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de Oliveira HC, Santos MDM, Camillo-Andrade AC, Castelli RF, Dos Reis FCG, Carvalho PC, Rodrigues ML. Proteomics reveals that the antifungal activity of fenbendazole against Cryptococcus neoformans requires protein kinases. Int J Antimicrob Agents 2024; 63:107157. [PMID: 38548248 DOI: 10.1016/j.ijantimicag.2024.107157] [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] [Revised: 02/09/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
Cryptococcus neoformans is responsible for over 100 000 deaths annually, and the treatment of this fungal disease is expensive and not consistently effective. Unveiling new therapeutic avenues is crucial. Previous studies have suggested that the anthelmintic drug fenbendazole is an affordable and nontoxic candidate to combat cryptococcosis. However, its mechanism of anticryptococcal activity has been only superficially investigated. In this study, we examined the global cellular response of C. neoformans to fenbendazole using a proteomic approach (data are available via ProteomeXchange with identifier PXD047041). Fenbendazole treatment mostly impacted the abundance of proteins related to metabolic pathways, RNA processing, and intracellular traffic. Protein kinases, in particular, were significantly affected by fenbendazole treatment. Experimental validation of the proteomics data using a collection of C. neoformans mutants led to the identification of critical roles of five protein kinases in fenbendazole's antifungal activity. In fact, mutants lacking the expression of genes encoding Chk1, Tco2, Tco3, Bub1, and Sch9 kinases demonstrated greater resistance to fenbendazole compared to wild-type cells. In combination with the standard antifungal drug amphotericin B, fenbendazole reduced the cryptococcal burden in mice. These findings not only contribute to the elucidation of fenbendazole's mode of action but also support its use in combination therapy with amphotericin B. In conclusion, our data suggest that fenbendazole holds promise for further development as an anticryptococcal agent.
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Affiliation(s)
| | - Marlon D M Santos
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil; Analytical Biochemistry and Proteomics Unit. IIBCE/Institut Pasteur de Montevideo, Uruguay
| | - Amanda C Camillo-Andrade
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil; Analytical Biochemistry and Proteomics Unit. IIBCE/Institut Pasteur de Montevideo, Uruguay
| | - Rafael F Castelli
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil
| | - Flavia C G Dos Reis
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil; Centro de Desenvolvimento Tecnológico em Saúde (CDTS), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paulo C Carvalho
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil
| | - Marcio L Rodrigues
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil; Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Nosratabadi M, Espahbodi A, Hedayati MT, Shokohi T, Badali H, Saeedi M, Moazeni M, Aghili SR, Javidnia J, Faeli L, Khojasteh S, Roohi B, Abbasi K, Abastabar M, Haghani I. In Vitro Combination of Terbinafine with Ketoconazole Against Aspergillus Species with Terbinafine High MIC Values Isolated From Otomycosis. Mycopathologia 2022; 188:119-127. [PMID: 36449121 DOI: 10.1007/s11046-022-00698-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
Otomycosis is a common mycotic infection of the external auditory canal, and Aspergillus species are one of the most frequent causative agents worldwide. The limited antifungal arsenal, the high toxicity and side effects of antifungal agents, and the growing resistance to the currently available antifungals underscore the need for new therapeutic strategies. The present study aimed to evaluate the combined in vitro efficacy of terbinafine and ketoconazole against Aspergillus species with terbinafine high MIC values isolated from patients with otomycosis.84 Aspergillus species with high MIC values to terbinafine (≥ 4 µg/ml), consisting of A. flavus, A. tubingensis, A. niger, and A. terreus, were included in this study. The checkerboard microdilution method evaluated the in vitro interactions using the CLSI reference technique. Synergistic effects were observed for 66.67% (56/84) of all isolates (FICI ranging from 0.19 to 0.5). However, the interactions of terbinafine and ketoconazole exhibited indifference in 33.33% (28/84) of the isolates, and no antagonism was observed for any combination. The interaction of terbinafine and ketoconazole showed synergistic activity against Aspergillus species with high MIC values, suggesting that this is an alternative and promising approach for treating otomycosis.
