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Chen Y, Han B, Guan X, Du G, Sheng B, Tang X, Zhang Q, Xie H, Jiang X, Tan Q, Chen S, Wang J, Chen W, Xiao W. Enteric fungi protect against intestinal ischemia-reperfusion injury via inhibiting the SAA1-GSDMD pathway. J Adv Res 2024; 61:223-237. [PMID: 37717911 PMCID: PMC11258666 DOI: 10.1016/j.jare.2023.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Prophylactic antifungal therapy has been widely used for critical patients, but it has failed to improve patient prognosis and has become a hot topic. This may be related to disruption of fungal homeostasis, but the mechanism of fungi action is not clear. As a common pathway in critical patients, intestinal ischemia-reperfusion (IIR) injury is fatal and regulated by gut microbiota. However, the exact role of enteric fungi in IIR injury remains unclear. OBJECTIVES This is a clinical study that aims to provide new perspectives in clarifying the underlying mechanism of IIR injury and propose potential strategies that could be relevant for the prevention and treatment of IIR injury in the near future. METHODS ITS sequencing was performed to detect the changes in fungi before and after IIR injury. The composition of enteric fungi was altered by pretreatment with single-fungal strains, fluconazole and mannan, respectively. Intestinal morphology and function impairment were evaluated in the IIR injury mouse model. Intestinal epithelial MODE-K cells and macrophage RAW264.7 cells were cultured for in vitro tests. RESULTS Fecal fungi diversity revealed the obvious alteration in IIR patients and mice, accompanied by intestinal epithelial barrier dysfunction. Fungal colonization and mannan supplementation could reverse intestinal morphology and function impairment that were exacerbated by fluconazole via inhibiting the expression of SAA1 from macrophages and decreasing pyroptosis of intestinal epithelial cells. Clodronate liposomes were used to deplete the number of macrophages, and it was demonstrated that the protective effect of mannan was dependent on macrophage involvement. CONCLUSION This finding firstly validates that enteric fungi play a crucial role in IIR injury. Preventive antifungal treatment should consider damaging fungal balance. This study provides a novel clue to clarify the role of enteric fungi in maintaining intestinal homeostasis.
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Affiliation(s)
- Yihui Chen
- Department of General Surgery, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing 400037, China
| | - Ben Han
- Department of Nutrition, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
| | - Xu Guan
- Department of Nephrology, Army Medical University, Chongqing, 400037, China
| | - Guangsheng Du
- Department of General Surgery, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing 400037, China
| | - Baifa Sheng
- Department of General surgery, The General Hospital of Western Theater Command, Chengdu, Sichuan Province, 610036, China
| | - Xiaoqi Tang
- Department of Clinical Laboratory Medicine, Southwest Hospital, Army Medical University, Chongqing 400037, China
| | - Quanchao Zhang
- Department of Nephrology, Army Medical University, Chongqing, 400037, China
| | - Huichao Xie
- Department of General Surgery, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing 400037, China
| | - Xianhong Jiang
- Department of Laboratory Animal Science, College of Basic Medical Science, Army Medical University, Chongqing 400038, China
| | - Qianshan Tan
- Department of General Surgery, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing 400037, China
| | - Shuaishuai Chen
- Department of General Surgery, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing 400037, China
| | - Jian Wang
- Department of Nutrition, Xinqiao Hospital, Army Medical University, Chongqing 400037, China.
| | - Wei Chen
- Department of Nosocomial Infection Management, Xinqiao Hospital, Army Medical University, Chongqing 400037, China.
| | - Weidong Xiao
- Department of General Surgery, Xinqiao Hospital, Army Medical University(Third Military Medical University), Chongqing 400037, China.
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Duricova J, Jadrnickova P, Brozmanova H, Kacirova I. Therapeutic drug monitoring guided fluconazole therapy in a patient with cholangitis sepsis. Per Med 2021; 19:9-14. [PMID: 34747184 DOI: 10.2217/pme-2021-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Candida and other fungal species play an increasing role in nosocomial infections, including cholangitis and cholangiosepsis. Early diagnosis and prompt treatment are essential in successful patient outcomes. Fluconazole is an antifungal of choice in fluconazole-sensitive Candida infections. Little information is known about the fluconazole biliary excretion. Decreased tissue penetration may be one of the possible causes of treatment failure. Due to favorable pharmacokinetics, therapeutic drug monitoring of this antifungal has not been recommended routinely. In the presented case we report the successful therapeutic drug monitoring-guided fluconazole treatment in a patient with cholangitis and cholangiosepsis caused by fluconazole-sensitive Candida spp.
