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Das S, Das A, Das N, Nath T, Langthasa M, Pandey P, Kumar V, Choure K, Kumar S, Pandey P. Harnessing the potential of microbial keratinases for bioconversion of keratin waste. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024:10.1007/s11356-024-34233-6. [PMID: 38985428 DOI: 10.1007/s11356-024-34233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/30/2024] [Indexed: 07/11/2024]
Abstract
The increasing global consumption of poultry meat has led to the generation of a vast quantity of feather keratin waste daily, posing significant environmental challenges due to improper disposal methods. A growing focus is on utilizing keratinous polymeric waste, amounting to millions of tons annually. Keratins are biochemically rigid, fibrous, recalcitrant, physiologically insoluble, and resistant to most common proteolytic enzymes. Microbial biodegradation of feather keratin provides a viable solution for augmenting feather waste's nutritional value while mitigating environmental contamination. This approach offers an alternative to traditional physical and chemical treatments. This review focuses on the recent findings and work trends in the field of keratin degradation by microorganisms (bacteria, actinomycetes, and fungi) via keratinolytic and proteolytic enzymes, as well as the limitations and challenges encountered due to the low thermal stability of keratinase, and degradation in the complex environmental conditions. Therefore, recent biotechnological interventions such as designing novel keratinase with high keratinolytic activity, thermostability, and binding affinity have been elaborated here. Enhancing protein structural rigidity through critical engineering approaches, such as rational design, has shown promise in improving the thermal stability of proteins. Concurrently, metagenomic annotation offers insights into the genetic foundations of keratin breakdown, primarily predicting metabolic potential and identifying probable keratinases. This may extend the understanding of microbial keratinolytic mechanisms in a complex community, recognizing the significance of synergistic interactions, which could be further utilized in optimizing industrial keratin degradation processes.
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Affiliation(s)
- Sandeep Das
- Department of Microbiology, Assam University, Silchar, 788011, Assam, India
| | - Ankita Das
- Department of Microbiology, Assam University, Silchar, 788011, Assam, India
| | - Nandita Das
- Department of Microbiology, Assam University, Silchar, 788011, Assam, India
| | - Tamanna Nath
- Department of Microbiology, Assam University, Silchar, 788011, Assam, India
| | | | - Prisha Pandey
- Department of Biotechnology, Royal Global University, Guwahati, 781035, Assam, India
| | - Vijay Kumar
- Himalayan School of Biosciences, Swami Rama Himalayan University, Dehradun, India, 248016
| | - Kamlesh Choure
- Department of Biotechnology, AKS University, Satna, 485001, Madhya Pradesh, India
| | - Sanjeev Kumar
- Department of Life Sciences and Bioinformatics, Assam University, Silchar, 788011, Assam, India
| | - Piyush Pandey
- Department of Microbiology, Assam University, Silchar, 788011, Assam, India.
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Caplan AS, Todd GC, Zhu Y, Sikora M, Akoh CC, Jakus J, Lipner SR, Babbush K, Acker KP, Morales AE, Rolón RMM, Westblade LF, Fonseca M, Cline A, Gold JAW, Lockhart SR, Smith DJ, Chiller T, Greendyke WG, Manjari SR, Banavali NK, Chaturvedi S. Clinical Course, Antifungal Susceptibility, and Genomic Sequencing of Trichophyton indotineae. JAMA Dermatol 2024; 160:701-709. [PMID: 38748419 PMCID: PMC11097098 DOI: 10.1001/jamadermatol.2024.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/18/2024] [Indexed: 05/18/2024]
Abstract
Importance Trichophyton indotineae is an emerging dermatophyte causing outbreaks of extensive tinea infections often unresponsive to terbinafine. This species has been detected worldwide and in multiple US states, yet detailed US data on infections with T indotineae are sparse and could improve treatment practices and medical understanding of transmission. Objective To correlate clinical features of T indotineae infections with in vitro antifungal susceptibility testing results, squalene epoxidase gene sequence variations, and isolate relatedness using whole-genome sequencing. Design, Setting, and Participants This retrospective cohort study of patients with T indotineae infections in New York City spanned May 2022 to May 2023. Patients with confirmed T indotineae infections were recruited from 6 New York City medical centers. Main Outcome and Measure Improvement or resolution at the last follow-up assessment. Results Among 11 patients with T indotineae (6 male and 5 female patients; median [range] age, 39 [10-65] years), 2 were pregnant; 1 had lymphoma; and the remainder were immunocompetent. Nine patients reported previous travel to Bangladesh. All had widespread lesions with variable scale and inflammation, topical antifungal monotherapy failure, and diagnostic delays (range, 3-42 months). Terbinafine treatment failed in 7 patients at standard doses (250 mg daily) for prolonged duration; these patients also had isolates with amino acid substitutions at positions 393 (L393S) or 397 (F397L) in squalene epoxidase that correlated with elevated terbinafine minimum inhibitory concentrations of 0.5 μg/mL or higher. Patients who were treated with fluconazole and griseofulvin improved in 2 of 4 and 2 of 5 instances, respectively, without correlation between outcomes and antifungal minimum inhibitory concentrations. Furthermore, 5 of 7 patients treated with itraconazole cleared or had improvement at the last follow-up, and 2 of 7 were lost to follow-up or stopped treatment. Based on whole-genome sequencing analysis, US isolates formed a cluster distinct from Indian isolates. Conclusion and Relevance The results of this case series suggest that disease severity, diagnostic delays, and lack of response to typically used doses and durations of antifungals for tinea were common in this primarily immunocompetent patient cohort with T indotineae, consistent with published data. Itraconazole was generally effective, and the acquisition of infection was likely in Bangladesh.
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Affiliation(s)
- Avrom S. Caplan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
- Dermatology Service, Bellevue Hospital Center, New York, New York
| | - Gabrielle C. Todd
- Wadsworth Center Mycology Laboratory, New York State Department of Health, Albany
| | - YanChun Zhu
- Wadsworth Center Mycology Laboratory, New York State Department of Health, Albany
| | - Michelle Sikora
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Christine C. Akoh
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
- Dermatology Service, Bellevue Hospital Center, New York, New York
| | - Jeannette Jakus
- SUNY Downstate Health Sciences University, Department of Dermatology, Brooklyn, New York
| | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Kayla Babbush
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Karen P. Acker
- Division of Infectious Diseases, Department of Pediatrics, Weill Cornell Medicine, New York, New York
| | - Ayana E. Morales
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Lars F. Westblade
- Division of Infectious Diseases, Department of Pediatrics, Weill Cornell Medicine, New York, New York
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Maira Fonseca
- Department of Dermatology, Weill Cornell Medicine, New York, New York
- NYC Health + Hospitals/Lincoln Medical Center, Department of Dermatology, Bronx, New York, USA Department of Dermatology, Weill Cornell Medicine, New York
| | - Abigail Cline
- Department of Dermatology, Weill Cornell Medicine, New York, New York
- NYC Health + Hospitals/Lincoln Medical Center, Department of Dermatology, Bronx, New York, USA Department of Dermatology, Weill Cornell Medicine, New York
| | - Jeremy A. W. Gold
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shawn R. Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dallas J. Smith
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Swati R. Manjari
- Division of Translational Medicine, Wadsworth Center, New York State Department of Health, Albany
| | - Nilesh K. Banavali
- Division of Translational Medicine, Wadsworth Center, New York State Department of Health, Albany
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, New York
| | - Sudha Chaturvedi
- Wadsworth Center Mycology Laboratory, New York State Department of Health, Albany
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, New York
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Mazurkeviciute A, Matulyte I, Ivaskiene M, Zilius M. Modeling, the Optimization of the Composition of Emulgels with Ciclopirox Olamine, and Quality Assessment. Polymers (Basel) 2024; 16:1816. [PMID: 39000671 PMCID: PMC11244097 DOI: 10.3390/polym16131816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/14/2024] [Accepted: 06/22/2024] [Indexed: 07/17/2024] Open
Abstract
The design and development of pharmaceutical products require specific knowledge, time, and investment. Response surface methodology (RSM) is a widely used technique in the design of experiments (DoE) to optimize various processes and products. The aim of this study was to model and produce experimental emulgels containing 1% ciclopirox olamine and to evaluate their physical, rheological, and mechanical properties and their ability to release ciclopirox olamine. The objective was to optimize the composition of the experimental emulgel containing 1% ciclopirox olamine by applying a central composite design based on selected criteria. The surfactant (polysorbate 80) had the greatest influence on the physical, rheological, and mechanical properties of the emulgels, as well as on the release of ciclopirox olamine from these systems. During the optimization process, an emulgel of optimal composition was generated containing 38.27% mineral oil, 6.56% polysorbate 80, and 55.17% hydrogel containing 1% ciclopirox olamine, meeting specified criteria (dependent variables) including the maximum flux of ciclopirox olamine, the minimum sol-gel transition temperature (Tsol/gel), and the minimum particle size of the oil phase. The oil phase particle size (D50) of this emulgel was determined to be 0.337 µm, the system Tsol/gel was 9.1 °C, and the flux of ciclopirox olamine from this gel matrix was calculated to be 1.44 mg/cm2. This emulgel of optimal composition could be used to treat fungal skin diseases.
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Affiliation(s)
- Agne Mazurkeviciute
- Institute of Pharmaceutical Technologies, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania; (A.M.); (I.M.)
- Department of Clinical Pharmacy, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania
| | - Inga Matulyte
- Institute of Pharmaceutical Technologies, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania; (A.M.); (I.M.)
- Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania
| | - Marija Ivaskiene
- Dr. L. Kraučeliūnas Small Animal Clinic, Veterinary Academy, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania;
| | - Modestas Zilius
- Institute of Pharmaceutical Technologies, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania; (A.M.); (I.M.)
- Department of Clinical Pharmacy, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania
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Oladzad V, Nasrollahi Omran A, Haghani I, Nabili M, Guillot J, Seyedmousavi S, Hedayati MT. Asymptomatic colonization of stray dogs and domestic cats with Trichophyton mentagrophytes II* in Northern Iran. J Mycol Med 2024; 34:101496. [PMID: 38986423 DOI: 10.1016/j.mycmed.2024.101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/19/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Despite changes in the epidemiology of dermatophyte infections, the incidence of fungal infections associated with Trichophyton species still remains high among dogs and cats. The objective of the present study was to isolate and characterize dermatophytes from dogs and cats in Iran. METHOD From December 2022 to May 2023, skin and hair samples were collected from symptomatic and asymptomatic cats and dogs in Mazandaran, a northern province of Iran. The samples were then inoculated into Mycosel™ Agar. Dermatophyte isolates were identified by sequencing the internal transcribed spacer region. Antifungal susceptibility tests were conducted using the Clinical and Laboratory Standards Institute (CLSI-M38-A3). RESULT Of the 250 samples collected (from 200 dogs and 50 cats), 20 (from 19 dogs and one cat) (8.0 %) were positive for dermatophyte growth. Based on sequence and phylogenetic analysis, all isolates belonged to T. mentagrophytes II*. Of these positive samples, 14 (70.0 %), 3 (15.0 %), 2 (10.0 %), and 1 (2.0 %) were isolated from asymptomatic stray dogs, symptomatic stray dogs, symptomatic domestic dogs, and symptomatic cats, respectively. Luliconazole and terbinafine displayed potent activity against all T. mentagrophytes isolates, with Minimum inhibitory concentration (MIC) values of 0.016 µg/ml. Miconazole and griseofulvin demonstrated higher MIC (1 and 8 µg/ml). CONCLUSION The present study indicated that T. mentagrophytes II* asymptomatic carriage is frequent in stray dogs in Iran. The potential risk to public health needs to be evaluated However, T. mentagrophytes genotype VIII, considered as an endemic and emerging human pathogenic clone in several countries, was not detected during the present survey.
