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Sugio CYC, Garcia AAMN, Kitamoto KADA, Santiago Júnior JF, Soares S, Porto VC, Urban VM, Ferrari PC, Fernandes MH, Neppelenbroek KH. Mucoadhesive delivery systems for oral candidiasis treatment: A systematic review and meta-analysis. Oral Dis 2024; 30:3771-3787. [PMID: 38523365 DOI: 10.1111/odi.14928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/01/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to evaluate the clinical and mycological effectiveness of mucoadhesives as vehicles for drugs or natural products in the treatment of oral candidiasis. MATERIALS AND METHODS The search for articles was carried out in the Medline/PubMed, SCOPUS, EMBASE, Web of Science, Cochrane Library, and SciELO databases before August 2023. We selected the studies, extracted the data, evaluated the study quality, graded the evidence, performed the risk of bias, and carried out meta-analysis. RESULTS A total of 389 potentially relevant articles were identified, and 11 studies (1869 participants) met the inclusion criteria of the systematic review. The overall risk of bias was considered low. The most common presentation of mucoadhesives was tablets, with miconazole being the most frequently drug used in the delivery system. Mucoadhesives demonstrated comparable efficacy with topical or systemic antifungal agents, with no significant differences between treatments in terms of clinical (RR = 0.907; 95CI = 0.3-1.297; p = 0.591; I2 = 64.648) or mycological (RR = 0.95; 95CI = 0.667-1.360; p = 0.789; I2 = 73.271) efficacy. CONCLUSIONS Mucoadhesives may be a suitable alternative to conventional treatments, with the advantage of reducing the frequency of application by up to 5 times and the daily dosage by up to 20 times.
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Affiliation(s)
- Carolina Yoshi Campos Sugio
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo (USP), Bauru, Brazil
- BoneLab-Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, Associated Laboratory for Green Chemistry/Network of Chemistry and Technology (LAQV/REQUIMTE), University of Porto (UP), Porto, Portugal
| | | | - Klaryssa Akemi de Araujo Kitamoto
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo (USP), Bauru, Brazil
- BoneLab-Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, Associated Laboratory for Green Chemistry/Network of Chemistry and Technology (LAQV/REQUIMTE), University of Porto (UP), Porto, Portugal
| | | | - Simone Soares
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo (USP), Bauru, Brazil
| | - Vinicius Carvalho Porto
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo (USP), Bauru, Brazil
| | | | | | - Maria Helena Fernandes
- BoneLab-Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, Associated Laboratory for Green Chemistry/Network of Chemistry and Technology (LAQV/REQUIMTE), University of Porto (UP), Porto, Portugal
| | - Karin Hermana Neppelenbroek
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo (USP), Bauru, Brazil
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Wang Y, Zhou H, Wang W, Duan N, Luo Z, Chai H, Jiang L, Chen Q, Liu J, Hua H, Yan Z, Fan Y, Xu J, Guan X, Wang H, Lu H, Lun W, Fei W, Zhang T, Zhao J, Jia C, Kong H, Shen X, Liu Q, Wang W, Tang G. Efficacy and safety of miconazole muco-adhesive tablet versus itraconazole in oropharyngeal candidiasis: A randomized, multi-centered, double-blind, phase 3 trial. Med Mycol 2022; 60:myac076. [PMID: 36149321 DOI: 10.1093/mmy/myac076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/16/2022] [Accepted: 09/21/2022] [Indexed: 11/14/2022] Open
Abstract
Oropharyngeal candidiasis (OPC) is an opportunistic infection treated with anti-fungal agents. Herein, we evaluate the efficacy and safety of miconazole buccal tablets (MBT) and itraconazole capsules in the localized treatment of patients with OPC. In this multi-centered, double-blinded, phase III trial (CTR20130414), both males and non-pregnant females (≥18 years) with OPC were randomized (1:1) to MBT plus placebo (experimental group) or itraconazole capsules plus placebo (control group). The primary endpoint was clinical cure at the end-of-treatment period [visit 4 (V4)] while secondary endpoints were clinical remission rates, partial remission rates, mycological cure, clinical relapse, and adverse events (AEs). All endpoints were statistically analyzed in both the full analysis set (FAS) and per-protocol (PP) set. A total of 431 (experimental: 216; control: 215) subjects were included. At V4, in the FAS set, the clinical cure was achieved in 68% and 59% patients in experimental and control groups, respectively with a treatment difference of 9% [95% confidence interval (CI): -1,19; P < .001] demonstrating non-inferiority of MBT over itraconazole. At V4, mycological cure rates were 68.2% and 42.0% in the experimental group and control groups (P < .001), respectively in FAS. The relapse rates were 5.4% and 6.6%, respectively, in the experimental and control groups. A total of 210 patients experienced AEs during treatment with 47.7% in the experimental group and 49.8% in the control group with no deaths. This study demonstrated that once-daily treatment with MBT was non-inferior to itraconazole with higher mycological cure rates and was tolerable with mild AE in patients with OPC.
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Affiliation(s)
- Yufeng Wang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Stomatological Center; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory, Shanghai 200011, China
| | - Haiwen Zhou
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Stomatological Center; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory, Shanghai 200011, China
| | - Wenmei Wang
- Department of Oral Medicine, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu, China
| | - Ning Duan
- Department of Oral Medicine, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu, China
| | - Zhixiao Luo
- Dental Department, Taihe Hospital, Affiliated Hospital of Hubei, University of Medicine, Shiyan 442099, Hubei, China
| | - Hongbo Chai
- Dental Department, Taihe Hospital, Affiliated Hospital of Hubei, University of Medicine, Shiyan 442099, Hubei, China
| | - Lu Jiang
- Department of Oral Medicine, West China School/Hospital Stomatology Sichuan University, Chengdu 610042, Sichuan, China
| | - Qianming Chen
- Department of Oral Medicine, West China School/Hospital Stomatology Sichuan University, Chengdu 610042, Sichuan, China
| | - Jinli Liu
- Department of Oral Medicine, West China School/Hospital Stomatology Sichuan University, Chengdu 610042, Sichuan, China
| | - Hong Hua
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Zhimin Yan
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Yuan Fan
- Department of Oral Medicine, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Juanyong Xu
- Department of Oral Medicine, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Xiaobing Guan
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Hongjian Wang
- Department of Oral Medicine, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Hongzhou Lu
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Wenhui Lun
- Department of Dermatology and Venereology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Wei Fei
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan, China
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Jizhi Zhao
- Department of Stomatology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Chunling Jia
- Department of Oral Medicine, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
| | - Hui Kong
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Medicine, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Xuemin Shen
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Stomatological Center; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory, Shanghai 200011, China
| | - Qing Liu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Medicine, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Weizhi Wang
- Department of Oral Medicine, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
| | - Guoyao Tang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Stomatological Center; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory, Shanghai 200011, China
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Edmans JG, Ollington B, Colley HE, Santocildes-Romero ME, Siim Madsen L, Hatton PV, Spain SG, Murdoch C. Electrospun patch delivery of anti-TNFα F(ab) for the treatment of inflammatory oral mucosal disease. J Control Release 2022; 350:146-157. [PMID: 35973471 DOI: 10.1016/j.jconrel.2022.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
Chronic ulcerative oral mucosal inflammatory diseases, including oral lichen planus and recurrent aphthous stomatitis, are painful and highly prevalent, yet lack effective clinical management. In recent years, systemic biologic therapies, including monoclonal antibodies that block the activity of cytokines, have been increasingly used to treat a range of immune-mediated inflammatory conditions such as rheumatoid arthritis and psoriasis. The ability to deliver similar therapeutic agents locally to the oral epithelium could radically alter treatment options for oral mucosal inflammatory diseases, where pro-inflammatory cytokines, in particular tumour-necrosis factor-α (TNFα), are major drivers of pathogenesis. To address this, an electrospun dual-layer mucoadhesive patch comprising medical-grade polymers was investigated for the delivery of F(ab) biologics to the oral mucosa. A fluorescent-labelled F(ab) was incorporated into mucoadhesive membranes using electrospinning with 97% v/v ethanol as a solvent. The F(ab) was detected within the fibres in aggregates when visualised by confocal microscopy. Biotinylated F(ab) was rapidly eluted from the patch (97 ± 5% released within 3 h) without loss of antigen-binding activity. Patches applied to oral epithelium models successfully delivered the F(ab), with fluorescent F(ab) observed within the tissue and 5.1 ± 1.5% cumulative transepithelial permeation reached after 9 h. Neutralising anti-TNFα F(ab) fragments were generated from whole IgG by papain cleavage, as confirmed by SDS-PAGE, then incorporated into patches. F(ab)-containing patches had TNFα neutralising activity, as shown by the suppression of TNFα-mediated CXCL8 release from oral keratinocytes cultured as monolayers. Patches were applied to lipopolysaccharide-stimulated immune-competent oral mucosal ulcer equivalents that contained primary macrophages. Anti-TNFα patch treatment led to reduced levels of active TNFα along with a reduction in the levels of disease-implicated T-cell chemokines (CCL3, CCL5, and CXCL10) to baseline concentrations. This is the first report of an effective device for the delivery of antibody-based biologics to the oral mucosa, enabling the future development of new therapeutic strategies to treat painful conditions.