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Affiliation(s)
- Jana Duricova
- Department of Clinical Pharmacology, Department of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Pavla Jadrnickova
- Department of Internal Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Hana Brozmanova
- Department of Clinical Pharmacology, Department of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ivana Kacirova
- Department of Clinical Pharmacology, Department of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Therapeutic Drug Monitoring of Antifungal Drugs: Another Tool to Improve Patient Outcome? Infect Dis Ther 2020; 9:137-149. [PMID: 32026399 PMCID: PMC7054538 DOI: 10.1007/s40121-020-00280-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Indexed: 01/28/2023] Open
Abstract
Introduction This study aimed to examine the relationship among adequate dose, serum concentration and clinical outcome in a non-selected group of hospitalized patients receiving antifungals. Methods Prospective cross-sectional study performed between March 2015 and June 2015. Dosage of antifungals was considered adequate according to the IDSA guidelines, whereas trough serum concentrations (determined with HPLC) were considered adequate as follows: fluconazole > 11 µg/ml, echinocandins > 1 µg/ml, voriconazole 1–5.5 µg/ml and posaconazole > 0.7 µg/ml. Results During the study period, 84 patients (65.4% male, 59.6 years) received antifungals for prophylaxis (40.4%), targeted (31.0%) and empirical therapy (28.6%). The most frequent drug was micafungin (28/84; 33.3%) followed by fluconazole (23/84; 27.4%), voriconazole (15/84; 17.9%), anidulafungin (8/84; 9.5%), posaconazole (7/84; 8.3%) and caspofungin (3/84; 3.6%). Considerable interindividual variability was observed for all antifungals with a large proportion of the patients (64.3%) not attaining adequate trough serum concentrations, despite receiving an adequate antifungal dose. Attaining the on-target serum antifungal level was significantly associated with a favorable clinical outcome (OR = 0.02; 95% CI 0.01–0.64; p = 0.03), whereas the administration of an adequate antifungal dosage was not. Conclusions With the standard antifungal dosage, a considerable proportion of patients have low drug concentrations, which are associated with poor clinical outcome.
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Nagy F, Bozó A, Tóth Z, Daróczi L, Majoros L, Kovács R. In vitro antifungal susceptibility patterns of planktonic and sessile Candida kefyr clinical isolates. Med Mycol 2019; 56:493-500. [PMID: 28992253 DOI: 10.1093/mmy/myx062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/13/2017] [Indexed: 12/25/2022] Open
Abstract
The activity of fluconazole, amphotericin B, caspofungin and micafungin was determined using XTT-based fungal damage assays against planktonic cells, early and mature biofilms of Candida kefyr. Median MICs of planktonic cells were 0.25 mg/l, 0.25 mg/l, 0.5 mg/l, and 0.06 mg/l for fluconazole, amphotericin B, caspofungin, and micafungin, respectively. Fluconazole showed at least 50% fungal damage at ≥4 mg/l (51.5% ± 6.63% to 78.38% ± 1.44%) and at ≥128 mg/l (57.88% ± 9.2% to 67.25% ± 9.59%), while amphotericin B produced an even higher anti-biofilm effect at ≥0.5 mg/l (64.63% ± 6.79% to 79.5% ± 5.9%) and at ≥0.12 mg/l (77.63% ± 8.43% to 92.75% ± 1.89%) against early and mature biofilms, respectively. In case of micafungin, 50% fungal damage was observed at ≥0.06 mg/l (66.88% ± 10.16% to 98.63% ± 1.24%) and ≥0.25 mg/l (74.13% ± 10.77% to 99.38% ± 0.38%) for early and mature biofilms, respectively. Caspofungin-exposed cells showed an unexpected susceptibility pattern, that is, planktonic cells showed significantly decreased susceptibility at concentrations ranging from 0.015 mg/l to 1 mg/l compared to biofilms (P < .05-.01). The damage in planktonic cells and biofilms was comparable at higher concentrations. For planktonic cells and biofilms, 50% fungal damage was observed first at 0.5 mg/l (59.75% ± 3.16%) and at 0.06 mg/l (70.25% ± 10.95%), respectively. This unexpected pattern was confirmed using scanning electron microscopy. The unusual susceptibility pattern observed at lower caspofungin concentrations may explain the poorer outcome of caspofungin-treated C. kefyr infections documented in certain patient populations. As this phenomenon was markedly less apparent in case of micafungin, these data suggest that micafungin may be a more reliable option than caspofungin for the treatment of C. kefyr infections.