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Affiliation(s)
- Vahid Oladzad
- Department of Mycology, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Ayatollah Nasrollahi Omran
- Department of Mycology, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran.
| | - Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran; Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mojtaba Nabili
- Department of Medical Laboratory Sciences, Faculty of Medical Sciences, Sari Branch, Islamic Azad University, Sari, Iran
| | - Jacques Guillot
- Oniris, Clinical Sciences Department, Nantes, France; Université d'Angers, Université de Brest, IRF, SFR ICAT, Angers, France
| | - Seyedmojtaba Seyedmousavi
- Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran; Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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Kane A, Rothwell JG, Guttentag A, Hainsworth S, Carter D. Bisphosphonates synergistically enhance the antifungal activity of azoles in dermatophytes and other pathogenic molds. mSphere 2024; 9:e0024824. [PMID: 38837382 DOI: 10.1128/msphere.00248-24] [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: 03/24/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Superficial infections of the skin, hair, and nails by fungal dermatophytes are the most prevalent of human mycoses, and many infections are refractory to treatment. As current treatment options are limited, recent research has explored drug synergy with azoles for dermatophytoses. Bisphosphonates, which are approved to treat osteoporosis, can synergistically enhance the activity of azoles in diverse yeast pathogens but their activity has not been explored in dermatophytes or other molds. Market bisphosphonates risedronate, alendronate, and zoledronate (ZOL) were evaluated for antifungal efficacy and synergy with three azole antifungals: fluconazole (FLC), itraconazole (ITR), and ketoconazole (KET). ZOL was the most active bisphosphonate tested, displaying moderate activity against nine dermatophyte species (MIC range 64-256 µg/mL), and was synergistic with KET in eight of these species. ZOL was also able to synergistically improve the anti-biofilm activity of KET and combining KET and ZOL prevented the development of antifungal resistance. Rescue assays in Trichophyton rubrum revealed that the inhibitory effects of ZOL alone and in combination with KET were due to the inhibition of squalene synthesis. Fluorescence microscopy using membrane- and ROS-sensitive probes demonstrated that ZOL and KET:ZOL compromised membrane structure and induced oxidative stress. Antifungal activity and synergy between bisphosphonates and azoles were also observed in other clinically relevant molds, including species of Aspergillus and Mucor. These findings indicate that repurposing bisphosphonates as antifungals is a promising strategy for revitalising certain azoles as topical antifungals, and that this combination could be fast-tracked for investigation in clinical trials. IMPORTANCE Fungal infections of the skin, hair, and nails, generally grouped together as "tineas" are the most prevalent infectious diseases globally. These infections, caused by fungal species known as dermatophytes, are generally superficial, but can in some cases become aggressive. They are also notoriously difficult to resolve, with few effective treatments and rising levels of drug resistance. Here, we report a potential new treatment that combines azole antifungals with bisphosphonates. Bisphosphonates are approved for the treatment of low bone density diseases, and in fungi they inhibit the biosynthesis of the cell membrane, which is also the target of azoles. Combinations were synergistic across the dermatophyte species and prevented the development of resistance. We extended the study to molds that cause invasive disease, finding synergy in some problematic species. We suggest bisphosphonates could be repurposed as synergents for tinea treatment, and that this combination could be fast-tracked for use in clinical therapy.
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Affiliation(s)
- Aidan Kane
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanna G Rothwell
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Annabel Guttentag
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Steven Hainsworth
- School of Science, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
| | - Dee Carter
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, New South Wales, Australia
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Sousa YV, Santiago MG, de Souza BM, Keller KM, Oliveira CSF, Mendoza L, Vilela RVR, Goulart GAC. Itraconazole in human medicine and veterinary practice. J Mycol Med 2024; 34:101473. [PMID: 38493607 DOI: 10.1016/j.mycmed.2024.101473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/03/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024]
Abstract
Diagnosis and management of fungal infections are challenging in both animals and humans, especially in immunologically weakened hosts. Due to its broad spectrum and safety profile when compared to other antifungals, itraconazole (ITZ) has been widely used in the treatment and prophylaxis of fungal infections, both in human and veterinary medicine. The dose and duration of management depend on factors such as the type of fungal pathogen, the site of infection, sensitivity to ITZ, chronic stages of the disease, the health status of the hosts, pharmacological interactions with other medications and the therapeutic protocol used. In veterinary practice, ITZ doses generally vary between 3 mg/kg and 50 mg/kg, once or twice a day. In humans, doses usually vary between 100 and 400 mg/day. As human and veterinary fungal infections are increasingly associated, and ITZ is one of the main medications used, this review addresses relevant aspects related to the use of this drug in both clinics, including case reports and different clinical aspects available in the literature.
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Affiliation(s)
- Yamara V Sousa
- Department of Pharmaceuticals, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av Antônio Carlos, 6627, Belo Horizonte, MG 31270-901, Brazil
| | - Marie G Santiago
- Department of Pharmaceuticals, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av Antônio Carlos, 6627, Belo Horizonte, MG 31270-901, Brazil
| | - Bianca M de Souza
- Department of Preventive Veterinary Medicine, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - Kelly M Keller
- Department of Preventive Veterinary Medicine, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - Camila S F Oliveira
- Department of Preventive Veterinary Medicine, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - Leonel Mendoza
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI 48824, United States
| | - Raquel V R Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI 48824, United States; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - Gisele A C Goulart
- Department of Pharmaceuticals, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av Antônio Carlos, 6627, Belo Horizonte, MG 31270-901, Brazil.
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Sierra-Maeda KY, Martínez-Hernández F, Arenas R, Boeta-Ángeles L, Martínez-Chavarría LC, Rodríguez-Colín SF, Xicohtencatl-Cortes J, Hernández-Castro R. Tinea corporis intrafamilial infection in pets due to Microsporum canis. Rev Inst Med Trop Sao Paulo 2024; 66:e30. [PMID: 38747851 PMCID: PMC11095247 DOI: 10.1590/s1678-9946202466030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/18/2024] [Indexed: 05/19/2024] Open
Abstract
Microsporum canis, one of the most widespread dermatophytes worldwide, is a zoonotic microorganism that transmits infection from reservoirs such as cats and dogs to humans. This microorganism is associated with Tinea corporis and other clinical manifestations; however, few studies have used genetic surveillance to determine and characterize the process of zoonotic transmission. In this study, we show a clear example of zoonotic transmission from a cat to an intrafamilial environment, where it caused Tinea corporis by infection with M. canis. Molecular characterization using the b-tubulin gene and Random Amplified Polymorphic DNA analysis made it possible to determine that the six isolates of M. canis obtained in this study belonged to the same genetic variant or clone responsible for reservoir-reservoir or reservoir-human transmission.
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Affiliation(s)
- Karla Yaeko Sierra-Maeda
- Hospital General ''Dr. Manuel Gea González'', Servicio de Dermatología, Tlalpan, Ciudad de México, Mexico
| | - Fernando Martínez-Hernández
- Hospital General "Dr. Manuel Gea González", Departamento de Ecología de Agentes Patógenos, Tlalpan, Ciudad de México, Mexico
| | - Roberto Arenas
- Hospital General ''Dr. Manuel Gea González'', Servicio de Micología, Tlalpan, Ciudad de México, Mexico
| | | | - Luary Carolina Martínez-Chavarría
- Universidad Nacional Autónoma de México, Facultad de Medicina Veterinaria y Zootecnia, Departamento Patología, Coyoacán, Ciudad de México, Mexico
| | | | - Juan Xicohtencatl-Cortes
- Hospital Infantil de México Dr. Federico Gómez, Laboratorio de Bacteriología Intestinal, Cuauhtémoc, Ciudad de México, Mexico
| | - Rigoberto Hernández-Castro
- Hospital General "Dr. Manuel Gea González", Departamento de Ecología de Agentes Patógenos, Tlalpan, Ciudad de México, Mexico
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Gupta AK, Polla Ravi S, Talukder M, Mann A. Effectiveness and safety of oral terbinafine for dermatophyte distal subungual onychomycosis. Expert Opin Pharmacother 2024; 25:15-23. [PMID: 38221907 DOI: 10.1080/14656566.2024.2305304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Terbinafine has been a cornerstone in dermatophyte infection treatment. Despite its global efficacy, the emergence of terbinafine resistance raises concerns, requiring ongoing vigilance. AREAS COVERED This paper focuses on evaluating the efficacy and safety of terbinafine in treating dermatophyte toenail infections. Continuous and pulse therapies, with a 24-week continuous regimen and a higher dosage of 500 mg/day have demonstrated superior efficacy to the FDA approved regimen of 250 mg/day x 12 weeks. Pulse therapies, though showing comparable effectiveness, present debates with regards to their efficacy as conflicting findings have been reported. Safety concerns encompass hepatotoxicity, gastrointestinal, cutaneous, neurologic, hematologic and immune adverse-effects, and possible drug interactions, suggesting the need for ongoing monitoring. EXPERT OPINION Terbinafine efficacy depends on dosage, duration, and resistance patterns. Continuous therapy for 24 weeks and a dosage of 500 mg/day may enhance outcomes, but safety considerations and resistance necessitate individualized approaches. Alternatives, including topical agents and alternative antifungals, are to be considered for resistant cases. Understanding the interplay between treatment parameters, adverse effects, and resistance mechanisms is critical for optimizing therapeutic efficacy while mitigating resistance risks. Patient education and adherence are vital for early detection and management of adverse effects and resistance, contributing to tailored and effective treatments.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Research Department, Mediprobe Research Inc, London, Ontario, Canada
| | | | - Mesbah Talukder
- Research Department, Mediprobe Research Inc, London, Ontario, Canada
- School of Pharmacy, BRAC University, Dhaka, Bangladesh
| | - Avantika Mann
- Research Department, Mediprobe Research Inc, London, Ontario, Canada
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Baveja S, Vashisht D, Kothari R, Venugopal R, Kumar Joshi R. Comparative evaluation of the efficacy of itraconazole with terbinafine cream versus itraconazole with sertaconazole cream in dermatophytosis: A within person pilot study. Med J Armed Forces India 2023; 79:526-530. [PMID: 37719899 PMCID: PMC10499633 DOI: 10.1016/j.mjafi.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background Current trend of rising drug-resistant dermatophyte infection is alarming and fretted by dermatologists. Dilemma prevails regarding use of the same or different class of antifungal agents topically and systemically. The aim was to study the efficacy of oral itraconazole 200 mg with 1% terbinafine cream versus oral itraconazole 200 mg with 2% sertaconazole cream in dermatophytosis. Methods This within-person open-label pilot study enrolled 50 patients with dermatophytosis. Two lesions of comparable size within each patient were randomly allotted to group A and B and treated with 2% sertaconazole and 1% terbinafine cream, respectively. Both groups received itraconazole 200 mg once daily for 4 weeks. The remaining lesions received 1% terbinafine cream. Response and adverse effects were assessed at 2 and 4 weeks. Reduction in erythema, scaling, pruritus and clinical, and mycological cure constituted efficacy outcomes. Results The mean duration of lesions was 2.82 ± 1.35 months. Complete clinical cure was observed in 50% and 48%, whereas mycological cure was attained in 56% and 52% patients in groups A and B, respectively, after 4 weeks, which was statistically insignificant. Reduction in erythema, scaling, and pruritus after 4 weeks when compared between the two groups, was also statistically insignificant. Conclusion Same class of oral and topical antifungal agents has comparable efficacy with different classes of oral and topical antifungal agents in dermatophyte infection.
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Affiliation(s)
- Sukriti Baveja
- Deputy Commandant, OTC, AMC (Centre & College), Lucknow, India
| | - Deepak Vashisht
- Professor (Dermatology), Command Hospital, (Southern Command), Pune, India
| | - Rohit Kothari
- Resident, Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Ruby Venugopal
- Assistant Professor (Dermatology), Command Hospital (Southern Command), Pune, India
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Gupta AK, Talukder M, Carviel JL, Cooper EA, Piguet V. Combatting antifungal resistance: Paradigm shift in the diagnosis and management of onychomycosis and dermatomycosis. J Eur Acad Dermatol Venereol 2023; 37:1706-1717. [PMID: 37210652 DOI: 10.1111/jdv.19217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/26/2023] [Indexed: 05/22/2023]
Abstract
Antifungal resistance has become prevalent worldwide. Understanding the factors involved in spread of resistance allows the formulation of strategies to slow resistance development and likewise identify solutions for the treatment of highly recalcitrant fungal infections. To investigate the recent explosion of resistant strains, a literature review was performed focusing on four main areas: mechanisms of resistance to antifungal agents, diagnosis of superficial fungal infections, management, and stewardship. The use of traditional diagnostic tools such as culture, KOH analysis and minimum inhibitory concentration values on treatment were investigated and compared to the newer techniques such as molecular methods including whole genome sequencing, and polymerase chain reaction. The management of terbinafine-resistant strains is discussed. We have emphasized the need for antifungal stewardship including increasing surveillance for resistant infection.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mesbah Talukder
- Mediprobe Research Inc., London, Ontario, Canada
- School of Pharmacy, BRAC University, Dhaka, Bangladesh
| | | | | | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
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Chen L, Zhang L, Xie Y, Wang Y, Tian X, Fang W, Xue X, Wang L. Confronting antifungal resistance, tolerance, and persistence: Advances in drug target discovery and delivery systems. Adv Drug Deliv Rev 2023; 200:115007. [PMID: 37437715 DOI: 10.1016/j.addr.2023.115007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
Human pathogenic fungi pose a serious threat to human health and safety. Unfortunately, the limited number of antifungal options is exacerbated by the continuous emergence of drug-resistant variants, leading to frequent drug treatment failures. Recent studies have also highlighted the clinical importance of other modes of fungal survival of antifungal treatment, including drug tolerance and persistence, pointing to the complexity of the fungal response to antifungal drugs. A lack of understanding of the fungal drug response has hampered the identification of new targets, the development of alternative antifungal strategies and the design of appropriate delivery systems. In this review we summarize recent advances in the study of antifungal resistance, tolerance and persistence, with an emphasis on promising drug targets and drug delivery systems that may yield important insights into the development of new or improved antifungal therapies against fungal infections.
