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Czerwoniec P, Kukawka R, Spychalski M, Koczura R, Mokracka J, Smiglak M. New biologically active ionic liquids with benzethonium cation-efficient SAR inducers and antimicrobial agents. PEST MANAGEMENT SCIENCE 2024; 80:3047-3055. [PMID: 38319125 DOI: 10.1002/ps.8014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/27/2024] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND An urgent need to find new methods for crop protection remains open due to the withdrawal from the market of the most toxic pesticides and increasing consumer awareness. One of the alternatives that can be used in modern agriculture is the use of bifunctional compounds whose actions towards plant protection are wider than those of conventional pesticides. RESULTS In this study, we present the investigation of the biological efficacy of nine dual-functional salts containing a systemic acquired resistance (SAR)-inducing anion and the benzethonium cation. A significant result of the presented study is the discovery of the SAR induction activity of benzethonium chloride, which was previously reported only as an antimicrobial agent. Moreover, the concept of dual functionality was proven, as the application of presented compounds in a given concentrations resulted both in the control of human and plant bacteria species and induction of SAR. CONCLUSION The strategy presented in this article shows the capabilities of derivatization of common biologically active compounds into their ionic derivatives to obtain bifunctional salts. This approach may be an example of the design of potential new compounds for modern agriculture. It provides plants with two complementary actions allowing to provide efficient protection to plants, if one mode of action is ineffective. © 2024 Society of Chemical Industry.
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Affiliation(s)
- Patrycja Czerwoniec
- Poznan Science and Technology Park, Adam Mickiewicz University Foundation, Poznań, Poland
- Faculty of Chemistry, Adam Mickiewicz University, Poznań, Poznań, Poland
| | - Rafal Kukawka
- Poznan Science and Technology Park, Adam Mickiewicz University Foundation, Poznań, Poland
| | - Maciej Spychalski
- Poznan Science and Technology Park, Adam Mickiewicz University Foundation, Poznań, Poland
| | - Ryszard Koczura
- Department of Microbiology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poznań, Poland
| | - Joanna Mokracka
- Department of Microbiology, Faculty of Biology, Adam Mickiewicz University, Poznań, Poznań, Poland
| | - Marcin Smiglak
- Poznan Science and Technology Park, Adam Mickiewicz University Foundation, Poznań, Poland
- Innosil Sp. z o.o., Poznań, Poland
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2
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Haapanen S, Barker H, Carta F, Supuran CT, Parkkila S. Novel Drug Screening Assay for Acanthamoeba castellanii and the Anti-Amoebic Effect of Carbonic Anhydrase Inhibitors. J Med Chem 2024; 67:152-164. [PMID: 38150360 PMCID: PMC10788897 DOI: 10.1021/acs.jmedchem.3c01020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
Acanthamoeba castellanii is an amoeba that inhabits soil and water in every part of the world. Acanthamoeba infection of the eye causes keratitis and can lead to a loss of vision. Current treatment options are only moderately effective, have multiple harmful side effects, and are tedious. In our study, we developed a novel drug screening method to define the inhibitory properties of potential new drugs against A. castellanii in vitro. We found that the clinically used carbonic anhydrase inhibitors, acetazolamide, ethoxzolamide, and dorzolamide, have promising antiamoebic properties.
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Affiliation(s)
- Susanna Haapanen
- Faculty
of Medicine and Health Technology, Tampere
University, FI-33520 Tampere, Finland
| | - Harlan Barker
- Faculty
of Medicine and Health Technology, Tampere
University, FI-33520 Tampere, Finland
- Fimlab
Ltd, Tampere University Hospital, FI-33520 Tampere, Finland
| | - Fabrizio Carta
- Neurofarba
Department, Sezione di Chimica Farmaceutica e Nutraceutica, Università degli Studi di Firenze, Via U. Schiff 6, Sesto Fiorentino, I-50019 Firenze, Italy
| | - Claudiu T. Supuran
- Neurofarba
Department, Sezione di Chimica Farmaceutica e Nutraceutica, Università degli Studi di Firenze, Via U. Schiff 6, Sesto Fiorentino, I-50019 Firenze, Italy
| | - Seppo Parkkila
- Faculty
of Medicine and Health Technology, Tampere
University, FI-33520 Tampere, Finland
- Fimlab
Ltd, Tampere University Hospital, FI-33520 Tampere, Finland
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3
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Latifi A, Mohebali M, Yasami S, Soleimani M, Rezaian M, Kazemirad E. Comparing cytotoxicity and efficacy of miltefosine and standard antimicrobial agents against Acanthamoeba trophozoites and cyst forms: An in vitro study. Acta Trop 2023; 247:107009. [PMID: 37643658 DOI: 10.1016/j.actatropica.2023.107009] [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: 06/16/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023]
Abstract
Acanthamoeba keratitis (AK) is an eye disease often occurring in contact lens wearers. AK treatment is prolonged and requires multiple drugs, which can lead to adverse effects. Our study aimed to compare the in vitro activities and safety of Miltefosine with that of conventional antimicrobial agents used to treat AK. Acanthamoeba castellanii genotype T4 was obtained from a patient with keratitis and subjected to in vitro susceptibility testing with various antimicrobial agents, including Chlorhexidine (CHX), Pentamidine isethionate (PI)Polyhexamethylene biguanide (PHMB), and Miltefosine to assess their efficacy against Acanthamoeba trophozoites and cyst. The cytotoxicity of the agents was evaluated in Vero cells, and their selectivity indexes (SI) were calculated. Chlorhexidine exhibited the highest amoebicidal activity with the highest selectivity index against the trophozoite and cyst, ranging from 1.17 to 8.35. The selectivity index of PHMB is slightly comparable to Chlorhexidine, exhibiting significant anti-Acanthamoeba activity. On the other hand, Pentamidine isethionate and Miltefosine displayed low SI among the compounds. Pentamidine isethionate was effective at high concentrations, which was toxic. Miltefosine exhibited the lowest cytotoxicity; nevertheless, due to the lowest anti-Acanthamoeba activity presented a low selectivity against the parasite. Further studies on more clinical samples and prolonged incubation time should be done to investigate the effectiveness and toxicity of drugs in both in vitro and in vivo conditions.
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Affiliation(s)
- Alireza Latifi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Center for Research of Endemic Parasites of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Setayesh Yasami
- Department of Parasitology, Pasteur Institute of Iran, Tehran, Iran
| | - Mohammad Soleimani
- Department of Ocular Trauma and Emergency, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Rezaian
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Kazemirad
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Büchele MLC, Nunes BF, Filippin-Monteiro FB, Caumo KS. Diagnosis and treatment of Acanthamoeba Keratitis: A scoping review demonstrating unfavorable outcomes. Cont Lens Anterior Eye 2023; 46:101844. [PMID: 37117130 DOI: 10.1016/j.clae.2023.101844] [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: 12/13/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
Acanthamoeba spp. are pathogens that cause Acanthamoeba keratitis (AK), a serious cornea inflammation that can lead to gradual loss of vision, permanent blindness, and keratoplasty. The efficacy of AK treatment depends on the drug's ability to reach the target tissue by escaping the protective eye barrier. No single drug can eradicate the living forms of the amoeba and be non-toxic to the cornea tissue. The treatment aims to eradicate both forms of protozoan life but is hampered by the resistance of the cysts to the most available drugs, leading to prolonged infection and relapses. Drug therapy is currently performed mainly using diamidines and biguanides, as they are more effective against cysts. However, they are cytotoxic to corneal cells. Drugs are applied topically, and hourly. Over time, the frequency of administration decreases, but the treatment time varies from month to years. This study aims to obtain an up-to-date summary of the literature since 2010, allowing us to identify the trends and gaps and address future research involving new alternatives for treating AK. The results were divided into three phases, pre-treatment, empirical treatment, and the treatment after diagnosis confirmation. The drugs prescribed were stratified into antiamoebic, antibiotic, antifungal, antivirals, and steroids. It was possible to observe the transition in drug prescription during three different stages until the diagnosis was confirmed. There were more indications for antibiotic, antifungal, and antiviral drugs in the early stages of the disease. The antiamoebic drugs were only prescribed after exhausting other treatments. This can be directly involved in developing complications and no responsiveness to medical treatment.
