Role of zinc in growth, stress response and virulence gene expression of pathogenic Mucorale Rhizopus arrhizus

Abstract

During COVID-19 pandemic, the cases of mucormycosis increased substantially, with rhino-orbito-cerebral form linked to uncontrolled diabetes being the predominant manifestation. Some clinical and epidemiological studies associated the usage of zinc supplements with the occurrence of COVID-19 associated mucormycosis, but experimental evidence remains limited. This study aimed to elucidate the impact of zinc enrichment on Rhizopus arrhizus, the predominant causative agent of mucormycosis. The effect of zinc supplementation (5 to 150 {micro}M) on fungal growth, metabolic activity, antifungal susceptibility and biofilm formation, along with cell-wall (Congo red), oxidative (hydrogen peroxide) and osmotic (sodium chloride) stress was evaluated in RPMI-1640. Morphological changes were visualized by scanning electron microscopy. Gene expression was monitored by RNA sequencing. Zinc supplementation promoted R. arrhizus growth in a concentration-dependent manner, with the effect being particularly pronounced under less-favorable conditions, such as alkaline conditions resembling the nasal pH of diabetics. Exposure to zinc enhanced the metabolic activity, and partly alleviated the cell-wall and oxidative stress. Susceptibility to amphotericin B and posaconazole was unchanged. Zinc-supplemented cultures over-expressed multiple genes, notably those associated with respiratory electron transport chain, ergosterol biosynthesis, chitosan production, oxidative stress response, mucoricin, high-affinity iron permease, iron transport multi-copper oxidase and ferric-reductase-like protein. Zinc also augmented the growth/metabolism of several other Mucorales but not Aspergillus fumigatus and Candida albicans. The findings suggest that zinc supplementation supports mucoralean growth and enhances the expression of key virulence factors, implying that excessive intake of zinc supplements during COVID-19 pandemic likely contributed to the emergence of mucormycosis. IMPORTANCEMucormycosis remains a highly devastating fungal infection that presented additional challenges during the COVID-19 pandemic. Several risk factors were implicated in the emergence of COVID-19 associated mucormycosis (CAM), including inappropriate corticosteroid usage and COVID-19 associated glycemic imbalance. The excessive intake of nutritional supplements, especially that of zinc, owing to self-medication and over-prescription, was also proposed as a plausible factor in the rise of CAM in many clinical/epidemiological studies. This study experimentally evaluated the potential impact of zinc enrichment on pathogenic Mucorales. The work demonstrates that zinc supplementation supports Rhizopus arrhizus growth, metabolism and stress response, and enhances the expression of key virulence factors, including mucoricin and iron transporters. Notably, the augmentation was specifically observed in pathogenic Mucorales but not Aspergillus fumigatus and Candida albicans. The work provides experimental evidence for the potential association of zinc over-availability with the occurrence of CAM, and strengthens evidence-based therapeutic practices in clinical settings.