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Affiliation(s)
- Lei Chen
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Lanyue Zhang
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Yuyan Xie
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Yiting Wang
- College of Life Sciences, Hebei University, Baoding, Hebei 071002, China
| | - Xiuyun Tian
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Wenxia Fang
- Institute of Biological Science and Technology, Guangxi Academy of Sciences, Nanning, 530007, Guangxi, China
| | - Xinying Xue
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University; Peking University Ninth School of Clinical Medicine, Beijing 100038, China; Department of Respiratory and Critical Care, Weifang Medical College, 261053, Weifang, Shandong, China.
| | - Linqi Wang
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China.
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12
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Su H, Jiang W, Verweij PE, Li L, Zhu J, Han J, Zhu M, Deng S. The in vitro Activity of Echinocandins Against Clinical Trichophyton rubrum Isolates and Review of the Susceptibility of T. rubrum to Echinocandins Worldwide. Infect Drug Resist 2023; 16:5395-5403. [PMID: 37621698 PMCID: PMC10444579 DOI: 10.2147/idr.s423735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction The emergence of resistance in Trichophyton rubrum to azoles and terbinafine has become increasingly evident in recent years, necessitating the development of novel antifungal drugs and the exploration of new indications for existing agents. Methods In this study, we retrospectively evaluated the in vitro antifungal activity of 3 echinocandins (anidulafungin, caspofungin, and micafungin) against 73 clinical isolates of T. rubrum collected from a teaching hospital in Shanghai, China, using EUCAST E.DEF 9.3.1 with minor modification. We also reviewed the susceptibility of T. rubrum to echinocandins globally by literature searching. Results Our findings revealed that micafungin exhibited the lowest modal minimum effective concentration (MEC) value (0.08 mg/L, n = 28) and the lowest geometric mean (GM) MEC value (0.014 mg/L) among the 73 isolates of T. rubrum tested, followed by anidulafungin with a modal MEC value of 0.016 mg/L (n = 67) and a GM of 0.018 mg/L. Caspofungin displayed a higher modal MEC value of 0.5 mg/L (n = 35) and a GM of 0.308 mg/L. Despite variations in methodologies, similar results were obtained from the review of five relevant studies included in our analysis. Discussion Echinocandins exhibited excellent in vitro activity against T. rubrum isolates, with micafungin and anidulafungin demonstrating greater potency than caspofungin. These findings suggest that echinocandins could be considered as potential treatment options for managing recalcitrant dermatophytoses resulting from the emergence of resistance. However, it is important to note that the clinical efficacy of these in vitro findings has yet to be established and warrants further investigation.
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Affiliation(s)
- Huilin Su
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of Medical Microbiology and Center of Expertise in Mycology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Weiwei Jiang
- Department of Dermatology, Hospital affiliated to the 72nd Army of Chinese PLA, Huzhou, People’s Republic of China
| | - Paul E Verweij
- Department of Medical Microbiology and Center of Expertise in Mycology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Medical Microbiology and Center of Expertise in Mycology, CWZ Hospital, Nijmegen, the Netherlands
| | - Li Li
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Junhao Zhu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jiande Han
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Min Zhu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Shuwen Deng
- Department of Medical Microbiology, The People’s Hospital of SND, Suzhou, People’s Republic of China
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Leung AKC, Barankin B, Lam JM, Leong KF, Hon KL. Tinea pedis: an updated review. Drugs Context 2023; 12:2023-5-1. [PMID: 37415917 PMCID: PMC10321471 DOI: 10.7573/dic.2023-5-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
Background Tinea pedis is one of the most common superficial fungal infections of the skin, with various clinical manifestations. This review aims to familiarize physicians with the clinical features, diagnosis and management of tinea pedis. Methods A search was conducted in April 2023 in PubMed Clinical Queries using the key terms 'tinea pedis' OR 'athlete's foot'. The search strategy included all clinical trials, observational studies and reviews published in English within the past 10 years. Results Tinea pedis is most often caused by Trichophyton rubrum and Trichophyton interdigitale. It is estimated that approximately 3% of the world population have tinea pedis. The prevalence is higher in adolescents and adults than in children. The peak age incidence is between 16 and 45 years of age. Tinea pedis is more common amongst males than females. Transmission amongst family members is the most common route, and transmission can also occur through indirect contact with contaminated belongings of the affected patient. Three main clinical forms of tinea pedis are recognized: interdigital, hyperkeratotic (moccasin-type) and vesiculobullous (inflammatory). The accuracy of clinical diagnosis of tinea pedis is low. A KOH wet-mount examination of skin scrapings of the active border of the lesion is recommended as a point-of-care testing. The diagnosis can be confirmed, if necessary, by fungal culture or culture-independent molecular tools of skin scrapings. Superficial or localized tinea pedis usually responds to topical antifungal therapy. Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis or in immunocompromised patients. Conclusion Topical antifungal therapy (once to twice daily for 1-6 weeks) is the mainstay of treatment for superficial or localized tinea pedis. Examples of topical antifungal agents include allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate and amorolfine. Oral antifungal agents used for the treatment of tinea pedis include terbinafine, itraconazole and fluconazole. Combined therapy with topical and oral antifungals may increase the cure rate. The prognosis is good with appropriate antifungal treatment. Untreated, the lesions may persist and progress.
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Affiliation(s)
- Alexander KC Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children’s Hospital, Calgary, Alberta, Canada
| | | | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia and BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, Chinese University of Hong Kong Medical Centre, The Chinese University of Hong Kong, Shatin, Hong Kong
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Costa-Orlandi CB, Bila NM, Bonatti JLC, Vaso CO, Santos MB, Polaquini CR, Santoni Biasioli MM, Herculano RD, Regasini LO, Fusco-Almeida AM, Mendes-Giannini MJS. Membranolytic Activity Profile of Nonyl 3,4-Dihydroxybenzoate: A New Anti-Biofilm Compound for the Treatment of Dermatophytosis. Pharmaceutics 2023; 15:pharmaceutics15051402. [PMID: 37242644 DOI: 10.3390/pharmaceutics15051402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 05/28/2023] Open
Abstract
The ability of dermatophytes to live in communities and resist antifungal drugs may explain treatment recurrence, especially in onychomycosis. Therefore, new molecules with reduced toxicity that target dermatophyte biofilms should be investigated. This study evaluated nonyl 3,4-dihydroxybenzoate (nonyl) susceptibility and mechanism of action on planktonic cells and biofilms of T. rubrum and T. mentagrophytes. Metabolic activities, ergosterol, and reactive oxygen species (ROS) were quantified, and the expression of genes encoding ergosterol was determined by real-time PCR. The effects on the biofilm structure were visualized using confocal electron microscopy, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). T. rubrum and T. mentagrophytes biofilms were susceptible to nonyl and resistant to fluconazole, griseofulvin (all strains), and terbinafine (two strains). The SEM results revealed that nonyl groups seriously damaged the biofilms, whereas synthetic drugs caused little or no damage and, in some cases, stimulated the development of resistance structures. Confocal microscopy showed a drastic reduction in biofilm thickness, and transmission electron microscopy results indicated that the compound promoted the derangement and formation of pores in the plasma membrane. Biochemical and molecular assays indicated that fungal membrane ergosterol is a nonyl target. These findings show that nonyl 3,4-dihydroxybenzoate is a promising antifungal compound.
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Affiliation(s)
- Caroline B Costa-Orlandi
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Níura M Bila
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
- Department of Para-Clinic, School of Veterinary, Eduardo Modlane University (UEM), Maputo 257, Mozambique
| | - Jean Lucas C Bonatti
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Carolina O Vaso
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Mariana B Santos
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (U.N.E.S.P.), Sao Jose do Rio Preto 15054-000, SP, Brazil
| | - Carlos R Polaquini
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (U.N.E.S.P.), Sao Jose do Rio Preto 15054-000, SP, Brazil
| | - Mariana M Santoni Biasioli
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Rondinelli D Herculano
- Department of Bioprocesses and Biotechnology, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Luis O Regasini
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (U.N.E.S.P.), Sao Jose do Rio Preto 15054-000, SP, Brazil
| | - Ana Marisa Fusco-Almeida
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Maria José S Mendes-Giannini
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
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15
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Handa S, Villasis-Keever A, Shenoy M, Anandan S, Bhrushundi M, Garodia N, Fife D, De Doncker P, Shalayda K, Hu P, Fonseca S, Cure-bolt N. No evidence of resistance to itraconazole in a prospective real-world trial of dermatomycosis in India. PLoS One 2023; 18:e0281514. [PMID: 36787305 PMCID: PMC9928099 DOI: 10.1371/journal.pone.0281514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/12/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The prevalence of superficial fungal infections in India is believed to have increased substantially in the past decade. We evaluated the treatment outcomes and risk factors associated with clinical response to a treatment course of itraconazole for the management of dermatomycosis in India. METHODS In this real-world, prospective pilot study (August 2019 to March 2020), adult participants (18-60 years), diagnosed with T. cruris or T. corporis, received itraconazole 200 mg/day (any formulation) orally for 7 days, and were followed for an additional 7 days. RESULTS The study was terminated early due to the COVID-19 pandemic. Of 40 enrolled participants (mean [SD] age, 35.5 [12.73] years; {62.5%}] male; 37 received itraconazole and 20 (50%) completed the study. The median (range) Clinical Evaluation Tool Signs and Symptoms total score at baseline was 5.5 (2-10). Clinical response of "healed" or "markedly improved" based on the Investigator Global Evaluation Tool at day 7 (primary objective) was 42.9% (12/28; 95% CI: 24.53%, 61.19%). Itraconazole minimum inhibitory concentration for identified microorganisms, T. mentagrophytes species complex (91.7%) and T. rubrum (8.3%), was within the susceptibility range (0.015-0.25 mcg/mL). At day 14, 8/13 (61.5%) participants achieved a mycological response, 2/13 participants (15.4%) had a mycological failure and 90% showed a clinical response. CONCLUSION COVID-19 pandemic affected patient recruitment and follow-up, so the findings call for a careful interpretation. Nevertheless, this real-world study reconfirmed the clinical efficacy and microbial susceptibility to itraconazole for the fungi causing dermatophytosis in India. TRIAL REGISTRATION Trial registration number: Clinicaltrials.gov NCT03923010.
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Affiliation(s)
- S. Handa
- Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - A. Villasis-Keever
- Janssen Research & Development, LLC, Titusville, New Jersey, United States of America
| | - M. Shenoy
- Yenepoya Medical College Hospital, Mangalore, Karnataka, India
| | - S. Anandan
- Sri Ramchandra Hospital, Chennai, Tamil Nadu, India
| | - M. Bhrushundi
- Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
| | - N. Garodia
- Janssen Medical Affairs, Mumbai, Maharashtra, India
| | - D. Fife
- Janssen Research & Development, LLC, Titusville, New Jersey, United States of America
| | - P. De Doncker
- Janssen Infectious Diseases-Diagnostics, Beerse, Belgium
| | - K. Shalayda
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - P. Hu
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - S. Fonseca
- Janssen Research & Development, LLC, Titusville, New Jersey, United States of America
| | - N. Cure-bolt
- Janssen Research & Development, LLC, Titusville, New Jersey, United States of America
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Antifungal and Antibiofilm Activity of Riparin III against Dermatophytes. J Fungi (Basel) 2023; 9:jof9020231. [PMID: 36836345 PMCID: PMC9966229 DOI: 10.3390/jof9020231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
The ability of dermatophytes to develop biofilms is possibly involved in therapeutic failure because biofilms impair drug effectiveness in the infected tissues. Research to find new drugs with antibiofilm activity against dermatophytes is crucial. In this way, riparins, a class of alkaloids that contain an amide group, are promising antifungal compounds. In this study, we evaluated the antifungal and antibiofilm activity of riparin III (RIP3) against Trichophyton rubrum, Microsporum canis, and Nannizzia gypsea strains. We used ciclopirox (CPX) as a positive control. The effects of RIP3 on fungal growth were evaluated by the microdilution technique. The quantification of the biofilm biomass in vitro was assessed by crystal violet, and the biofilm viability was assessed by quantifying the CFU number. The ex vivo model was performed on human nail fragments, which were evaluated by visualization under light microscopy and by quantifying the CFU number (viability). Finally, we evaluated whether RIP3 inhibits sulfite production in T. rubrum. RIP3 inhibited the growth of T. rubrum and M. canis from 128 mg/L and N. gypsea from 256 mg/L. The results showed that RIP3 is a fungicide. Regarding antibiofilm activity, RIP3 inhibited biofilm formation and viability in vitro and ex vivo. Moreover, RIP3 inhibited the secretion of sulfite significantly and was more potent than CPX. In conclusion, the results indicate that RIP3 is a promising antifungal agent against biofilms of dermatophytes and might inhibit sulfite secretion, one relevant virulence factor.
