Type:
Whole Allergen
Whole Allergen
Whole Allergen
Aspergillus terreus
m36
Trichocomaceae
A. terreus
Inhalation
Aspergillus terreus
XN25K
(ICD-11 is currently under implementation by WHO and the ICD-11 codes displayed in the encyclopedia may not yet be available in all countries)
Aspergillus terreus is a thermotolerant filamentous fungus belonging to the genus Aspergillus. A relatively rare cause of aspergillosis in man, however, it is reported as an emerging pathogen in Austria and Texas, US. An important pathogen in invasive aspergillosis, A. terreus infection is associated with increased morbidity and mortality, in part due to resistance to amphotericin B. A. terreus is also a cause of allergic bronchopulmonary aspergillosis in patients with asthma and cystic fibrosis. Exposure to allergens is by inhalation and three allergens specific to Aspergillus terreus are recognized. Asp t 36 has been identified as a possible major allergen and shares molecular homology with a diverse range of phylogenetically related and unrelated allergens.
Aspergillus terreus is a filamentous thermotolerant fungus (1, 2). A. terreus is pathogenic to human and plant species (3). Whereas A. fumigatus is the most prevalent pathogen of the genera, causing 67‒73% of infections in man, A. terreus is the causative organism in 3‒4% of Aspergillus infections (1). Distinguishing morphological features of A. terreus include relatively small conidial heads (2.0‒3.5 µm) and tan color colonies (4). A. terreus is one of a few species that produce lateral conidia (aleuroconidia), which have been shown to induce inflammation in an invasive aspergillosis murine model (5).
A. terreus is an opportunistic pathogen and is associated with a high rate of dissociative infection and poor outcome, predominantly in patients with prolonged neutropenia, allogenic haematopoietic stem cell transplant, solid organ transplant, inherited or acquired immunodeficiencies and corticosteroid use (5, 6). A. terreus is a cause of allergic bronchopulmonary aspergillosis (ABPA), a hypersensitivity syndrome in patients with asthma and cystic fibrosis (3, 7). A. terreus is also classified as resistant to amphotericin B, meaning the clinical management of A. terreus associated disease can be challenging (1, 5). A. terreus is also a major plant pathogen which is estimated to destroy over 125 million tons of crops such as rice, wheat and potato globally every year (8).
A. terreus has economic and pharmaceutical importance. As well as its use in the fermentation industry for producing itaconic acid and itatartaric acid, its secondary metabolites are used to manufacture clinically valuable drugs, including lovastatin, antitumor metabolites and cyclosporine A (9).
Taxonomic tree of Aspergillus terreus (10) |
|
Domain |
Eukaryota |
Kingdom |
Fungi |
Phylum |
Ascomycota |
Subphylum |
Pezizomycotina |
Class |
Eurotiomycetes |
Subclass |
Eurotiomycetidae |
Order |
Eurotiales |
Family |
Trichocomaceae |
Genus |
Aspergillus |
A. terreus has a global distribution and is found in a wide variety of habitats (5). However, there are reports of local increases of prevalence of A. terreus-associated invasive aspergillosis, such as Innsbruck in Austria and Houston, Texas. The reason for this increase is unclear (5, 11). An international, multi-center surveillance study, which surveyed the prevalence of A. terreus positive isolates amongst mold positive cultures over 12 consecutive months (n = 7116) from 38 centers in 21 countries, reported A. terreus was isolated from 5.2% of cultures. The same study found that Spain and Austria hosted the highest recorded density of A. terreus isolates. The greatest proportion of A. terreus isolates (39.2%) was most commonly isolated from patients with chronic lung disease (12).
The estimated prevalence of sensitization to Aspergillus spp. antigens in patients with allergic respiratory diseases is between 15.3‒38.0% (13). Sensitization to Aspergillus is also a risk factor for more severe asthma (14). Up to 70% of patients with severe asthma have Aspergillus sensitized IgE, compared to 10% of patients with mild to moderate disease and 5% of the general population (15).
