Hepcidin deficiency increases susceptibility to disseminating candidiasis and renal failure

Background Candida albicans is the single most common human fungal pathogen, and invasive candida infections carry a mortality rate of about 25%. C. albicans possesses a range of iron acquisition mechanisms that contribute to its persistence, and virulence. Patients with fungal infection have substantially increased transferrin saturation and serum iron concentrations independent of underlying hematological disorder, suggesting that host iron handling is critical to the outcome of the infection. Using a murine model of systemic iron overload, we investigated whether C.albicans-induced pathology is influenced by iron availability. Experiment Iron overloaded hepcidin knockout (Hamp−/−) and wild type (WT) litter mates were infected with C. albicans SC5314 and outcomes of infection were evaluated after 3 days. Results Compared to WT mice, Hamp−/− mice displayed increased renal fungal burden, had more renal injury, inflammation and mortality. C. albicans was in yeast form in the kidneys of WT mice but had transformed into hyphae in the iron rich renal tubular segments of Hamp−/− mice. Despite the greater pathogen burden, kidneys of Hamp−/− mice had reduced numbers of neutrophils with increased expression of p21. Conclusion Our data identify systemic iron overload as a susceptibility factor to C. albicans induced renal failure. Hepcidin deficiency was associated with increased renal iron burden and transformation of yeast into hyphae, suggesting increased virulence. Increased p21 expression in neutrophils suggests impaired NETosis and may possibly explain increased fungal burden. Our data highlight importance of dysregulated iron metabolism in disseminating candidiasis.