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Sharma A, Cipriano M, Ferrins L, Hajduk SL, Mensa-Wilmot K. Hypothesis-generating proteome perturbation to identify NEU-4438 and acoziborole modes of action in the African Trypanosome. iScience 2022; 25:105302. [PMID: 36304107 PMCID: PMC9593816 DOI: 10.1016/j.isci.2022.105302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/24/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022] Open
Abstract
NEU-4438 is a lead for the development of drugs against Trypanosoma brucei, which causes human African trypanosomiasis. Optimized with phenotypic screening, targets of NEU-4438 are unknown. Herein, we present a cell perturbome workflow that compares NEU-4438's molecular modes of action to those of SCYX-7158 (acoziborole). Following a 6 h perturbation of trypanosomes, NEU-4438 and acoziborole reduced steady-state amounts of 68 and 92 unique proteins, respectively. After analysis of proteomes, hypotheses formulated for modes of action were tested: Acoziborole and NEU-4438 have different modes of action. Whereas NEU-4438 prevented DNA biosynthesis and basal body maturation, acoziborole destabilized CPSF3 and other proteins, inhibited polypeptide translation, and reduced endocytosis of haptoglobin-hemoglobin. These data point to CPSF3-independent modes of action for acoziborole. In case of polypharmacology, the cell-perturbome workflow elucidates modes of action because it is target-agnostic. Finally, the workflow can be used in any cell that is amenable to proteomic and molecular biology experiments.
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Affiliation(s)
- Amrita Sharma
- Department of Molecular and Cellular Biology, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Michael Cipriano
- Department of Biochemistry & Molecular Biology, University of Georgia, Athens, GA 30602, USA
| | - Lori Ferrins
- Department of Chemistry and Chemical Biology, Northeastern University, Boston, MA 02115, USA
| | - Stephen L. Hajduk
- Department of Biochemistry & Molecular Biology, University of Georgia, Athens, GA 30602, USA
| | - Kojo Mensa-Wilmot
- Department of Molecular and Cellular Biology, Kennesaw State University, Kennesaw, GA 30144, USA,Corresponding author
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Gupta AK, Simkovich AJ, Hall DC. The March Against Onychomycosis: A Systematic Review of the Sanitization Methods for Shoes, Socks, and Textiles. J Am Podiatr Med Assoc 2022; 112:21-223. [PMID: 36074338 DOI: 10.7547/21-223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Drug-based treatment of superficial fungal infections, such as onychomycosis, is not the only defense. Sanitization of footwear such as shoes, socks/stockings, and other textiles is integral to the prevention of recurrence and reduction of spread for superficial fungal mycoses. The goal of this review was to examine the available methods of sanitization for footwear and textiles against superficial fungal infections. A systematic literature search of various sanitization devices and methods that could be applied to footwear and textiles using PubMed, Scopus, and MEDLINE was performed. Fifty-four studies were found relevant to the different methodologies, devices, and techniques of sanitization as they pertain to superficial fungal infections of the feet. These included topics of basic sanitization, antifungal and antimicrobial materials, sanitization chemicals and powder, laundering, ultraviolet, ozone, nonthermal plasma, microwave radiation, essential oils, and natural plant extracts. In the management of onychomycosis, it is necessary to think beyond treatment of the nail, as infections enter through the skin. Those prone to onychomycosis should examine their environment, including surfaces, shoes, and socks, and ensure that proper sanitization is implemented.
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Affiliation(s)
- Aditya K Gupta
- *Mediprobe Research Inc, London, Ontario, Canada.,†Department of Medicine, Division of Dermatology, University of Toronto School of Medicine, Toronto, Ontario, Canada
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19
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Cui X, Wang L, Lü Y, Yue C. Development and research progress of anti-drug resistant fungal drugs. J Infect Public Health 2022; 15:986-1000. [PMID: 35981408 DOI: 10.1016/j.jiph.2022.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
With the widespread use of immunosuppressive agents and the increase in patients with severe infections, the incidence of fungal infections worldwide has increased year by year. The fungal pathogens Candida albicans, Cryptococcus neoformans and Aspergillus fumigatus cause a total of more than 1 million deaths each year. Long-term use of antifungal drugs can easily lead to fungal resistance, and the prevalence of drug-resistant fungi is a major global health challenge. In order to effectively control global fungal infections, there is an urgent need for new drugs that can exert effective antifungal activity and overcome drug resistance. We must promote the discovery of new antifungal targets and drugs, and find effective ways to control drug-resistant fungi through different ways, so as to reduce the threat of drug-resistant fungi to human life, health and safety. In the past few years, certain progress has been made in the research and development of antifungal drugs. In addition to summarizing some of the antifungal drugs currently approved by the FDA, this review also focuses on potential antifungal drugs, the repositioned drugs, and drugs that can treat drug-resistant bacteria and fungal infections, and provide new ideas for the development of antifungal drugs in the future.
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Affiliation(s)
- Xiangyi Cui
- Key Laboratory of Microbial Drugs Innovation and Transformation of Yan'an, School of Basic Medicine, Yan'an University, Yan'an 716000, Shaanxi, China; Shaanxi Engineering & Technological Research Center for Conversation & Utilization of Regional Biological Resources,Yan'an University, NO.580 Shengdi Road, Baota District, Yan'an 716000, Shaanxi, China.
| | - Lanlin Wang
- Key Laboratory of Microbial Drugs Innovation and Transformation of Yan'an, School of Basic Medicine, Yan'an University, Yan'an 716000, Shaanxi, China; Shaanxi Engineering & Technological Research Center for Conversation & Utilization of Regional Biological Resources,Yan'an University, NO.580 Shengdi Road, Baota District, Yan'an 716000, Shaanxi, China.
| | - Yuhong Lü
- Key Laboratory of Microbial Drugs Innovation and Transformation of Yan'an, School of Basic Medicine, Yan'an University, Yan'an 716000, Shaanxi, China; Shaanxi Engineering & Technological Research Center for Conversation & Utilization of Regional Biological Resources,Yan'an University, NO.580 Shengdi Road, Baota District, Yan'an 716000, Shaanxi, China.
| | - Changwu Yue
- Key Laboratory of Microbial Drugs Innovation and Transformation of Yan'an, School of Basic Medicine, Yan'an University, Yan'an 716000, Shaanxi, China; Shaanxi Engineering & Technological Research Center for Conversation & Utilization of Regional Biological Resources,Yan'an University, NO.580 Shengdi Road, Baota District, Yan'an 716000, Shaanxi, China.
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Ferjani H, Bechaieb R, Dege N, El-Fattah WA, Elamin NY, Frigui W. Stabilization of supramolecular network of fluconazole drug polyiodide: Synthesis, computational and spectroscopic studies. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2022.133192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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21
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New Organic-Inorganic Salt Based on Fluconazole Drug: TD-DFT Benchmark and Computational Insights into Halogen Substitution. Int J Mol Sci 2022; 23:ijms23158765. [PMID: 35955897 PMCID: PMC9369134 DOI: 10.3390/ijms23158765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
In this study, we report the synthesis of a new organic–inorganic molecular salt of the clinically used antifungal drug fluconazole, (H2Fluconazole).SnCl6.2H2O. By detailed investigation and analysis of its structural properties, we show that the structure represents a 0D structure built of alternating organic and inorganic zig-zag layers along the crystallographic c-axis and the primary supramolecular synthons in this salt are hydrogen bonding, F···π and halogen bonding interactions. Magnetic measurements reveal the co-existence of weak ferromagnetic behavior at low magnetic field and large diamagnetic contributions, indicating that the synthesized material behaves mainly as a diamagnetic material, with very low magnetic susceptibility and with a band gap energy of 3.6 eV, and the salt is suitable for semiconducting applications. Extensive theoretical study is performed to explain the acceptor donor reactivity of this compound and to predict the Cl-substitution effect by F, Br and I. The energy gap, frontier molecular orbitals (FMOs) and the different chemical reactivity descriptors were evaluated at a high theoretical level. Calculations show that Cl substitution by Br and I generates compounds with more important antioxidant ability and the intramolecular charge transfer linked to the inorganic anion.
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Dehari D, Mehata AK, Priya V, Parbat D, Kumar D, Srivastava AK, Singh S, Agrawal AK. Luliconazole Nail Lacquer for the Treatment of Onychomycosis: Formulation, Characterization and In Vitro and Ex Vivo Evaluation. AAPS PharmSciTech 2022; 23:175. [PMID: 35750993 DOI: 10.1208/s12249-022-02324-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Onychomycosis is the most common fungal infection of the nail affecting the skin under the fingertips and the toes. Currently, available therapy for onychomycosis includes oral and topical therapies, either alone or in combination. Oral antifungal medication has been associated with poor drug bioavailability and potential gastrointestinal and systemic side effects. The objective of this study was to prepare and evaluate the luliconazole nail lacquer (LCZ-NL) for the effective treatment of onychomycosis. In the current work, LCZ-NL was formulated in combination with penetration enhancers to overcome poor penetration. A 32 full factorial formulation design of experiment (DOE) was applied for optimization of batches with consideration of dependent (drying time, viscosity, and rate of drug diffusion) and independent (solvent ratio and film former ratio) variables. The optimized formulation was selected based on drying time, viscosity, and rate of drug diffusion. The optimized formulation was further evaluated for % non-volatile content assay, smoothness of flow, water resistance, drug content, scanning electron microscope (SEM), atomic force microscope (AFM), X-ray diffraction (XRD), differential scanning calorimetry (DSC), in vitro drug release, ex vivo transungual permeation, antifungal efficacy, and stability study. The optimized LCZ-NL contained 70:30 solvent ratio and 1:1 film former ratio and was found to have ~ 1.79-fold higher rate of drug diffusion in comparison with LULY™. DSC and XRD studies confirmed that luliconazole retains its crystalline property in the prepared formulation. Antifungal study against Trichophyton spp. showed that LCZ-NL has comparatively higher growth inhibition than LULY™. Hence, developed LCZ-NL can be a promising topical drug delivery system for treating onychomycosis.
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Affiliation(s)
- Deepa Dehari
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi, 221005, India
| | - Abhishesh Kumar Mehata
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi, 221005, India
| | - Vishnu Priya
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi, 221005, India
| | - Dharmnath Parbat
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi, 221005, India
| | - Deepak Kumar
- Department of Microbiology, Institute of Medical Sciences (BHU), Varanasi, 221005, India
| | - Anand Kumar Srivastava
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi, 221005, India.
| | - Sanjay Singh
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi, 221005, India.,Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh, 226025, India
| | - Ashish Kumar Agrawal
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi, 221005, India.
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Pir M, Budak F, Metiner K. In vitro antifungal activity of heterocyclic organoboron compounds against Trichophyton mentagrophytes and Microsporum canis obtained from clinical isolates. Braz J Microbiol 2022; 53:1297-1303. [PMID: 35697970 DOI: 10.1007/s42770-022-00777-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate the in vitro activity of thirty-eight heterocyclic organoboron compounds (1a-o, 2a-j, 3a-m) against clinically isolated dermatophytes Trichophyton mentagrophytes and Microsporum canis. Minimum inhibitory concentrations (MICs) of compounds (1a-o, 2a-j, 3a-m) were determined according to published protocol Clinical and Laboratory Standards Institute (CLSI) M38-A2 broth microdilution method. The minimum fungicidal concentrations (MFCs) for both T. mentagrophytes and M. canis were found by subculturing each fungal suspension on potato dextrose agar. According to the results, heterocyclic organoboron compounds (1a-o, 2a-j, 3a-m) were found to be more effective against dermatophyte M. canis (MIC = 3.12-25 µg/ml) than T. mentagrophytes (MIC = 12.5-100 µg/ml). Our findings showed that 7-membered heterocyclic organoboron compounds (3a-m) (MIC = 12.5-50 µg/ml) have stronger in vitro antifungal activity against T. mentagrophytes than 5-membered heterocyclic organoboron compounds (1a-o, 2a-j) (MIC = 25-100 µg/ml). The MFC values for all compounds ranged from 6.25 to 200 µg/ml. The limited number of systemic antifungal agents used in the treatment of dermatophyte infections and the presence of side effects have led to the search for new treatment resources in recent years. Therefore, investigation of the effect of heterocyclic organoboron compounds against dermatophytes will be promising for the discovery of new antifungal compounds that have gained great importance today.
