# Nakaseomyces glabratus drug resistance genes expression in vulvovaginal candidiasis: a systematic review

## TL;DR

This systematic review explores drug resistance gene expression in Nakaseomyces glabratus related to vulvovaginal candidiasis, focusing on the CDR1 gene.

## Contribution

The study systematically identifies and compares drug resistance gene expression patterns in Nakaseomyces glabratus and related species.

## Key findings

- CDR1 gene expression is increased in fluconazole-resistant Nakaseomyces glabratus, indicating efflux mechanisms.
- C. nivariensis shows enhanced CDR1 expression, suggesting similar resistance mechanisms to N. glabratus.
- Gene expression profiles differ between N. glabratus and C. nivariensis, highlighting diverse resistance mechanisms.

## Abstract

Antifungal resistance in Nakaseomyces glabratus presents a notable obstacle in the management of vulvovaginitis.
Comprehension of drug-resistance gene expression is fundamental in the development of efficacious treatment strategies. This systematic review endeavored to ascertain the existing knowledge
regarding the expression of drug resistance genes in N. glabratus associated with vulvovaginal candidiasis by the amalgamation of published research findings.

Under the PRISMA guidelines, a systematic review was conducted from January 2000 to December 2024, utilizing the articles from "Web of Sciences", "PubMed", and "Scopus".
The search incorporated the terms C. glabrata complex (C. glabrata sensu stricto, C. nivariensis, C. bracarensis) in conjunction
with drug resistance gene expression in N. glabratus and closely related species with vulvovaginal candidiasis. The review was restricted to publications in English.
The data extraction process employed EndNote software (version 21.4), and a meticulous selection process was undertaken to identify relevant studies.

Three eligible studies reported an increase in the expression of the CDR1 gene in fluconazole-resistant N. glabratus, suggesting the presence of efflux
mechanisms that reduce drug accumulation. Another study found enhanced CDR1 expression in fluconazole-resistant C. nivariensis, indicating the existence of similar resistance mechanisms.
The observed variations in gene expression profiles between N. glabratus and C. nivariensis underscore the presence of diverse resistance mechanisms.

Review of the previous studies showed that the CDR1 gene was the most important resistance gene and that this resistance is more evident in C. nivarensis, compared to N. glabratus.