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Affiliation(s)
- Fruzsina Nagy
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Hungary
| | - Aliz Bozó
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Hungary
| | - Zoltán Tóth
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Hungary
| | - Lajos Daróczi
- Department of Solid State Physics, Faculty of Science and Technology, University of Debrecen, Hungary
| | - László Majoros
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Hungary
| | - Renátó Kovács
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Hungary.,Faculty of Pharmacy, University of Debrecen, Hungary
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Hepatotoxicity of Antimycotics Used for Invasive Fungal Infections: In Vitro Results. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9658018. [PMID: 28473992 PMCID: PMC5394398 DOI: 10.1155/2017/9658018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/17/2017] [Accepted: 03/21/2017] [Indexed: 12/11/2022]
Abstract
Purpose. Drug-induced liver injury (DILI) is the most common cause of liver injury and a serious clinical problem; antimycotics are involved in approximately 3% of all DILI cases. The hepatotoxicity of many drugs, including the antimycotics, is poorly screened in human models. Methods. In a standardized assay the cytotoxicity on hepatocytes of different concentrations (Cmax, 5x Cmax, and 10x Cmax) of the antimycotics used for systemic infections was tested. Anidulafungin (ANI), liposomal amphotericerin B (L-AmB), caspofungin (CASPO), fluconazole (FLUCO), and voriconazole (VORI) were incubated with HepG2/C3A cells. After incubation, the viability of cells (XTT test, LDH release, trypan blue staining), the synthesis of albumin, the cytochrome 1A2 activity, and the cell death (DNA fragmentation) were determined. Kruskal-Wallis and Mann-Whitney tests were used for statistical analyses. Results. L-AmB, ANI, and CASPO showed a mild hepatotoxicity in the Cmax concentrations. Higher concentrations of anidulafungin led to a severe impairment of hepatocyte viability and function. The azoles FLUCO and VORI had a higher hepatotoxic potential in all concentrations. Conclusion. Antimycotics, especially azoles, used for systemic infections should be given with caution in patient with liver insufficiency or liver failure or high risk for this; therefore, therapeutic drug monitoring should be used. Further studies with this approach are encouraged.
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Roelofs MJE, Temming AR, Piersma AH, van den Berg M, van Duursen MBM. Conazole fungicides inhibit Leydig cell testosterone secretion and androgen receptor activation in vitro. Toxicol Rep 2014; 1:271-283. [PMID: 28962244 PMCID: PMC5598417 DOI: 10.1016/j.toxrep.2014.05.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 11/23/2022] Open
Abstract
Conazole fungicides are widely used in agriculture despite their suspected endocrine disrupting properties. In this study, the potential (anti-)androgenic effects of ten conazoles were assessed and mutually compared with existing data. Effects of cyproconazole (CYPRO), fluconazole (FLUC), flusilazole (FLUS), hexaconazole (HEXA), myconazole (MYC), penconazole (PEN), prochloraz (PRO), tebuconazole (TEBU), triadimefon (TRIA), and triticonazole (TRIT) were examined using murine Leydig (MA-10) cells and human T47D-ARE cells stably transfected with an androgen responsive element and a firefly luciferase reporter gene. Six conazoles caused a decrease in basal testosterone (T) secretion by MA-10 cells varying from 61% up to 12% compared to vehicle-treated control. T secretion was concentration-dependently inhibited after exposure of MA-10 cells to several concentrations of FLUS (IC50 = 12.4 μM) or TEBU (IC50 = 2.4 μM) in combination with LH. The expression of steroidogenic and cholesterol biosynthesis genes was not changed by conazole exposure. Also, there were no changes in reactive oxygen species (ROS) formation that could explain the altered T secretion after exposure to conazoles. Nine conazoles decreased T-induced AR activation (IC50s ranging from 10.7 to 71.5 μM) and effect potencies (REPs) were calculated relative to the known AR antagonist flutamide (FLUT). FLUC had no effect on AR activation by T. FLUS was the most potent (REP = 3.61) and MYC the least potent (REP = 0.03) AR antagonist. All other conazoles had a comparable REP from 0.12 to 0.38. Our results show distinct in vitro anti-androgenic effects of several conazole fungicides arising from two mechanisms: inhibition of T secretion and AR antagonism, suggesting potential testicular toxic effects. These effects warrant further mechanistic investigation and clearly show the need for accurate exposure data in order to perform proper (human) risk assessment of this class of compounds.