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Affiliation(s)
- Meryem Pir
- Chemistry and Chemical Processing Technology, Kocaeli Vocational School, Kocaeli University, Kocaeli, Turkey
| | - Fatma Budak
- Department of Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Kemal Metiner
- Department of Microbiology, Faculty of Veterinary Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Gnat S, Łagowski D, Dyląg M, Jóźwiak G, Trościańczyk A, Nowakiewicz A. In Vitro Activity of Ebselen and Diphenyl Diselenide Alone and in Combination with Drugs against Trichophyton mentagrophytes Strains. Pharmaceutics 2022; 14:pharmaceutics14061158. [PMID: 35745731 PMCID: PMC9229022 DOI: 10.3390/pharmaceutics14061158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/10/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Dermatophytoses are one of the most prevalent infectious diseases in the world for which the pace of developing new drugs has not kept pace with the observed therapeutic problems. Thus, searching for new antifungals with an alternative and novel mechanism of action is necessary. Objective: This study aimed to evaluate the antifungal activity of ebselen and diphenyl diselenide against Trichophyton mentagrophytes clinical isolates. Methods: In vitro antifungal susceptibility was assessed for organoselenium compounds used alone or in combination with allylamines and azoles according to the 3rd edition of the CLSI M38 protocol. Results: Ebselen demonstrated high antifungal activity with MICGM equal to 0.442 μg/mL and 0.518 μg/mL in the case of human and animal origin strains, respectively. The values of MICGM of diphenyl diselenide were higher: 17.36 μg/mL and 13.45 μg/mL for the human and animal isolates, respectively. Synergistic or additive effects between terbinafine and ebselen or diphenyl diselenide were observed in the case of 12% and 20% strains, respectively. In turn, the combination of itraconazole with diphenyl diselenide showed a synergistic effect only in the case of 6% of the tested strains, whereas no synergism was shown in the combination with ebselen. Conclusions: The results highlight the promising activity of organoselenium compounds against Trichophyton mentagrophytes. However, their use in combinational therapy with antifungal drugs seems to be unjustified due to the weak synergistic effect observed.
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Affiliation(s)
- Sebastian Gnat
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Life Sciences, Akademicka 12, 20-033 Lublin, Poland; (D.Ł.); (A.T.); (A.N.)
- Correspondence: ; Tel.: +48-81-445-6093
| | - Dominik Łagowski
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Life Sciences, Akademicka 12, 20-033 Lublin, Poland; (D.Ł.); (A.T.); (A.N.)
| | - Mariusz Dyląg
- Department of Mycology and Genetics, Faculty of Biological Sciences, University of Wroclaw, S. Przybyszewskiego 63, 50-137 Wroclaw, Poland;
| | - Grzegorz Jóźwiak
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland;
| | - Aleksandra Trościańczyk
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Life Sciences, Akademicka 12, 20-033 Lublin, Poland; (D.Ł.); (A.T.); (A.N.)
| | - Aneta Nowakiewicz
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Life Sciences, Akademicka 12, 20-033 Lublin, Poland; (D.Ł.); (A.T.); (A.N.)
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Abstract
AbstractThe order Onygenales is classified in the class Eurotiomycetes of the subphylum Pezizomycotina. Families in this order have classically been isolated from soil and dung, and two lineages contain causative agents of superficial, cutaneous and systemic infections in mammals. The ecology and habitat choices of the species are driven mainly by the keratin and cellulose degradation abilities. The present study aimed to investigate whether the ecological trends of the members of Onygenales can be interpreted in an evolutionary sense, linking phylogenetic parameters with habitat preferences, to achieve polyphasic definitions of the main taxonomic groups. Evolutionary processes were estimated by multiple gene genealogies and divergence time analysis. Previously described families, namely, Arthrodermataceae, Ajellomycetaceae, Ascosphaeraceae, Eremascaceae, Gymnoascaceae, Onygenaceae and Spiromastigoidaceae, were accepted in Onygenales, and two new families, Malbrancheaceae and Neogymnomycetaceae, were introduced. A number of species could not be assigned to any of the defined families. Our study provides a revised overview of the main lines of taxonomy of Onygenales, supported by multilocus analyses of ITS, LSU, TUB, TEF1, TEF3, RPB1, RPB2, and ribosomal protein 60S L10 (L1) (RP60S) sequences, combined with available data on ecology, physiology, morphology, and genomics.
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Wal P, Saraswat N, Vig H. A detailed insight on the molecular and cellular mechanism of action of the antifungal drugs used in the treatment of superficial fungal infections. CURRENT DRUG THERAPY 2022. [DOI: 10.2174/1574885517666220328141054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Dermatomycosis, a type of fungal infection that can infect human skin, hair, and nails; day by day the growth of fungal infections ranging from superficial to systemic infection is alarming. Common causative agents included are Candida, Cryptococcus, Aspergillus, and Pneumocystis species.
Objective:
The effective treatment of the fungal infection includes the use of proper antifungal drug therapy. Antifungal drugs are classified into various classes. This paper focuses on understanding and interpreting the detailed molecular and cellular mechanism of action of various classes of an anti-fungal drug along with their important characteristics along with the safety and efficacy data of individual drugs of the particular class.
Methods:
The data selection for carrying out the respective study has been done by studying the combination of review articles and research papers from different databases like Research Gate, PubMed, MDPI, Elsevier, Science Direct, and Med Crave ranging from the year 1972 to 2019 by using the keywords like “anti-fungal agents”, “dermatophytes”, “cutaneous candidiasis”, “superficial fungal infections”, “oral candidiasis”, “amphotericin”, “echinocandins”, “azoles”, “polyenes” “ketoconazole”, “terbinafine”, “griseofulvin”, “azoles”.
Result:
Based on interpretation, we have concluded that the different classes of antifungal drugs follow the different mechanisms of action and target the fungal cell membrane, and are efficient in reducing fungal disease by their respective mechanism.
Conclusion:
The prevention and cure of fungal infections can be done by oral or topical antifungal drugs that aim to destroy the fungal cell membrane. These drugs show action by their respective pathways that are either preventing the formation of ergosterol or squalene or act by inhibiting β-1,3-glucan synthase enzyme. All the drugs are effective in treating fungal infections.
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Affiliation(s)
- Pranay Wal
- Dean & Professor, Institute of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
| | - Nikita Saraswat
- Assistant Professor, Institute of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
| | - Himangi Vig
- Research Scholar, Institute of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
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Gupta AK, Friedlander SF, Simkovich AJ. Tinea capitis: An update. Pediatr Dermatol 2022; 39:167-172. [PMID: 35075666 DOI: 10.1111/pde.14925] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 11/26/2022]
Abstract
Tinea capitis is an important superficial infection and affects children globally. A literature review was conducted to identify recent findings and the current understanding of this fungal infection. Here, we highlight updates on important aspects of tinea capitis including advances in dermatophyte detection and diagnosis and comparing these new methods to more traditional techniques. Additionally, aspects of treating tinea capitis are discussed, including the importance of mycological confirmation and current means of treatment, and the treatment of asymptomatic carriers are reviewed. This review also examines the subject of laboratory monitoring of patients undergoing treatment with systemic antifungals; we discuss the opinions of prominent researchers and currently accepted guidelines. Lastly, we provide answers to several common questions that practitioners may encounter when treating a child with tinea capitis.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.,Mediprobe Research Inc., London, Ontario, Canada
| | - Sheila Fallon Friedlander
- Department of Dermatology, University of California School of Medicine, San Diego, California, USA.,Department of Dermatology, Scripps Clinic, San Diego, California, USA
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Pathogenesis, Immunology and Management of Dermatophytosis. J Fungi (Basel) 2021; 8:jof8010039. [PMID: 35049979 PMCID: PMC8781719 DOI: 10.3390/jof8010039] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/31/2022] Open
Abstract
Dermatophytic infections of the skin and appendages are a common occurrence. The pathogenesis involves complex interplay of agent (dermatophytes), host (inherent host defense and host immune response) and the environment. Infection management has become an important public health issue, due to increased incidence of recurrent, recalcitrant or extensive infections. Recent years have seen a significant rise in incidence of chronic infections which have been difficult to treat. In this review, we review the literature on management of dermatophytoses and bridge the gap in therapeutic recommendations.
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Towards a Standardized Procedure for the Production of Infective Spores to Study the Pathogenesis of Dermatophytosis. J Fungi (Basel) 2021; 7:jof7121029. [PMID: 34947011 PMCID: PMC8709344 DOI: 10.3390/jof7121029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
Dermatophytoses are superficial infections of human and animal keratinized tissues caused by filamentous fungi named dermatophytes. Because of a high and increasing incidence, as well as the emergence of antifungal resistance, a better understanding of mechanisms involved in adhesion and invasion by dermatophytes is required for the further development of new therapeutic strategies. In the last years, several in vitro and in vivo models have emerged to study dermatophytosis pathogenesis. However, the procedures used for the growth of fungi are quite different, leading to a highly variable composition of inoculum for these models (microconidia, arthroconidia, hyphae), thus rendering difficult the global interpretation of observations. We hereby optimized growth conditions, including medium, temperature, atmosphere, and duration of culture, to improve the sporulation and viability and to favour the production of arthroconidia of several dermatophyte species, including Trichophyton rubrum and Trichophyton benhamiae. The resulting suspensions were then used as inoculum to infect reconstructed human epidermis in order to validate their ability to adhere to and to invade host tissues. By this way, this paper provides recommendations for dermatophytes culture and paves the way towards a standardized procedure for the production of infective spores usable in in vitro and in vivo experimental models.
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Osman M, Kasir D, Rafei R, Kassem II, Ismail MB, El Omari K, Dabboussi F, Cazer C, Papon N, Bouchara JP, Hamze M. Trends in the epidemiology of dermatophytosis in the Middle East and North Africa region. Int J Dermatol 2021; 61:935-968. [PMID: 34766622 DOI: 10.1111/ijd.15967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/31/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022]
Abstract
Dermatophytosis corresponds to a broad series of infections, mostly superficial, caused by a group of keratinophilic and keratinolytic filamentous fungi called dermatophytes. These mycoses are currently considered to be a major public health concern worldwide, particularly in developing countries such as those in the Middle East and North Africa (MENA) region. Here we compiled and discussed existing epidemiologic data on these infections in the MENA region. Most of the available studies were based on conventional diagnostic strategies and were published before the last taxonomic revision of dermatophytes. This has led to misidentifications, which might have resulted in the underestimation of the real burden of these infections in the MENA countries. Our analysis of the available literature highlights an urgent need for further studies based on reliable diagnostic tools and standard susceptibility testing methods for dermatophytosis, which represents a major challenge for these countries. This is crucial for guiding appropriate interventions and activating antifungal stewardship programs in the future.
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Affiliation(s)
- Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.,Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Dalal Kasir
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Issmat I Kassem
- Center for Food Safety and Department of Food Science and Technology, University of Georgia, Griffin, GA, USA
| | - Mohamad Bachar Ismail
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.,Faculty of Science, Lebanese University, Tripoli, Lebanon
| | - Khaled El Omari
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.,Quality Control Center Laboratories, Chamber of Commerce, Industry, and Agriculture of Tripoli and North Lebanon, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Casey Cazer
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Nicolas Papon
- Univ Angers, Univ Brest, GEIHP, SFR ICAT, Angers, France
| | | | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
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Adi-Dako O, Kumadoh D, Egbi G, Okyem S, Addo PY, Nyarko A, Osei-Asare C, Oppong EE, Adase E. Strategies for formulation of effervescent granules of an herbal product for the management of typhoid fever. Heliyon 2021; 7:e08147. [PMID: 34746457 PMCID: PMC8551464 DOI: 10.1016/j.heliyon.2021.e08147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/23/2021] [Accepted: 10/06/2021] [Indexed: 11/26/2022] Open
Abstract
Herbal medicines are currently being adopted as alternatives to orthodox medicines for the management of drug-resistant and emerging multidrug-resistant microbial strains of various diseases, including typhoid fever. A herbal decoction, MA 001, manufactured by the Centre for Plant Medicine Research (CPMR), has been used for the treatment of typhoid fever for at least two decades in Ghana with desirable outcomes. MA 001 is formulated from Citrus aurantifolia, Spondias mombin, Latana camara, Bidens pilosa, Trema occidentalis, Psidium guajava, Morinda lucida, Vernonia amygdalina, Persea americana, Paulina pinnatta, Momordia charantia and Cnestis ferruguinea medicinal plants. The low palatability and compliance to treatment due to the bulky nature of the decoction poses challenges in its optimum use. This study sought to design and formulate the therapeutic components of the aqueous herbal decoction of MA 001 into an optimal solid dosage form of effervescent granules to improve the delivery of MA 001 as well as increase patient compliance and convenience of product handling. The methods involved pre-formulation studies on the suitability of effervescent vehicles, formulation and evaluation of effervescent granules for drug excipient interactions using high performance liquid chromatography analysis. The findings indicate that the effervescent granules were suitable for use in the delivery of the therapeutic constituents for the treatment of typhoid fever as done with the decoction due to minimal herbal extract-excipient interaction.