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Affiliation(s)
- Maria Luiza Carneiro Büchele
- Laboratório de Investigação Aplicada a Protozoários de Protozoários Emergentes (LADIPE), Florianópolis, SC 88040-970, Brazil
| | - Bruno Fonseca Nunes
- Department of Clinical Analyses, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC 88040900, Brazil
| | - Fabíola Branco Filippin-Monteiro
- Department of Clinical Analyses, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC 88040900, Brazil.
| | - Karin Silva Caumo
- Laboratório de Investigação Aplicada a Protozoários de Protozoários Emergentes (LADIPE), Florianópolis, SC 88040-970, Brazil; Department of Clinical Analyses, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC 88040900, Brazil.
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Wang Y, Jiang L, Zhao Y, Ju X, Wang L, Jin L, Fine RD, Li M. Biological characteristics and pathogenicity of Acanthamoeba. Front Microbiol 2023; 14:1147077. [PMID: 37089530 PMCID: PMC10113681 DOI: 10.3389/fmicb.2023.1147077] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Acanthamoeba is an opportunistic protozoa, which exists widely in nature and is mainly distributed in soil and water. Acanthamoeba usually exists in two forms, trophozoites and cysts. The trophozoite stage is one of growth and reproduction while the cyst stage is characterized by cellular quiescence, commonly resulting in human infection, and the lack of effective monotherapy after initial infection leads to chronic disease. Acanthamoeba can infect several human body tissues such as the skin, cornea, conjunctiva, respiratory tract, and reproductive tract, especially when the tissue barriers are damaged. Furthermore, serious infections can cause Acanthamoeba keratitis, granulomatous amoebic encephalitis, skin, and lung infections. With an increasing number of Acanthamoeba infections in recent years, the pathogenicity of Acanthamoeba is becoming more relevant to mainstream clinical care. This review article will describe the etiological characteristics of Acanthamoeba infection in detail from the aspects of biological characteristic, classification, disease, and pathogenic mechanism in order to provide scientific basis for the diagnosis, treatment, and prevention of Acanthamoeba infection.
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Affiliation(s)
- Yuehua Wang
- College of Laboratory Medicine, Jilin Medical University, Jilin City, China
| | - Linzhe Jiang
- General Surgery, Jilin People’s Hospital, Jilin City, China
| | - Yitong Zhao
- College of Laboratory Medicine, Jilin Medical University, Jilin City, China
| | - Xiaohong Ju
- College of Laboratory Medicine, Jilin Medical University, Jilin City, China
| | - Le Wang
- Department of Laboratory Medicine, Jilin Hospital of Integrated Chinese and Western Medicine, Jilin City, China
| | - Liang Jin
- Department of Laboratory Medicine, Jilin Hospital of Integrated Chinese and Western Medicine, Jilin City, China
| | - Ryan D. Fine
- Center for Human Genetics and Genomics, New York University Grossman School of Medicine, New York City, NY, United States
| | - Mingguang Li
- College of Laboratory Medicine, Jilin Medical University, Jilin City, China
- *Correspondence: Mingguang Li,
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Chuprom J, Sangkanu S, Mitsuwan W, Boonhok R, Mahabusarakam W, Singh LR, Dumkliang E, Jitrangsri K, Paul AK, Surinkaew S, Wilairatana P, Pereira MDL, Rahmatullah M, Wiart C, Oliveira SMR, Nissapatorn V. Anti- Acanthamoeba activity of a semi-synthetic mangostin derivative and its ability in removal of Acanthamoeba triangularis WU19001 on contact lens. PeerJ 2022; 10:e14468. [PMID: 36523474 PMCID: PMC9745913 DOI: 10.7717/peerj.14468] [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: 04/04/2022] [Accepted: 11/06/2022] [Indexed: 12/13/2022] Open
Abstract
Garcinia mangostana L., also known as the mangosteen tree, is a native medicinal plant in Southeast Asia having a wide variety of pharmacologically active compounds, including xanthonoid mangostin. In this study, we examined the pharmacological activities of the selected semi-synthetic mangostin derivative, namely, amoebicidal activity, encystation inhibition, excystation activity, and removal capacity of adhesive Acanthamoeba from the surface of contact lens (CL). Among the three derivatives, C1 exhibited promising anti-Acanthamoeba activity against Acanthamoeba triangularis WU19001 trophozoites and cysts. SEM images displayed morphological changes in Acanthamoeba trophozoites, including the loss of acanthopodia, pore formation in the cell membrane, and membrane damage. In addition, the treated cyst was shrunken and adopted an irregular flat cyst shape. Under a fluorescence microscope, acridine orange and propidium iodide (AO/PI) staining revealed C1 induced condensation of cytoplasm and chromatin with the loss of cell volume in the treated trophozoites, while calcofluor white staining demonstrated the leakage of cell wall in treated cysts, leading to cell death. Interestingly, at the concentration ranges in which C1 showed the anti-Acanthamoeba effects (IC50 values ranging from 0.035-0.056 mg/mL), they were not toxic to Vero cells. C1 displayed the highest inhibitory effect on A. triangularis encystation at 1/16×MIC value (0.004 mg/mL). While C1 demonstrated the excystation activity at 1/128×MIC value with a high rate of 89.47%. Furthermore, C1 exhibited the removal capacity of adhesive Acanthamoeba from the surface of CL comparable with commercial multipurpose solutions (MPSs). Based on the results obtained, C1 may be a promising lead agent to develop a therapeutic for the treatment of Acanthamoeba infections and disinfectant solutions for CL.
