Critical factors affecting the adherence of Candida albicans to the vaginal epithelium

Peer review under responsibility of Taibah University.

Figures & data

Fig. 1 Light micrograph of C. albicans (on corn meal agar with Tween 80) showing the terminal chlamydospores on pseudohyphae with blastospores. 400× magnification.

Table 1 Effect of the initial pH values on the adherence of C. albicans to the vaginal epithelial cells.

Initial pH	Adherence % Mean ± SE	Number of adhered yeast cells/VEC Mean ± SE
5	84.50 ± 5.50	157.50 ± 3.50
6	81.00 ± 8.00	150.50 ± 1.50
7	62.00 ± 2.00	133.50 ± 4.50
8	32.00 ± 1.00	65.00 ± 3.00
9	25.50 ± 1.50	55.50 ± 4.50

VEC: vaginal epithelial cell.

Table 2 Statistical analysis (one-way ANOVA test) for the data obtained in Table 1.

			p-Value
Adherence %			.001^**
Number of adhered yeast cells/VEC			.000^**
pH		p-value
pH (I)	pH (J)	Adherence %	Number of adhered yeast cells/VEC
5	6	.606^#	.225^#
	7	.017^*	.005^*
	8	.000^**	.000^**
	9	.000^**	.000^**
6	7	.031^*	.020^*
	8	.001^**	.000^**
	9	.000^**	.000^**
7	8	.005^*	.000^**
	9	.002^*	.000^**
8	9	.354^#	.119^#

* The mean difference is significant (p ≤ .05).

** The mean difference is highly significant (p ≤ .001).

# The mean difference is insignificant (p > .05).

Table 3 Statistical analysis (bivariate correlations test) for the data obtained in Table 1.

Initial pH	Adherence %	Number of adhered yeast cells/VEC
Pearson correlation (r)	−.952	−.940
p-Value	.000^**	.000^**
Strength of the correlation (r^2)	91	88

* Correlation is significant (p ≤ .05).

** Correlation is highly significant (p ≤ .001).

# Correlation is insignificant (p > .05).

Table 4 Effect of the assay temperature on the adherence of C. albicans to the vaginal epithelial cells.

Temperature (°C) of the adherence assay	Adherence % Mean ± SE	Number of adhered yeast cells/VEC Mean ± SE
25	36.00 ± 3.00	89.50 ± 2.50
37	62.50 ± 0.50	132.00 ± 3.00
40	32.50 ± 2.50	70.50 ± 9.50

VEC: vaginal epithelial cell.

Table 5 Statistical analysis (one-way ANOVA test) for the data obtained in Table 4.

			p-Value
Adherence %			.005^*
Number of adhered yeast cells/VEC			.011^*
Temperature (°C) of the adherence assay p-value
Temperature (I)	Temperature (J)	Adherence %	Number of adhered yeast cells/VEC
25	37	.004^*	.015^*
	40	.356^#	.108^#
37	40	.003^*	.005^*

* The mean difference is significant (p ≤ .05).

** The mean difference is highly significant (p ≤ .001).

# The mean difference is insignificant (p > .05).

Table 6 Statistical analysis (bivariate correlations test) for the data obtained in Table 4.

Temperature (°C) of the adherence assay	Adherence %	Number of adhered yeast cells/VEC
Pearson correlation (r)	.221	.026
p-Value	.673^#	.961^#
Strength of the correlation (r^2)	49	4

* Correlation is significant (p ≤ .05).

** Correlation is highly significant (p ≤ .001).

# Correlation is insignificant (p > .05).

Table 7 Effect of the age of C. albicans on its adherence to the vaginal epithelial cells.

Yeast age (h)	Adherence % Mean ± SE	Number of adhered yeast cells/VEC Mean ± SE
8	51.50 ± 1.50	108.00 ± 3.00
16	62.50 ± 0.50	130.00 ± 5.00
24	54.00 ± 1.00	115.50 ± 0.50
32	43.00 ± 1.00	93.50 ± 4.50
44	39.00 ± 3.00	86.00 ± 5.00
56	31.50 ± 2.50	60.50 ± 3.50

VEC: vaginal epithelial cell.

Table 8 Statistical analysis (one way ANOVA test) for the data obtained in Table 7.

			p-Value
Adherence %			.000^**
Number of adhered yeast cells/VEC			.000^**
Yeast age (h)		p-value
Yeast age (I)	Yeast age (J)	Adherence %	Number of adhered yeast cells/VEC
8	16	.005^*	.007^*
	24	.368^#	.224^#
	32	.016^*	.039^*
	44	.003^*	.007^*
	56	.000^**	.000^**
16	24	.016^*	.039^*
	32	.000^**	.001^**
	44	.000^**	.000^**
	56	.000^**	.000^**
24	32	.005^*	.007^*
	44	.001^**	.002^*
	56	.000^**	.000^**
32	44	.170^#	.224^#
	56	.004^*	.001^**
44	56	.027^*	.004^*

* The mean difference is significant (p ≤ .05).

** The mean difference is highly significant (p ≤ .001).

# The mean difference is insignificant (p > .05).

Table 9 Statistical analysis (bivariate correlations test) for the data obtained in Table 7.

Yeast age (h)	Adherence %	Number of adhered yeast cells/VEC
Pearson correlation (r)	−.866	−.868
p-Value	.000^**	.000^**
Strength of the correlation (r^2)	75	75

* Correlation is significant (p ≤ .05).

** Correlation is highly significant (p ≤ .001).

# Correlation is insignificant (p > .05).

Table 10 Effect of the incubation temperature on the adherence of C. albicans to the vaginal epithelial cells.

Incubation temperature (°C)	Adherence % Mean ± SE	Number of adhered yeast cells/VEC Mean ± SE
25	63.50 ± 5.50	130.50 ± 9.50
30	51.50 ± 4.50	99.50 ± 1.50
35	44.00 ± 5.00	89.00 ± 1.00
40	25.00 ± 2.00	59.00 ± 7.00

VEC: vaginal epithelial cell.

Table 11 Statistical analysis (one way ANOVA test) for the data obtained in Table 10.

			p-Value
Adherence %			.015^*
Number of adhered yeast cells/VEC			.005^*
Incubation temperature (°C)		p-Value
Temperature (I)	Temperature (J)	Adherence %	Number of adhered yeast cells/VEC
25	30	.130^#	.021^*
	35	.036^*	.008^*
	40	.004^*	.001^**
30	35	.300^#	.281^#
	40	.014^*	.009^*
35	40	.039^*	.024^*

* The mean difference is significant (p ≤ .05).

** The mean difference is highly significant (p ≤ .001).

# The mean difference is insignificant (p > .05).

Table 12 Statistical analysis (bivariate correlations test) for the data obtained in Table 10.

Incubation temperature (°C)	Adherence %	Number of adhered yeast cells/VEC
Pearson correlation (r)	−.937	−.959
p-Value	.001^**	.000^**
Strength of the correlation (r^2)	88	92

* Correlation is significant (p ≤ .05).

** Correlation is highly significant (p ≤ .001).

# Correlation is insignificant (p > .05).

Fig. 2 Scanning electron micrograph showing (a) the adherence of C. albicans to the surface of the vaginal epithelial cells. (b) A direct attachment of the yeast cells of C. albicans to the vaginal epithelial cell and yeast cells co-adherence. Scale bar: 10 μm. (c) The formation of germ tubes by C. albicans. Scale bar: 5 μm. (d) the formation of pseudomycelium by C. albicans. Scale bar: 1 μm.