, whereas the closest relatives for Cryptococcus pathogenic species are fungal saprotrophs associated with trees and insects. We summarize here a cellular and molecular description of some interactions of Malassezia with humans and speculate on properties (release of allergen-containing nanovesicles, mating) that may be critical to Malassezia virulence. 10.1371/journal.ppat.1002701.g001 Figure 1 Malassezia phylogeny, impact on human skin, and mating type (MAT) locus. (A) An ITS sequence-based phylogenetic tree of 14 Malassezia species inferred using neighbor joining method and a 500 replicate bootstrap analysis. Closely related Ustilago maydis and Cryptococcus neoformans were used as outgroups. (B) Malassezia-associated dandruff (photograph by Holly Krigbaum). (C) M. globosa MAT locus, comprising the bW- and bE-encoded transcription factors (the b locus) and genes for a pheromone and pheromone receptor (the a locus). What Is Known about the Gene Content of Malassezia? A genome sequence of Malassezia globosa reveals as small a genome size as any free-living fungus, with only 4,285 genes and spanning just ∼9 Mb [4]. This small genome size may reflect adaptation to the organisms' limited niche, the skin of warm-blooded vertebrates [5]. While many of the genes for biosynthetic enzymes are present, M. globosa is the only free-living fungus known to lack a fatty acid synthase gene [4]. With a plethora of lipase genes, M. globosa likely satisfies its lipid requirement by hydrolysis of sebum triglycerides. Within the genus, only Malassezia pachydermatis, isolated from dogs and other non-human animals [5], is known to grow in the absence of exogenous lipid [1]. It will be interesting to learn whether this atypical species contains a fatty acid synthase gene similar to that found in the close relative Ustilago maydis and whether the habitat requirements of M. pachydermatis are, as a consequence, less stringent by relieving the requirement for exogenous lipids. While it is possible to culture Malassezia species axenically under laboratory conditions by providing exogenous lipids that mimic those available on human skin, some species are still quite fastidious, suggesting in vitro culture conditions may not be optimized. Are Malassezia Species Related to Dermatophytes or Other Fungi Living on Vertebrate Skin? Strictly no, despite the similarity of habitat. Dermatophytes such as Trichophyton rubrum, the cause of athlete's foot infections, colonize and infect the skin and nails. The dermatophytes are ascomycetous fungi that are related phylogenetically to the dimorphic fungal pathogens. By contrast, the Malassezia species are superficial commensals of the skin but can provoke inflammatory reactions resulting in symptomatic skin diseases (folliculitis, dandruff, eczema) in humans and other animals. Yet a third fungal pathogen of animal skin is Batrachochytrium dendrobatidis, a chytrid fungus found on frog skin and associated with amphibian population declines and even species extinction events throughout the world [6]. This chytrid fungus is from a basal group of fungi, quite phylogenetically divergent from either dermatophytes or Malassezia [7]. A fourth fungal pathogen of animal skin is Geomyces destructans, an ascomycete associated with white-nose syndrome and mortality of bats [8]. All four groups of fungi have been subject to whole genome analysis ([4], [9], [10]; http://www.broadinstitute.org), and their comparisons may reveal convergent solutions to adapting to such a unique environment as animal skin. Are Malassezia Capable of Mating? Maybe! So far no sexual cycle has been observed for any of the 14 species of Malassezia. But they are phylogenetically related to the Ustilago genus of plant fungal pathogens, and these organisms are stimulated to complete their sexual cycle during infection of their plant hosts [11]. In turn, it is the U. maydis filamentous dikaryon produced by mating that is capable of infecting the host plant—the yeast form is not infectious. By analogy, the Malassezia species may complete their sexual cycle during growth on human skin. There is a precedent among fungi: skin was found to stimulate mating of Candida albicans [12]. As with U. maydis, mating may result in the production of novel Malassezia growth forms, such as hyphae, or differences in their secreted antigen repertoire. Based on whole genome analysis, a region corresponding to the mating type locus (MAT) has been identified for M. globosa, a species associated with dandruff [4]. One region encodes homeodomain transcription factors and the other a candidate pheromone and pheromone receptor, similar to other basidiomycete fungi, such as U. maydis. But interestingly, these two regions appear to be physically linked in M. globosa, which is more similar to the organization of the MAT locus of a related plant pathogen Ustilago hordei [13]. This suggests that if there is an extant sexual cycle for M. globosa