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Affiliation(s)
- Ofosua Adi-Dako
- Department of Pharmaceutics and Microbiology, School of Pharmacy, University of Ghana, Ghana
| | - Doris Kumadoh
- Centre for Plant Medicine Research, Mampong, Akuapem, Ghana
| | - Godfred Egbi
- Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana
| | - Samuel Okyem
- Central Laboratory, Kwame Nkrumah University of Science and Technology, Ghana.,University of Illinois-Urbana Champaign, USA
| | - Papa Yaw Addo
- Department of Pharmaceutics and Microbiology, School of Pharmacy, University of Ghana, Ghana
| | - Alexander Nyarko
- Department of Pharmacology and Toxicology, School of Pharmacy, University of Ghana, Ghana
| | | | - Esther Eshun Oppong
- School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel Adase
- Centre for Plant Medicine Research, Mampong, Akuapem, Ghana
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Raj N, Vanathi M, Ahmed NH, Gupta N, Lomi N, Tandon R. Recent Perspectives in the Management of Fungal Keratitis. J Fungi (Basel) 2021; 7:jof7110907. [PMID: 34829196 PMCID: PMC8621027 DOI: 10.3390/jof7110907] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 12/28/2022] Open
Abstract
Mycotic keratitis is common in warm, humid regions with a varying profile of pathogenic fungi according to geographical origin, socioeconomic status, and climatic condition. Clinical diagnosis can be challenging in difficult cases and those refractory to treatment. Fungal hyphae on microscopic examination and culture isolation have been the gold standard in the laboratory diagnosis of fungal keratitis. A culture isolate of the aetiological fungus is essential to perform antifungal susceptibility testing. As the culture isolation of fungi is time-consuming, causing delays in the initiation of treatment, newer investigative modalities such as in vivo confocal microscopy and molecular diagnostic methods have recently gained popularity. Molecular diagnostic techniques now help to obtain a rapid diagnosis of fungal keratitis. Genomic approaches are based on detecting amplicons of ribosomal RNA genes, with internal transcribed spacers being increasingly adopted. Metagenomic deep sequencing allows for rapid and accurate diagnosis without the need to wait for the fungus to grow. This is also helpful in identifying new emerging strains of fungi causing mycotic keratitis. A custom-tear proteomic approach will probably play an important diagnostic role in future in the management of mycotic keratitis. Positive repeat cultures are being suggested as an important gauge indicative of a poor prognosis. Positive repeat fungal cultures help to modify a treatment regimen by increasing its frequency, providing the addition of another topical and oral antifungal agent along with close follow-up for perforation and identifying need for early therapeutic keratoplasty. The role of collagen crosslinking in the treatment of fungal keratitis is not convincingly established. Rapid detection by multiplex PCR and antifungal susceptibility testing of the pathogenic fungi, adopted into a routine management protocol of fungal keratitis, will help to improve treatment outcome. Early therapy is essential in minimizing damage to the corneal tissue, thereby providing a better outcome. The role of conventional therapy with polyenes, systemic and targeted therapy of antifungal agents, newer azoles and echinocandins in fungal keratitis has been widely studied in recent times. Combination therapy can be more efficacious in comparison to monotherapy. Given the diversity of fungal aetiology, the emergence of new corneal pathogenic fungi with varying drug susceptibilities, increasing the drug resistance to antifungal agents in some genera and species, it is perhaps time to adopt recent molecular methods for precise identification and incorporate antifungal susceptibility testing as a routine.
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Affiliation(s)
- Nimmy Raj
- Cornea, Lens & Refractive Surgery Services—Dr R P Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi 110029, India; (N.R.); (N.G.); (N.L.); (R.T.)
| | - Murugesan Vanathi
- Cornea, Lens & Refractive Surgery Services—Dr R P Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi 110029, India; (N.R.); (N.G.); (N.L.); (R.T.)
- Correspondence: ; Tel.: +91-11-26593010; Fax: +91-11-26588919
| | - Nishat Hussain Ahmed
- Ocular Microbiology Services—Dr R P Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi 110029, India;
| | - Noopur Gupta
- Cornea, Lens & Refractive Surgery Services—Dr R P Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi 110029, India; (N.R.); (N.G.); (N.L.); (R.T.)
| | - Neiwete Lomi
- Cornea, Lens & Refractive Surgery Services—Dr R P Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi 110029, India; (N.R.); (N.G.); (N.L.); (R.T.)
| | - Radhika Tandon
- Cornea, Lens & Refractive Surgery Services—Dr R P Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi 110029, India; (N.R.); (N.G.); (N.L.); (R.T.)
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Wang X, Wang Y, Li X, Yu Z, Song C, Du Y. Nitrile-containing pharmaceuticals: target, mechanism of action, and their SAR studies. RSC Med Chem 2021; 12:1650-1671. [PMID: 34778767 PMCID: PMC8528211 DOI: 10.1039/d1md00131k] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/27/2021] [Indexed: 12/12/2022] Open
Abstract
The nitrile group is an important functional group widely found in both pharmaceutical agents and natural products. More than 30 nitrile-containing pharmaceuticals have been approved by the FDA for the management of a broad range of clinical conditions in the last few decades. Incorporation of a nitrile group into lead compounds has gradually become a promising strategy in rational drug design as it can bring additional benefits including enhanced binding affinity to the target, improved pharmacokinetic profile of parent drugs, and reduced drug resistance. This paper reviews the existing drugs with a nitrile moiety that have been approved or in clinical trials, involving their targets, molecular mechanism of pharmacology and SAR studies, and classifies them into different categories based on their clinical usages.
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Affiliation(s)
- Xi Wang
- School of Pharmaceutical Science and Technology, Tianjin University Tianjin 300072 China
| | - Yuanxun Wang
- National Institution of Biological Sciences, Beijing No. 7 Science Park Road, Zhongguancun Life Science Park Beijing 102206 China
| | - Xuemin Li
- School of Pharmaceutical Science and Technology, Tianjin University Tianjin 300072 China
| | - Zhenyang Yu
- School of Pharmaceutical Science and Technology, Tianjin University Tianjin 300072 China
| | - Chun Song
- State Key Laboratory of Microbial Technology, Shandong University Qingdao City Shandong Province 266237 China
| | - Yunfei Du
- School of Pharmaceutical Science and Technology, Tianjin University Tianjin 300072 China
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Nair AB, Al-Dhubiab BE, Shah J, Gorain B, Jacob S, Attimarad M, Sreeharsha N, Venugopala KN, Morsy MA. Constant Voltage Iontophoresis Technique to Deliver Terbinafine via Transungual Delivery System: Formulation Optimization Using Box-Behnken Design and In Vitro Evaluation. Pharmaceutics 2021; 13:pharmaceutics13101692. [PMID: 34683985 PMCID: PMC8538220 DOI: 10.3390/pharmaceutics13101692] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
Topical therapy of antifungals is primarily restricted due to the low innate transport of drugs through the thick multi-layered keratinized nail plate. The objective of this investigation was to develop a gel formulation, and to optimize and evaluate the transungual delivery of terbinafine using the constant voltage iontophoresis technique. Statistical analysis was performed using Box–Behnken design to optimize the transungual delivery of terbinafine by examining crucial variables namely concentration of polyethylene glycol, voltage, and duration of application (2–6 h). Optimization data in batches (F1–F17) demonstrated that chemical enhancer, applied voltage, and application time have influenced terbinafine nail delivery. Higher ex vivo permeation and drug accumulation into the nail tissue were noticed in the optimized batch (F8) when compared with other batches (F1–F17). A greater amount of terbinafine was released across the nails when the drug was accumulated by iontophoresis than the passive counterpart. A remarkably higher zone of inhibition was observed in nails with greater drug accumulation due to iontophoresis, as compared to the passive process. The results here demonstrate that the optimized formulation with low voltage iontophoresis could be a viable and alternative tool in the transungual delivery of terbinafine, which in turn could improve the success rate of topical nail therapy in onychomycosis.
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Affiliation(s)
- Anroop B. Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
- Correspondence: ; Tel.: +966-536-219-868
| | - Bandar E. Al-Dhubiab
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
| | - Jigar Shah
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad 382481, India;
| | - Bapi Gorain
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia;
- Centre for Drug Delivery and Molecular Pharmacology, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia
| | - Shery Jacob
- Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, Ajman 4184, United Arab Emirates;
| | - Mahesh Attimarad
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
| | - Nagaraja Sreeharsha
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
- Department of Pharmaceutics, Vidya Siri College of Pharmacy, Off Sarjapura Road, Bangalore 560035, India
| | - Katharigatta N. Venugopala
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
- Department of Biotechnology and Food Technology, Durban University of Technology, Durban 4000, South Africa
| | - Mohamed A. Morsy
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
- Department of Pharmacology, Faculty of Medicine, Minia University, El-Minia 61511, Egypt
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35
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Gnat S, Łagowski D, Dyląg M, Zielinski J, Nowakiewicz A. In vitro evaluation of photodynamic activity of methylene blue against Trichophyton verrucosum azole-susceptible and -resistant strains. JOURNAL OF BIOPHOTONICS 2021; 14:e202100150. [PMID: 34185387 DOI: 10.1002/jbio.202100150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
The intense search for the "Holy Grail" of antifungal therapy can be observed today. The searches are not limited only to discovery of potential antifungal drugs, but also new therapeutic strategies involving the use of chemosensitizers to achieve synergistic effect or physicochemical factors inducing stress conditions in fungal cells. In this study was examined in vitro effectiveness of photodynamic antifungal strategy with methylene blue using a light beam with a wavelength equal to 635 nm toward the Trichophyton verrucosum susceptible and itraconazole- and/or fluconazole-resistant strains. Methylene blue used at concentration equal to 5 μg/mL and in the presence of 40 J/cm2 of light energy showed fungicidal effect toward the susceptible strains. However, for azole-resistant isolates, only the energy dose equal to 60 J/cm2 at 5 μg/mL of methylene blue allowed to kill the pathogen. This study confirms that methylene blue induced by red light has a definite inhibitory effect on zoophilic dermatophytes.
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Affiliation(s)
- Sebastian Gnat
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, University of Life Sciences, Lublin, Poland
| | - Dominik Łagowski
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, University of Life Sciences, Lublin, Poland
| | - Mariusz Dyląg
- Faculty of Biological Sciences, Department of Mycology and Genetics, University of Wroclaw, Wroclaw, Poland
| | - Jessica Zielinski
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aneta Nowakiewicz
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, University of Life Sciences, Lublin, Poland
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Wang Y, Van Driel ML, McGuire TM, Hollingworth SA. Trends in systemic antifungal use in Australia, 2005-2016: a time-series analysis. Jpn J Infect Dis 2021; 75:254-261. [PMID: 34588371 DOI: 10.7883/yoken.jjid.2021.505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Data on antifungal utilization trends are important to encourage antifungal stewardship. This study explored the utilization of antifungal agents for systemic use and the impact of reimbursement policy changes in Australia. We analyzed national data from the Australian Pharmaceutical Benefits Scheme (PBS) (2005-2016). We examined patterns of use over time and the impact of reimbursement decisions on antifungal use with an interrupted time-series model. In 2005-2016, there has been an increase in the use of most antifungals, especially fluconazole, itraconazole and posaconazole. Ketoconazole was the most commonly dispensed systemic antifungal (46.0%) before its PBS listing removal, when it was replaced by fluconazole (69.8%). The PBS event "Fluconazole and itraconazole restrictions eased" led to increased use of fluconazole (0.025/1000 per day with no delay). Both the largest rates and numerical increase were among obstetricians and gynecologists (1,969%; 1,851 dispensed prescriptions) and dermatologists (1,723%; 1,689 dispensed prescriptions) except general practitioner (2010-2016). This is the first Australian national longitudinal estimate of systemic antifungal use. It shows an overall increase in prescribing of most antifungals during study period, with reimbursement decisions impacting utilization. These data provide a baseline to inform development of national antifungal guidelines and policies to encourage more targeted antifungal stewardship.