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Affiliation(s)
- Jake G Edmans
- School of Clinical Dentistry, 19 Claremont Crescent, University of Sheffield, Sheffield S10 2TA, UK; Department of Chemistry, Brook Hill, University of Sheffield, Sheffield S3 7HF, UK
| | - Bethany Ollington
- School of Clinical Dentistry, 19 Claremont Crescent, University of Sheffield, Sheffield S10 2TA, UK
| | - Helen E Colley
- School of Clinical Dentistry, 19 Claremont Crescent, University of Sheffield, Sheffield S10 2TA, UK.
| | | | - Lars Siim Madsen
- AFYX Therapeutics, Lergravsej 57, 2. tv, 2300 Copenhagen, Denmark
| | - Paul V Hatton
- School of Clinical Dentistry, 19 Claremont Crescent, University of Sheffield, Sheffield S10 2TA, UK
| | - Sebastian G Spain
- Department of Chemistry, Brook Hill, University of Sheffield, Sheffield S3 7HF, UK
| | - Craig Murdoch
- School of Clinical Dentistry, 19 Claremont Crescent, University of Sheffield, Sheffield S10 2TA, UK
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Effects of a miconazole oral patch on preventing development of oral candidiasis in patients with head and neck cancer undergoing radiotherapy: results of a preliminary study quantifying the prevalence of Candida albicans in saliva. Support Care Cancer 2021; 30:907-914. [PMID: 34410460 DOI: 10.1007/s00520-021-06480-7] [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] [Received: 05/22/2021] [Accepted: 07/28/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Serious oral mucositis develops during radiation therapy (RT) for head and neck cancer, but there is no effective preventive method. We have used a steroid ointment to prevent oral mucositis during RT, but the use of steroid ointment is discontinued when oral candidiasis develops. Therefore, prevention of oral candidiasis is important. The purpose of this study was to examine whether administration of a miconazole oral patch reduced the amount of Candida albicans in saliva and prevented the development of oral candidiasis during RT. METHODS Participants were patients with head and neck cancer receiving RT ≥ 60 Gy. Patients in the intervention group received miconazole oral patches for 14 days after the appearance of grade 2 oral mucositis. The control group received oral care only. Total bacteria and C. albicans counts in the saliva were analyzed by real-time polymerase chain reaction. The incidence of oral candidiasis was compared between the groups. RESULTS Total bacterial counts did not change throughout RT in either the intervention or the control group. However, C. albicans count significantly increased at 30 Gy and 60 Gy in the control group but was suppressed in the intervention group. The saliva pH did not show a significant change throughout RT in either group. The incidence of oral candidiasis in the intervention group tended to be lower than that in the control group. CONCLUSION This study suggested that prophylactic use of a miconazole oral patch was effective in suppressing the growth of C. albicans count in saliva during RT for head and neck cancer.
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Pezzotti G, Asai T, Adachi T, Ohgitani E, Yamamoto T, Kanamura N, Boschetto F, Zhu W, Zanocco M, Marin E, Bal BS, McEntire BJ, Makimura K, Mazda O, Nishimura I. Antifungal activity of polymethyl methacrylate/Si 3N 4 composites against Candida albicans. Acta Biomater 2021; 126:259-276. [PMID: 33727194 DOI: 10.1016/j.actbio.2021.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 12/16/2022]
Abstract
Previous studies using gram-positive and -negative bacteria demonstrated that hydrolysis of silicon nitride (Si3N4) in aqueous suspensions elutes nitrogen and produces gaseous ammonia while buffering pH. According to immunochemistry assays, fluorescence imaging, and in situ Raman spectroscopy, we demonstrate here that the antipathogenic surface chemistry of Si3N4 can be extended to polymethylmethacrylate (PMMA) by compounding it with a minor fraction (~8 vol.%) of Si3N4 particles without any tangible loss in bulk properties. The hydrolytic products, which were eluted from partly exposed Si3N4 particles at the composite surface, exhibited fungicidal action against Candida albicans. Using a specific nitrative stress sensing dye and highly resolved fluorescence micrographs, we observed in situ congestion of peroxynitrite (ONOO-) radicals in the mitochondria of the Candida cells exposed to the PMMA/Si3N4 composite, while these radicals were absent in the mitochondria of identical cells exposed to monolithic PMMA. These in situ observations suggest that the surface chemistry of Si3N4 mimics the antifungal activity of macrophages, which concurrently produce NO radicals and superoxide anions (O2•-) resulting in the formation of candidacidal ONOO-. The fungicidal properties of PMMA/Si3N4 composites could be used in dental appliances to inhibit the uncontrolled growth of Candida albicans and ensuing candidiasis while being synergic with chemoprophylaxis. STATEMENT OF SIGNIFICANCE: In a follow-up of previous studies of gram-positive and gram-negative bacteria, we demonstrate here that the antipathogenic surface chemistry of Si3N4 could be extended to polymethylmethacrylate (PMMA) containing a minor fraction (~8 vol.%) of Si3N4 particles without tangible loss in bulk properties. Hydrolytic products eluted from Si3N4 particles at the composite surface exhibited fungicidal action against Candida albicans. Highly resolved fluorescence microscopy revealed congestion of peroxynitrite (ONOO-) radicals in the mitochondria of the Candida cells exposed to the PMMA/Si3N4 composite, while radicals were absent in the mitochondria of identical cells exposed to monolithic PMMA. The fungicidal properties of PMMA/Si3N4 composites could be used in dental appliances to inhibit uncontrolled growth of Candida albicans and ensuing candidiasis in synergy with chemoprophylaxis.
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Ho CY, Chang AC, Hsu CH, Tsai TF, Lin YC, Chou KY, Chen HE, Lin JF, Chen PC, Hwang TIS. Miconazole induces protective autophagy in bladder cancer cells. ENVIRONMENTAL TOXICOLOGY 2021; 36:185-193. [PMID: 32981224 DOI: 10.1002/tox.23024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/17/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Autophagy plays a dual function in cancer progression; autophagy activation can support cancer cell survival or contribute to cell death. Miconazole, a Food and Drug Administration-approved antifungal drug, has been implicated in oncology research recently. Miconazole was found to exert antitumor effects in various tumors, including bladder cancer (BC). However, whether it provokes protective autophagy has been never discussed. We provide evidence that miconazole induces protective autophagy in BC for the first time. The results indicated that 1A/1B-light chain 3 (LC3)-II processing and p62 expression were elevated after miconazole exposure. Also, adenosine monophosphate-activated protein kinase phosphorylation was increased after miconazole treatment. We also confirmed the autophagy-promoting effect of miconazole in the presence of bafilomycin A1 (Baf A1). The result indicates that a combination treatment of miconazole and Baf A1 improved LC3-II processing, confirming that miconazole promoted autophagic flux. The acridine orange, Lysotracker, and cathepsin D staining results indicate that miconazole increased lysosome formation, revealing its autophagy-promoting function. Finally, miconazole and autophagy inhibitor 3-methyladenine cotreatment further reduced the cell viability and induced apoptosis in BC cells, proving that miconazole provokes protective autophagy in BC cells. Our findings approve that miconazole has an antitumor effect in promoting cell apoptosis; however, its function of protective autophagy is needed to be concerned in cancer treatment.
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Affiliation(s)
- Chao-Yen Ho
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - An-Chen Chang
- Translational Medicine Center, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chung-Hua Hsu
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Te-Fu Tsai
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Yi-Chia Lin
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Kuang-Yu Chou
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Hung-En Chen
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ji-Fan Lin
- Translational Medicine Center, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Po-Chun Chen
- Translational Medicine Center, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Thomas I-Sheng Hwang
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
- Department of Urology, Taipei Medical University, Taipei, Taiwan
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Fang J, Huang B, Ding Z. Efficacy of antifungal drugs in the treatment of oral candidiasis: A Bayesian network meta-analysis. J Prosthet Dent 2021; 125:257-265. [DOI: 10.1016/j.prosdent.2019.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 12/31/2019] [Accepted: 12/31/2019] [Indexed: 12/26/2022]
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Edmans JG, Murdoch C, Santocildes-Romero ME, Hatton PV, Colley HE, Spain SG. Incorporation of lysozyme into a mucoadhesive electrospun patch for rapid protein delivery to the oral mucosa. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 112:110917. [DOI: 10.1016/j.msec.2020.110917] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/04/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022]
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Edmans JG, Clitherow KH, Murdoch C, Hatton PV, Spain SG, Colley HE. Mucoadhesive Electrospun Fibre-Based Technologies for Oral Medicine. Pharmaceutics 2020; 12:E504. [PMID: 32498237 PMCID: PMC7356016 DOI: 10.3390/pharmaceutics12060504] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 02/07/2023] Open
Abstract
Oral disease greatly affects quality of life, as the mouth is required for a wide range of activities including speech, food and liquid consumption. Treatment of oral disease is greatly limited by the dose forms that are currently available, which suffer from short contact times, poor site specificity, and sensitivity to mechanical stimulation. Mucoadhesive devices prepared using electrospinning offer the potential to address these challenges by allowing unidirectional site-specific drug delivery through intimate contact with the mucosa and with high surface areas to facilitate drug release. This review will discuss the range of electrospun mucoadhesive devices that have recently been reported to address oral inflammatory diseases, pain relief, and infections, as well as new treatments that are likely to be enabled by this technology in the future.