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Affiliation(s)
- Mohsen Nosratabadi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran
| | - Amirreza Espahbodi
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Taghi Hedayati
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Badali
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Moazeni
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Reza Aghili
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Javad Javidnia
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Faeli
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran
| | - Shaghayegh Khojasteh
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran
| | - Behrad Roohi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran
| | - Kiana Abbasi
- Department of Microbiology, Zanjan Branch, Islamic Azad University, Zanjan, Iran
| | - Mahdi Abastabar
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran.
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Iman Haghani
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran Province, Iran.
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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Antifungal Combination Therapy for Invasive Fungal Infections in a Paediatric Oncology and Haematology Department: A Retrospective Analysis of Practice. J Mycol Med 2022; 32:101276. [DOI: 10.1016/j.mycmed.2022.101276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 11/23/2022]
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Tóth L, Poór P, Ördög A, Váradi G, Farkas A, Papp C, Bende G, Tóth GK, Rákhely G, Marx F, Galgóczy L. The combination of Neosartorya ( Aspergillus) fischeri antifungal proteins with rationally designed γ-core peptide derivatives is effective for plant and crop protection. BIOCONTROL (DORDRECHT, NETHERLANDS) 2022; 67:249-262. [PMID: 35463117 PMCID: PMC8993730 DOI: 10.1007/s10526-022-10132-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/18/2022] [Indexed: 05/09/2023]
Abstract
UNLABELLED Plant pathogenic fungi are responsible for enormous crop losses worldwide. Overcoming this problem is challenging as these fungi can be highly resistant to approved chemical fungicides. There is thus a need to develop and introduce fundamentally new plant and crop protection strategies for sustainable agricultural production. Highly stable extracellular antifungal proteins (AFPs) and their rationally designed peptide derivatives (PDs) constitute feasible options to meet this challenge. In the present study, their potential for topical application to protect plants and crops as combinatorial biofungicides is supported by the investigation of two Neosartorya (Aspergillus) fischeri AFPs (NFAP and NFAP2) and their γ-core PDs. Previously, the biofungicidal potential of NFAP, its rationally designed γ-core PD (γNFAP-opt), and NFAP2 was reported. Susceptibility tests in the present study extended the in vitro antifungal spectrum of NFAP2 and its γ-core PD (γNFAP2-opt) to Botrytis, Cladosporium, and Fusarium spp. Besides, in vitro additive or indifferent interactions, and synergism were observed when NFAP or NFAP2 was applied in combination with γNFAP-opt. Except for γNFAP2-opt, the investigated proteins and peptides did not show any toxicity to tomato plant leaves. The application of NFAP in combination with γNFAP-opt effectively inhibited conidial germination, biofilm formation, and hyphal extension of the necrotrophic mold Botrytis cinerea on tomato plant leaves. However, the same combination only partially impeded the B. cinerea-mediated decay of tomato fruits, but mitigated the symptoms. Our results highlight the feasibility of using the combination of AFP and PD as biofungicide for the fungal infection control in plants and crops. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10526-022-10132-y.