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Affiliation(s)
- Yan Wang
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, China.,School of Pharmacy, University of Queensland, Australia
| | - Mieke L Van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Australia
| | - Treasure M McGuire
- School of Pharmacy, University of Queensland, Australia.,Faculty of Health Sciences & Medicine, Bond University, Australia.,Mater Pharmacy, Mater Health, Australia
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Brescini L, Fioriti S, Morroni G, Barchiesi F. Antifungal Combinations in Dermatophytes. J Fungi (Basel) 2021; 7:jof7090727. [PMID: 34575765 PMCID: PMC8469868 DOI: 10.3390/jof7090727] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
Dermatophytes are the most common cause of fungal infections worldwide, affecting millions of people annually. The emergence of resistance among dermatophytes along with the availability of antifungal susceptibility procedures suitable for testing antifungal agents against this group of fungi make the combinatorial approach particularly interesting to be investigated. Therefore, we reviewed the scientific literature concerning the antifungal combinations against dermatophytes. A literature search on the subject performed in PubMed yielded 68 publications: 37 articles referring to in vitro studies and 31 articles referring to case reports or clinical studies. In vitro studies involved over 400 clinical isolates of dermatophytes (69% Trichophyton spp., 29% Microsporum spp., and 2% Epidermophyton floccosum). Combinations included two antifungal agents or an antifungal agent plus another chemical compound including plant extracts or essential oils, calcineurin inhibitors, peptides, disinfectant agents, and others. In general, drug combinations yielded variable results spanning from synergism to indifference. Antagonism was rarely seen. In over 700 patients with documented dermatophyte infections, an antifungal combination approach could be evaluated. The most frequent combination included a systemic antifungal agent administered orally (i.e., terbinafine, griseofulvin, or azole-mainly itraconazole) plus a topical medication (i.e., azole, terbinafine, ciclopirox, amorolfine) for several weeks. Clinical results indicate that association of antifungal agents is effective, and it might be useful to accelerate the clinical and microbiological healing of a superficial infection. Antifungal combinations in dermatophytes have gained considerable scientific interest over the years and, in consideration of the interesting results available so far, it is desirable to continue the research in this field.
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Affiliation(s)
- Lucia Brescini
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, 60020 Ancona, Italy; (L.B.); (S.F.); (G.M.)
| | - Simona Fioriti
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, 60020 Ancona, Italy; (L.B.); (S.F.); (G.M.)
| | - Gianluca Morroni
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, 60020 Ancona, Italy; (L.B.); (S.F.); (G.M.)
| | - Francesco Barchiesi
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, 60020 Ancona, Italy; (L.B.); (S.F.); (G.M.)
- Malattie Infettive, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
- Correspondence: ; Tel.: +39-721-36-5505
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38
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Segal E, Elad D. Human and Zoonotic Dermatophytoses: Epidemiological Aspects. Front Microbiol 2021; 12:713532. [PMID: 34421872 PMCID: PMC8378940 DOI: 10.3389/fmicb.2021.713532] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/09/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Dermatophytes are a group of molds characterized by the ability to produce keratinases, thereby carving out for themselves specific ecological niches. Their traditional division into three genera, Trichophyton, Microsporum, and Epidermophyton has been expanded to nine and the species in each genus were modified. Dermatophytes are among the most prevalent causes of human and animal mycoses. Their epidemiology is influenced by various factors. These factors may be evolutive such as the predilected environment of the fungus, namely, humans (anthropophilic), animals (zoophilic), or environment (geophilic), is evolutionary and thus may require centuries to develop. Many other factors, however, result from a variety of causes, affecting the epidemiology of dermatophytoses within a shorter time frame. Objective This review aims at summarizing the factors that have modified the epidemiology of dermatophytoses during the last decades. Results Geographic and climatic conditions, demography such as age and gender, migration, socio-economic conditions, lifestyle, and the environment have had an impact on changes in the epidemiology of dermatophytoses, as have changes in the pattern of human interaction with animals, including pets, farm, and wild animals. A typical example of such changes is the increased prevalence of Trichophyton tonsurans, which spread from Latin America to the United States and subsequently becoming a frequent etiological agent of tinea capitis in Africa, Middle East, and other areas. Conclusion The comprehension of the epidemiology of dermatophytoses has a major bearing on their prevention and treatment. Since it is undergoing continuous changes, periodic assessments of the most recent developments of this topic are required. This article aims at providing such an overview.
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Affiliation(s)
- Esther Segal
- Sackler School of Medicine, Department of Clinical Microbiology and Immunology, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Elad
- Department of Clinical Bacteriology and Mycology, Kimron Veterinary Institute, Bet Dagan, Israel
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Khalid A, Ahmed N, Qindeel M, Asad MI, Khan GM, Ur Rehman A. Development of novel biopolymer-based nanoparticles loaded cream for potential treatment of topical fungal infections. Drug Dev Ind Pharm 2021; 47:1090-1099. [PMID: 34279160 DOI: 10.1080/03639045.2021.1957914] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Biodegradable polymers are extensively used due to their efficient safety profiles. The aim of the current study was to fabricate, evaluate, and characterize biodegradable, biocompatible fluconazole (FLZ) loaded chitosan (CHS) chondroitin sulfate (CS) nanoparticles (NPs) for topical delivery. Polymers utilized in the formulation not only served as a carrier system but also aided in fighting with complex etiology of the disease due to their innate antifungal activities. METHODS NPs were prepared by the complex coacervation method, then were optimized for various parameters and subsequently loaded into a cream. RESULTS Scanning electron microscopic (SEM) analysis showed spherical morphology of the NPs. Prepared NPs showed an average particle size in the range of 350-450 nm and an encapsulation efficiency (EE) of 86%. The polydispersity index (PDI) was found to be 0.148 that showed a uniform distribution of NPs. Fourier transform infrared (FTIR) spectroscopy confirmed the absence of any electrostatic interaction between ingredients. In vitro drug release analyses exhibited a sustained release of the drug and higher antifungal activity than free FLZ. Ex vivo permeability and drug distribution in different skin layers ensured a site-specific delivery of the FLZ-NPs. As compared with free FLZ and other control groups, the prepared NPs also exhibited significantly higher antifungal activity against Candida albicans (p < .01). CONCLUSION It was concluded from the results that the FLZ-NPs laden cream could be a potential candidate for topical and site-specific delivery of the drug cargo for the potential treatment of fungal infections.
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Affiliation(s)
- Aimen Khalid
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Naveed Ahmed
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Maimoona Qindeel
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | | | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Asim Ur Rehman
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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40
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State-of-the-Art Dermatophyte Infections: Epidemiology Aspects, Pathophysiology, and Resistance Mechanisms. J Fungi (Basel) 2021; 7:jof7080629. [PMID: 34436168 PMCID: PMC8401872 DOI: 10.3390/jof7080629] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/23/2022] Open
Abstract
The burden of fungal infections is not widely appreciated. Although these infections are responsible for over one million deaths annually, it is estimated that one billion people are affected by severe fungal diseases. Mycoses of nails and skin, primarily caused by fungi known as dermatophytes, are the most common fungal infections. Trichophyton rubrum appears to be the most common causative agent of dermatophytosis, followed by Trichophyton interdigitale. An estimated 25% of the world’s population suffers from dermatomycosis. Although these infections are not lethal, they compromise the quality of life of infected patients. The outcome of antidermatophytic treatments is impaired by various conditions, such as resistance and tolerance of certain dermatophyte strains. The adage “know your enemy” must be the focus of fungal research. There is an urgent need to increase awareness about the significance of these infections with precise epidemiological data and to improve knowledge regarding fungal biology and pathogenesis, with an emphasis on adaptive mechanisms to tackle adverse conditions from host counteractions. This review outlines the current knowledge about dermatophyte infections, with a focus on signaling pathways required for fungal infection establishment and a broad perspective on cellular and molecular factors involved in antifungal resistance and tolerance.
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41
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Costa-Orlandi CB, Martinez LR, Bila NM, Friedman JM, Friedman AJ, Mendes-Giannini MJS, Nosanchuk JD. Nitric Oxide-Releasing Nanoparticles Are Similar to Efinaconazole in Their Capacity to Eradicate Trichophyton rubrum Biofilms. Front Cell Infect Microbiol 2021; 11:684150. [PMID: 34336712 PMCID: PMC8319823 DOI: 10.3389/fcimb.2021.684150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
Filamentous fungi such as Trichophyton rubrum and T. mentagrophytes, the main causative agents of onychomycosis, have been recognized as biofilm-forming microorganisms. Nitric oxide-releasing nanoparticles (NO-np) are currently in development for the management of superficial and deep bacterial and fungal infections, with documented activity against biofilms. In this context, this work aimed to evaluate, for the first time, the in vitro anti-T. rubrum biofilm potential of NO-np using standard ATCC MYA-4438 and clinical BR1A strains and compare it to commonly used antifungal drugs including fluconazole, terbinafine and efinaconazole. The biofilms formed by the standard strain produced more biomass than those from the clinical strain. NO-np, fluconazole, terbinafine, and efinaconazole inhibited the in vitro growth of planktonic T. rubrum cells. Similarly, NO-np reduced the metabolic activities of clinical strain BR1A preformed biofilms at the highest concentration tested (SMIC50 = 40 mg/mL). Scanning electron and confocal microscopy revealed that NO-np and efinaconazole severely damaged established biofilms for both strains, resulting in collapse of hyphal cell walls and reduced the density, extracellular matrix and thickness of the biofilms. These findings suggest that biofilms should be considered when developing and testing new drugs for the treatment of dermatophytosis. Development of a biofilm phenotype by these fungi may explain the resistance of dermatophytes to some antifungals and why prolonged treatment is usually required for onychomycosis.
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Affiliation(s)
- Caroline Barcelos Costa-Orlandi
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, United States.,Deparment of Clinical Analysis, School of Pharmaceutical Sciences, Sao Paulo State University (UNESP), Araraquara, Brazil
| | - Luis R Martinez
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Níura Madalena Bila
- Deparment of Clinical Analysis, School of Pharmaceutical Sciences, Sao Paulo State University (UNESP), Araraquara, Brazil.,Department of Para-Clinic, School of Veterinary, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Joel M Friedman
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Adam J Friedman
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC, United States.,Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Maria José S Mendes-Giannini
- Deparment of Clinical Analysis, School of Pharmaceutical Sciences, Sao Paulo State University (UNESP), Araraquara, Brazil
| | - Joshua D Nosanchuk
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, United States
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42
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MFS1, a Pleiotropic Transporter in Dermatophytes That Plays a Key Role in Their Intrinsic Resistance to Chloramphenicol and Fluconazole. J Fungi (Basel) 2021; 7:jof7070542. [PMID: 34356921 PMCID: PMC8303221 DOI: 10.3390/jof7070542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022] Open
Abstract
A recently identified Trichophyton rubrum major facilitator superfamily (MFS)-type transporter (TruMFS1) has been shown to give resistance to azole compounds and cycloheximide (CYH) when overexpressed in Saccharomyces cerevisiae. We investigated the roles of MFS1 in the intrinsic resistance of dermatophytes to CYH and chloramphenicol (CHL), which are commonly used to isolate these fungi, and to what extent MFS1 affects the susceptibility to azole antifungals. Susceptibility to antibiotics and azoles was tested in S. cerevisiae overexpressing MFS1 and ΔMFS1 mutants of Trichophyton benhamiae, a dermatophyte that is closely related to T. rubrum. We found that TruMFS1 functions as an efflux pump for CHL in addition to CYH and azoles in S. cerevisiae. In contrast, the growth of T. benhamiae ΔMFS1 mutants was not reduced in the presence of CYH but was severely impaired in the presence of CHL and thiamphenicol, a CHL analog. The suppression of MFS1 in T. benhamiae also increased the sensitivity of the fungus to fluconazole and miconazole. Our experiments revealed a key role of MFS1 in the resistance of dermatophytes to CHL and their high minimum inhibitory concentration for fluconazole. Suppression of MFS1 did not affect the sensitivity to CYH, suggesting that another mechanism was involved in resistance to CYH in dermatophytes.
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Kaur N, Bains A, Kaushik R, Dhull SB, Melinda F, Chawla P. A Review on Antifungal Efficiency of Plant Extracts Entrenched Polysaccharide-Based Nanohydrogels. Nutrients 2021; 13:2055. [PMID: 34203999 PMCID: PMC8232670 DOI: 10.3390/nu13062055] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 02/08/2023] Open
Abstract
Human skin acts as a physical barrier; however, sometimes the skin gets infected by fungi, which becomes more severe if the infection occurs on the third layer of the skin. Azole derivative-based antifungal creams, liquids, or sprays are available to treat fungal infections; however, these formulations show various side effects on the application site. Over the past few years, herbal extracts and various essential oils have shown effective antifungal activity. Additionally, autoxidation and epimerization are significant problems with the direct use of herbal extracts. Hence, to overcome these obstacles, polysaccharide-based nanohydrogels embedded with natural plant extracts and oils have become the primary choice of pharmaceutical scientists. These gels protect plant-based bioactive compounds and are effective delivery agents because they release multiple bioactive compounds in the targeted area. Nanohydrogels can be applied to infected areas, and due to their contagious nature and penetration power, they get directly absorbed through the skin, quickly reaching the skin's third layer and effectively reducing the fungal infection. In this review, we explain various skin fungal infections, possible treatments, and the effective utilization of plant extract and oil-embedded polysaccharide-based nanohydrogels.