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Affiliation(s)
- Jake G. Edmans
- School of Clinical Dentistry, 19 Claremont Crescent, University of Sheffield, Sheffield S10 2TA, UK; (J.G.E.); (K.H.C.); (P.V.H.); (H.E.C.)
- Department of Chemistry, Brook Hill, University of Sheffield, Sheffield S3 7HF, UK;
| | - Katharina H. Clitherow
- School of Clinical Dentistry, 19 Claremont Crescent, University of Sheffield, Sheffield S10 2TA, UK; (J.G.E.); (K.H.C.); (P.V.H.); (H.E.C.)
- Department of Chemistry, Brook Hill, University of Sheffield, Sheffield S3 7HF, UK;
| | - Craig Murdoch
- School of Clinical Dentistry, 19 Claremont Crescent, University of Sheffield, Sheffield S10 2TA, UK; (J.G.E.); (K.H.C.); (P.V.H.); (H.E.C.)
| | - Paul V. Hatton
- School of Clinical Dentistry, 19 Claremont Crescent, University of Sheffield, Sheffield S10 2TA, UK; (J.G.E.); (K.H.C.); (P.V.H.); (H.E.C.)
| | - Sebastian G. Spain
- Department of Chemistry, Brook Hill, University of Sheffield, Sheffield S3 7HF, UK;
| | - Helen E. Colley
- School of Clinical Dentistry, 19 Claremont Crescent, University of Sheffield, Sheffield S10 2TA, UK; (J.G.E.); (K.H.C.); (P.V.H.); (H.E.C.)
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Tsai TF, Chen PC, Lin YC, Chou KY, Chen HE, Ho CY, Lin JF, Hwang TIS. Miconazole Contributes to NRF2 Activation by Noncanonical P62-KEAP1 Pathway in Bladder Cancer Cells. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:1209-1218. [PMID: 32273683 PMCID: PMC7102888 DOI: 10.2147/dddt.s227892] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/18/2020] [Indexed: 11/23/2022]
Abstract
Purpose Nuclear factor (erythroid-derived 2)-like 2, also known as NFE2L2 or NRF2, a transcription factor capable of upregulating antioxidant response element (ARE)-mediated expression and cytoprotective proteins, plays critical roles in chemoprevention, inflammation and aging. NRF2 has recently been proposed as a novel target for cancer chemoprevention. The fungicide miconazole has shown promising antiproliferative effects in cancer cells. Materials and Methods After miconazole treatment, the p62-KEAP1-NRF2 activation was analyzed by qPCR and Western blot. The nuclear translocation indicating NRF2 activation was further confirmed by immunofluorescence. Finally, the ROS production was detected by CM-H2DCFDA staining. Results We demonstrate in this study that miconazole dramatically increases NRF2 activation in bladder cancer cells, in a dose- and time-dependent manner. Interestingly, levels of expression of p62, a noncanonical pathway that mediates NRF2 activation, appeared to increase in accordance with NRF2. We also investigated levels of the negative regulator kelch-like ECH-associated protein 1 (KEAP1), which is involved in NRF2 activation. As expected, a decrease in KEAP1 expression was found after miconazole exposure. Confirmation of NRF2 nuclear translocation was monitored by immunofluorescence. Miconazole-induced generation of reactive oxygen species (ROS) promoted NRF2 activation. Pretreatment of bladder cancer cells with ROS scavengers abolished NRF2 expression and nuclear translocation, indicating that miconazole activates the noncanonical p62-KEAP1-NRF2 pathway, which is regulated by ROS production. Conclusion Our study elucidates the mechanisms through which miconazole stimulates NRF2 which may contribute to cancer chemopreventive effects.
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Affiliation(s)
- Te-Fu Tsai
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Po-Chun Chen
- Central Laboratory, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan
| | - Yi-Chia Lin
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Kuang-Yu Chou
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Hung-En Chen
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chao-Yen Ho
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ji-Fan Lin
- Central Laboratory, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Thomas I-Sheng Hwang
- Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan.,Department of Urology, Taipei Medical University, Taipei, Taiwan
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11
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Saito H, Shodo R, Yamazaki K, Katsura K, Ueki Y, Nakano T, Oshikane T, Yamana N, Tanabe S, Utsunomiya S, Ohta A, Abe E, Kaidu M, Sasamoto R, Aoyama H. The association between oral candidiasis and severity of chemoradiotherapy-induced dysphagia in head and neck cancer patients: A retrospective cohort study. Clin Transl Radiat Oncol 2019; 20:13-18. [PMID: 31737796 PMCID: PMC6849117 DOI: 10.1016/j.ctro.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/21/2019] [Accepted: 10/26/2019] [Indexed: 11/27/2022] Open
Abstract
Oral candidiasis (OC) aggravated dysphagia in chemoradiation for HNC. OC patients required higher doses of opioids. Early diagnosis of chemoradiation-associated OC seems difficult. Antifungal prophylaxis may reduce the severity of mucositis and dysphagia.
Background and purpose Concurrent chemoradiotherapy (CCRT) for head and neck cancer (HNC) is a risk factor for oral candidiasis (OC). As Candida spp. are highly virulent, we conducted a retrospective study to determine whether OC increases the severity of dysphagia related to mucositis in HNC patients. Patients and methods We retrospectively analyzed the cases of consecutive patients with carcinomas of the oral cavity, pharynx, and larynx who underwent CCRT containing cisplatin (CDDP) at our hospital. The diagnosis of OC was based on gross mucosal appearance. We performed a multivariate analysis to determine whether OC was associated with the development of grade 3 dysphagia in the Radiation Therapy Oncology Group (RTOG) Acute Toxicity Criteria. The maximum of the daily opioid doses was compared between the patients with and without OC. Results We identified 138 HNC patients. OC was observed in 51 patients (37%). By the time of their OC diagnosis, 19 (37%) had already developed grade 3 dysphagia. Among the 30 patients receiving antifungal therapy, 12 (40%) showed clinical deterioration. In the multivariate analysis, OC was independently associated with grade 3 dysphagia (OR 2.75; 95%CI 1.22–6.23; p = 0.015). The patients with OC required significantly higher morphine-equivalent doses of opioids (45 vs. 30 mg/day; p = 0.029). Conclusion Candida infection causes refractory dysphagia. It is worth investigating whether antifungal prophylaxis reduces severe dysphagia related to candidiasis.
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Affiliation(s)
- Hirotake Saito
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8520, Japan
| | - Ryusuke Shodo
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8510, Japan
| | - Keisuke Yamazaki
- Department of Otolaryngology Head and Neck Surgery, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8520, Japan
| | - Kouji Katsura
- Department of Oral Radiology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8520, Japan
| | - Yushi Ueki
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8510, Japan
| | - Toshimichi Nakano
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8510, Japan
| | - Tomoya Oshikane
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8510, Japan
| | - Nobuko Yamana
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8520, Japan
| | - Satoshi Tanabe
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8520, Japan
| | - Satoru Utsunomiya
- Department of Radiologic Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-dori, Chuo-ku, Niigata 951-8518, Japan
| | - Atsushi Ohta
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8510, Japan
| | - Eisuke Abe
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8510, Japan
| | - Motoki Kaidu
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8510, Japan
| | - Ryuta Sasamoto
- Department of Radiologic Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-dori, Chuo-ku, Niigata 951-8518, Japan
| | - Hidefumi Aoyama
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8510, Japan
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12
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Miranda-Cadena K, Marcos-Arias C, Mateo E, Aguirre JM, Quindós G, Eraso E. Prevalence and antifungal susceptibility profiles of Candida glabrata, Candida parapsilosis and their close-related species in oral candidiasis. Arch Oral Biol 2018; 95:100-107. [PMID: 30096698 DOI: 10.1016/j.archoralbio.2018.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/18/2018] [Accepted: 07/30/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the importance of Candida glabrata, Candida parapsilosis and their close-related species, Candida bracarensis, Candida nivariensis, Candida metapsilosis and Candida orthopsilosis in patients with oral candidiasis and, to determine the in vitro activities of antifungal drugs currently used for the treatment. METHODS One hundred fourteen isolates of C. glabrata and 97 of C. parapsilosis, previously identified by conventional mycological methods, were analysed by molecular techniques. In vitro antifungal susceptibility to fluconazole, itraconazole, miconazole, and nystatin was evaluated by CLSI M44-A2 disk diffusion test, and by CLSI M27-A3 microdilution for fluconazole. RESULTS All C. glabrata isolates were identified as C. glabrata sensu stricto, 93 out of 97 C. parapsilosis isolates as C. parapsilosis sensu stricto, three as C. orthopsilosis and one as C. metapsilosis. Candida glabrata was mainly isolated in mixed cultures but C. parapsilosis complex was more frequent in pure culture. Candida metapsilosis and C. orthopsilosis were isolated as pure culture and both species were susceptible to all antifungal agents tested. Most C. glabrata isolates were susceptible to miconazole and nystatin, but resistant to fluconazole and itraconazole. Azole cross resistance was also observed. Candida parapsilosis isolates were susceptible to fluconazole although azole cross resistance to miconazole and itraconazole was observed. CONCLUSION This study highlights the importance of accurate identification and antifungal susceptibility testing of oral Candida isolates in order to have an in-depth understanding of the role of C. glabrata and C. parapsilosis in oral candidiasis.