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Key Words
- 17β-HSD3, 17β-hydroxysteroid dehydrogenase type 3
- 3β-HSD1, 3β-hydroxysteroid dehydrogenase type 1
- AR, androgen receptor
- Androgen receptor (AR)
- BMR, benchmark response
- CHO cells, Chinese hamster ovary cells
- CYP19, cytochrome P450 enzyme 19 (aromatase)
- CYP51, cytochrome P450 enzyme 51/lanosterol 14α-demethylase
- CYPRO, cyproconazole
- Conazole fungicides
- Cyp11A1, cytochrome P450 enzyme 11A
- Cyp17, cytochrome P450 enzyme 17
- Cyproconazole (PubChem CID: 86132)
- DMEM, Dulbecco's Modified Eagle Medium
- EC50, half maximal effective concentration
- EDCs, endocrine disrupting chemicals
- Endocrine disrupting chemicals (EDCs)
- FLUC, fluconazole
- FLUS, flusilazole
- FLUT, flutamide
- FP, forward primer
- FSH(R), follicle-stimulating hormone (receptor)
- Fluconazole (PubChem CID: 3365)
- Flusilazole (PubChem CID: 73675)
- H295R, human adrenocortical carcinoma cells
- HEXA, hexaconazole
- HMG-CoA red, HMG-CoA reductase
- HSD(s), hydroxysteroid dehydrogenase(s)
- Hexaconazole (PubChem CID: 66461)
- IC50, half maximal inhibitory concentration
- LH(R), luteinizing hormone (receptor)
- MA-10 Leydig cells
- MTT, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide
- MYC, myclobutanil
- Myclobutanil (PubChem CID: 6336)
- NCBI, National Center for Biotechnology Information
- PBS, phosphate-buffered saline
- PEN, penconazole
- PRO, prochloraz
- Penconazole (PubChem CID: 91693)
- Por, cytochrome P450 oxidoreductase
- Prochloraz (PubChem CID: 73665)
- REP, relative effect potency
- RIA, radioimmunoassay
- ROS, reactive oxygen species
- RP, reverse primer
- RT-qPCR, real time quantitative polymerase chain reaction
- Spermatogenesis
- StAR, steroidogenic acute regulatory protein
- T, testosterone
- TEBU, tebuconazole
- TRIA, triadimefon
- TRIT, triticonazole
- Tebuconazole (PubChem CID: 86102)
- Testosterone (T)
- Triadimefon (PubChem CID: 39385)
- Triticonazole (PubChem CID: 6537961)
- cAMP, 8-bromoadenosine 3′,5′-cyclic monophosphate
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Affiliation(s)
- Maarke J E Roelofs
- Endocrine Toxicology Research Group, Institute for Risk Assessment Sciences (IRAS), Utrecht University, P.O. Box 80.177, NL-3508 TD Utrecht, The Netherlands.,Center for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - A Roberto Temming
- Endocrine Toxicology Research Group, Institute for Risk Assessment Sciences (IRAS), Utrecht University, P.O. Box 80.177, NL-3508 TD Utrecht, The Netherlands
| | - Aldert H Piersma
- Center for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands.,Endocrine Toxicology Research Group, Institute for Risk Assessment Sciences (IRAS), Utrecht University, P.O. Box 80.177, NL-3508 TD Utrecht, The Netherlands
| | - Martin van den Berg
- Endocrine Toxicology Research Group, Institute for Risk Assessment Sciences (IRAS), Utrecht University, P.O. Box 80.177, NL-3508 TD Utrecht, The Netherlands
| | - Majorie B M van Duursen
- Endocrine Toxicology Research Group, Institute for Risk Assessment Sciences (IRAS), Utrecht University, P.O. Box 80.177, NL-3508 TD Utrecht, The Netherlands
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Kami M, Murashige N, Tanaka Y, Narimatsu H. Antifungal prophylaxis following reduced-intensity stem cell transplantation. Transpl Infect Dis 2006; 8:190-202. [PMID: 17116132 DOI: 10.1111/j.1399-3062.2006.00152.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reduced-intensity stem cell transplantation (RIST) has been developed to be a novel curative option for advanced hematologic diseases. Its minimal toxicity allows for transplantation in patients with advanced age or with organ dysfunction. Young patients without comorbidity can undergo RIST as outpatients. However, fungal infection remains an important complication in RIST. Given the poor prognosis of fungal infection, prophylaxis is critical in its management. The prophylactic strategy is recently changing with the development of RIST. Hospital equipment is important for fungal prophylaxis; however, the median day for the development of fungal infection is day 100, when most RIST patients are followed as outpatients. The focus of fungal management after RIST needs to shift from in-hospital equipment to oral antifungals. Various antifungals have recently been developed and introduced for clinical use. A major change in antifungal management will probably occur within several years.