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Affiliation(s)
- Julalak Chuprom
- School of Allied Health Sciences, Southeast Asia Water Team (SEA Water Team) and World Union for Herbal Drug Discovery (WUHeDD), Walailak University, Nakhon Si Thammarat, Thailand,School of Languages and General Education (SOLGEN), Walailak University, Nakhon Si Thammarat, Thailand
| | - Suthinee Sangkanu
- School of Allied Health Sciences, Southeast Asia Water Team (SEA Water Team) and World Union for Herbal Drug Discovery (WUHeDD), Walailak University, Nakhon Si Thammarat, Thailand
| | - Watcharapong Mitsuwan
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat, Thailand
| | - Rachasak Boonhok
- Department of Medical Technology, School of Allied Health Sciences, Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat, Thailand
| | - Wilawan Mahabusarakam
- Division of Physical Science, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - L. Ravithej Singh
- Fluoro-Agrochemicals Division, CSIR–Indian Institute of Chemical Technology, Tarnaka, Hyderabad, India,Chemical Sciences Division, Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Ekachai Dumkliang
- Faculty of Pharmacy, Silpakorn University, Pharmaceutical Development of Green Innovations Group (PDGIG), Nakhon Pathom, Thailand
| | - Kritamorn Jitrangsri
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Alok K. Paul
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Sirirat Surinkaew
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Maria de Lourdes Pereira
- CICECO-Aveiro Institute of Materials & Department of Medical Sciences, University of Aveiro, Aveiro, Portugal,Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Mohammed Rahmatullah
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka, Bangladesh
| | - Christophe Wiart
- The Institute for Tropical Biology and Conservation, University Malaysia Sabah, Kota Kin-abalu, Sabah, Malaysia
| | - Sonia Marlene Rodrigues Oliveira
- CICECO-Aveiro Institute of Materials & Department of Medical Sciences, University of Aveiro, Aveiro, Portugal,Hunter Medical Research Institute, New Lambton, Australia
| | - Veeranoot Nissapatorn
- School of Allied Health Sciences, Southeast Asia Water Team (SEA Water Team) and World Union for Herbal Drug Discovery (WUHeDD), Walailak University, Nakhon Si Thammarat, Thailand
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7
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Megha K, Sharma M, Sharma C, Gupta A, Sehgal R, Khurana S. Evaluation of in vitro activity of five antimicrobial agents on Acanthamoeba isolates and their toxicity on human corneal epithelium. Eye (Lond) 2022; 36:1911-1917. [PMID: 34548636 PMCID: PMC9500015 DOI: 10.1038/s41433-021-01768-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/12/2021] [Accepted: 09/10/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Acanthamoeba keratitis (AK) is an important cause of ocular morbidity in both contact lens wearers and non wearers. Medical management comprises prolonged empiric treatment with multiple drugs, leading to adverse effects and suboptimal cure. The present study evaluated the efficiency and safety of common antimicrobial agents used in treatment of AK. METHODS Six Acanthamoeba isolates (four AK, two water samples) were axenized and subjected to in vitro susceptibility testing against chlorhexidine, pentamidine isethionate, polymyxin B, miltefosine, and fluconazole to check for trophocidal and cysticidal activity. The safety profile was analysed by observing the cytotoxicity of the highest cidal concentration toward human corneal epithelial cell (HCEC) line. RESULTS Chlorhexidine had the lowest cidal concentration against both cysts and trophozoites (range 4.16-25 μg/ml) followed by pentamidine isethionate (range 25-166.7 μg/ml). Both agents were nontoxic to HCEC. Polymyxin B (range 25-200 μg/ml) and fluconazole (range 64-512 μg/ml) had relatively higher minimum inhibitory concentrations (MIC); fluconazole was nontoxic even at 1024 μg/ml, but cytotoxicity was observed at 400 μg/ml with polymyxin B. Miltefosine was not effective against cysts at tested concentrations. A. castellanii were more susceptible to all agents (except pentamidine isethionate) than A. lenticulata. Clinical isolates were less susceptible to polymyxin B and fluconazole than environmental isolates, reverse was true for miltefosine. CONCLUSION Chlorhexidine and pentamidine isethionate were the most effective and safe agents against both trophozoites and cysts forms of our Acanthamoeba isolates. Fluconazole had higher MIC but was nontoxic. Polymyxin B was effective at high MIC but therapeutic dose was found toxic. Miltefosine, at tested concentrations, could not inhibit cysts of Acanthamoeba. Clinical isolates had higher MICs for polymyxin B and fluconazole.
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Affiliation(s)
- Kirti Megha
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chayan Sharma
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumeeta Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Sifaoui I, Díaz-Rodríguez P, Rodríguez-Expósito RL, Reyes-Batlle M, Lopez-Arencibia A, Salazar Villatoro L, Castelan-Ramírez I, Omaña-Molina M, Oliva A, Piñero JE, Lorenzo-Morales J. Pitavastatin loaded nanoparticles: a suitable ophthalmic treatment for Acanthamoeba Keratitis inducing cell death and autophagy in Acanthamoeba polyphaga. Eur J Pharm Biopharm 2022; 180:11-22. [PMID: 36162636 DOI: 10.1016/j.ejpb.2022.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022]
Abstract
Statins are effective sterol lowering agents with high amoebicidal activity. Nevertheless, due to their poor aqueous solubility, they remain underused especially in eye drop formulation. The aim of the present study is to develop Pitavastatin loaded nanoparticles suitable for ophthalmic administration and designed for the management of Acanthamoeba Keratitis. These nanocarriers are aimed to solve both the ophthalmic route-associated problems and the limited aqueous drug solubility issues of Pitavastatin. Nanoparticles were obtained by a nanoprecipitation-solvent displacement method and their amoebicidal activity was evaluated against four strains of Acanthamoeba: A. castellanii Neff, A. polyphaga, A. griffini and A. quina. In Acanthamoeba polyphaga, the effect of the present nanoparticles was investigated with respect to the microtubule distribution and several programmed cell death features. Nanoparticles were able to eliminate all the tested strains and Acanthamoeba polyphaga was determined to be the most resistance strain. Nanoparticles induced chromatin condensation, autophagic vacuoles and mitochondria dysfunction.
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Affiliation(s)
- Ines Sifaoui
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Cooperativa en Enfermedades Tropicales (RICET)
| | - Patricia Díaz-Rodríguez
- Institute of Biomedical Technologies (ITB), Universidad de La Laguna, 38320 La Laguna, Spain; Department of Pharmacology, Pharmacy and Pharmaceutical Technology, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Rubén L Rodríguez-Expósito
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Cooperativa en Enfermedades Tropicales (RICET)
| | - María Reyes-Batlle
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Cooperativa en Enfermedades Tropicales (RICET)
| | - Atteneri Lopez-Arencibia
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Cooperativa en Enfermedades Tropicales (RICET)
| | - Lizbeth Salazar Villatoro
- Departamento de Infectómica y Patogénesis Molecular, Centro de Investigación y de Estudios Avanzados del IPN, 07360, Ciudad de México, México
| | - Ismael Castelan-Ramírez
- Facultad de Estudios Superiores Iztacala, Medicina, UNAM, Tlalnepantla, 54090, Estado de México, México
| | - Maritza Omaña-Molina
- Department of Chemical Engineering and Pharmaceutical Technology, Universidad de La Laguna, 38206 La Laguna, Spain
| | - Alexis Oliva
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Department of Chemical Engineering and Pharmaceutical Technology, Universidad de La Laguna, 38206 La Laguna, Spain
| | - José E Piñero
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Cooperativa en Enfermedades Tropicales (RICET); CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - Jacob Lorenzo-Morales
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna (ULL), Tenerife, 38206, Spain; Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Cooperativa en Enfermedades Tropicales (RICET); CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain
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9
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Niro A, Pignatelli F, Fallico M, Sborgia A, Passidomo F, Gigliola S, Nacucchi A, Sborgia G, Boscia G, Alessio G, Boscia F, Addabbo G, Reibaldi M, Avitabile T. Polyhexamethylene biguanide hydrochloride (PHMB)-properties and application of an antiseptic agent. A narrative review. Eur J Ophthalmol 2022; 33:11206721221124684. [PMID: 36083163 DOI: 10.1177/11206721221124684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
The prevention and management of ocular surface infections is still one of the great challenges for ophthalmologists. The spread of antimicrobial resistance makes it necessary to use antiseptic substances with a broad antimicrobial spectrum. Polyhexamethylene biguanide hydrochloride (Polyhexanide, PHMB) is a broad-spectrum antiseptic with excellent tolerance and a low-risk profile. Its physicochemical action on the phospholipid membrane and DNA replication or repair mechanism, prevents or impedes the development of resistant bacterial strains. PHMB revealed its effective against numerous organisms like viruses, Gram-negative and Gram-positive bacteria, and fungi. Polyhexanide is commonly used as preservative in commercially available disinfecting solutions for contact lens care and in ophthalmic formulations at different concentrations ranging from 1 µg/ml to 50 µg/ml. The administration of 0.02% (200 µg/ml) PHMB is often the first-line therapy of Acanthamoeba keratitis. However, to date, only one close-out randomized controlled study tested the efficacy of 0.02% PHMB in Acanthamoeba keratitis and a phase III study is still ongoing. This paper reviews the antiseptic agent PHMB, focusing on biochemical mechanisms, safety profile and applications in ophthalmology.
