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The stages of a fungal infection between cryptococcal cells and macrophages are well documented 1-3. After yeast cells are ingested by macrophages, a variety of interactions may occur: the macrophage may lyse releasing its fungal load into the extracellular space, or it could control the infection by keeping the yeast cells within the confines of its cellular membrane 4. However, several years ago a new outcome was described independently by two groups: non-lytic exocytosis, a process in which a macrophage expunged some or all of the cryptococcal cells into the surrounding environment or a neighboring cell and both host and pathogen remain viable 5-8. Several studies have attempted to understand the molecular mechanisms behind this interaction but we still do not have a full grasp on what drives this phenomenon.
The capability to capture images in real-time and then subsequently analyze multiple infected macrophages allows one to answer many questions about the physical properties surrounding non-lytic exocytosis in regards to timing, spatial capacity, change in morphology and even stress of macrophages during a fungal infection. By allowing the cells to be housed in an environment that is comparable to that of an incubator, we can glimpse the dynamic nature of macrophage-fungal cell interactions. Researchers have used this technique to study various components of this process. The role of the phagosome in this process was made apparent using fluorescent staining and actin blocking agents 9, while another group used this method to show that non-lytic exocytosis was blocked in cells that have had the WASH nucleating protein domains deleted 10. The effect of cytokine signaling has also been ascertained using real-time microscopy 11. This process is not limited to C. neoformans as it has also been observed with Candida albicans, another fungal pathogen that has the capability to infect macrophages 12. These findings are examples of how this method can provide a wealth of information to an area we know so little about.