that it is more likely to be bipolar with just two mating types, rather than tetrapolar with many mating types. Transitions from tetrapolar to bipolar mating configurations are common in the basidiomycetes, and may be the consequence of transitions from outbreeding to inbreeding as species specialize to a particular host niche [14]–[16]. The M. globosa genome also reveals other genes associated with sexual reproduction, such as those encoding key proteins required for meiosis [4]. Another indirect line of evidence that species in this genus may be sexual is the observation that certain lineages of Malassezia furfur appear to be hybrids, based on amplified fragment length polymorphism molecular analysis that reveals their genomes are a composite of two parental lineages [17]. These hybrids may have been produced by mating of isolates of opposite mating type. Next steps in the ongoing analysis of sexual potential will involve 1) population genetic tests for recombination as an indirect measure of sex, 2) direct tests of mating under laboratory conditions, 3) analysis of whether mating genes are expressed during fungal culture on skin, possibly leading to fungal sex occurring on our skin, resulting in virulence, and 4) characterization of the organization and allele diversity of the mating type locus. How Does Malassezia Interact with the Host? Unlike its phylogenetically close relative, U. maydis (the causative agent of corn smut), M. globosa has a paucity of glycosyl hydrolases, suggesting it lacks the carbohydrate-degrading capacity found in plant pathogens. In contrast, M. globosa and a phylogenetically distant relative, the ascomycete human pathogen C. albicans, have a similar set of multicopy genes encoding secreted enzymes, including lipases and acid sphingomyelinases [4], [18]. C. albicans can survive in several body sites, including the skin where M. globosa is found. This set of secreted enzymes may enable these fungi to survive and even thrive on human skin. Within the M. globosa genome, extracellular lipases, acid sphingomyelinases, aspartyl proteases, and phospholipases are encoded by clusters of similar genes, suggesting recent gene duplication [19]. While some of these enzyme families are known to be involved in fungal pathogenesis, development of transformation and homologous recombination approaches will be necessary to test the roles of these enzymes. Are there any beneficial effects for the host to harbor these yeasts on the skin? This isn't known, but many individuals have used anti-fungal treatment for decades or longer without problems. If the fungi do confer benefits, they are either modest or at sites other than the scalp. Since Malassezia species belong to the skin commensal flora, the host immune system will be regularly exposed to the fungi. IgG and IgM specific to Malassezia can be detected in healthy individuals [1]. The defective skin barrier in AE patients, both in lesional and non-lesional skin, fails to provide sufficient protection against microbes and allergens, facilitating interactions with Malassezia and the host immune system. Approximately 50% of adult patients with AE are sensitized to Malassezia reflected as allergen-specific IgE and T cell reactivity and/or positive atopy patch test reactions to the yeast [20]. Sensitization to Malassezia is most likely a combination of a dysfunctional skin barrier, genetic background, and environmental factors [21]. In addition, patients with AE lack appropriate induction of anti-microbial peptides, such as LL-37 and human beta-defensin-2 (HBD-2), which are produced in the skin as a first line of defense against bacteria, fungi, and some viruses, also suggesting an explanation for the frequent infections with Staphylococcus aureus in the skin of AE patients [22]. Moreover, the host interaction with Malassezia can stimulate the production of allergens. The release of Malassezia sympodialis allergens is indeed significantly higher at pH 6, reflecting the higher pH of skin from patients with AE compared to allergen release at pH 5.5, which is the normal skin pH [23]. Thirteen allergens from Malassezia species are reported to date by the official allergen nomenclature list (http://www.allergen.org). Interestingly, four of the M. sympodialis allergens, Mala s 1 and Mala s 7–9, encode proteins of unknown function without sequence homology to known allergens or to other known proteins [20]. Mala s 6, a cyclophilin, and Mala s 13, a thioredoxin, belong to a class of phylogenetically highly conserved proteins and are members of so called pan-allergen families. These proteins, together with Mala s 11 (a manganese-dependent superoxide dismutase), share a high degree of sequence identity to the corresponding human enzymes and might play an essential role in perpetuating skin inflammation of AE due to cross-reactivity [20], [24]. Human monocyte-derived DCs (MDDCs), as representatives of antigen presenting