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Investigation
Development of new diagnostic methods for invasive fungal infection
Research Lines
Content with Investigacion .
El diagnóstico de la infección fúngica invasora (IFI) es complicado y con frecuencia se retrasa ya que en muchas ocasiones a la falta de sospecha clínica se le suma la falta de herramientas diagnósticas eficaces. Esta línea de investigación se inició en el año 2003, primero liderada por el Dr. Manuel Cuenca-Estrella y posteriormente por la Dra. María José Buitrago con el objetivo general de desarrollar nuevas herramientas, basadas en la PCR en tiempo Real, para un diagnóstico rápido de IFI. Los objetivos concretos que se han ido alcanzando a lo largo de estos años han sido los siguientes:
Detección precoz de hongos causantes de infecciones fúngicas oportunistas más frecuentes en pacientes inmunodeprimidos (Aspergilosis y Candidiasis invasoras)
Se han desarrollado y validado técnicas de PCR en tiempo Real en formato multiplex para el cribado de pacientes en riesgo de padecer estas infecciones, así como para el diagnóstico en pacientes con sospecha.
Detección de IFIs causadas por hongos emergentes (Escedosporiosis, Fusariosis etc...)
El aumento de especies raras o poco frecuentes causantes de IFI hizo necesario el desarrollo de técnicas para su detección
Detección “panfúngica”
Para aquellos casos en los que no exista evidencia clara del hongo causante de la infección se han desarrollado técnicas basadas en PCR en tiempo Real.
Mejora del diagnóstico y la identificación de los hongos causantes de micosis importadas (micosis endémicas)
Debido al aumento de la inmigración y los viajes a lugares exóticos en los últimos años se ha producido un incremento de las micosis importadas en España, en concreto de aquellas causadas por hongos endémicos de determinadas regiones, los cuales son además patógenos primarios. Este objetivo es relevante en el contexto de una región no-endémica ya que existe falta de experiencia en el manejo de estas infecciones y las técnicas diagnósticas disponibles son muy escasas. A lo largo de estos años se han desarrollado y validado distintas técnicas para el diagnóstico rápido de estas micosis y se han realizado diferentes trabajos encaminados a un mejor conocimiento de los hongos que las causan.
Las técnicas desarrolladas a lo largo de estos años se han incorporado a la Cartera de Servicios del Centro Nacional de Microbiología para ofrecerlas al Sistema Nacional de Salud. Además, algunas de ellas se han patentado.
Research projects
Content with Investigacion .
1. Nombre del proyecto: Mejora del pronóstico del paciente con riesgo de enfermedad fúngica invasora: estudio de susceptibilidad del huésped y desarrollo de nuevos métodos de diagnóstico clínico. Entidad/es financiadora/s: Instituto de Salud Carlos III. Fecha de inicio-fin: 01/01/2018 - 31/12/2020. Cuantía: 72.000 €. Investigadores principales (IP, Co-IP,...): María José Buitrago Serna/Laura Alcazar Fuoli
2. Nombre del proyecto: Red española de Investigación en Patologías infecciosas REIPI
Entidad/es financiadora/s: ISCIII-FEDER Fecha de inicio-fin: 01/01/2017 - 31/12/2021
Cuantía total: 195.612 €. Coordinador: Emilia Mellado
3. Nombre del proyecto: Desarrollo y validación de un método de detección de tipo “point of care”. Entidad/es financiadora/s: Instituto de Salud Carlos III. Fecha de inicio-fin: 01/01/2015 - 31/12/2017. Cuantía total: 46.000 €. Investigador principal: María José Buitrago.
4. Nombre del proyecto: European Research Infrastructure on Highly Pathogenic Agents 2-ERINHA2(Horizon2020). Nombre del programa: FP7-Infraestructuras-2015. Programa marco. THEME (INFRA-2010-2.2.8: High Security BLS4 Laboratory). Entidad financiadora: Unión Europea. Fecha de inicio-fin: 01/01/2016 - 01/06/2017. Cuantía total: 524.848 €. Cuantía subproyecto: 141.562 €. Coordinador (IP): Raoul Hervé.
