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Simitsopoulou M, Roilides E, Dotis J, Dalakiouridou M, Dudkova F, Andreadou E, Walsh TJ. Differential expression of cytokines and chemokines in human monocytes induced by lipid formulations of amphotericin B. Antimicrob Agents Chemother 2005; 49:1397-403. [PMID: 15793118 PMCID: PMC1068615 DOI: 10.1128/aac.49.4.1397-1403.2005] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The immunomodulatory effects of liposomal amphotericin B (LAMB), amphotericin B lipid complex (ABLC), and amphotericin B colloidal dispersion (ABCD) on mRNA and protein profiles of five cytokines and chemokines expressed by human monocyte-enriched mononuclear leukocytes (MNCs) were comprehensively evaluated by semiquantitative reverse transcription-PCR and enzyme-linked immunosorbent assays; they were compared to those of deoxycholate amphotericin B (DAMB). mRNAs of interleukin-1beta (IL-1beta), IL-1 receptor antagonist (IL-1ra), tumor necrosis factor alpha (TNF-alpha), monocyte chemotactic protein 1 (MCP-1), and macrophage inflammatory protein 1beta (MIP-1beta) were assessed after treatment of MNCs with each drug for 0.5, 2, 6, and 22 h. The cytokine protein profiles were obtained after incubation of MNCs with the drugs for 2 h (TNF-alpha) or 6 h (all the others). In the mRNA studies, DAMB resulted in an early increase of inflammatory cytokines or chemokines IL-1beta, TNF-alpha, MCP-1, and MIP-1beta (2 to 6 h) and in a late increase of anti-inflammatory IL-1ra (22 h). ABCD showed a general similar trend of inflammatory gene up-regulation. LAMB and ABLC decreased or did not affect IL-1beta and TNF-alpha, whereas ABLC additionally decreased MIP-1beta. In protein measurement studies, DAMB and ABCD up-regulated production of IL-1beta (P < 0.05), decreased the IL-1ra/IL-1beta ratio, and up-regulated the production of MCP-1 and MIP-1beta. In comparison, LAMB and ABLC down-regulated or did not affect the production of these cytokines/chemokines compared to untreated MNCs; furthermore, ABLC tended to increase the IL-1ra/IL-1beta ratio. These studies demonstrate that amphotericin B formulations differentially affect gene expression and release of an array of proinflammatory and anti-inflammatory cytokines that potentially may explain the differences in infusion-related reactions and dose-dependent nephrotoxicity as well as modulation of the host immune response to invasive fungal infections.
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Affiliation(s)
- M Simitsopoulou
- Laboratory of Infectious Diseases, 3rd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Greece
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154
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Falk R, Hacham M, Nyska A, Foley JF, Domb AJ, Polacheck I. Induction of interleukin-1beta, tumour necrosis factor-alpha and apoptosis in mouse organs by amphotericin B is neutralized by conjugation with arabinogalactan. J Antimicrob Chemother 2005; 55:713-20. [PMID: 15814605 DOI: 10.1093/jac/dki090] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To investigate the possibilities that: (i) organ toxicity of amphotericin B-deoxycholate (AMB-DOC) is related to induction of interleukin-1beta (IL-1beta), tumour necrosis factor-alpha (TNF-alpha) and apoptosis in target organs; and (ii) the reduced toxicity resulting from the conjugation of AMB with water-soluble arabinogalactan (AMB-AG), is related to modulation of these parameters. METHODS Organ expression of IL-1beta and TNF-alpha was evaluated by enzyme-linked immunosorbent assay (ELISA) in mouse organ biological fluids and in situ by immunohistochemistry. Tissue damage was evaluated histologically, and apoptosis was demonstrated by terminal dUTP nick end-labelling (TUNEL) staining. AMB-AG conjugate was compared with the micellar (AMB-DOC) and liposomal (AmBisome) AMB formulations. RESULTS Treatment with AMB-AG or AmBisome caused no observable histopathological damage in the kidneys. In contrast, treatment with AMB-DOC resulted in disruptive changes and apoptosis in renal tubular cells. These effects were found to correlate with induction of high levels of IL-1beta and TNF-alpha in kidney lysates. Unlike AMB-AG, AMB-DOC also induced enhanced IL-1beta and TNF-alpha expression in lysates of lungs, brain, liver and spleen. The marked elevation of these inflammation-apoptosis-promoting cytokines after treatment with AMB-DOC may mediate its systemic and local renal damage. Treatment with AMB-AG (but not AmBisome) appears to uniquely modulate the in situ expression of IL-1beta and enhance secretion of TNF-alpha in kidneys, effects possibly involved in prevention of apoptosis. CONCLUSIONS AMB-related toxicity is associated with induction of IL-1beta, TNF-alpha and apoptosis in organs. These effects were not observed with AMB-AG conjugate, suggesting its potential as a safer formulation for therapy.