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Affiliation(s)
- Navkiranjeet Kaur
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara 144411, Punjab, India;
| | - Aarti Bains
- Department of Biotechnology, Chandigarh Group of Colleges Landran, Mohali 140307, Punjab, India;
| | - Ravinder Kaushik
- School of Health Sciences, University of Petroleum and Energy Studies, Dehradun 248007, Uttrakhand, India;
| | - Sanju B. Dhull
- Department of Food Science and Technology, Chaudhary Devi Lal University, Sirsa 125055, Haryana, India;
| | - Fogarasi Melinda
- Department of Food Engineering, University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Mănăstur 3–5, 400372 Cluj-Napoca, Romania
| | - Prince Chawla
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara 144411, Punjab, India;
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Bila NM, Costa-Orlandi CB, Vaso CO, Bonatti JLC, de Assis LR, Regasini LO, Fontana CR, Fusco-Almeida AM, Mendes-Giannini MJS. 2-Hydroxychalcone as a Potent Compound and Photosensitizer Against Dermatophyte Biofilms. Front Cell Infect Microbiol 2021; 11:679470. [PMID: 34055673 PMCID: PMC8155603 DOI: 10.3389/fcimb.2021.679470] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022] Open
Abstract
Dermatophytes, fungi that cause dermatophytosis, can invade keratinized tissues in humans and animals. The biofilm-forming ability of these fungi was described recently, and it may be correlated with the long treatment period and common recurrences of this mycosis. In this study, we evaluated the anti-dermatophytic and anti-biofilm activity of 2-hydroxychalcone (2-chalcone) in the dark and photodynamic therapy (PDT)-mediated and to determine its mechanism of action. Trichophyton rubrum and Trichophyton mentagrophytes strains were used in the study. The antifungal susceptibility test of planktonic cells, early-stage biofilms, and mature biofilms were performed using colorimetric methods. Topographies were visualized by scanning electron microscopy (SEM). Human skin keratinocyte (HaCat) monolayers were also used in the cytotoxicity assays. The mechanisms of action of 2-chalcone in the dark and under photoexcitation were investigated using confocal microscopy and the quantification of ergosterol, reactive oxygen species (ROS), and death induction by apoptosis/necrosis. All strains, in the planktonic form, were inhibited after treatment with 2-chalcone (minimum inhibitory concentration (MIC) = 7.8-15.6 mg/L), terbinafine (TRB) (MIC = 0.008–0.03 mg/L), and fluconazole (FLZ) (1–512 mg/L). Early-stage biofilm and mature biofilms were inhibited by 2-chalcone at concentrations of 15.6 mg/L and 31.2 mg/L in all tested strains. However, mature biofilms were resistant to all the antifungal drugs tested. When planktonic cells and biofilms (early-stage and mature) were treated with 2-chalcone-mediated PDT, the inhibitory concentrations were reduced by four times (2–7.8 mg/L). SEM images of biofilms treated with 2-chalcone showed cell wall collapse, resulting from a probable extravasation of cytoplasmic content. The toxicity of 2-chalcone in HaCat cells showed higher IC50 values in the dark than under photoexcitation. Further, 2-chalcone targets ergosterol in the cell and promotes the generation of ROS, resulting in cell death by apoptosis and necrosis. Overall, 2-chalcone-mediated PDT is a promising and safe drug candidate against dermatophytes, particularly in anti-biofilm treatment.
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Affiliation(s)
- Níura Madalena Bila
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil.,Department of Para-Clinic, School of Veterinary, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Caroline Barcelos Costa-Orlandi
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil
| | - Carolina Orlando Vaso
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil
| | - Jean Lucas Carvalho Bonatti
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil
| | - Letícia Ribeiro de Assis
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, Universidade Estadual Paulista (UNESP), Sao Jose do Rio Preto, Brazil
| | - Luís Octavio Regasini
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, Universidade Estadual Paulista (UNESP), Sao Jose do Rio Preto, Brazil
| | - Carla Raquel Fontana
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil
| | - Ana Marisa Fusco-Almeida
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil
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Gnat S, Łagowski D, Nowakiewicz A, Dyląg M. A global view on fungal infections in humans and animals: infections caused by dimorphic fungi and dermatophytoses. J Appl Microbiol 2021; 131:2688-2704. [PMID: 33754409 DOI: 10.1111/jam.15084] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/18/2021] [Indexed: 12/28/2022]
Abstract
Fungal infections are still underappreciated and their prevalence is underestimated, which renders them a serious public health problem. Realistic discussions about their distribution, symptoms, and control can improve management and diagnosis and contribute to refinement of preventive actions using currently available tools. This article represents an overview of dermatophytes and endemic fungi that cause infections in humans and animals. In addition, the impact of climate change on the fungal spread is discussed. The endemic fungal infections characterized in this article include coccidioidomycosis, histoplasmosis, blastomycosis, lobomycosis, emergomycosis and sporotrichosis. Moreover the geographic distribution of these fungi, which are known to be climate sensitive and/or limited to endemic tropical and subtropical areas, is highlighted. In turn, dermatophytes cause superficial fungal infections of skin, hairs and nails, which are the most prevalent mycoses worldwide with a high economic burden. Therefore, the possibility of causing zoonoses and reverse zoonoses by dermatophytes is highly important. In conclusion, the article illustrates the current issues of the epidemiology and distribution of fungal diseases, emphasizing the lack of public programmes for prevention and control of these types of infection.
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Affiliation(s)
- S Gnat
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - D Łagowski
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - A Nowakiewicz
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - M Dyląg
- Faculty of Biological Sciences, Department of Mycology and Genetics, Institute of Genetics and Microbiology, University of Wroclaw, Wroclaw, Poland
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The Growing Problem of Antifungal Resistance in Onychomycosis and Other Superficial Mycoses. Am J Clin Dermatol 2021; 22:149-157. [PMID: 33354740 DOI: 10.1007/s40257-020-00580-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 01/06/2023]
Abstract
Superficial mycoses are becoming increasingly resistant to current antifungal medications. As alternative therapeutic options are limited, the increasing frequency of reports of antifungal resistance is alarming. This epidemic parallels the rise of antibiotic resistance; however, the significance of this problem has yet to gain global attention. Here, we discuss the reports of antifungal resistance from around the world, present our own experience with treatment-resistant infections, and examine alternative treatment strategies. The majority of reports of recalcitrant infections indicate terbinafine resistance as the causative factor. Single-point mutations in the squalene oxidase gene is the most reported mechanism of resistance to terbinafine. Mixed infections of dermatophytes with non-dermatophyte molds and/or yeasts are becoming more prevalent and contributing to the resistant nature of these infections. The key to selecting an effective antifungal therapy for a recalcitrant infection is identification of the infectious organisms(s) and testing susceptibility of the organism(s) to antifungal drugs. Combination and sequential therapy regimens are options, but both require active monitoring for hepatic and renal function, drug interactions, and other adverse effects. Selected topical antifungals with a wide spectrum of activity may also be considerations in some clinical presentations. Innovative treatment regimens and novel therapeutics are needed to overcome the rising epidemic of antifungal resistance.
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Arias AF, Diaz A, Erdem G. Tinea faciei caused by Trichophyton benhamiae in a child. Pediatr Dermatol 2021; 38:520-521. [PMID: 33336837 DOI: 10.1111/pde.14486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/18/2020] [Accepted: 11/27/2020] [Indexed: 01/13/2023]
Abstract
Tinea faciei is a common pediatric skin disease, most often caused by fungi of the genus Trichophyton. T benhamiae has been recently reclassified as a distinct species and is recognized as an emerging zoonotic dermatophyte with a wide range of possible infectious reservoirs worldwide. We present a previously healthy 7-year-old child presenting with unusual inflammatory facial plaques due to T benhamiae, confirmed by mass spectroscopy.
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Affiliation(s)
- Andres Felipe Arias
- Division of Pediatric Infectious Diseases, Hospital Universitario Erasmo Meoz, Cúcuta, Colombia
| | - Alejandro Diaz
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Guliz Erdem
- Division of Pediatric Infectious Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
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Gnat S, Łagowski D, Nowakiewicz A, Dyląg M, Osińska M. Complementary effect of mechanism of multidrug resistance in Trichophyton mentagrophytes isolated from human dermatophytoses of animal origin. Mycoses 2021; 64:537-549. [PMID: 33448025 DOI: 10.1111/myc.13242] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/30/2020] [Accepted: 01/10/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Dermatophytoses have gained interest worldwide due to the increased resistance to terbinafine and azoles and difficulty in management of these refractory diseases. OBJECTIVES In this study, we identified and analysed Trichophyton mentagrophytes clinical isolates obtained from humans with infections of animal origin. METHODS We used quantitative real-time PCR (qRT-PCR) to examine the transcriptional modulation of three MDR genes (PDR1, MDR2 and MDR4) and analysed squalene epoxidase (SQLE) gene sequences from multidrug-resistant Trichophyton mentagrophytes isolates. RESULTS The expression profile revealed a 2- to 12-fold increase in mRNA accumulation in the presence of any of the antifungals, compared to cells incubated without drugs. A statistically significant relationship between the isolates exposed to itraconazole and increased expression of the tested genes was revealed. Substantially lower transcription levels were noted for cells exposed to luliconazole, that is, a third-generation azole. Additionally, in the case of 50% of terbinafine-resistant strains, Leu397Phe substitution in the SQLE gene was detected. Furthermore, the reduced susceptibility to itraconazole and voriconazole was overcome by milbemycin oxime. CONCLUSIONS In conclusion, our study shed more light on the role of the ABC transporter family in T. mentagrophytes, which, if overexpressed, can confer resistance to single azole drugs and even cross-resistance. Finally, milbemycin oxime could be an interesting compound supporting treatment with azole drugs in the case of refractory dermatomycoses.
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Affiliation(s)
- Sebastian Gnat
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - Dominik Łagowski
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - Aneta Nowakiewicz
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - Mariusz Dyląg
- Faculty of Biological Sciences, Department of Mycology and Genetics, Institute of Genetics and Microbiology, University of Wroclaw, Wroclaw, Poland
| | - Marcelina Osińska
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
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Shen JJ, Arendrup MC, Jemec GBE, Saunte DML. Photodynamic therapy: A treatment option for terbinafine resistant Trichophyton species. Photodiagnosis Photodyn Ther 2021; 33:102169. [PMID: 33497815 DOI: 10.1016/j.pdpdt.2020.102169] [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: 10/30/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Terbinafine is a first-line agent against Trichophyton-infections. However, treatment failure and resistance due to squalene epoxidase (SQLE) alterations are increasingly being reported. Photodynamic therapy (PDT) is based on combining a photosensitizer, light and oxygen to create photo-activated reactive oxygen species. It has demonstrated in vitro and in vivo activity against various microorganisms including dermatophytes. We investigated if PDT is equally effective against terbinafine resistant and susceptible strains. METHODS Minimum inhibitory concentrations (MIC) of methylene blue (MB)-PDT against wildtype and resistant Trichophyton rubrum and Trichophyton interdigitale were determined in duplicate in microtitre plates following EUCAST E.Def 11.0 reference methodology. Included mutants harboured F397L, L393F, L393S, F415S or F397I SQLE-alterations. Illumination with red diode light was performed after <3 min, 30 min and 3 h of incubation, respectively, and plates were cultured at 25 °C for 5 days. Geometric mean MICs and MIC ranges were calculated for each isolate. RESULTS MB-PDT led to complete inhibition of all isolates at geometric mean concentrations of 1-16 mg/L. Efficacy was independent of incubation time prior to illumination, terbinafine susceptibility (MICs ≤0.004-4 mg/L) and presence of SQLE mutations. However, the MB-PDT MIC was slightly elevated (MB: 2-8 mg/L and 8-16 mg/L) in isolates from two pigmented cultures of Trichophyton interdigitale (one wildtype and one harbouring L393F) with a darker color when compared to unpigmented cultures (MB: 0.5-4 mg/L). CONCLUSION Terbinafine resistant and susceptible strains are equally susceptible to MB-PDT. Lower efficacy was observed against dark coloured isolates which we speculate may be due to melanisation interfering with photo-activation due to preferential light absorption.
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Affiliation(s)
- Julia J Shen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Maiken C Arendrup
- Department of Clinical Medicine, Falculty of Health Science, University of Copenhagen, Copenhagen, Denmark; Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark; Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Falculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Marie L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Falculty of Health Science, University of Copenhagen, Copenhagen, Denmark; Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.
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Mathew J, Anuthara R, Midhun S. An in vitro and in silico study of anti-dermatophytic activity of gossypol from fruits of Thespesia populnea (L.) Sol. ex Correa. Asian Pac J Trop Biomed 2021. [DOI: 10.4103/2221-1691.331270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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