cells, can efficiently bind and rapidly internalize M. sympodialis as well as allergenic components from the yeast. This process is associated with maturation of the MDDCs, induction of lymphocyte proliferation, and of a Th2-like immune response. DCs can interact with natural killer (NK) cells in the skin, and M. sympodialis stimulates this interaction in patients with AE [25]. Furthermore, M. sympodialis enhances NK cell-induced DC maturation in healthy individuals [26]. NK and/or NKT cells might selectively eliminate DCs that have phagocytosed Malassezia before they activate the immune system, a function that might be impaired in AE. The dominating symptom in AE is severe itching, which provokes scratching and increased inflammation. Mast cells most likely play a central role in this vicious cycle. Fungal products like zymosan can activate mast cells through TLR2, and cross-linking of the high-affinity IgE receptor, FcεRI, on mast cells leads to the release of potent inflammatory mediators, such as histamine, proteases, chemotactic factors, cytokines, and arachidonic acid metabolites. Recent data show that M. sympodialis can activate mast cells to release cysteinyl leukotrienes, enhance the mast cell IgE response, modulate MAPK activation, and by signaling through the TLR-2/MyD88 pathway alter IL-6 production [27]. Thus, these effects of M. sympodialis on mast cells most likely contribute to the inflammation and itching in AE. A newly discovered route via which fungi interact with the host is the release of nanovesicles. M. sympodialis can release nanosized exosome-like extracellular vesicles with the capacity to induce inflammatory cytokine responses in both healthy individuals and patients with AE [28]. Theses vesicles can also carry allergen components from the yeast and induce significantly higher IL-4 production in patients with AE compared to healthy controls, suggesting that extracellular vesicles from M. sympodialis participate in host–microbe interactions in the pathogenesis of AE. Many anti-dandruff shampoos contain anti-fungal agents as the active ingredients, and these agents remove the scalp-associated fungi as the scalp flaking symptoms improve. The root causes of dandruff may be similar to that of AE. Individuals with dandruff may have a skin barrier defect, as shown by their increased susceptibility to an externally applied irritating fatty acid, oleic acid [29]. Malassezia may have multiple roles in aggravating a barrier defect, including the production of increased amounts of irritating fatty acids as a result of lipase-mediated hydrolysis of sebum triglycerides [29]. There are likely differences in the ways in which dermatophytes and Malassezia interact with their environment. For example, the dermatophyte Arthroderma benhamiae has 26 genes encoding polyketide synthases and non-ribosomal peptide synthetases [9], whereas M. globosa has one copy of each gene. A. benhamiae encodes a hydrophobin gene that may affect interaction with the host [9]. We have not found a hydrophin gene within the M. globosa genome. There are few animal models to explore the interaction of Malassezia with skin, although one could study natural infections of several non-human animals [5]. How Do People Treat or Eradicate Malassezia from Their Skin? The anti-fungal mechanism of action has recently been described for one commonly used anti-dandruff shampoo active ingredient, zinc pyrithione (ZPT). Based on the ionophore properties of pyrithione and the demonstrated increase in mammalian cell zinc levels upon ZPT treatment [30], it was expected that ZPT would act by delivering high intracellular zinc levels to inhibit fungal growth. With the use of Saccharomyces cerevisiae as a model yeast, ZPT was discovered instead to increase cellular copper levels, and genetics was used to demonstrate the biological activity of the elevated copper [31]. As is the case with copper-mediated growth inhibition in bacteria [32], [33], iron-sulfur clusters are the targets of ZPT. The role of copper in ZPT-mediated growth inhibition was also found with M. globosa, but the iron-sulfur theme was not tested due to experimental challenges with Malassezia. If these principles apply to the scalp, then the zinc from ZPT must be replaced by a scalp source of copper, either from the natural disintegration of skin cells or immune cells, which have been recently shown to exploit copper to control microbes [34]. Restoring the epidermal-barrier function and avoiding IgE sensitization are major targets for the prevention and treatment of AE [1]. It is important to stress that while there is some evidence that anti-fungal therapies may be of clinical benefit in patients with eczema associated with M. sympodialis, the vast majority of patients are treated with topical steroids or other immunosuppressive agents. For example, topical calcineurin inhibitors, including tacrolimus (Protopic) and pimecrolimus (Elidel), are