5. Nombre del proyecto: Iberian network of laboratories of Biological Alert Acreditation of methods for detection of highly pathogenic agents/IB-BiOALERNET Entidad/es financiadora/s: DG-Home (Unión Europea). Fecha de inicio-fin: 2013 – 2015. Cuantía total: 629.382,67 €. Coordinador (IP): Carmen Cañavate
6. Nombre del proyecto: Desarrollo de nuevos métodos de diagnóstico e identificación de especies fúngicas causantes de neumonías oportunistas. Entidad/es financiadora/s: ISCIII. Fecha de inicio-fin: 2012 – 2015. Cuantía total: 67.429,67 €. Investigador principal: María José Buitrago.
7. Nombre del proyecto: European Research Infrastructure on Highly Pathogenic Agents 2-ERINHA2 (Horizon2020). Nombre del programa: FP7-Infraestructuras-2015. Programa marco. THEME (INFRA-2010-2.2.8: High Security BLS4 Laboratory. Entidad financiadora: Unión Europea. Fecha de inicio-fin: 01/01/2010 - 31/12/2013. Cuantía total: 4.859.782,5 €. Coordinador (IP): Raoul Hervé.
8. Nombre del proyecto: RED iberoamericana de diagnóstico molecular de las infecciones endémicas y oportunistas. Entidad/es financiadora/s: CYTED-AECI. Fecha de inicio-fin: 2008 – 2009. Cuantía total: 70.000 €. Investigador principal: Luz-Elena Cano
9. Nombre del proyecto: “Desarrollo de nuevos métodos de diagnóstico en alertas biosanitarias relacionadas con la Micología”. Entidad/es financiadora/s: Instituto de Salud Carlos III. Fecha de inicio-fin: 2007 – 2009. Cuantía total: 58.500 €. Investigador Principal: María José Buitrago
Publications
Telomere Length Increase in HIV/HCV-Coinfected Patients with Cirrhosis after HCV Eradication with Direct-Acting Antivirals JOURNAL OF CLINICAL MEDICINE.
Molina-Carrion, Silvia; Brochado-Kith, Oscar; Gonzalez-Garcia, Juan; et al; Jimenez-Sousa, Maria Angeles. (12/12). 2020. Telomere Length Increase in HIV/HCV-Coinfected Patients with Cirrhosis after HCV Eradication with Direct-Acting Antivirals JOURNAL OF CLINICAL MEDICINE. 9. ISSN 2077-0383. https://doi.org/10.3390/jcm9082407.
Treatment of Chronic Pulmonary Aspergillosis: Current Standards and Future Perspectives. Respiration. 2018 Jul
Alastruey-Izquierdo A, Cadranel J, Flick H, Godet C, Hennequin C, Hoenigl M, Kosmidis C, Lange C, Munteanu O, Page I, Salzer HJF; on behalf of CPAnet. Treatment of Chronic Pulmonary Aspergillosis: Current Standards and Future Perspectives. Respiration. 2018 Jul 6:1-12. doi: 10.1159/000489474. [Epub ahead of print] Review. PMID: 29982245.
PUBMED DOIThe Diagnostic Laboratory Hub: A New Health Care System Reveals the Incidence and Mortality of Tuberculosis, Histoplasmosis, and Cryptococcosis of PWH in Guatemala. Open Forum Infect Dis. 2019 Dec
Samayoa B, Aguirre L, Bonilla O, Medina N, Lau-Bonilla D, Mercado D, Moller A, Perez JC, Alastruey-Izquierdo A, Arathoon E, Denning DW, Rodríguez-Tudela JL; “Fungired”. The Diagnostic Laboratory Hub: A New Health Care System Reveals the Incidence and Mortality of Tuberculosis, Histoplasmosis, and Cryptococcosis of PWH in Guatemala. Open Forum Infect Dis. 2019 Dec 15;7(1):ofz534. doi: 10.1093/ofid/ofz534. PMID: 31915715.
PUBMED DOIFungired. Comparative performance of the laboratory assays used by a Diagnostic Laboratory Hub for opportunistic infections in people living with HIV. AIDS. 2020 Sep 1
Medina N, Alastruey-Izquierdo A, Mercado D, Bonilla O, Pérez JC, Aguirre L, Samayoa B, Arathoon E, Denning DW, Rodriguez-Tudela JL; Fungired. Comparative performance of the laboratory assays used by a Diagnostic Laboratory Hub for opportunistic infections in people living with HIV. AIDS. 2020 Sep 1;34(11):1625-1632. doi: 10.1097/QAD.0000000000002631. PMID: 32694415.