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Affiliation(s)
- Alfredo Niro
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto, Italy
| | | | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Fedele Passidomo
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto, Italy
| | - Samuele Gigliola
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto, Italy
| | | | - Giancarlo Sborgia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Giacomo Boscia
- Eye Clinic Section, Department of Surgical Sciences, 9314University of Turin, Turin, Italy
| | - Giovanni Alessio
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Francesco Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Giuseppe Addabbo
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto, Italy
| | - Michele Reibaldi
- Eye Clinic Section, Department of Surgical Sciences, 9314University of Turin, Turin, Italy
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10
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Shin JH, Jung YH, Song HB, Kim MK, Yoon CH. Sutureless contact lens-type amniotic membrane for persistent epithelial defects after infectious keratitis. Int J Ophthalmol 2022; 15:1404-1406. [PMID: 36017035 DOI: 10.18240/ijo.2022.08.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jung Hye Shin
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Young-Ho Jung
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.,Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyun Beom Song
- Department of Medical Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.,Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Chang Ho Yoon
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.,Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
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11
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Bellini NK, Thiemann OH, Reyes-Batlle M, Lorenzo-Morales J, Costa AO. A history of over 40 years of potentially pathogenic free-living amoeba studies in Brazil - a systematic review. Mem Inst Oswaldo Cruz 2022; 117:e210373. [PMID: 35792751 PMCID: PMC9252135 DOI: 10.1590/0074-02760210373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/28/2022] [Indexed: 12/17/2022] Open
Abstract
Free-living amoeba (FLA) group includes the potentially pathogenic genera Acanthamoeba, Naegleria, Balamuthia, Sappinia, and Vermamoeba, causative agents of human infections (encephalitis, keratitis, and disseminated diseases). In Brazil, the first report on pathogenic FLA was published in the 70s and showed meningoencephalitis caused by Naegleria spp. FLA studies are emerging, but no literature review is available to investigate this trend in Brazil critically. Thus, the present work aims to integrate and discuss these data. Scopus, PubMed, and Web of Science were searched, retrieving studies from 1974 to 2020. The screening process resulted in 178 papers, which were clustered into core and auxiliary classes and sorted into five categories: wet-bench studies, dry-bench studies, clinical reports, environmental identifications, and literature reviews. The papers dating from the last ten years account for 75% (134/178) of the total publications, indicating the FLA topic has gained Brazilian interest. Moreover, 81% (144/178) address Acanthamoeba-related matter, revealing this genus as the most prevalent in all categories. Brazil’s Southeast, South, and Midwest geographic regions accounted for 96% (171/178) of the publications studied in the present work. To the best of our knowledge, this review is the pioneer in summarising the FLA research history in Brazil.
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Affiliation(s)
- Natália Karla Bellini
- Universidade Federal de Minas Gerais, Faculdade de Farmácia, Departamento de Análises Clínicas e Toxicológicas, Belo Horizonte, MG, Brasil
| | - Otavio Henrique Thiemann
- Universidade de São Paulo, Instituto de Física de São Carlos, São Carlos, SP, Brasil.,Universidade Federal de São Carlos, Departamento de Genética e Evolução, São Carlos, SP, Brasil
| | - María Reyes-Batlle
- Universidad de La Laguna, Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Red de Investigación Cooperativa en Enfermedades Tropicales, Tenerife, Islas Canarias, Spain
| | - Jacob Lorenzo-Morales
- Universidad de La Laguna, Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Red de Investigación Cooperativa en Enfermedades Tropicales, Tenerife, Islas Canarias, Spain.,Instituto de Salud Carlos III, Consorcio Centro de Investigación Biomédica en Red MP de Enfermedades Infecciosas, Madrid, Spain
| | - Adriana Oliveira Costa
- Universidade Federal de Minas Gerais, Faculdade de Farmácia, Departamento de Análises Clínicas e Toxicológicas, Belo Horizonte, MG, Brasil
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12
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Seas C, Legua P. Meningoencephalitis Due to Free-Living Amoebas in the Tropics. CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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de Carvalho Clímaco M, de Oliveira YLM, Ramos ACS, Ramos-de-Souza J, Silva ARST, Jain S, Rott MB, Scher R, Correa CB, Barbosa AAT, Dolabella SS. Nisin Induces Cell-Cycle Arrest in Free-Living Amoebae Acanthamoeba castellanii. Acta Parasitol 2022; 67:511-517. [PMID: 34156633 DOI: 10.1007/s11686-021-00436-x] [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: 10/25/2020] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Acanthamoeba spp. are free-living amoebas with worldwide distribution and play an important role as disease-causing agents in humans. Drug inability to completely eradicate these parasites along with their toxic effects suggest urgent need for new antimicrobials. Nisin is a natural antimicrobial peptide produced by Lactococcus lactis. Nisin is also the only bacteriocin approved for use in food preservation. In this work, we analyzed the effect of nisin on the growth of Acanthamoeba castellanii trophozoites. METHODS A total of 8 × 104 trophozoites were exposed to increasing concentrations of nisin to determine its activity. Changes in cell membrane and cellular cycle of trophozoites were investigated by flow cytometry, and nisin cytotoxicity in mammalian cells was evaluated in L929 cells by MTT method. RESULTS After 24 h exposure to increasing nisin concentrations, an IC50 of 4493.2 IU mL-1 was obtained for A. castellanii trophozoites. However, after 72 h a recovery in amoebic growth was observed, and it was no longer possible to determine IC50. Flow cytometry analysis showed that nisin has no effect on the membrane integrity. Treatment with nisin induced cell-cycle arrest during G1 and S phases in A. castellanii trophozoites, which recovered their growth after 72 h. CONCLUSION This is one of the first studies showing the effect of internationally approved nisin against A. castellanii trophozoites. Nisin caused cell-cycle arrest in trophozoites, momentarily interfering with the DNA replication process. The data highlight the amoebostatic activity of nisin, and suggest its use as an adjuvant for the treatment of infections caused by Acanthamoeba spp.
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Büchele MLC, Filippin-Monteiro FB, de Lima B, Camargo CDJ, Restrepo JAS, Souza LC, Creczynski-Pasa TB, Caumo KS. Super aggregated amphotericin B with a thermoreversible in situ gelling ophthalmic system for amoebic keratitis treatment. Acta Trop 2021; 224:106144. [PMID: 34562424 DOI: 10.1016/j.actatropica.2021.106144] [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: 03/12/2021] [Revised: 08/31/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
Acanthamoeba spp. are the causative agents of a sight-threatening infection of the cornea known as Acanthamoeba keratitis (AK). Amphotericin B - deoxycholate (AB) is used in the treatment of infectious keratitis, however, its topical administration has side effects as blepharitis, iritis, and painful instillation. In this context, the preheating of AB can decrease its toxicity by the formation of super aggregates (hAB). hAB associated with a thermoreversible in situ gelling ophthalmic system is a promising option due to the latter biocompatibility, low toxicity, and high residence time on the ocular surface. Our objective was to develop a topical ocular formulation of hAB for the treatment of AK. After heating at 70°C for 20 min, hAB was incorporated into a thermoreversible gelling system. The amebicidal activity of AB and hAB was evaluated against trophozoites and cysts of A. castellanii (ATCC 50492) and a regional clinical isolate (IC01). The results showed that the preheating of AB did not change the pharmacological action of the drug, with the amebicidal effect of AB and hAB under trophozoites and cysts of Acanthamoeba spp. The thermoreversible system remained stable, allowing the increase of drug retention time. For assessment of cytotoxicity, HUVEC (ATCC® CRL-1730) cells were challenged with AB and hAB for 48h. Cell viability was assessed, and hAB did not show cytotoxicity for HUVEC cells. As far as we know this was the first study that showed the preheated AB associated with a thermoreversible in situ gelling ophthalmic system as a promising system for topical ocular topical administration of hAB for AK therapy.