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Affiliation(s)
- M Kami
- Division of Exploratory Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
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8
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Kami M, Matsumura T. [Fungal infection following reduced-intensity stem cell transplantation (RIST)]. NIHON ISHINKIN GAKKAI ZASSHI = JAPANESE JOURNAL OF MEDICAL MYCOLOGY 2006; 47:143-53. [PMID: 16940947 DOI: 10.3314/jjmm.47.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hematopoietic stem cell transplantation has been established as a curative treatment for advanced hematologic malignancies. Transplantation with a reduced-intensity conditioning regimen has been developed, and the minimal toxicity of reduced-intensity stem cell transplantation (RIST) has made this procedure available for patients of advanced age or with organ dysfunction. The response of malignant lymphoma and some solid tumors to RIST has been observed. RIST with unrelated donors and umbilical cord blood has been studied. Fungal infection is an important complication of RIST. Since the prognosis of fungal infection is poor, the management has been focused on its prophylaxis. Given recent progression in RIST management, the strategy of infectious prophylaxis has also changed. Equipment in the hospital is important for fungal infection; however, the median day of the development of fungal infection is day 100, when most patients are followed as outpatients. The focus of fungal management after RIST is oral antifungal agents rather than in-hospital equipment. Various antifungal agents have recently been developed and applied for clinical use, and many of these have been developed simultaneously for the first time. A major change in antifungal management will probably occur in the next several years.
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Affiliation(s)
- Masahiro Kami
- Division of Exploratory Research, The Institute of Medical Science, The University of Tokyo, Japan
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Arikan S, Rex JH. New agents for the treatment of systemic fungal infections – current status. Expert Opin Emerg Drugs 2005; 7:3-32. [PMID: 15989533 DOI: 10.1517/14728214.7.1.3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Systemic antifungal chemotherapy is enjoying its most dynamic era. More antifungal agents are under development than ever before, including agents in entirely new classes. Major goals of current investigations are to identify compounds with a wide spectrum of activity, minimal toxicity and a high degree of target specificity. The antifungal drugs in development include new azoles {voriconazole, posaconazole (formerly SCH-56592), ravuconazole (formerly BMS-207147)}, lipid formulations of amphotericin B, a lipid formulation of nystatin, echinocandins {anidulafungin (formerly, LY-303366, VER-002), caspofungin (formerly MK-991), micafungin (formerly FK-463)}, antifungal peptides other than echinocandins, and sordarin derivatives. This discussion reviews the currently available antifungal agents and summarises the developmental issues that surround these new systemic antifungal drugs.
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Affiliation(s)
- Sevtap Arikan
- Department of Microbiology and Clinical Microbiology, Hacettepe University Medical School, 06100 Ankara, Turkey.
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Egle H, Trittler R, Kümmerer K. A New, Rapid, Fully Automated Method for Determination of Fluconazole in Serum by Column-Switching Liquid Chromatography. Ther Drug Monit 2004; 26:425-31. [PMID: 15257073 DOI: 10.1097/00007691-200408000-00013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A sensitive and rapid HPLC assay for the determination of fluconazole in serum is described. HPLC-integrated sample preparation allows direct injection of serum samples without any pretreatment. The in-line extraction technique is carried out by automatically switching from the extraction column (Lichrospher ADS C8) to the analytic column (Nucleosil C18). After 6 minutes the matrix passes the extraction column, and the retained analyte is quantitatively transferred to the analytic column, where separation by isocratic HPLC is performed. The extraction eluent is sodium dihydrogen phosphate buffer, pH 5.0 (50 mM), and the analytic eluent is acetonitrile/sodium dihydrogen phosphate buffer, pH 5.0 (50 mM) (26.8/73.2, vol/vol). Fluconazole is detected according to its absorption maximum at 210 nm. The lower limit of quantification (LLOQ) is 0.65 microg/mL, the limit of detection (LOD) is 0.2 microg/mL, and the quantification range is 0.65-23.3 microg/mL. The assay was precise with a between-run coefficient of variation of < or = 5.59%. The within-run accuracy was 99.8% and 103.4%, and the between-run accuracy was 99.2% and 99.7%, respectively, for the concentrations 23.3 microg/mL and 1.3 microg/mL. The recovery was 78%. The described procedure allows sample cleanup and determination within 20 minutes, thereby facilitating drug monitoring in clinical routine. The method was applied successfully.