PUBMED DOIPopulation-Based Program of filamentous fungi and Antifungal Resistance in Spain (FILPOP STUDY). Antimicrob Agents Chemother. 2013 Jul
Ana Alastruey-Izquierdo*, Emilia Mellado, Teresa Pelaez, Javier Pemán, Soledad Zapico, María Álvarez, Juan L Rodriguez-Tudela, Manuel Cuenca-Estrella Population-Based Program of filamentous fungi and Antifungal Resistance in Spain (FILPOP STUDY). Antimicrob Agents Chemother. 2013 Jul;57(7):3380-7. doi: 10.1128/AAC.01287-13. PMID: 28319466
PUBMED DOIThe global problem of antifungal resistance: prevalence, mechanisms, and management. Lancet Infect Dis. 2017 Dec
Perlin DS, Rautemaa-Richardson R, Alastruey-Izquierdo A. The global problem of antifungal resistance: prevalence, mechanisms, and management. Lancet Infect Dis. 2017 Dec;17(12. doi: 10.1016/S1473-3099(17)30316-X. PMID: 28774698.
PUBMED DOISequence Analysis of In Vivo-Expressed HIV-1 Spliced RNAs Reveals the Usage of New and Unusual Splice Sites by Viruses of Different Subtypes.
Vega Y, Delgado E, de la Barrera J, Carrera C, Zaballos Á, Cuesta I, Mariño A, Ocampo A, Miralles C, Pérez-Castro S, Álvarez H, López-Miragaya I, García-Bodas E, Díez-Fuertes F, Thomson MM. Sequence Analysis of In Vivo-Expressed HIV-1 Spliced RNAs Reveals the Usage of New and Unusual Splice Sites by Viruses of Different Subtypes. PLoS One. 2016 Jun 29;11(6):e0158525.
PUBMED DOIY155H amino acid substitution in influenza A(H1N1)pdm09 viruses does not confer a phenotype of reduced susceptibility to neuraminidase inhibitors
Perez-Sautu U, Pozo F, Cuesta I, Monzon S, Calderon A, Gonzalez M, Molinero M, Lopez-Miragaya I, Rey S, Cañizares A, Rodriguez G, Gonzalez-Velasco C, Lackenby A, Casas I. Y155H amino acid substitution in influenza A(H1N1)pdm09 viruses does not confer a phenotype of reduced susceptibility to neuraminidase inhibitors. Euro Surveill. 2014 Jul 10;19(27):14-20.
PUBMED DOIComparison of two highly discriminatory typing methods to analyze Aspergillus fumigatus azole resistance
Garcia-Rubio R, Escribano P, Gomez A, Guinea J, and Mellado E. Comparison of two highly discriminatory typing methods to analyze Aspergillus fumigatus azole resistance. Frontiers in Microbiology 2018. Jul 20;9:1626.
PUBMED DOIEvaluation of the possible influence of trailing and paradoxical effects on the clinical outcome of patients with candidemia.
Rueda C, Puig-Asensio M, Guinea J, Almirante B, Cuenca-Estrella M, Zaragoza O. Evaluation of the possible influence of trailing and paradoxical effects on the clinical outcome of patients with candidemia. CANDIPOP Project from GEIH-GEMICOMED (SEIMC) and REIPI. Clin Microbiol Infect. 2017 Jan; 23(1):49.e1-49.e8.
PUBMED DOIDevelopment and Validation of a High-Resolution Melting Assay To Detect Azole Resistance in Aspergillus fumigatus.
Bernal-Martínez L, Gil H, Rivero-Menéndez O, Gago S, Cuenca-Estrella M, Mellado E, Alastruey-Izquierdo A. Development and Validation of a High-Resolution Melting Assay To Detect Azole Resistance in Aspergillus fumigatus. Antimicrob Agents Chemother. 2017 Nov 22;61(12). pii: e01083-17.
PUBMED DOICervicofacial lymphadenitis due Mycobacterium mantenii: rapid and reliable identification by MALDI-TOF MS.