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Affiliation(s)
- Maria Luiza Carneiro Büchele
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Estudos de Protozoários Emergentes e Oportunistas. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Fabíola Branco Filippin-Monteiro
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Imunobiologia do Tecido Adiposo. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Barbara de Lima
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Imunobiologia do Tecido Adiposo. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Carolina de Jesus Camargo
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Estudos de Protozoários Emergentes e Oportunistas. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Jelver Alexander Sierra Restrepo
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Grupo de Estudos de Interações entre Micro e Macromoléculas, CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Liliete Canes Souza
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Imunobiologia do Tecido Adiposo. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Tania Beatriz Creczynski-Pasa
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Grupo de Estudos de Interações entre Micro e Macromoléculas, CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Karin Silva Caumo
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Estudos de Protozoários Emergentes e Oportunistas. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil..
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15
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In Vitro Antimicrobial Activity of a New Ophthalmic Solution Containing Hexamidine Diisethionate 0.05% (Keratosept). Cornea 2021; 39:1415-1418. [PMID: 32452982 DOI: 10.1097/ico.0000000000002375] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the in vitro antimicrobial activity of a new commercial ophthalmic solution containing hexamidine diisethionate 0.05% (Keratosept). METHODS Staphylococcus aureus American Type Culture Collection (ATCC 43300), Pseudomonas aeruginosa ATCC 27853, 3 ocular bacterial isolates (1 Staphylococcus epidermidis, 1 S. aureus, and 1 P. aeruginosa), and 5 Candida species were used. The bacterial and fungal isolates were cultured on Columbia blood agar base and Sabouraud-dextrose agar plates, respectively, and incubated overnight at 37°C. Suspensions were prepared in a sterile saline solution with optical density equal to 0.5 McFarland standard (∼10 CFU/mL). Isolate suspensions were made in Keratosept solution to obtain a concentration of 10 CFU/mL. The suspensions were then distributed in conical tubes with a final volume of 1 mL and incubated at 37°C. After 1, 5, 10, 15, 20, 25, 30 minutes, and 24 hours, 10 μL of each suspension was removed, seeded on Columbia blood agar base and Sabouraud-dextrose agar plates and then incubated for 24 hours at 37°C. RESULTS After 1-minute incubation, there was no growth on the plates seeded with S. aureus ATCC 43300, S. aureus clinical isolate, S. epidermidis clinical isolate, and all 5 Candida species tested. Conversely, Keratosept solution failed to kill the Pseudomonas isolates after 30 minutes exposure and needed 24 hours to eradicate the organisms. CONCLUSIONS Keratosept ophthalmic solution showed in vitro antimicrobial activity against S. epidermidis, S. aureus, and Candida species. Results suggest that it may be a potential candidate for the treatment of staphylococcal and Candida infections of the ocular surface and have some role in antimicrobial prophylaxis before intravitreal injections.
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Abstract
PURPOSE Voriconazole was shown to inhibit ergosterol synthesis in various acanthamoeba species. The purpose of this study was to evaluate the clinical outcome of treatment with supplemental topical voriconazole in patients with acanthamoeba keratitis (AK). METHODS All patients who had been treated for AK with voriconazole 1% drops in conjunction with topical first-line antiacanthamoeba therapy composed of polyhexamethylene biguanide (PHMB) 0.02% and propamidine isethionate 0.1% (Brolene) between November 2014 and August 2017 at the Department of Ophthalmology, University Medical Center Mainz, were included. The main outcomes were treatment failure and recurrence rate. Secondary outcomes were visual acuity, need for keratoplasty, and presence of adverse reactions. RESULTS Twenty-eight eyes of 28 patients with AK, whose treatment had included topical voriconazole, were identified (12 men, 16 women, mean age: 41.7 ± 16.3 years), and 26 of them could be tracked for at least 3 months after cessation of therapy. Resolution of infection under therapy was seen in all eyes, and only one of 26 (3.85%) had a relapse after the therapy had been stopped. Best-corrected visual acuity improved during therapy. Keratoplasty because of central corneal scarring was scheduled in 5 of 26 patients (19.2%) after the pharmacological therapy had been stopped. Five of 26 patients (19.2%) reported on stinging or burning sensation after application of voriconazole 1% drops. CONCLUSIONS Topical voriconazole 1% combined with first-line therapy composed of polyhexamethylene biguanide 0.02% and propamidine isethionate 0.1% appears to be an effective option with minor side effects for the treatment of AK.
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17
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Kaur A, Sahu SK, Mitra S, Das S. Microsporidial stromal keratitis in an immunocompromised patient: Successful management with medical therapy. Indian J Ophthalmol 2021; 68:2552-2554. [PMID: 33120689 PMCID: PMC7774215 DOI: 10.4103/ijo.ijo_2348_20] [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] [Indexed: 11/04/2022] Open
Abstract
Microsporidial stromal keratitis is refractory to topical drugs and is classically described in immunocompetent hosts. A 55-year-old patient with renal transplant and oral immunosuppressants, presented with a 15-day history of redness, pain, and diminution of vision in the right eye. Slit-lamp examination revealed epithelial defect and mid-stromal infiltrate. On corneal scraping, microsporidial spores were observed. The patient was started on topical 0.02% polyhexamethylene biguanide (PHMB) and the infiltrate resolved after 6 weeks of initiation of topical therapy.
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Affiliation(s)
- Amanjot Kaur
- L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | | | - Sujata Das
- L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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18
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Raghavan A, Nair AV, N K, Venkatapathy N, Rammohan R. Voriconazole in the successful management of a case of Acanthamoeba-Cladosporium keratitis. Am J Ophthalmol Case Rep 2021; 22:101107. [PMID: 33981917 PMCID: PMC8085662 DOI: 10.1016/j.ajoc.2021.101107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/02/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Acanthamoeba and fungal infections can be recalcitrant to therapy - more so when the deeper layers of the corneas are involved. We describe the diagnosis and successful management strategies employed in a case of deep keratitis due to co-infection with Acanthamoeba and Cladosporium sp. Observations Once the diagnosis of co-infection with both Acanthamoeba and Cladosporium was made, treatment was initiated with a combination of PHMB, chlorhexidine, natamycin, and voriconazole; to which the response was favorable. Signs of relapse with spread of the infection to the deeper plane and the presence of endothelial exudates were noted at 5 weeks. This was attributed to poor compliance. Though the response to re-initiation of therapy under direct supervision was once again favorable; it was only after the introduction of intrastromal voriconazole repeated at timely intervals that rapid and complete resolution was obtained. Conclusions Severe keratitis due to fungi or Acanthamoeba very often requires surgical intervention. Complete resolution with medical therapy was obtained only after the introduction of intrastromal voriconazole; thereby avoiding a therapeutic keratoplasty. The addition of voriconzole both topically and particularly intrastromally facilitated faster resolution as well as restricted the duration of therapy with more toxic drugs such as phmb and chlorhexidine.