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Affiliation(s)
- Liliána Tóth
- Institute of Plant Biology, Biological Research Centre, Eötvös Loránd Research Network, Temesvári krt. 62, 6726 Szeged, Hungary
- Department of Biotechnology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, 6726 Szeged, Hungary
| | - Péter Poór
- Department of Plant Biology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, 6726 Szeged, Hungary
| | - Attila Ördög
- Department of Plant Biology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, 6726 Szeged, Hungary
| | - Györgyi Váradi
- Department of Medical Chemistry, Faculty of Medicine, University of Szeged, Dóm tér 8, 6720 Szeged, Hungary
| | - Attila Farkas
- Institute of Plant Biology, Biological Research Centre, Eötvös Loránd Research Network, Temesvári krt. 62, 6726 Szeged, Hungary
| | - Csaba Papp
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, 6726 Szeged, Hungary
| | - Gábor Bende
- Department of Biotechnology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, 6726 Szeged, Hungary
| | - Gábor K. Tóth
- Department of Medical Chemistry, Faculty of Medicine, University of Szeged, Dóm tér 8, 6720 Szeged, Hungary
- MTA-SZTE Biomimetic Systems Research Group, University of Szeged, Dóm tér 8, 6720 Szeged, Hungary
| | - Gábor Rákhely
- Department of Biotechnology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, 6726 Szeged, Hungary
- Institute of Biophysics, Biological Research Centre, Eötvös Loránd Research Network, Temesvári krt. 62, 6726 Szeged, Hungary
| | - Florentine Marx
- Institute of Molecular Biology, Biocenter, Medical University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria
| | - László Galgóczy
- Institute of Plant Biology, Biological Research Centre, Eötvös Loránd Research Network, Temesvári krt. 62, 6726 Szeged, Hungary
- Department of Biotechnology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, 6726 Szeged, Hungary
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do Carmo Silva L, de Oliveira AA, de Souza DR, Barbosa KLB, Freitas e Silva KS, Carvalho Júnior MAB, Rocha OB, Lima RM, Santos TG, Soares CMDA, Pereira M. Overview of Antifungal Drugs against Paracoccidioidomycosis: How Do We Start, Where Are We, and Where Are We Going? J Fungi (Basel) 2020; 6:jof6040300. [PMID: 33228010 PMCID: PMC7712482 DOI: 10.3390/jof6040300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
Paracoccidioidomycosis is a neglected disease that causes economic and social impacts, mainly affecting people of certain social segments, such as rural workers. The limitations of antifungals, such as toxicity, drug interactions, restricted routes of administration, and the reduced bioavailability in target tissues, have become evident in clinical settings. These factors, added to the fact that Paracoccidioidomycosis (PCM) therapy is a long process, lasting from months to years, emphasize the need for the research and development of new molecules. Researchers have concentrated efforts on the identification of new compounds using numerous tools and targeting important proteins from Paracoccidioides, with the emphasis on enzymatic pathways absent in humans. This review aims to discuss the aspects related to the identification of compounds, methodologies, and perspectives when proposing new antifungal agents against PCM.
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Affiliation(s)
- Lívia do Carmo Silva
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
- Correspondence: (L.d.C.S.); (M.P.); Tel./Fax: +55-62-3521-1110 (M.P.)
| | - Amanda Alves de Oliveira
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Dienny Rodrigues de Souza
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Katheryne Lohany Barros Barbosa
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Kleber Santiago Freitas e Silva
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Marcos Antonio Batista Carvalho Júnior
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Olívia Basso Rocha
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Raisa Melo Lima
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Thaynara Gonzaga Santos
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Célia Maria de Almeida Soares
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Maristela Pereira
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Correspondence: (L.d.C.S.); (M.P.); Tel./Fax: +55-62-3521-1110 (M.P.)
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Malik MA, Lone SA, Gull P, Dar OA, Wani MY, Ahmad A, Hashmi AA. Efficacy of Novel Schiff base Derivatives as Antifungal Compounds in Combination with Approved Drugs Against Candida Albicans. Med Chem 2019; 15:648-658. [PMID: 30501599 DOI: 10.2174/1573406415666181203115957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The increasing incidence of fungal infections, especially caused by Candida albicans, and their increasing drug resistance has drastically increased in recent years. Therefore, not only new drugs but also alternative treatment strategies are promptly required. METHODS We previously reported on the synergistic interaction of some azole and non-azole compounds with fluconazole for combination antifungal therapy. In this study, we synthesized some non-azole Schiff-base derivatives and evaluated their antifungal activity profile alone and in combination with the most commonly used antifungal drugs- fluconazole (FLC) and amphotericin B (AmB) against four drug susceptible, three FLC resistant and three AmB resistant clinically isolated Candida albicans strains. To further analyze the mechanism of antifungal action of these compounds, we quantified total sterol contents in FLC-susceptible and resistant C. albicans isolates. RESULTS A pyrimidine ring-containing derivative SB5 showed the most potent antifungal activity against all the tested strains. After combining these compounds with FLC and AmB, 76% combinations were either synergistic or additive while as the rest of the combinations were indifferent. Interestingly, none of the combinations was antagonistic, either with FLC or AmB. Results interpreted from fractional inhibitory concentration index (FICI) and isobolograms revealed 4-10-fold reduction in MIC values for synergistic combinations. These compounds also inhibit ergosterol biosynthesis in a concentration-dependent manner, supported by the results from docking studies. CONCLUSION The results of the studies conducted advocate the potential of these compounds as new antifungal drugs. However, further studies are required to understand the other mechanisms and in vivo efficacy and toxicity of these compounds.
