Pathogenic bacteria and fungi can utilize and respond to host and environmental cholesterol and its metabolites, including steroid hormones and bile salts. Although the role these compounds play in host health and metabolic diseases has been intensely studied over the past several centuries, the effects of steroids and their metabolites on microbial pathogenesis has not received much attention until recently. Cholesterol rafts have been shown to play an essential role in the activity of the cholesterol-dependent cytolysins e.g., listeriolysin O, and the interaction of Helicobacter pylori with the gastric epithelium while bile salt stress affects enteropathogenic Escherichia coli adherence to epithelial cells. Cholesterol has also been shown to play a role in the metabolism of candidal species with regards to both metabolism and resistance to antifungal agents. Steroidal hormones including progesterone have been shown to have a marked effect on the interaction of Candida with mammalian cells. Other steroids, e.g. DHEA, with a hydroxyl group in the 3’position have been demonstrated to affect the properties of Staphylococcus aureus both MSSA and MRSA with regards to response to vancomycin. This review examines the various roles steroids play in modulating host - pathogen interaction and what effects these compounds may have on treatment.
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