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Affiliation(s)
- Anita Raghavan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Arjun Velayudhan Nair
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Kavitha N
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Narendran Venkatapathy
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Ram Rammohan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
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Nasef MH, El Emam SY, ElShorbagy MS, Allam WA. Acanthamoeba Keratitis in Egypt: Characteristics and Treatment Outcomes. Clin Ophthalmol 2021; 15:1339-1347. [PMID: 33824578 PMCID: PMC8018414 DOI: 10.2147/opth.s301903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To study the predisposing factors, clinical manifestations, and treatment outcome of patients with Acanthamoeba keratitis (AK) at Tanta University’s Ophthalmology Hospital in Tanta, Egypt. Methods A retrospective study of 42 patients (44 eyes) with Acanthamoeba keratitis who had medical records available for review over 4 years. Results Forty-four eyes of 42 patients were treated for AK over the study period. In 29 eyes (65.8%), AK was related to contact lens wear. Severe ocular pain was the main presenting symptom in 38 eyes (86.3%). The most common ocular signs were radial perineural corneal infiltrates (65.9%), pseudo-dendrites (43.2%), ring infiltrates (45.5%), and diffuse stromal infiltration (59%). Acanthamoeba was detected by culture, smear, and in-vivo confocal microscopy (IVCM) in 25 eyes (56.8%), while in 19 eyes (43.2%) the diagnosis was based solely on the clinical findings. IVCM was effective in detection of Acanthamoeba in cases with early presentation, while culture was more sensitive in late presentation with corneal melting. The mean duration of treatment was 73.3 ± 23.7 days. Surgical intervention in the form of tectonic grafts or amniotic membrane transplant was required in five cases (11.3%) due to progressive corneal thinning and perforation. Seventeen patients (38.6%) had 0.2 or better final best-corrected visual acuity after treatment. Conclusion The diagnosis of AK remains a major challenge for most ophthalmologists. Contact lens abuse is the major risk factor. Early diagnosis and appropriate treatment of AK with biocidal agents can improve the final outcome and help avoid surgical intervention. IVCM is an excellent tool for early diagnosis of AK.
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Affiliation(s)
- Mohamed H Nasef
- Ophthalmology Department, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - Sharif Y El Emam
- Ophthalmology Department, Tanta University, Faculty of Medicine, Tanta, Egypt
| | | | - Waleed A Allam
- Ophthalmology Department, Tanta University, Faculty of Medicine, Tanta, Egypt
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Folliero V, Zannella C, Chianese A, Stelitano D, Ambrosino A, De Filippis A, Galdiero M, Franci G, Galdiero M. Application of Dendrimers for Treating Parasitic Diseases. Pharmaceutics 2021; 13:343. [PMID: 33808016 PMCID: PMC7998910 DOI: 10.3390/pharmaceutics13030343] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 01/02/2023] Open
Abstract
Despite advances in medical knowledge, parasitic diseases remain a significant global health burden and their pharmacological treatment is often hampered by drug toxicity. Therefore, drug delivery systems may provide useful advantages when used in combination with conventional therapeutic compounds. Dendrimers are three-dimensional polymeric structures, characterized by a central core, branches and terminal functional groups. These nanostructures are known for their defined structure, great water solubility, biocompatibility and high encapsulation ability against a wide range of molecules. Furthermore, the high ratio between terminal groups and molecular volume render them a hopeful vector for drug delivery. These nanostructures offer several advantages compared to conventional drugs for the treatment of parasitic infection. Dendrimers deliver drugs to target sites with reduced dosage, solving side effects that occur with accepted marketed drugs. In recent years, extensive progress has been made towards the use of dendrimers for therapeutic, prophylactic and diagnostic purposes for the management of parasitic infections. The present review highlights the potential of several dendrimers in the management of parasitic diseases.
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Affiliation(s)
- Veronica Folliero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.F.); (C.Z.); (A.C.); (D.S.); (A.A.); (M.G.)
| | - Carla Zannella
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.F.); (C.Z.); (A.C.); (D.S.); (A.A.); (M.G.)
| | - Annalisa Chianese
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.F.); (C.Z.); (A.C.); (D.S.); (A.A.); (M.G.)
| | - Debora Stelitano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.F.); (C.Z.); (A.C.); (D.S.); (A.A.); (M.G.)
| | - Annalisa Ambrosino
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.F.); (C.Z.); (A.C.); (D.S.); (A.A.); (M.G.)
| | - Anna De Filippis
- Department of Pharmacy, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.F.); (C.Z.); (A.C.); (D.S.); (A.A.); (M.G.)
| | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Massimiliano Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.F.); (C.Z.); (A.C.); (D.S.); (A.A.); (M.G.)
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Wu J, Xie H. Orthokeratology lens-related Acanthamoeba keratitis: case report and analytical review. J Int Med Res 2021; 49:3000605211000985. [PMID: 33752507 PMCID: PMC7995463 DOI: 10.1177/03000605211000985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
Acanthamoeba keratitis (AK) is a rare but severe ocular infection with a significant risk of vision loss. Contact lens use is the main risk factor for AK. The orthokeratology (OK) lens, a specially designed contact lens, has been used worldwide as an effective method of myopia control. However, the OK lens is associated with an increased risk of Acanthamoeba infection. Many primary practitioners are concerned about this infection because of its relative rarity, the lack of promising therapeutic medications, and the need for referral. We herein report two cases of AK associated with OK lenses, present a systematic review of such cases, and discuss the possible reasons for the higher incidence rate of this infection in patients who wear OK lenses. We combined the clinical knowledge and skills of corneal specialists and lens experts with the sole objective of addressing these OK lens-related AK cases. We found that the most common risk factors were rinsing the lenses or lens cases with tap water. Prompt and accurate diagnosis along with adequate amoebicidal treatment are essential to ensure desirable outcomes for OK lens wearers who develop AK. Appropriate OK lens parameters and regular checkups are also important.
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Affiliation(s)
- Jinfang Wu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Huatao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Aoki T, Kitazawa K, Deguchi H, Sotozono C. Current Evidence for Corynebacterium on the Ocular Surface. Microorganisms 2021; 9:microorganisms9020254. [PMID: 33513871 PMCID: PMC7912348 DOI: 10.3390/microorganisms9020254] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
Corynebacterium species are commonly found in the conjunctiva of healthy adults and are recognized as non-pathogenic bacteria. In recent years, however, Corynebacterium species have been reported to be potentially pathogenic in various tissues. We investigated Corynebacterium species on the ocular surface and reviewed various species of Corynebacterium in terms of their antimicrobial susceptibility and the underlying molecular resistance mechanisms. We identified a risk for Corynebacterium-related ocular infections in patients with poor immunity, such as patients with diabetes or long-term users of topical steroids, and in those with corneal epithelial damage due to trauma, contact lens wear, lagophthalmos, and trichiasis. The predominant strain in the conjunctiva was C. macginleyi, and the species associated with keratitis and conjunctivitis were C. macginleyi, C. propinquum, C. mastitidis, C. pseudodiphtheriticum, C. accolens, C. striatum, C. xerosis, and C. bovis. Overall, Corynebacterium species present on the ocular surface were resistant to quinolones, whereas those in the nasal cavity were more susceptible. The prevalence of fluoroquinolone-resistant Corynebacterium has not changed in the past 10 years; however, Corynebacterium species remain susceptible to third-generation cephems. In conclusion, the use of third-generation cephems should be a reasonable and pragmatic approach for treatment of ocular infections caused by Corynebacterium species.