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Affiliation(s)
- Katherine Miranda-Cadena
- UFI 11/25 "Microbios y Salud", Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea, UPV/EHU, Bilbao, Spain
| | - Cristina Marcos-Arias
- UFI 11/25 "Microbios y Salud", Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea, UPV/EHU, Bilbao, Spain
| | - Estibaliz Mateo
- UFI 11/25 "Microbios y Salud", Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea, UPV/EHU, Bilbao, Spain
| | - José Manuel Aguirre
- UFI 11/25 "Microbios y Salud", Departamento de Estomatología II, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea, UPV/EHU, Bilbao, Spain
| | - Guillermo Quindós
- UFI 11/25 "Microbios y Salud", Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea, UPV/EHU, Bilbao, Spain
| | - Elena Eraso
- UFI 11/25 "Microbios y Salud", Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea, UPV/EHU, Bilbao, Spain.
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13
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Sroussi HY, Epstein JB, Bensadoun R, Saunders DP, Lalla RV, Migliorati CA, Heaivilin N, Zumsteg ZS. Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med 2017; 6:2918-2931. [PMID: 29071801 PMCID: PMC5727249 DOI: 10.1002/cam4.1221] [Citation(s) in RCA: 335] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 12/22/2022] Open
Abstract
Patients undergoing radiation therapy for the head and neck are susceptible to a significant and often abrupt deterioration in their oral health. The oral morbidities of radiation therapy include but are not limited to an increased susceptibility to dental caries and periodontal disease. They also include profound and often permanent functional and sensory changes involving the oral soft tissue. These changes range from oral mucositis experienced during and soon after treatment, mucosal opportunistic infections, neurosensory disorders, and tissue fibrosis. Many of the oral soft tissue changes following radiation therapy are difficult challenges to the patients and their caregivers and require life-long strategies to alleviate their deleterious effect on basic life functions and on the quality of life. We discuss the presentation, prognosis, and management strategies of the dental structure and oral soft tissue morbidities resulting from the administration of therapeutic radiation in head and neck patient. A case for a collaborative and integrated multidisciplinary approach to the management of these patients is made, with specific recommendation to include knowledgeable and experienced oral health care professionals in the treatment team.
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Affiliation(s)
- Herve Y Sroussi
- Division of Oral Medicine & Dentistry, Brigham and Women's Hospital BostonMA
| | - Joel B. Epstein
- Samuel Oschin Comprehensive Cancer InstititueCedars‐Sinai Medical CenterLos AngelesCA
- Division of Otolaryngology and Head and Neck SurgeryDuarteCalifornia
| | | | - Deborah P. Saunders
- Department of Dental OncologyHealth Sciences NorthNortheastern Cancer CentreSudburyOntarioCanada
- Northern Ontario School of MedicineRm 42036SudburyOntarioP3E 5J1Canada
| | - Rajesh V. Lalla
- Section of Oral MedicineUniversity of Connecticut HealthFarmingtonConnecticut
| | - Cesar A. Migliorati
- Department of Oral and Maxillofacial Diagnostic SciencesUniversity of FloridaGainesvilleFlorida
| | - Natalie Heaivilin
- Oral Maxillofacial Surgery DepartmentUniversity of CaliforniaSan FranciscoCalifornia
| | - Zachary S. Zumsteg
- Department of Radiation OncologyCedars‐Sinai Medical CenterLos AngelesCalifornia90048
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14
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De-la-Torre J, Ortiz-Samperio ME, Marcos-Arias C, Marichalar-Mendia X, Eraso E, Echebarria-Goicouria MÁ, Aguirre-Urizar JM, Quindós G. In Vitro Antifungal Susceptibility of Oral Candida Isolates from Patients Suffering from Caries and Chronic Periodontitis. Mycopathologia 2017; 182:471-485. [PMID: 28124220 DOI: 10.1007/s11046-017-0112-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 01/09/2017] [Indexed: 12/19/2022]
Abstract
Caries and chronic periodontitis are common oral diseases where a higher Candida colonization is reported. Antifungal agents could be adjuvant drugs for the therapy of both clinical conditions. The aim of the current study has been to evaluate the in vitro activities of conventional and new antifungal drugs against oral Candida isolates from patients suffering from caries and/or chronic periodontitis. In vitro activities of amphotericin B, fluconazole, itraconazole, miconazole, nystatin, posaconazole and voriconazole against 126 oral Candida isolates (75 Candida albicans, 18 Candida parapsilosis, 11 Candida dubliniensis, six Candida guilliermondii, five Candida lipolytica, five Candida glabrata, four Candida tropicalis and two Candida krusei) from 61 patients were tested by the CLSI M27-A3 method. Most antifungal drugs were highly active, and resistance was observed in less than 5% of tested isolates. Miconazole was the most active antifungal drug, being more than 98% of isolates susceptible. Fluconazole, itraconazole, and the new triazoles, posaconazole and voriconazole, were also very active. Miconazole, fluconazole and voriconazole have excellent in vitro activities against all Candida isolates and could represent suitable treatment for a hypothetically adjunctive therapy of caries and chronic periodontitis.
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Affiliation(s)
- Janire De-la-Torre
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, UFI 11/25, Facultad de Medicina y Enfermería, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Apartado 699, 48080, Bilbao, Spain
- Unidad de Medicina Bucal, Servicio Clínica Odontológica, Departamento de Estomatología II, UFI 11/25, Facultad de Medicina y Enfermería, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain
| | - María Esther Ortiz-Samperio
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, UFI 11/25, Facultad de Medicina y Enfermería, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Apartado 699, 48080, Bilbao, Spain
| | - Cristina Marcos-Arias
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, UFI 11/25, Facultad de Medicina y Enfermería, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Apartado 699, 48080, Bilbao, Spain
| | - Xabier Marichalar-Mendia
- Unidad de Medicina Bucal, Servicio Clínica Odontológica, Departamento de Estomatología II, UFI 11/25, Facultad de Medicina y Enfermería, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain
| | - Elena Eraso
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, UFI 11/25, Facultad de Medicina y Enfermería, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Apartado 699, 48080, Bilbao, Spain
| | - María Ángeles Echebarria-Goicouria
- Unidad de Medicina Bucal, Servicio Clínica Odontológica, Departamento de Estomatología II, UFI 11/25, Facultad de Medicina y Enfermería, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain
| | - José Manuel Aguirre-Urizar
- Unidad de Medicina Bucal, Servicio Clínica Odontológica, Departamento de Estomatología II, UFI 11/25, Facultad de Medicina y Enfermería, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain
| | - Guillermo Quindós
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, UFI 11/25, Facultad de Medicina y Enfermería, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Apartado 699, 48080, Bilbao, Spain.