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Affiliation(s)
- Rama Falk
- Department of Clinical Microbiology and Infectious Diseases, The Hebrew University-Hadassah Medical Center, PO Box 12000, Jerusalem 91120, Israel
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155
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Bellocchio S, Gaziano R, Bozza S, Rossi G, Montagnoli C, Perruccio K, Calvitti M, Pitzurra L, Romani L. Liposomal amphotericin B activates antifungal resistance with reduced toxicity by diverting Toll-like receptor signalling from TLR-2 to TLR-4. J Antimicrob Chemother 2005; 55:214-22. [PMID: 15649994 DOI: 10.1093/jac/dkh542] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Neutrophils play a crucial role in the control of the Aspergillus fumigatus infection and act in concert with antifungal drugs. This study was undertaken to obtain insights into the possible involvement of Toll-like receptors (TLRs) in the interaction of liposomal amphotericin B (L-AmB; AmBisome) with neutrophils in response to A. fumigatus. METHODS For generation of bone marrow-transplanted mice, irradiated C57BL6 mice were infused with T cell-depleted allogeneic donor cells. For infection, mice were injected intranasally with Aspergillus fumigatus conidia and treated with L-Amb and deoxycholate amphotericin B prophylactically or therapeutically. For TLR-dependent antifungal functions, murine neutrophils were preincubated with antifungals or TLR ligands before the addition of Aspergillus conidia. RESULTS The results show that: (a) neutrophil activation by Aspergillus occurs through TLR signalling pathways differently affecting the oxidative and non-oxidative mechanisms of the killing machinery; (b) by diverting signalling from TLR-2 to TLR-4, liposomes of AmBisome activate neutrophils to an antifungal state while attenuating the pro-inflammatory effects of deoxycholate amphotericin B; (c) this translates in vivo to the optimization of the AmBisome therapeutic efficacy in mice with aspergillosis. CONCLUSIONS These results provide a putative molecular basis for the reduced infusion-related toxicity of AmBisome and suggest that TLR manipulation in vivo is amenable to the induction of optimal microbicidal activity in the absence of inflammatory cytotoxicity to host cells.
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Affiliation(s)
- Silvia Bellocchio
- Microbiology Sections, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
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156
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Siddiqui AA, Brouwer AE, Wuthiekanun V, Jaffar S, Shattock R, Irving D, Sheldon J, Chierakul W, Peacock S, Day N, White NJ, Harrison TS. IFN-γ at the Site of Infection Determines Rate of Clearance of Infection in Cryptococcal Meningitis. THE JOURNAL OF IMMUNOLOGY 2005; 174:1746-50. [PMID: 15661940 DOI: 10.4049/jimmunol.174.3.1746] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In animal models, immunity to cryptococcal infection, as in many chronic fungal and bacterial infections, is associated with a granulomatous inflammatory response, intact cell-mediated immunity, and a Th1 pattern of cytokine release. To examine the correlates of human immunity to cryptococcal infection in vivo, we analyzed immune parameters at the site of infection over time and assessed the rate of clearance of infection by serial quantitative cerebrospinal fluid (CSF) fungal cultures in 62 patients in a trial of antifungal therapy for HIV-associated cryptococcal meningitis. CSF IL-6, IFN-gamma, TNF-alpha, and IL-8 were significantly higher in survivors compared with nonsurvivors. There were negative correlations between log TNF-alpha, IFN-gamma, and IL-6 levels and baseline cryptococcal CFU. Log IFN-gamma, G-CSF, TNF-alpha, and IL-6 were correlated positively with the rate of fall in log CFU/ml CSF/day. In a linear regression model including antifungal treatment group, baseline CFU, and these cytokines, only treatment group and log IFN-gamma remained independently associated with rate of clearance of infection. The results provide direct in vivo evidence for the importance of quantitative differences in IFN-gamma secretion in human immune control of granulomatous infections, and increase the rationale for adjunctive IFN-gamma in the treatment of refractory HIV-associated cryptococcosis.
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Affiliation(s)
- Asna A Siddiqui
- Department of Infectious Diseases, St. George's Hospital Medical School, London, United Kingdom
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157
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Gaziano R, Bozza S, Bellocchio S, Perruccio K, Montagnoli C, Pitzurra L, Salvatori G, De Santis R, Carminati P, Mantovani A, Romani L. Anti-Aspergillus fumigatus efficacy of pentraxin 3 alone and in combination with antifungals. Antimicrob Agents Chemother 2004; 48:4414-21. [PMID: 15504871 PMCID: PMC525434 DOI: 10.1128/aac.48.11.4414-4421.2004] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The collectin pentraxin 3 (PTX3) is an essential component of host resistance to pulmonary aspergillosis. Here we examined the protective effects of administration of PTX3 alone or together with deoxycholate amphotericin B (Fungizone) or liposomal amphotericin B (AmBisome) against invasive aspergillosis in a murine model of allogeneic bone marrow transplantation. PTX3, alone or in combination with the polyenes, was given intranasally or parenterally either before, in concomitance with, or after the intranasal infection with Aspergillus fumigatus conidia. Mice were monitored for resistance to infection and parameters of innate and adaptive T-helper immunity. The results showed the following: (i) complete resistance to infection and reinfection was observed in mice treated with PTX3 alone; (ii) the protective effect of PTX3 was similar or superior to that observed with liposomal amphotericin B or deoxycholate amphotericin B, respectively; (iii) protection was associated with accelerated recovery of lung phagocytic cells and T-helper-1 lymphocytes and concomitant decrease of inflammatory pathology; and (iv) PTX3 potentiated the therapeutic efficacy of suboptimal doses of either antimycotic drug. Together, these data suggest the potential therapeutic use of PTX3 either alone or as an adjunctive therapy in A. fumigatus infections.