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23
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Oliverio GW, Spinella R, Postorino EI, Inferrera L, Aragona E, Aragona P. Safety and Tolerability of an Eye Drop Based on 0.6% Povidone-Iodine Nanoemulsion in Dry Eye Patients. J Ocul Pharmacol Ther 2020; 37:90-96. [PMID: 33370213 PMCID: PMC7984652 DOI: 10.1089/jop.2020.0085] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose: To evaluate safety and tolerability on the ocular surface of an anti-septic formulation containing 0.6% povidone–iodine (0.6% PVI) for a 4 week period. Methods: An observational, prospective study included 20 mild-moderate dry eye disease (DED) patients who enrolled at the Ocular Surface Disease Unit of the University of Messina, receiving 0.6% PVI eye drops for 28 days, 2 drops twice daily (BID). The assessment included the Ocular Surface Disease Index questionnaire; symptoms score (0 = absent to 3 = severe) for burning, ocular dryness, foreign body sensation, watery eyes, tearing, photophobia, and ocular pain; fluorescein tear break-up time (TBUT); and corneal-conjunctival staining, performed at baseline (T0), after 7 (T7) and 28 (T28). Schirmer I-test, corneal endothelial cell count, intraocular pressure, and fundus examination were performed at T0 and T28. The main outcome measures were TBUT and corneal-conjunctival staining as markers of ocular surface homeostasis. For statistical analysis, Student's T-test and Wilcoxon test were used as appropriate. Results: No significant alterations of the safety parameters were found throughout the study. Further, at T28 a significant improvement of burning, ocular dryness, foreign body sensation, and watery eyes (T0 vs. T28 P < 0.03) were observed; corneal-conjunctival staining improved at T28 (T0 vs. T28 P < 0.0001), and TBUT improved already at T7 (T0 vs. T7 P = 0.0008) lasting so till the end of the study. The only adverse event was mild burning at instillation for the first 3 days of treatment in most of the patients. Conclusions: The treatment with 0.6% PVI was safe and well tolerated in a group of patients with a damaged ocular surface.
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Affiliation(s)
| | - Rosaria Spinella
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Elisa Imelde Postorino
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Leandro Inferrera
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Emanuela Aragona
- Department of Ophthalmology, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Aragona
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
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24
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Effectiveness and Safety of Topical Chlorhexidine and Vitamin E TPGS in the Treatment of Acanthamoeba Keratitis: A Survey on 29 Cases. J Clin Med 2020; 9:jcm9113775. [PMID: 33238434 PMCID: PMC7700543 DOI: 10.3390/jcm9113775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022] Open
Abstract
This study aimed to test the effectiveness of a solution of chlorhexidine (CHX) and D-α-tocopheryl polyethylene glycol succinate (Vitamin E TPGS or TPGS) in the treatment of Acanthamoeba keratitis (AK) via a prospective, interventional case series study. Twenty-nine consecutive patients with AK were enrolled. At baseline, best-corrected visual acuity (BCVA), slit lamp examination, confocal microscopy, and polymerase chain reaction (PCR) were performed. Topical therapy with CHX 0.02% and VE-TPGS 0.2% was administered hourly/24 h for the first day, hourly in the daytime for the next three days, and finally, every two hours in the daytime up to one month. BCVA and ocular inflammation were recorded after two weeks, four weeks, and three months from baseline. Mean logMAR BCVA significantly improved at two weeks (0.78) compared to baseline (1.76), remaining stable over time (0.80 at four weeks, 0.77 at three months). Ocular inflammation improved in 14 eyes at 2 weeks, with further slow improvements in all cases. At three months, no patient had signs of corneal inflammation. The presence of corneal scars was first recorded at the two-week follow-up, with an enlargement at the four-week follow-up. At the three-month follow-up, 19 eyes still showed corneal opacities. In conclusion, the tested solution was shown to be effective for the treatment of AK. Furthermore, it might represent a good first-line treatment.
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Histone Deacetylase Inhibitors Enhance the Amoebicidal Effect of Low Concentration of Polyhexamethylene Biguanide by Inducing Apoptosis. Cornea 2020; 39:245-249. [PMID: 31724982 DOI: 10.1097/ico.0000000000002201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The aim of this study was to reduce the cytotoxicity and improve the amoebicidal effect of polyhexamethylene biguanide (PHMB) at low concentrations by combining it with histone deacetylase (HDAC) inhibitors. METHODS To reduce the cytotoxic effect on human corneal epithelial (HCE) cells, the concentration of PHMB was reduced to 0.0002%. To enhance the amoebicidal effect of PHMB, HDAC inhibitors such as suberoylanilide hydroxamic acid, MS275, or MC1568 were combined with it. Acanthamoeba and HCE cells were treated with 3 combinations to evaluate the amoebicidal and cytotoxic effects. Microscopy and fluorescence-activated cell sorting analysis were performed to investigate the apoptotic cell death of Acanthamoeba by these combinatorial treatments. RESULTS The low concentration of PHMB (0.0002%) alone demonstrated no cytopathic effects (CPEs) on HCE cells. Three combinatorial treatments using 0.0002% PHMB with 10 μM suberoylanilide hydroxamic acid, 10 μM MS275, or 10 μM MC1568 showed higher amoebicidal effects on A. castellanii trophozoites than PHMB alone. Fluorescence-activated cell sorting analysis confirmed that HDAC inhibitors increased the apoptotic cell death of Acanthamoeba. Mild CPEs were observed from HCE cells cotreated with PHMB and the HDAC inhibitors after 24 hours of exposure. CONCLUSIONS Combinatorial treatments showed high amoebicidal effects on Acanthamoeba and low CPEs on HCE cells, which suggests their potential application for Acanthamoeba keratitis treatment.
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Mencucci R, Favuzza E, Bottino P, Mazzantini C, Zanotto E, Pellegrini-Giampietro DE, Landucci E. A new ophthalmic formulation containing antiseptics and dexpanthenol: In vitro antimicrobial activity and effects on corneal and conjunctival epithelial cells. Exp Eye Res 2020; 201:108269. [PMID: 32980315 DOI: 10.1016/j.exer.2020.108269] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/01/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
Abstract
Antibiotic resistance is increasing even in ocular pathogens, therefore the interest towards antiseptics in Ophthalmology is growing. The aim of this study was to analyze the in vitro antimicrobial efficacy and the in vitro effects of an ophthalmic formulation containing hexamidine diisethionate 0.05%, polyhexamethylene biguanide (PHMB) 0.0001% disodium edetate (EDTA) 0.01%, dexpanthenol 5% and polyvinyl alcohol 1.25% (Keratosept, Bruschettini, Genova, Italy) on cultured human corneal and conjunctival cells. The in vitro antimicrobial activity was tested on Staphylococcus aureus, Methicillin-Resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Streptococcus pneumoniae, Streptococcus pyogenes and Streptococcus mitis. For each microbial strain 10 μL of a 0.5 MacFarland standardized bacterial inoculum were incubated at 25 °C with 100 μL of ophthalmic solution for up to 6 h. After different periods of time, samples were inoculated on blood agar with 5% sheep blood. Moreover, a 0.5 MacFarland bacterial inoculum was seeded in triplicate on Mueller-Hinton Agar or on Mueller-Hinton Fastidious Agar; then a cellulose disc soaked with 50 μL of ophthalmic solution was applied on the surface of agar and plates were incubated for 18 h at 37 °C, in order to evaluate the inhibition of bacterial growth around the disc. Human corneal and conjunctival epithelial cells in vitro were incubated for 5, 10 and 15 min with Keratosept or its components. The cytotoxicity was assessed through the release of cytoplasmic enzyme lactate dehydrogenase (LDH) into the medium immediately after exposure to the drugs; the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was performed to evaluate the metabolic cell activity. Our results show that Keratosept ophthalmic solution gave an average logarithmic (log) reduction of bacterial load of 2.14 ± 0.35 within 6 h of exposure (p-value < 0.05 versus control saline solution). On agar plates, all microbial strains, excluding P. Aeruginosa, showed an inhibition zone of growth around the Keratosept-soaked discs. Keratosept and its components after 5 and 10 min did not show any cytotoxic effect on cultured corneal and conjunctival cells, and only after 15 min a significant reduction of cell viability and an increase of cytotoxicity compared to control (vehicle) was seen; dexpanthenol 5% and polyvinyl alcohol accelerated the wounding of corneal cells in vitro. In conclusion, Keratosept showed good antimicrobial activity on the tested strains; the ophthalmic solution and its components were safe and non-toxic for the corneal and conjunctival epithelial cells for 5 and 10 min at the concentrations analyzed, and dexpanthenol 5% and polyvinyl alcohol promoted the wounding of corneal cells.