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Affiliation(s)
- Manzoor Ahmad Malik
- Department of Chemistry, Jamia Millia Islamia (Central University), New Delhi-110025, India
| | - Shabir Ahmad Lone
- Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa
| | - Parveez Gull
- Department of Chemistry, Jamia Millia Islamia (Central University), New Delhi-110025, India
| | - Ovas Ahmad Dar
- Department of Chemistry, Jamia Millia Islamia (Central University), New Delhi-110025, India
| | - Mohmmad Younus Wani
- Chemistry Department, Faculty of Science, University of Jeddah, P.O. Box 80327, Jeddah 21589, Saudi Arabia
| | - Aijaz Ahmad
- Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa.,Infection Control, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, 2193, South Africa
| | - Athar Adil Hashmi
- Department of Chemistry, Jamia Millia Islamia (Central University), New Delhi-110025, India
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Emergence of Invasive Fungal Infection: Diagnosis and Treatment in Humans. Fungal Biol 2019. [DOI: 10.1007/978-3-030-18586-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bellmann R, Smuszkiewicz P. Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients. Infection 2017; 45:737-779. [PMID: 28702763 PMCID: PMC5696449 DOI: 10.1007/s15010-017-1042-z] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/25/2017] [Indexed: 02/08/2023]
Abstract
Introduction Because of the high mortality of invasive fungal infections (IFIs), appropriate exposure to antifungals appears to be crucial for therapeutic efficacy and safety. Materials and methods This review summarises published pharmacokinetic data on systemically administered antifungals focusing on co-morbidities, target-site penetration, and combination antifungal therapy. Conclusions and discussion Amphotericin B is eliminated unchanged via urine and faeces. Flucytosine and fluconazole display low protein binding and are eliminated by the kidney. Itraconazole, voriconazole, posaconazole and isavuconazole are metabolised in the liver. Azoles are substrates and inhibitors of cytochrome P450 (CYP) isoenzymes and are therefore involved in numerous drug–drug interactions. Anidulafungin is spontaneously degraded in the plasma. Caspofungin and micafungin undergo enzymatic metabolism in the liver, which is independent of CYP. Although several drug–drug interactions occur during caspofungin and micafungin treatment, echinocandins display a lower potential for drug–drug interactions. Flucytosine and azoles penetrate into most of relevant tissues. Amphotericin B accumulates in the liver and in the spleen. Its concentrations in lung and kidney are intermediate and relatively low myocardium and brain. Tissue distribution of echinocandins is similar to that of amphotericin. Combination antifungal therapy is established for cryptococcosis but controversial in other IFIs such as invasive aspergillosis and mucormycosis.