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Affiliation(s)
- Roberta Gaziano
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Sigma-Tau Industrie Farmaceutiche Riunite S.P.A, Pomezia, Rome, Department of Immunology and Cell Biology, Mario Negri Institute, Milan, Italy
| | - Silvia Bozza
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Sigma-Tau Industrie Farmaceutiche Riunite S.P.A, Pomezia, Rome, Department of Immunology and Cell Biology, Mario Negri Institute, Milan, Italy
| | - Silvia Bellocchio
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Sigma-Tau Industrie Farmaceutiche Riunite S.P.A, Pomezia, Rome, Department of Immunology and Cell Biology, Mario Negri Institute, Milan, Italy
| | - Katia Perruccio
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Sigma-Tau Industrie Farmaceutiche Riunite S.P.A, Pomezia, Rome, Department of Immunology and Cell Biology, Mario Negri Institute, Milan, Italy
| | - Claudia Montagnoli
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Sigma-Tau Industrie Farmaceutiche Riunite S.P.A, Pomezia, Rome, Department of Immunology and Cell Biology, Mario Negri Institute, Milan, Italy
| | - Lucia Pitzurra
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Sigma-Tau Industrie Farmaceutiche Riunite S.P.A, Pomezia, Rome, Department of Immunology and Cell Biology, Mario Negri Institute, Milan, Italy
| | - Giovanni Salvatori
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Sigma-Tau Industrie Farmaceutiche Riunite S.P.A, Pomezia, Rome, Department of Immunology and Cell Biology, Mario Negri Institute, Milan, Italy
| | - Rita De Santis
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Sigma-Tau Industrie Farmaceutiche Riunite S.P.A, Pomezia, Rome, Department of Immunology and Cell Biology, Mario Negri Institute, Milan, Italy
| | - Paolo Carminati
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Sigma-Tau Industrie Farmaceutiche Riunite S.P.A, Pomezia, Rome, Department of Immunology and Cell Biology, Mario Negri Institute, Milan, Italy
| | - Alberto Mantovani
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Sigma-Tau Industrie Farmaceutiche Riunite S.P.A, Pomezia, Rome, Department of Immunology and Cell Biology, Mario Negri Institute, Milan, Italy
| | - Luigina Romani
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Perugia, Sigma-Tau Industrie Farmaceutiche Riunite S.P.A, Pomezia, Rome, Department of Immunology and Cell Biology, Mario Negri Institute, Milan, Italy
- Corresponding author. Mailing address: Department of Experimental Medicine and Biochemical Sciences—Microbiology Section, University of Perugia, Via del Giochetto, 06122 Perugia, Italy. Phone and fax: 039-075-585-7411. E-mail:
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Abstract
Cryptococcal meningitis is a common opportunistic infection in AIDS patients, particularly in Southeast Asia and Africa. Cases also occur in patients with other forms of immunosupression and in apparently immunocompetent individuals. Mortality from HIV-associated cryptococcal meningitis remains high (10-30%), even in developed countries, because of the inadequacy of current antifungal drugs and the complication of raised intracranial pressure. In cohorts of HIV-infected patients from sub-Saharan Africa, cryptococcosis has accounted for 13-44% of all deaths. Optimal current therapy is with amphotericin B 0.7-1 mg/kg/day plus flucytosine 100 mg/kg/day for 2 weeks, followed by fluconazole 400 mg/day for 8 weeks and 200 mg/day thereafter. Saline loading reduces amphotericin B nephrotoxicity. If there is no contraindication on CT head scan, repeat lumbar puncture with drainage of cerebrospinal fluid (CSF) is recommended for patients with very raised CSF opening pressure. Expansion of antiretroviral programmes raises the prospect of transforming the long-term prognosis of these patients, provided that they survive the acute phase of the illness. Studies are needed to define more fungicidal drug regimens and to improve the treatment of raised intracranial pressure.
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Affiliation(s)
- Tihana Bicanic
- Division of Infectious Diseases, Department of Cellular and Molecular Medicine, St. George's Hospital Medical School, London, UK
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