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15
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The Efficacy and Safety of Miconazole Nitrate Mucoadhesive Tablets versus Itraconazole Capsules in the Treatment of Oral Candidiasis: An Open-Label, Randomized, Multicenter Trial. PLoS One 2016; 11:e0167880. [PMID: 27977721 PMCID: PMC5157999 DOI: 10.1371/journal.pone.0167880] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/18/2016] [Indexed: 11/29/2022] Open
Abstract
Background Oral candidiasis (OC) is a common oral fungal infection. Recently, miconazole mucoadhesive tablets have been gaining attention for OC treatment. Despite trials in patients with human immunodeficiency virus and cancer, evidence of its application in the large-scale, general population with OC is lacking. This study aimed to evaluate the efficacy and safety of miconazole nitrate mucoadhesive tablets in comparison with itraconazole capsules for OC treatment. Methods The study was a randomized, open-label, parallel-armed, multicenter clinical trial. Totally, 343 patients diagnosed with OC, who met the inclusion criteria, were randomly assigned to either a treatment group that received miconazole nitrate mucoadhesive tablets (10 mg) once daily or a control group that received itraconazole capsules (100 mg QD) for 2 weeks, and were followed up for 2 weeks. The clinical cure, improvement of clinical symptoms/signs, mycologic cure, and safety were evaluated. Results The mucoadhesive tablets (n = 171) did not show inferiority to itraconazole (n = 172) in the treatment of OC. At the end of the 14-day treatment, the clinical cure rates were 45.29% and 41.76% in the miconazole and itraconazole groups, respectively (P = 0.3472). At the end of the 14-day follow-up, the clinical cure rates were 51.18% and 41.76% in the miconazole and itraconazole groups, respectively (P = 0.0329). Adverse events occurred in 53 subjects (33 in the miconazole group and 20 in the itraconazole group). There was no statistical difference in the safety profile between miconazole and itraconazole (P = 0.0533). Thrombocytopenic purpura, although rare, occurred in one patient in the miconazole group and was considered a drug-related, severe adverse event. Conclusion Miconazole nitrate mucoadhesive tablets may be as effective as systemic itraconazole capsule for OC treatment. Physicians should be cautious about thrombocytopenic purpura occurring as a rare and serious adverse event of miconazole nitrate. Trial Registration Chinese Clinical Trial Register ChiCTR-TRC-13003935
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16
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Aljaeid BM, Hosny KM. Miconazole-loaded solid lipid nanoparticles: formulation and evaluation of a novel formula with high bioavailability and antifungal activity. Int J Nanomedicine 2016; 11:441-7. [PMID: 26869787 PMCID: PMC4734792 DOI: 10.2147/ijn.s100625] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and objective Miconazole is a broad-spectrum antifungal drug that has poor aqueous solubility (<1 µg/mL); as a result, a reduction in its therapeutic efficacy has been reported. The aim of this study was to formulate and evaluate miconazole-loaded solid lipid nanoparticles (MN-SLNs) for oral administration to find an innovative way to alleviate the disadvantages associated with commercially available capsules. Methods MN-SLNs were prepared by hot homogenization/ultrasonication. The solubility of miconazole in different solid lipids was measured. The effect of process variables, such as surfactant types, homogenization and ultrasonication times, and the charge-inducing agent on the particle size, zeta potential, and encapsulation efficiency were determined. Furthermore, in vitro drug release, antifungal activity against Candida albicans, and in vivo pharmacokinetics were studied in rabbits. Results The MN-SLN, consisting of 1.5% miconazole, 2% Precirol ATO5, 2.5% Cremophor RH40, 0.5% Lecinol, and 0.1% Dicetylphosphate, had an average diameter of 23 nm with a 90.2% entrapment efficiency. Furthermore, the formulation of MN-SLNs enhanced the antifungal activity compared with miconazole capsules. An in vivo pharmacokinetic study revealed that the bioavailability was enhanced by >2.5-fold. Conclusion MN-SLN was more efficient in the treatment of candidiasis with enhanced oral bioavailability and could be a promising carrier for the oral delivery of miconazole.
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Affiliation(s)
- Bader Mubarak Aljaeid
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khaled Mohamed Hosny
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni Suef University, Beni Suef, Egypt
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17
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Patil S, Rao RS, Majumdar B, Anil S. Clinical Appearance of Oral Candida Infection and Therapeutic Strategies. Front Microbiol 2015; 6:1391. [PMID: 26733948 PMCID: PMC4681845 DOI: 10.3389/fmicb.2015.01391] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/23/2015] [Indexed: 02/05/2023] Open
Abstract
Candida species present both as commensals and opportunistic pathogens of the oral cavity. For decades, it has enthralled the clinicians to investigate its pathogenicity and to improvise newer therapeutic regimens based on the updated molecular research. Candida is readily isolated from the oral cavity, but simple carriage does not predictably result in development of an infection. Whether it remains as a commensal, or transmutes into a pathogen, is usually determined by pre-existing or associated variations in the host immune system. The candida infections may range from non-life threatening superficial mucocutaneous disorders to invasive disseminated disease involving multiple organs. In fact, with the increase in number of AIDS cases, there is a resurgence of less common forms of oral candida infections. The treatment after confirmation of the diagnosis should include recognizing and eliminating the underlying causes such as ill-fitting oral appliances, history of medications (antibiotics, corticosteroids, etc.), immunological and endocrine disorders, nutritional deficiency states and prolonged hospitalization. Treatment with appropriate topical antifungal agents such as amphotericin, nystatin, or miconazole usually resolves the symptoms of superficial infection. Occasionally, administration of systemic antifungal agents may be necessary in immunocompromised patients, the selection of which should be based upon history of recent azole exposure, a history of intolerance to an antifungal agent, the dominant Candida species and current susceptibility data.
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Affiliation(s)
- Shankargouda Patil
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences Bangalore, India
| | - Roopa S Rao
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences Bangalore, India
| | - Barnali Majumdar
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences Bangalore, India
| | - Sukumaran Anil
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University Riyadh, Saudi Arabia
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18
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Zhang LW, Fu JY, Hua H, Yan ZM. Efficacy and safety of miconazole for oral candidiasis: a systematic review and meta-analysis. Oral Dis 2015; 22:185-95. [PMID: 26456226 DOI: 10.1111/odi.12380] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/07/2015] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Abstract
The objective of this study is to assess the efficacy and safety of miconazole for treating oral candidiasis. Twelve electronic databases were searched for randomized controlled trials evaluating treatments for oral candidiasis and complemented by hand searching. The clinical and mycological outcomes, as well as adverse effects, were set as the primary outcome criteria. Seventeen trials were included in this review. Most studies were considered to have a high or moderate level of bias. Miconazole was more effective than nystatin for thrush. For HIV-infected patients, there was no significant difference in the efficacy between miconazole and other antifungals. For denture wearers, microwave therapy was significantly better than miconazole. No significant difference was found in the safety evaluation between miconazole and other treatments. The relapse rate of miconazole oral gel may be lower than that of other formulations. This systematic review and meta-analysis indicated that miconazole may be an optional choice for thrush. Microwave therapy could be an effective adjunct treatment for denture stomatitis. Miconazole oral gel may be more effective than other formulations with regard to long-term results. However, future studies that are adequately powered, large-scale, and well-designed are needed to provide higher-quality evidence for the management of oral candidiasis.
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Affiliation(s)
- L-W Zhang
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - J-Y Fu
- Department of stomatology, Peking University International Hospital, Changping District, Beijing, China
| | - H Hua
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - Z-M Yan
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
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Van Sebille YZA, Stansborough R, Wardill HR, Bateman E, Gibson RJ, Keefe DM. Management of Mucositis During Chemotherapy: From Pathophysiology to Pragmatic Therapeutics. Curr Oncol Rep 2015; 17:50. [DOI: 10.1007/s11912-015-0474-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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20
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Garcia-Cuesta C, Sarrion-Pérez MG, Bagán JV. Current treatment of oral candidiasis: A literature review. J Clin Exp Dent 2014; 6:e576-82. [PMID: 25674329 PMCID: PMC4312689 DOI: 10.4317/jced.51798] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/26/2014] [Indexed: 12/29/2022] Open
Abstract
Candidiasis or oral candidosis is one of the most common human opportunistic fungal infections of the oral cavity. This pathology has a wide variety of treatment which has been studied until these days. The present study offers a literature review on the treatment of oral candidiasis, with the purpose of establish which treatment is the most suitable in each case. Searching the 24 latest articles about treatment of candidiasis it concluded that the incidence depends on the type of the candidiasis and the virulence of the infection. Although nystatin and amphotericin b were the most drugs used locally, fluconazole oral suspension is proving to be a very effective drug in the treatment of oral candidiasis. Fluconazole was found to be the drug of choice as a systemic treatment of oral candidiasis. Due to its good antifungal properties, its high acceptance of the patient and its efficacy compared with other antifungal drugs. But this drug is not always effective, so we need to evaluate and distinguish others like itraconazole or ketoconazole, in that cases when Candida strains resist to fluconazole.
Key words:Candidiasis, treatment, miconazole, fluconazole, nystatin.