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Affiliation(s)
- Romuald Bellmann
- Clinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Piotr Smuszkiewicz
- Department of Anesthesiology, Intensive Therapy and Pain Treatment, University Hospital, Poznań, Poland
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Scorzoni L, de Paula E Silva ACA, Marcos CM, Assato PA, de Melo WCMA, de Oliveira HC, Costa-Orlandi CB, Mendes-Giannini MJS, Fusco-Almeida AM. Antifungal Therapy: New Advances in the Understanding and Treatment of Mycosis. Front Microbiol 2017; 8:36. [PMID: 28167935 PMCID: PMC5253656 DOI: 10.3389/fmicb.2017.00036] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/06/2017] [Indexed: 01/08/2023] Open
Abstract
The high rates of morbidity and mortality caused by fungal infections are associated with the current limited antifungal arsenal and the high toxicity of the compounds. Additionally, identifying novel drug targets is challenging because there are many similarities between fungal and human cells. The most common antifungal targets include fungal RNA synthesis and cell wall and membrane components, though new antifungal targets are being investigated. Nonetheless, fungi have developed resistance mechanisms, such as overexpression of efflux pump proteins and biofilm formation, emphasizing the importance of understanding these mechanisms. To address these problems, different approaches to preventing and treating fungal diseases are described in this review, with a focus on the resistance mechanisms of fungi, with the goal of developing efficient strategies to overcoming and preventing resistance as well as new advances in antifungal therapy. Due to the limited antifungal arsenal, researchers have sought to improve treatment via different approaches, and the synergistic effect obtained by the combination of antifungals contributes to reducing toxicity and could be an alternative for treatment. Another important issue is the development of new formulations for antifungal agents, and interest in nanoparticles as new types of carriers of antifungal drugs has increased. In addition, modifications to the chemical structures of traditional antifungals have improved their activity and pharmacokinetic parameters. Moreover, a different approach to preventing and treating fungal diseases is immunotherapy, which involves different mechanisms, such as vaccines, activation of the immune response and inducing the production of host antimicrobial molecules. Finally, the use of a mini-host has been encouraging for in vivo testing because these animal models demonstrate a good correlation with the mammalian model; they also increase the speediness of as well as facilitate the preliminary testing of new antifungal agents. In general, many years are required from discovery of a new antifungal to clinical use. However, the development of new antifungal strategies will reduce the therapeutic time and/or increase the quality of life of patients.
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Affiliation(s)
- Liliana Scorzoni
- Laboratório de Micologia Clínica, Departamento de Análises Clínicas, Universidade Estadual Paulista (UNESP), Faculdade de Ciências Farmacêuticas Araraquara, Brasil
| | - Ana C A de Paula E Silva
- Laboratório de Micologia Clínica, Departamento de Análises Clínicas, Universidade Estadual Paulista (UNESP), Faculdade de Ciências Farmacêuticas Araraquara, Brasil
| | - Caroline M Marcos
- Laboratório de Micologia Clínica, Departamento de Análises Clínicas, Universidade Estadual Paulista (UNESP), Faculdade de Ciências Farmacêuticas Araraquara, Brasil
| | - Patrícia A Assato
- Laboratório de Micologia Clínica, Departamento de Análises Clínicas, Universidade Estadual Paulista (UNESP), Faculdade de Ciências Farmacêuticas Araraquara, Brasil
| | - Wanessa C M A de Melo
- Laboratório de Micologia Clínica, Departamento de Análises Clínicas, Universidade Estadual Paulista (UNESP), Faculdade de Ciências Farmacêuticas Araraquara, Brasil
| | - Haroldo C de Oliveira
- Laboratório de Micologia Clínica, Departamento de Análises Clínicas, Universidade Estadual Paulista (UNESP), Faculdade de Ciências Farmacêuticas Araraquara, Brasil
| | - Caroline B Costa-Orlandi
- Laboratório de Micologia Clínica, Departamento de Análises Clínicas, Universidade Estadual Paulista (UNESP), Faculdade de Ciências Farmacêuticas Araraquara, Brasil
| | - Maria J S Mendes-Giannini
- Laboratório de Micologia Clínica, Departamento de Análises Clínicas, Universidade Estadual Paulista (UNESP), Faculdade de Ciências Farmacêuticas Araraquara, Brasil
| | - Ana M Fusco-Almeida
- Laboratório de Micologia Clínica, Departamento de Análises Clínicas, Universidade Estadual Paulista (UNESP), Faculdade de Ciências Farmacêuticas Araraquara, Brasil
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Svetaz LA, Postigo A, Butassi E, Zacchino SA, Sortino MA. Antifungal drugs combinations: a patent review 2000-2015. Expert Opin Ther Pat 2016; 26:439-53. [DOI: 10.1517/13543776.2016.1146693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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