Nebreda T, Andres AG, Fuentes S, Calleja R, Jimenez MS. Cervicofacial lymphadenitis due Mycobacterium mantenii: rapid and reliable identification by MALDI-TOF MS. New Microbes and New Infections .2018. March 22:1-3.
PUBMED DOIIn-depth analysis of the genome sequence of a clinical, extensively drug-resistant Mycobacterium bovis strain.
Sagasta S, Millan-Lou MI, Jiménez MS, Martin C, Samper S. In-depth analysis of the genome sequence of a clinical, extensively drug-resistant Mycobacterium bovis strain. Tuberculosis. 2016. Sep. 100:46-52.
PUBMED DOIGeneration and Characterization of ALX-0171, a Potent Novel Therapeutic Nanobody for the Treatment of Respiratory Syncytial Virus Infection
Detalle L, Stohr T, Palomo C, Piedra PA, Gilbert BE, Mas V, et al. Generation and Characterization of ALX-0171, a Potent Novel Therapeutic Nanobody for the Treatment of Respiratory Syncytial Virus Infection. Antimicrob Agents Chemother. 2016;60(1):6-13.
PUBMED DOICharacterization of an enhanced antigenic change in the pandemic 2009 H1N1 influenza virus haemagglutinin
Garcia-Barreno B, Delgado T, Benito S, Casas I, Pozo F, Cuevas MT, et al. Characterization of an enhanced antigenic change in the pandemic 2009 H1N1 influenza virus haemagglutinin. J Gen Virol. 2014;95(Pt 5):1033-42.
PUBMED DOIEpidemic history of hepatitis C virus genotypes and subtypes in Portugal.
Palladino C, Ezeonwumelu IJ, Marcelino R, Briz V, Moranguinho I, Serejo F, Velosa JF, Tato Marinho R, Borrego P, Taveira N. 2018. Epidemic history of hepatitis C virus genotypes and subtypes in Portugal. Sci Rep. 2018; 8:12266. (A; FI= 4.12; Q1 Multidisciplinary Sciences; DOI:10.1038/s41598-018-30528-0).
PUBMED DOILow frequency of NS5A relevant resistance-associated substitutions to Elbasvir among hepatitis C virus genotype 1a in Spain: a cross-sectional study.
Palladino C, Sanchez-Carrillo M, Mate-Cano I, Vazquez-Morón S, Jiménez-Sousa MA, Gutiérrez-Rivas M, Resino S, Briz V. Low frequency of NS5A relevant resistance-associated substitutions to Elbasvir among hepatitis C virus genotype 1a in Spain: a cross-sectional study. Sci Rep. 2017; 7(1):2892. (A; FI= 4.12; Q1 Multidisciplinary Sciences).
PUBMED DOIPlasma miRNA profile at COVID-19 onset predicts severity status and mortality.
Fernández-Pato A; Virseda-Berdices A, Ryan P; Martínez-González O, Peréz-García F, Resino S, Martin-Vicente M, Valle-Millares D, Brochado-Kith O; Blancas R; Ceballos FC; Bartolome-Sánchez S; Vidal-Alcántara EJ; Alonso-Menchén D, Blanca-López N; Ramirez Martinez-Acitores I, Rava M, Jiménez-Sousa MA (‡ *), Amanda Fernández-Rodríguez (‡ *). Plasma miRNA profile at COVID-19 onset predicts severity status and mortality. Emerg Microbes Infect 2022; 11(1):676-688 (A; FI= 19.57; D1, Infectious Diseases; JCR 2021).
PUBMED DOIMild profile improvement of immune biomarkers in HIV/HCV-coinfected patients who removed hepatitis C after HCV treatment: a prospective study.
García-Broncano P, Medrano LM, Berenguer J, Brochado O, González-García J, Jiménez-Sousa MA, Quereda C, Sanz J, Téllez MJ, Díaz L, Jiménez JL, Muñoz-Fernández MA, Resino S (*). Mild profile improvement of immune biomarkers in HIV/HCV-coinfected patients who removed hepatitis C after HCV treatment: a prospective study. J Infect 2020; 80(1):99-110. (A; FI= 6.07; Q1, Infectious Diseases; JCR 2020).
PUBMED DOIContent with Investigacion .