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Affiliation(s)
| | | | - Jose V Bagán
- Chairman of Oral Medicine. Oral Medicine Unit. Department of Stomatology. University of Valencia. Head of the Department of Stomatology and Maxilofacial Surgery. Valencia University General Hospital
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Orvain C, Moles-Moreau MP, François S, Mercier M, Moal F, Hamel JF, Parot-Schinkel E, Ifrah N, Hunault-Berger M, Tanguy-Schmidt A. Miconazole mucoadhesive buccal tablet in high-dose therapy with autologous stem cell transplantation (HDT/ASCT)-induced mucositis. Support Care Cancer 2014; 23:359-64. [DOI: 10.1007/s00520-014-2365-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
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Mendes A, Silva A, Catita J, Cerqueira F, Gabriel C, Lopes C. Miconazole-loaded nanostructured lipid carriers (NLC) for local delivery to the oral mucosa: Improving antifungal activity. Colloids Surf B Biointerfaces 2013; 111:755-63. [DOI: 10.1016/j.colsurfb.2013.05.041] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/15/2013] [Accepted: 05/15/2013] [Indexed: 11/29/2022]
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Abstract
Since the early 1990's, the death rate from AIDS among adults has declined in most developed countries, largely because of newer antiretroviral therapies and improved access to these therapies. In addition, from 2006 to 2011, the total number of new cases of HIV infection worldwide has declined somewhat and has remained relatively constant. Nevertheless, because of the large numbers of existing and new cases of HIV infection, the dental practitioner and other healthcare practitioners will still be required to treat oral and periodontal conditions unique to HIV/AIDS as well as conventional periodontal diseases in HIV-infected adults and children. The oral and periodontal conditions most closely associated with HIV infection include oral candidiasis, oral hairy leukoplakia, Kaposi's sarcoma, salivary gland diseases, oral warts, other oral viral infections, linear gingival erythema and necrotizing gingival and periodontal diseases. While the incidence and prevalence of these oral lesions and conditions appear to be declining, in part because of antiretroviral therapy, dental and healthcare practitioners will need to continue to diagnose and treat the more conventional periodontal diseases in these HIV-infected populations. Finding low-cost and easily accessible and acceptable diagnostic and treatment approaches for both the microbiological and the inflammatory aspects of periodontal diseases in these populations are of particular importance, as the systemic spread of the local microbiota and inflammatory products of periodontal diseases may have adverse effects on both the progression of HIV infection and the effectiveness of antiretroviral therapy approaches. Developing and assessing low-cost and accessible diagnostic and treatment approaches to periodontal diseases, particularly in developing countries, will require an internationally coordinated effort to design and conduct standardized clinical trials.
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Kutyła MJ, Lambert LK, Davies NM, McGeary RP, Shaw PN, Ross BP. Cyclodextrin-crosslinked poly(acrylic acid): Synthesis, physicochemical characterization and controlled release of diflunisal and fluconazole from hydrogels. Int J Pharm 2013; 444:175-84. [DOI: 10.1016/j.ijpharm.2013.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 12/13/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
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Murata Y, Isobe T, Kofuji K, Nishida N, Kamaguchi R. Development of Film Dosage Forms Containing Miconazole for the Treatment of Oral Candidiasis. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/pp.2013.43047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pinel B, Cassou-Mounat T, Bensadoun RJ. [Oropharyngeal candidiasis and radiotherapy]. Cancer Radiother 2012; 16:222-9. [PMID: 22537826 DOI: 10.1016/j.canrad.2011.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Revised: 11/04/2011] [Accepted: 11/14/2011] [Indexed: 10/28/2022]
Abstract
The oropharyngeal candidiasis is a common condition in cancer patients treated by irradiation, during and after their treatment. For example, almost 70% of patients treated with chemoradiation for head and neck cancer are colonized, and 40% of symptomatic patients have an oropharyngeal candidiasis. Furthermore, we noticed an increase in non-albicans Candida strains, which are present in almost 50% of samples. Cancer treatments, especially radiation therapy, and comorbidities are risk factors of oropharyngeal candidiasis. Oropharyngeal candidiasis has substantial effects on quality of life, and may limit treatment. Epidemiologic data, physiopathology, clinical diagnosis criteria, consequences and treatment of oropharyngeal candidiasis will be discussed in this article.
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Affiliation(s)
- B Pinel
- Service d'oncologie radiothérapique, CHU de Poitiers, France
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Vazquez JA, Sobel JD. Miconazole mucoadhesive tablets: a novel delivery system. Clin Infect Dis 2012; 54:1480-4. [PMID: 22495075 DOI: 10.1093/cid/cis205] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Oropharyngeal candidiasis (OPC) is among the most common opportunistic infections observed in persons infected with human immunodeficiency virus. A once-daily miconazole 50 mg mucoadhesive buccal tablet (MBT) is a novel delivery system with potent in vitro activity against many Candida species, including some that may be resistant to other azoles. MBT, although more expensive, offers an effective, safe, and well-tolerated topical treatment option for OPC that is administered as a convenient once-daily dose.
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Affiliation(s)
- José A Vazquez
- Department of Medicine, Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI 48201, USA.
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Hearnden V, Sankar V, Hull K, Juras DV, Greenberg M, Kerr AR, Lockhart PB, Patton LL, Porter S, Thornhill MH. New developments and opportunities in oral mucosal drug delivery for local and systemic disease. Adv Drug Deliv Rev 2012; 64:16-28. [PMID: 21371513 DOI: 10.1016/j.addr.2011.02.008] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 02/15/2011] [Accepted: 02/23/2011] [Indexed: 02/08/2023]
Abstract
The oral mucosa's accessibility, excellent blood supply, by-pass of hepatic first-pass metabolism, rapid repair and permeability profile make it an attractive site for local and systemic drug delivery. Technological advances in mucoadhesives, sustained drug release, permeability enhancers and drug delivery vectors are increasing the efficient delivery of drugs to treat oral and systemic diseases. When treating oral diseases, these advances result in enhanced therapeutic efficacy, reduced drug wastage and the prospect of using biological agents such as genes, peptides and antibodies. These technologies are also increasing the repertoire of drugs that can be delivered across the oral mucosa to treat systemic diseases. Trans-mucosal delivery is now a favoured route for non-parenteral administration of emergency drugs and agents where a rapid onset of action is required. Furthermore, advances in drug delivery technology are bringing forward the likelihood of transmucosal systemic delivery of biological agents.
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Pitman SK, Drew RH, Perfect JR. Addressing current medical needs in invasive fungal infection prevention and treatment with new antifungal agents, strategies and formulations. Expert Opin Emerg Drugs 2011; 16:559-586. [DOI: 10.1517/14728214.2011.607811] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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In Vitro Activities of New Triazole Antifungal Agents, Posaconazole and Voriconazole, Against Oral Candida Isolates from Patients Suffering from Denture Stomatitis. Mycopathologia 2011; 173:35-46. [DOI: 10.1007/s11046-011-9460-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 08/03/2011] [Indexed: 11/27/2022]
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31
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Patton LL, Ranganathan K, Naidoo S, Bhayat A, Balasundaram S, Adeyemi O, Taiwo O, Speicher DJ, Chandra L. Oral lesions, HIV phenotypes, and management of HIV-related disease: Workshop 4A. Adv Dent Res 2011; 23:112-6. [PMID: 21441491 DOI: 10.1177/0022034511400079] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The workshop considered 5 questions related to oral lesions, HIV phenotypes, and the management of HIV-related disease, with a focus on evidence and challenges in resource-poor settings. First, are oral lesions unique with respect to geographic location or phenotype? Second, how useful would an oral lesion index be to predict HIV in resource-poor countries with no access to CD4 counts or viral load? Third, what are the latest methods and delivery modes for drugs used to treat oral lesions associated with HIV? Fourth, what is the role of the oral health care worker in rapid diagnostic testing for HIV? Fifth, what ethical and legal issues are to be considered when managing the HIV patient? The consensus of the workshop was the need for additional research in 4 key areas in developing countries: (1) additional investigation of comorbidities associated with HIV infection that may affect oral lesion presentation and distribution, especially in pediatric populations; (2) the development of region-specific algorithms involving HIV oral lesions, indicating cumulative risk of immune suppression and the presence of HIV disease; (3) well-designed clinical trials to test new therapies for oral lesions, new treatments for resistant oral fungal and viral diseases, effectiveness of therapies in children, and new drug delivery systems; and (4) the role of the oral health care worker in rapid diagnostic testing for HIV in various regions of the world.
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Affiliation(s)
- L L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA.
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Rautemaa R, Ramage G. Oral candidosis--clinical challenges of a biofilm disease. Crit Rev Microbiol 2011; 37:328-36. [PMID: 21777047 DOI: 10.3109/1040841x.2011.585606] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This review summarizes the impact of biofilms in oral candidosis with special emphasis on medically compromised patients. The concept of oral candidosis as a mixed candidal-bacterial biofilm infection has changed our understanding of its epidemiology and diagnosis as well as approach to its treatment. Candida albicans is the most common causative agent of oral candidosis although Candida species other than C. albicans are often seen in medically compromised patients with a history of multiple courses of azole antifungals. Although C. albicans is usually susceptible to all commonly used antifungals when tested in vitro, their biofilm form are highly resistant to most antifungals. Therefore, treatment consists of mechanical destruction of the biofilm in combination with topical drugs. Azole antifungals should be avoided for patients suffering from recurrent oral yeast infections due to a risk of selection and enrichment of resistant strains within the biofilm. Oral candidosis can also be a symptom of an undiagnosed or poorly controlled systemic disease such as HIV infection or diabetes. If the response to appropriate treatment is poor, other causes of oral mucositis should be excluded. Oral candidosis arises from the patient's mixed candidal-bacterial biofilm, i.e., dental plaque, whereby good self-care is important for successful therapy.