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Affiliation(s)
- Hannes Egle
- Institute of Environmental Medicine and Hospital Epidemiology, University Hospital Freiburg, D 79106 Freiburg i. Br., Germany
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Imataki O, Kami M, Kim SW, Gotoh M, Komaba S, Kasai M, Hashino S, Naito K, Masuda M, Anan K, Teshima H, Togitani K, Inoue T, Nishimura M, Adachi Y, Fukuhara T, Yamashita T, Uike N, Kobayashi Y, Hamaguchi M, Higuchi M, Kawakami K, Takaue Y. A nationwide survey of deep fungal infections and fungal prophylaxis after hematopoietic stem cell transplantation in Japan. Bone Marrow Transplant 2004; 33:1173-9. [PMID: 15094754 DOI: 10.1038/sj.bmt.1704526] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We conducted a nationwide survey to define incidence of deep fungal infections and fungal prophylaxis practices after HSCT. In all, 63 institutions responded. Total number of in-patient transplantations was 935: 367 autologous, 414 allogeneic myeloablative, and 154 allogeneic reduced-intensity (RIST) (n=154). Number of patients who were cared for in a clean room at transplant was 261 (71%) in autologous, 409 (99%) in conventional and 93 (66%) in RIST, respectively. All patients received prophylactic antifungal agents; 89% fluconazole. Number of patients who received the dosage recommended in the CDC guidelines (400 mg/day) was 135 (42%) in conventional transplant and 34 (30%) in RIST (P=0.037). Number of patients who received fluconazole until engraftment and beyond day 75 in conventional transplant vs RIST was, respectively, 324 (100%) vs 109 (97%), and 39 (12%) vs 18 (16%), with no significant difference between the two groups. A total of 37 patients (4.0%) were diagnosed with deep fungal infections; autologous transplantation (0.03%), conventional transplantation (6.0%) and RIST (7.1%). Wide variations in antifungal prophylaxis practice according to the type of transplant and the institutions, and deep fungal infection remain significant problems in RIST.
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Affiliation(s)
- O Imataki
- Hematopoietic Stem Cell Transplant Unit, National Cancer Center Hospital, Tokyo, Japan
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12
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Kami M, Machida U, Okuzumi K, Matsumura T, Mori Si SI, Hori A, Kashima T, Kanda Y, Takaue Y, Sakamaki H, Hirai H, Yoneyama A, Mutou Y. Effect of fluconazole prophylaxis on fungal blood cultures: an autopsy-based study involving 720 patients with haematological malignancy. Br J Haematol 2002; 117:40-6. [PMID: 11918531 DOI: 10.1046/j.1365-2141.2002.03414.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To investigate the utility of blood culture of invasive fungal infections in patients with haematological malignancies, an autopsy survey was conducted in 720 patients who were treated between 1980 and 1999. We identified 252 patients with invasive mycosis. These included Candida (n = 94), Aspergillus (n = 91), Zygomycetes (n = 34), Cryptococcus (n = 7), Trichosporon (n = 11), Fusarium (n = 1), and unknown fungi (n = 20). Of the 94 patients with invasive candidiasis, 20 had positive blood cultures. Of the 11 patients with invasive trichosporonosis, seven had positive blood cultures. The sensitivities of blood cultures were 1.1%, 0% and 14% for detecting invasive aspergillosis, zygomycosis and cryptococcosis respectively. Multiple regression analysis showed a significant correlation between results of Candida blood cultures and some variables, including prophylactic use of absorbable antifungals (P = 0.0181) and infection by Candida albicans (P = 0.0086). The sensitivity of blood cultures decreased when patients received antifungal chemoprophylaxis. Unless these agents are inactivated in culture bottles, conventional blood cultures might produce false-negative results.
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Affiliation(s)
- Masahiro Kami
- Department of Hematology, Toranomon Hospital, Tokyo, Japan.
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