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Leticia Bernal Martínez
Staff Scientist
ORCID code: 0000-0002-1694-5522
Dr. Bernal-Martínez obtained her degree in Biochemistry from the University of Zaragoza in 2005. She joined the Mycology Reference and Research Laboratory (LRIM) in 2006 under a trainee contract and completed her PhD within the Official Doctoral Program in Microbiology and Parasitology at the Complutense University of Madrid, defending her thesis in 2010 with highest honors (Cum Laude). In 2007, she continued her research activity at LRIM within the framework of the Spanish Network for Research in Infectious Diseases (REIPI). In 2016, she completed a Postgraduate Diploma in Promotion and Management of International Projects (Technical University of Madrid) and undertook a research stay at the Microbiology and Infection Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho (Braga, Portugal). She was subsequently appointed as a PhD researcher within the Biomedical Research Networking Center in Infectious Diseases (CIBERINFEC). Since 2024, she serves as Specialist Scientist at the Carlos III Health Institute (ISCIII) and is responsible for the Diagnostic and Serology Section for Endemic Fungi at the Mycology Reference and Research Laboratory.
Dr. Bernal-Martínez has authored more than 30 peer-reviewed scientific publications and two book chapters. She has actively participated in over 12 research projects and has presented her work at numerous national and international scientific conferences. Her research has focused on human fungal infections, antifungal resistance, therapeutic drug monitoring, genetic variants associated with antifungal metabolism, and the identification of predictive biomarkers of invasive fungal infections. However, her primary expertise lies in the diagnostic field, particularly in the design, optimization, and validation of real-time PCR–based methodologies.
She is currently Principal Investigator of a research project aimed at improving current diagnostic techniques for invasive fungal infections, evaluating emerging diagnostic technologies, and studying primary fungal pathogens. A substantial part of her work has been transferred to the Spanish National Health System and to research centers in Latin America. Many of the diagnostic methodologies developed have been incorporated into the official service portfolio of ISCIII. She has collaborated with multiple hospitals through research projects and clinical trials applying these technologies, as well as with the ISCIII spin-off company Micomol S.L.
Dr. Bernal-Martínez has supervised several Master’s and Undergraduate Final Degree Projects from students at the Complutense University of Madrid and the University of Alcalá. She is a member of the teaching staff of the UNED-ISCIII PhD Program in Biomedical Sciences and Public Health and serves as lecturer in the Master’s Program in Public Health and Research in Infectious Diseases at the University of Alcalá.
List of staff
Additional Information
RECENT COLLABORATIONS
1. Dr. Marco Teixeira. Visiting professor at the University of Brasilia (UnB). Affiliated researcher at Northern Arizona University (NAU)
2. Dr. Alexandre Alanio. Researcher at Hôpital St. Louis, Paris. France
3. Dr. Dunja Wilmes. Researcher at the Robert Koch Institute. Sedan. Germany.
4. Dr. Paula Sampaio. Center for Molecular and Environmental Biology (CBMA), Department of Biology, University of Minho, Braga, Portugal