commonly used to treat eczema based on their immunosuppressive properties. But these agents also inhibit fungal calcineurin, and exhibit anti-fungal activity that has been well documented for Malassezia species [35]. Thus, the efficacy of these topical agents may stem from a dual action to suppress host immune response and concomitantly inhibit growth of the fungus provoking host immune responses. Well-designed clinical trials are required to test this hypothesis. An alternative future treatment could be the use of selected cell-penetrating peptides, harmless toward mammalian cells but with anti-fungal activity [36]. Conclusion The study of host–pathogen interactions is more straightforward with skin pathogens than with systemic pathogens, as the pathogen is more easily studied in vivo. Malassezia are a ubiquitous component of the human skin microbiome and are associated with a myriad of skin problems, including dandruff in billions of people [37]. Malassezia are rarely found in places other than on animal skin, where they are such a common constituent of the flora that many (or possibly even all) warm-blooded animals harbor Malassezia on their skin. With the use of modern genomic and systems biology tools, we are poised to gain new insights in the interaction between humans and those eukaryotes with which we are most intimately associated, leading to perspectives on the duality of our symbiotic and antagonistic relationship.
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              Coral-associated marine fungi form novel lineages and heterogeneous assemblages.

              Coral stress tolerance is intricately tied to the animal's association with microbial symbionts. The most well-known of these symbioses is that between corals and their dinoflagellate photobionts (Symbiodinium spp.), whose genotype indirectly affects whether a coral can survive cyclical and anthropogenic warming events. Fungi comprise a lesser-known coral symbiotic community whose taxonomy, stability and function is largely un-examined. To assess how fungal communities inside a coral host correlate with water temperature and the genotype of co-occurring Symbiodinium, we sampled Acropora hyacinthus coral colonies from adjacent natural pools with different water temperatures and Symbiodinium identities. Phylogenetic analysis of coral-associated fungal ribosomal DNA amplicons showed a high diversity of Basidiomycetes and Ascomycetes, including several clades separated from known fungal taxa by long and well-supported branches. Community similarity did not correlate with any measured variables, and total fungal community composition was highly variable among A. hyacinthus coral colonies. Colonies in the warmer pool contained more phylogenetically diverse fungal communities than the colder pool and contained statistically significant 'indicator' species. Four taxa were present in all coral colonies sampled, and may represent obligate associates. Messenger RNA sequenced from a subset of these same colonies contained an abundance of transcripts involved in metabolism of complex biological molecules. Coincidence between the taxonomic diversity found in the DNA and RNA analysis indicates a metabolically active and diverse resident marine fungal community.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS Pathog
                PLoS Pathog
                plos
                plospath
                PLoS Pathogens
                Public Library of Science (San Francisco, USA )
                1553-7366
                1553-7374
                February 2014
                27 February 2014
                : 10
                : 2
                : e1003892
                Affiliations
                [1]Veterinary Mycology Group, Department of Animal Health and Anatomy, Veterinary School, Universitat Autònoma de Barcelona, Bellaterra, Catalonia, Spain
                Duke University Medical Center, United States of America
                Author notes

                The author has declared that no competing interests exist.

                Article
                PPATHOGENS-D-13-02998
                10.1371/journal.ppat.1003892
                3937305
                24586146
                ebfce615-7ec1-4d16-980a-99eb35ea0e4e
                Copyright @ 2014

                Javier Cabañes. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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                Pages: 4
                Funding
                This work was supported by the grant PREI 2008 from the Universitat Autònoma de Barcelona. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Pearls
                Biology
                Microbiology
                Mycology
                Veterinary Science
                Veterinary Diseases
                Veterinary Mycology

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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