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Affiliation(s)
- Riina Rautemaa
- Manchester Academic Health Science Centre, School of Translational Medicine, The University of Manchester, Manchester, UK.
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Bouchaert P, Jardel P, Osdoit S, Bodard AG, Gangneux JP, Scotté F, Salino S, Bensadoun RJ. Candidoses oropharyngées en oncologie : enjeux diagnostiques. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-2006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nairy HM, Charyulu NR, Shetty VA, Prabhakara P. A pseudo-randomised clinical trial of in situ gels of fluconazole for the treatment of oropharngeal candidiasis. Trials 2011; 12:99. [PMID: 21504616 PMCID: PMC3096580 DOI: 10.1186/1745-6215-12-99] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 04/19/2011] [Indexed: 11/10/2022] Open
Abstract
Background Oropharyngeal candidasis is a common opportunistic infection seen in immunocompromised patients. Fluconazole has a broad spectrum antifungal activity including a wide variety of candida species. Aim of the present investigation was to formulate and find out the relative efficacy of in situ gels of fluconazole. Method The in situ gels were prepared using polymers which exhibited sol-to-gel phase transition due to change in specific physico-chemical parameters, such as ion triggered system using gellan gum (0.5% w/v) along with sodium carboxylmethylcellulose (0.35%w/v). The study design was bicenter, 'pseudo-randomised, single blind trial conducted in Mangalore., India, which includes 15 HIV positive patients, 15 patients with partial or completes dentures, and 15 patients who were treated with (active control) fluconazole tablets 100 mg/day for 14 days. Severity of disease was scored clinically before treatment and at clinical evaluations on day 3, 7, 14, 18, 21, 35, and 42. Semiquantitative microbiological cultures of oral swabs were also obtained on same days. Results All patients had mycological documented oropharyngeal candidiasis and were treated with fluconazole (0.5%w/v) in situ gels for 14 days Severity of disease was scored clinically before treatment and at different predetermined time intervals along with semi quantitative culture of oral swabs. The clinical response rate showed 97% cure after 14 days in the treated with in situ gel. In comparison, the control group treated with fluconazole tablets showed 85% improvement in symptoms of oral candidiasis. The patients suffering from HIV infection showed relapse in oral candidiasis at the end of 21 days. The patients having oral candidiasis due to partial or complete dentures showed complete recovery and were free from signs and symptoms of oral candidiasis. Conclusions The in situ gel formulation of fluconazole was well tolerated with no severe adverse reaction and offers a better alternative to tablet formulation in the treatment of oropharyngeal candidasis. Trial registration Current Controlled Trails ISRCTN90634047
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Affiliation(s)
- Harish M Nairy
- Department of Pharmaceutics, NGSM Institute of Pharmaceutical Sciences, Paneer, Deralakatte Post, Mangalore, India.
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35
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Bensadoun RJ, Patton LL, Lalla RV, Epstein JB. Oropharyngeal candidiasis in head and neck cancer patients treated with radiation: update 2011. Support Care Cancer 2011; 19:737-44. [PMID: 21479787 DOI: 10.1007/s00520-011-1154-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 03/28/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Oropharyngeal candidiasis (OPC) is a major cause of morbidity in patients with malignancies. It is a common complication of head and neck radiation therapy and can result in pain, dysgeusia (taste changes), anorexia, malnutrition, and esophageal or systemic dissemination. Clinicians should be aware of current epidemiology, elements of diagnosis, and therapeutic trials guiding the recent recommendations for prophylaxis and management of OPC, a disease often incorrectly perceived as benign. METHODS This review discusses OPC with focus in head and neck cancer patients receiving radiotherapy. RESULTS Local treatments are recommended as first-line therapy in milder forms of OPC. In the setting of local therapy, products that provide prolonged contact time and are not sucrose sweetened may result in successful prevention and management with low risk of oral/dental complications. CONCLUSION Diagnosis and management of OPC is required in head and neck cancer patients treated with radiation. Local therapy is suggested as first-line treatment for OPC, unless severe clinical infection or high risk immune suppression necessitate systemic therapy. The availability of effective locally delivered (topical) medications may provide potential for prophylaxis for carriers of Candida species in head and cancer patients during radiation therapy.
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Affiliation(s)
- Rene-Jean Bensadoun
- Radiation Oncology Department, Poitiers University Hospital and Faculty of Medicine, 2 rue de la Milétrie, BP 577, 86021, Poitiers Cedex, France.
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Lalla RV, Bensadoun RJ. Miconazole mucoadhesive tablet for oropharyngeal candidiasis. Expert Rev Anti Infect Ther 2011; 9:13-7. [PMID: 21171872 DOI: 10.1586/eri.10.152] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oropharyngeal candidiasis is a commonly encountered problem in daily clinical practice. Topical therapies for oropharyngeal candidiasis are considered preferable to systemic therapies in most patient populations. However, traditional topical therapies have limitations including short contact time with the oral mucosa and the need for multiple doses each day. Miconazole mucoadhesive tablet has recently been approved in Europe (Loramyc®) and the USA (Oravig™) for the treatment of oropharyngeal candidiasis. This tablet adheres to the oral mucosa and provides sustained local release of miconazole over a period of several hours with just one daily application. This article reviews the pharmacology, safety and efficacy of this novel agent.
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Affiliation(s)
- Rajesh V Lalla
- Section of Oral Medicine, Department of Oral Health and Diagnostic Sciences, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1605, USA.
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Collins CD, Cookinham S, Smith J. Management of oropharyngeal candidiasis with localized oral miconazole therapy: efficacy, safety, and patient acceptability. Patient Prefer Adherence 2011; 5:369-74. [PMID: 21845036 PMCID: PMC3150165 DOI: 10.2147/ppa.s14047] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Indexed: 11/23/2022] Open
Abstract
Oropharyngeal candidiasis is a very common localized infection of the mucus membranes of the oropharynx that is most commonly caused by the patient's own commensal Candida albicans. It is the most common opportunistic infection affecting patients with the human immunodeficiency virus (HIV) and is also quite common in patients with hematological malignancies. Effective treatment options are of high importance given the worldwide incidence of these disease states and the potential for development of oropharyngeal candidiasis in these patients. Various systemic and topical treatment options for patients with oropharyngeal candidiasis have existed for many years. Miconazole buccal tablets have recently been approved by the US Food and Drug Administration for the treatment of oropharyngeal candidiasis. Clinical trials have demonstrated noninferiority in the treatment of oropharyngeal candidiasis when compared with clotrimazole troches in patients with HIV and against miconazole gel in patients with head and neck cancer. Miconazole buccal tablets exhibit few drug interactions because of low systemic absorption and are generally well tolerated with a safety profile similar to comparators. The once-daily dosing schedule may improve patient adherence compared with topical alternatives; however, the cost of therapy may be a barrier for some patients and should be considered by prescribers compared with alternative treatments.