5. Dr. Rosely Zancope-Oliveira. Professor at the Oswaldo Cruz Foundation. Rio de Janeiro, Brazil.
6. Dr. Ana Cecilia Mesa Arango. Professor at the University of Antioquia. Medellin. Colombia
7. Dr. Néstor Pakasa. Professor, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
8. Dr. David aka. Researcher at the Félix Houphouët-Boigny University, Abidjan, Ivory Coast
PATENTS
a) Registered industrial property title: “Development of a rapid method for the diagnosis of histoplasmosis and/or paracoccidioidomycosis by multiplex Real-Time PCR with Molecular Beacon type probe initiators.” Inventors: María José Buitrago Serna; Manuel Cuenca Estrella; Juan Luis RodriguezTudela; Alicia Gómez López. Rights holder entity: Carlos III Health Institute. Application number: P200802665. Country of registration: Spain. Registration date: 09/19/2008. Grant date: 09/14/2011
b) Registered industrial property title: Riboflavin-synthese in Ashbya gossypii. Inventors/authors/breeders: Jose Luis Revuelta Doval; María José Buitrago Serna; Maria de los Angeles Santos García. Rights holder entity: BASF Aktiengesellschaft. Application number: CA 2186403. Registration date: 03/25/1994. Grant date: 01/24/2006
c) Registered industrial property title: Riboflavin-Synthese in Hefen. Inventors/authors/breeders: Jose Luis Revuelta Doval; Jose Javier García Ramírez; Maria de Los Angeles Santos García; Gloria Angélica González; María José Buitrago Serna. Rights holder entity: BASF Aktiengesellschaft. Application number: EP19940901793. Registration date: 11/19/199. Grant date: 05/07/1997
DIRECTION OF DOCTORAL THESES
1. Title: Development of new methods for diagnosis and identification of fungal species that cause opportunistic pneumonia. Implementation entity: Complutense University-ISCIII. Student: Clara Valero Fernández. Qualification obtained: Excellent Cum Laude. Defense date: 05/19/2017
2. Title: Development and Validation of diagnostic techniques for invasive fungal infection. Implementation entity: Complutense University of Madrid-ISCIII. Student: Sara Gago Prieto. Grade obtained: Excellent cum laude. Defense date: 07/18/2014
3. Title: Development of techniques based on real-time PCR for the diagnosis of invasive fungal infections. Implementation entity: Complutense University of
Madrid-ISCIII. Student: Leticia Bernal Martinez. Grade obtained: Excellent cum laude. Defense date: 2010
RECENT COLLABORATIONS
1. Dr. Marco Teixeira. Visiting professor at the University of Brasilia (UnB). Affiliated researcher at Northern Arizona University (NAU)
2. Dr. Alexandre Alanio. Researcher at Hôpital St. Louis, Paris. France
3. Dr. Dunja Wilmes. Researcher at the Robert Koch Institute. Sedan. Germany.
4. Dr. Paula Sampaio. Center for Molecular and Environmental Biology (CBMA), Department of Biology, University of Minho, Braga, Portugal
5. Dr. Rosely Zancope-Oliveira. Professor at the Oswaldo Cruz Foundation. Rio de Janeiro, Brazil.
6. Dr. Ana Cecilia Mesa Arango. Professor at the University of Antioquia. Medellin. Colombia
7. Dr. Néstor Pakasa. Professor, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
8. Dr. David aka. Researcher at the Félix Houphouët-Boigny University, Abidjan, Ivory Coast
PATENTS
a) Registered industrial property title: “Development of a rapid method for the diagnosis of histoplasmosis and/or paracoccidioidomycosis by multiplex Real-Time PCR with Molecular Beacon type probe initiators.” Inventors: María José Buitrago Serna; Manuel Cuenca Estrella; Juan Luis RodriguezTudela; Alicia Gómez López. Rights holder entity: Carlos III Health Institute. Application number: P200802665. Country of registration: Spain. Registration date: 09/19/2008. Grant date: 09/14/2011
b) Registered industrial property title: Riboflavin-synthese in Ashbya gossypii. Inventors/authors/breeders: Jose Luis Revuelta Doval; María José Buitrago Serna; Maria de los Angeles Santos García. Rights holder entity: BASF Aktiengesellschaft. Application number: CA 2186403. Registration date: 03/25/1994. Grant date: 01/24/2006
c) Registered industrial property title: Riboflavin-Synthese in Hefen. Inventors/authors/breeders: Jose Luis Revuelta Doval; Jose Javier García Ramírez; Maria de Los Angeles Santos García; Gloria Angélica González; María José Buitrago Serna. Rights holder entity: BASF Aktiengesellschaft. Application number: EP19940901793. Registration date: 11/19/199. Grant date: 05/07/1997
DIRECTION OF DOCTORAL THESES
1. Title: Development of new methods for diagnosis and identification of fungal species that cause opportunistic pneumonia. Implementation entity: Complutense University-ISCIII. Student: Clara Valero Fernández. Qualification obtained: Excellent Cum Laude. Defense date: 05/19/2017
2. Title: Development and Validation of diagnostic techniques for invasive fungal infection. Implementation entity: Complutense University of Madrid-ISCIII. Student: Sara Gago Prieto. Grade obtained: Excellent cum laude. Defense date: 07/18/2014
3. Title: Development of techniques based on real-time PCR for the diagnosis of invasive fungal infections. Implementation entity: Complutense University of
Madrid-ISCIII. Student: Leticia Bernal Martinez. Grade obtained: Excellent cum laude. Defense date: 2010