A meta-analysis has reported that the pooled prevalence of sensitization to Aspergillus spp. was 39.1% in patients with cystic fibrosis (CF). Prevalence was higher with the skin test compared to specific IgE assay (43.8% vs. 32.8%, P=0.002) (16). ABPA occurs in approximately 9% of CF patients and 1–3% asthmatic patients (7). Furthermore, it has also been shown that 12.4% of patients with A. terreus isolates were diagnosed with ABPA (12). A terreus is the third most common filamentous fungus isolated from airway secretions of patients with CF (2).
The primary route of exposure to A. terreus is allergen inhalation (17). Aspergillus spp. have small conidiospores (2–5 µm), which means they can reach the terminal bronchial airways. However, their presence in large clusters in the upper respiratory tract can also provoke a sensitivity reaction (18).
Aspergillus spp. are the causative agents of a spectrum of hypersensitivity disease in humans including allergic asthma (with or without rhinitis), allergic rhinosinusitis, hypersensitivity pneumonitis and ABPA (10). ABPA can cause irreversible lung damage, so there is an imperative to reach an early diagnosis (17).
A significant clinical implication of hypersensitivity to A. terreus is resistance to amphotericin B, where a treatment failure rate of 80-90% is reported (5). The aim of the treatment of ABPA is to prevent irreversible lung damage. Amphotericin B has been used in nebulized form to treat ABPA in patients with CF (19).
Three A. terreus specific allergens have been recognized by the WHO/IUIS Allergen Nomenclature Sub-committee. In a study that used a proteomic approach to identify A. terreus allergens, the allergen Asp t 36, a triosephosphate isomerase was characterized and purified in its native state and recombinant form. Both natural TPI and recombinant TPI resulted in a significant amount of IgE binding in A. terreus-sensitized patients (P<0.05), indicating the potential to be a major allergen. The authors stated that Asp t 36 had potential for use in both diagnosis of A. terreus hypersensitivities and as a target for immunotherapy (3).
Another potential allergen, glycolytic enolase, has been identified on the surface of A. terreus. Glycolytic enolase is an intracellular enzyme required for glycolysis and gluconeogenesis. However, surface localization results in its exposure to the host immune system (21).
Table adapted from (20).
Allergen name |
Protein group (if known) |
Size (kDa) |
Asp t 3 |
Peroxisomal protein (PMP) |
- |
Asp t 36 |
Triosephosphate isomerase |
28 (mono) 56 (Di) (3) |
Asp t 36.0101 |
Triphosphate Isomerase |
- |
Asp t 4 |
Group 4 protein, unknown biological function |
- |
Several studies have demonstrated cross-reactivity of A. terreus extract with specific allergens of other Aspergillus spp. One study, which analyzed type III hypersensitivity responses, found that levels of A. fumigatus specific IgG were significantly correlated with A. terreus specific IgG (22), indicating cross-reactivity. Similarly, a study found that patients positive for A. terreus specific IgE were all found to be positive to A. fumigatus specific antigen, although it is thought that A. terreus is less cross-reactive with A. fumigatus than A. flavus (17).
TPI homologues are found in crustaceans and shellfish and are a common cause of food allergy in these species (3). The discovery that Asp t 36 is a homologue to crustaceans and shellfish allergens could anticipate further examples of cross-reactivity between fungal and arthropod allergens (3, 23). Karmakar’s group demonstrated significant sequence homology between Asp t 36 and Der f 25, an allergen specific to the dust mite Dermatophagoides farina, as well as triosephosphate isomerases from the cockroach Blatella germanica (3). They also found the sequence was highly conserved, and similarities were noted with the TPI of wheat, house dust mite and the German cockroach, with conservation of IgE binding epitopes and implicating high cross-reactivity with both phylogenetically related and unrelated species (3).
Author: RubyDuke Communications
Reviewer: Dr. Christian Fischer
Last reviewed: February 2022