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Affiliation(s)
- Curtis D Collins
- Department of Pharmacy Services
- Correspondence: Curtis D Collins, UHB2D301/0008, Department of Pharmacy Services University of Michigan Health System 1500 E. Med Ctr Dr, Ann Arbor, MI 48109, USA, Tel +1 734 936 8210, Fax +1 734 936 7027, Email
| | - Sarah Cookinham
- Department of Medicine, Division of Infectious Disease, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jeannina Smith
- Department of Medicine, Division of Infectious Disease, University of Michigan Health System, Ann Arbor, MI, USA
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Vazquez JA, Patton LL, Epstein JB, Ramlachan P, Mitha I, Noveljic Z, Fourie J, Conway B, Lalla RV, Barasch A, Attali P. Randomized, Comparative, Double-Blind, Double-Dummy, Multicenter Trial of Miconazole Buccal Tablet and Clotrimazole Troches for the Treatment of Oropharyngeal Candidiasis: Study of Miconazole Lauriad ®Efficacy and Safety (SMiLES). HIV CLINICAL TRIALS 2010; 11:186-196. [DOI: 10.1310/hct1104-186] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Worthington HV, Clarkson JE, Khalid T, Meyer S, McCabe M. Interventions for treating oral candidiasis for patients with cancer receiving treatment. Cochrane Database Syst Rev 2010; 2010:CD001972. [PMID: 20614427 PMCID: PMC7063978 DOI: 10.1002/14651858.cd001972.pub4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Treatment of cancer is increasingly effective but is associated with short and long term side effects. Oral and gastrointestinal side effects, including oral candidiasis, remain a major source of illness despite the use of a variety of agents to treat them. OBJECTIVES To assess the effectiveness of interventions for the treatment of oral candidiasis for patients with cancer receiving chemotherapy or radiotherapy or both. SEARCH STRATEGY Computerised searches of Cochrane Oral Health Group and PaPaS Trials Registers (to 1 June 2010), CENTRAL via the Cochrane Library (Issue 2, 2010, 1 June 2010), MEDLINE via OVID (1 June 2010), EMBASE via OVID (1 June 2010), CINAHL via EBSCO (1 June 2010), CANCERLIT via PubMed (1 June 2010), OpenSIGLE (1 June 2010) and LILACS via Virtual Health Library (1 June 2010) were undertaken. Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information. SELECTION CRITERIA All randomised controlled trials comparing agents prescribed to treat oral candidiasis in people receiving chemotherapy or radiotherapy for cancer. The outcomes were eradication of oral candidiasis, dysphagia, systemic infection, amount of analgesia, length of hospitalisation, cost and patient quality of life. DATA COLLECTION AND ANALYSIS Data were independently extracted, in duplicate, by two review authors. Trial authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. Risk ratios (RR) were calculated using fixed-effect models. MAIN RESULTS Ten trials involving 940 patients, satisfied the inclusion criteria and are included in this review. Drugs absorbed from the gastrointestinal (GI) tract were beneficial in eradication of oral candidiasis compared with drugs not absorbed from the GI tract (three trials: RR = 1.29, 95% confidence interval (CI) 1.09 to 1.52), however there was significant heterogeneity. A drug absorbed from the GI tract, ketoconazole, was more beneficial than placebo in eradicating oral candidiasis (one trial: RR = 3.61, 95% CI 1.47 to 8.88). Clotrimazole, at a higher dose of 50 mg was more effective than a lower 10 mg dose in eradicating oral candidiasis, when assessed mycologically (one trial: RR = 2.00, 95% CI 1.11 to 3.60). Only one of the ten trials was assessed as at low risk of bias. AUTHORS' CONCLUSIONS There is insufficient evidence to claim or refute a benefit for any antifungal agent in treating candidiasis. Further well designed, placebo-controlled trials assessing the effectiveness of old and new interventions for treating oral candidiasis are needed. Clinicians need to make a decision on whether to prevent or treat oral candidiasis in patients receiving treatment for cancer.
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Affiliation(s)
- Helen V Worthington
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Jan E Clarkson
- University of DundeeDental Health Services Research UnitThe Mackenzie BuildingKirsty Semple WayDundeeUKDD2 4BF
| | - Tasneem Khalid
- Royal Manchester Children's HospitalDepartment of Haematology/OncologyOxford RoadManchesterUKM13 9WL
| | - Stefan Meyer
- The University of ManchesterPaediatric and Adolescent Oncology, Royal Manchester Children's and Christie Hospital, School of Cancer and Enabling Sciences, Manchester Academic Health Science CentreYoung Oncology Unit, Christie HospitalWilmslow RoadManchesterUKM20 4BX
| | - Martin McCabe
- University of ManchesterSchool of Cancer and Enabling Sciences, Manchester Academic Health Science CentreAcademic Unit of Paediatric and Adolescent Oncology, Young Oncology UnitThe Christie NHS Foundation Trust, Wilmslow RoadManchesterUKM20 4BX
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Jose A Vazquez. Management of oropharyngeal and esophageal candidiasis in patients with HIV infection. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/hiv.10.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mucocutaneous candidiasis is frequently one of the first signs of HIV infection. Over 90% of patients with AIDS will develop oropharyngeal candidiasis at some time during their illness. Although numerous antifungal agents have been developed, azoles, both topical (clotrimazole) and systemic (fluconazole, itraconazole, voriconazole and posaconazole), have replaced older topical antifungals (gentian violet and nystatin) in the management of oropharyngeal candidiasis in these patients. The systemic azoles are generally safe and effective agents in HIV-infected patients with oropharyngeal candidiasis. A constant concern in these patients are relapses, which depend on the degree of immunosuppression and are commonly encountered after topical therapy rather than with systemic azole therapy. In patients with fluconazole-refractory mucosal candidiasis, treatment options now include itraconazole solution, voriconazole, posaconazole and the newer echinocandins (caspofungin, micafungin and anidulafungin). The objective of this article is to review the epidemiology, diagnosis and newer management modalities of oropharyngeal and esophageal candidiasis in HIV-infected individuals.
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Vazquez JA. Optimal management of oropharyngeal and esophageal candidiasis in patients living with HIV infection. HIV AIDS (Auckl) 2010; 2:89-101. [PMID: 22096388 PMCID: PMC3218701 DOI: 10.2147/hiv.s6660] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mucocutaneous candidiasis is frequently one of the first signs of human immunodeficiency virus (HIV) infection. Over 90% of patients with AIDS will develop oropharyngeal candidiasis (OPC) at some time during their illness. Although numerous antifungal agents are available, azoles, both topical (clotrimazole) and systemic (fluconazole, itraconazole, voriconazole, posaconazole) have replaced older topical antifungals (gentian violet and nystatin) in the management of oropharyngeal candidiasis in these patients. The systemic azoles, are generally safe and effective agents in HIV-infected patients with oropharyngeal candidiasis. A constant concern in these patients is relapse, which is dependent on the degree of immunosuppression commonly seen after topical therapy, rather than with systemic azole therapy. Candida esophagitis (CE) is also an important concern since it occurs in more than 10% of patients with AIDS and can lead to a decrease in oral intake and associated weight loss. Fluconazole has become the most widely used antifungal in the management of mucosal candidiasis. However, itraconazole and posaconazole have similar clinical response rates as fluconazole and are also effective alternative agents. In patients with fluconazole-refractory mucosal candidiasis, treatment options now include itraconazole solution, voriconazole, posaconazole, and the newer echinocandins (caspofungin, micafungin, and anidulafungin).
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Affiliation(s)
- Jose A Vazquez
- Division of Infectious Diseases, Henry Ford Hospital, Wayne State University School of Medicine, Detroit, MI, USA
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42
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Laudenbach JM, Epstein JB. Treatment strategies for oropharyngeal candidiasis. Expert Opin Pharmacother 2010; 10:1413-21. [PMID: 19505211 DOI: 10.1517/14656560902952854] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Oropharyngeal candidiasis (OPC) is a common oral disease that may cause oral symptoms, lead to regional infection (e.g., esophageal candidiasis) and increase the risk of systemic fungal infection in the compromised host. OBJECTIVE Critical review of the literature of prevention and therapy. METHODS The literature was reviewed using PubMed, and specific keywords from the MeSH Database were used. RESULTS/CONCLUSION Management of OPC requires that the underlying risk factors of infection be diagnosed and managed whenever possible. Antimicrobials may be provided as topical or systemic therapy. Topical therapies may provide effective management for candidiasis in the non-compromised host and increase the control of colonization in the compromised host. Advances in prevention and management include new agents and improved mechanisms of topical drug delivery.
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Affiliation(s)
- Joel M Laudenbach
- University of Illinois at Chicago College of Dentistry, Department of Oral Medicine and Diagnostic Sciences, 801 South Paulina Street (MC 838), Rm 554A, Chicago, IL 60612, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ben Slama L, Hasni W. [Miconazole in gingival muco-adhesive tablet (Loramyc 50mg)]. ACTA ACUST UNITED AC 2008; 109:197-200. [PMID: 18538809 DOI: 10.1016/j.stomax.2008.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Accepted: 04/23/2008] [Indexed: 10/22/2022]
Affiliation(s)
- L Ben Slama
- Service de stomatologie et de chirurgie maxillofaciale, hôpital de la Salpêtrière, 45, boulevard de l'hôpital, 75013 Paris, France.
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Barasch A, Griffin AV. Miconazole revisited: new evidence of antifungal efficacy from laboratory and clinical trials. Future Microbiol 2008; 3:265-9. [DOI: 10.2217/17460913.3.3.265] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the past 40 years imidazoles have been used extensively in medicine for their antifungal properties. All members of the azole antifungal family inhibit ergosterol biosynthesis. However, the discovery of an additional fungicidal mode of action for miconazole has drawn renewed attention to this compound. In this article we review recent evidence of mechanistic efficacy, as well as clinical trial results of miconazole in new topical formulations.
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Affiliation(s)
- Andrei Barasch
- Dept of Diagnostic Sciences, University of Alabama at Birmingham, SDB 111, 1530 3rd Avenue S Birmingham, AL 35294-0007, USA
| | - Andreea Voinea Griffin
- Dept of Diagnostic Sciences, University of Alabama at Birmingham, SDB 111, 1530 3rd Avenue S Birmingham, AL 35294-0007, USA
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