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Affiliation(s)
- Rita Mencucci
- Eye Clinic, Department of Neurosciences, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Eleonora Favuzza
- Eye Clinic, Department of Neurosciences, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Paolo Bottino
- AOU Città della Salute e della Scienza di Torino, Microbiology and Virology Unit, Turin, Italy.
| | - Costanza Mazzantini
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
| | - Elisa Zanotto
- AOU Città della Salute e della Scienza di Torino, Microbiology and Virology Unit, Turin, Italy.
| | - Domenico E Pellegrini-Giampietro
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
| | - Elisa Landucci
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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A Novel Vitamin E TPGS-Based Formulation Enhances Chlorhexidine Bioavailability in Corneal Layers. Pharmaceutics 2020; 12:pharmaceutics12070642. [PMID: 32650410 PMCID: PMC7407793 DOI: 10.3390/pharmaceutics12070642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023] Open
Abstract
Keratitis is a severe condition characterized by inflammation of the cornea following a local trauma. The most common ocular disease is the bacterial one, which requires an antibiotic treatment. The major limitation of this therapy is the resistance of the antibiotic. For this reason, alternative procedures have been developed and consist of antimicrobial molecules. One of the most used is the chlorhexidine gluconate, which has shown activity versus Gram-positive and Gram-negative bacteria and fungi. In addition to its efficiency, chlorhexidine shows low toxicity levels for mammalian cells and is a low-cost molecule. Despite its multiple benefits, chlorhexidine, if used at concentrations higher than 0.02% (w/w), can cause local eye irritation. Additionally, its poor penetrability through the cornea makes necessary frequent instillation of eye drops for a prolonged time. Due to these limitations, alternative drug delivery strategies are required. Here, we report a novel formulation based on the combination of d-alpha-tocopherol polyethylene glycol 1000 succinate with chlorhexidine, which results in higher accumulation of the drug in human corneas measured by liquid chromatography and strong antimicrobial activity. Moreover, this formulation does not cause any toxic effect on human cells and is well tolerated by rabbit eyes. Therefore this novel formulation represents a good candidate for the treatment of keratitis that overcomes the risk of antibiotic resistance.
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28
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An Original Use of a Bioluminescence Assay to Test the In Vitro Efficacy of Polihexanide in the Eradication of Acanthamoeba Cysts. Cornea 2020; 39:892-897. [DOI: 10.1097/ico.0000000000002308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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In Vitro Amoebicidal Activity of Imidazolium Salts Against Trophozoites. Acta Parasitol 2020; 65:317-326. [PMID: 31939031 DOI: 10.2478/s11686-019-00161-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 12/16/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Several strains of the free-living genus Acanthamoeba can cause granulomatous amoebic encephalitis (GAE), a rare chronic and slowly progressive infection of the central nervous system (CNS), and Acanthamoeba keratitis (AK), a sight-threatening eye infectious disease. AK incidence has increased with the popularization of the contact lens wear and its treatment is currently limited and frequently unsuccessful. As imidazolium salts (IS), cationic imidazole derivatives, have promising antimicrobial potential. MATERIALS AND METHODS The present study evaluated the amoebicidal activity of four IS; 1-n-hexadecyl-3-methylimidazolium methanesulfonate (C16MImMeS), chloride (C16MImCl) and bis (triluoromethylsulfonyl) imide (C16MImNTf2 ), and 1-methyl-3-n-octadecylimidazolium chloride (C18MImCl), against the Acanthamoeba castellanii (ATCC30010) environmental strain and a clinical isolate (genotype T4). RESULTS Three IS showed being lethal to 100% of the Acanthamoeba trophozoites at the minimum inhibitory concentrations of 125 and 62.5 μg/mL (C16MImMeS), 31.25 and 62.5 μg/mL (C16MImCl), and 125 and 125 μg/mL (C18MImCl) for ATCC30010 and isolate T4, respectively. C16MImNTf2 did not demonstrate amoebicidal activity. All active IS caused the hemolysis of erythrocytes. The cytotoxic effect of the IS was tested in RAW macrophages and human brain microvascular endothelial cells, which demonstrated cytotoxicity in all concentrations tested against both cell lines. As a consequence, these IS with amoebicidal activity presented low selectivity index values (SI) (SI < 1.0), demonstrating lack of parasite selectivity. CONCLUSION Thus, C16MImMeS, C16MImCl, and C18MImCl seem to hold greater promise as components for contact lens cleaning and disinfection solutions, instead of direct human application.
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Khurana S, Sharma M. Parasitic keratitis - An under-reported entity. Trop Parasitol 2020; 10:12-17. [PMID: 32775286 PMCID: PMC7365502 DOI: 10.4103/tp.tp_84_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/12/2020] [Accepted: 01/20/2020] [Indexed: 11/04/2022] Open
Abstract
Parasitic keratitis (PK) is unique entity among parasitic infections where corneal involvement could result from direct inoculation of the parasite via exogenous environment or spread via endogenous neighboring organs or as a result of immune-mediated damage secondary to a systemic parasitic infection. Most cases of PK are caused by Acanthamoeba spp. and Microsporidia spp. though few other parasitic agents can also lead to corneal involvement. Mimicking as other infectious and non-infectious causes of keratitis, PK often escapes detection. This review summarizes the predominant causes of PK along with the epidemiological, clinical and microbiological details of each. Though several gaps exist in our understanding of the prevalence of PK, the one thing for sure is that PK is on the rise. With advanced diagnostic modalities and enough literature on optimal management of cases of PK, it is now imperative that a strong clinical suspicion of PK is kept when examining a case of corneal pathology and adequate investigations are ordered.
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Affiliation(s)
- Sumeeta Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Chao M, Thongseesuksai T, Boonmars T, Laummaunwai P. Investigation of the in vitro cysticidal activity of miltefosine against Acanthamoeba spp. J Parasit Dis 2020; 44:491-495. [PMID: 32508430 DOI: 10.1007/s12639-020-01204-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 02/05/2020] [Indexed: 10/25/2022] Open
Abstract
The present study evaluated the in vitro efficacy of miltefosine against cysts of Acanthamoeba spp. belonging to genotypes T3, T4 and T5. Each genotype was incubated with miltefosine at the concentration of 2.42, 4.84, 9.68, 19.36, 38.72 and 77.44 mM for different periods; 1, 3, 5, 7 d at 37 °C. The viability was assessed by staining with 0.4% trypan blue and culturing on NNA medium at 30 °C for 1 month. The results showed 100% eradication of cyst stage of all concentrations, but exhibited a different degree of activity against different genotypes. The MCC of 38.72 mM could kill genotype T4 and T5 after 1 d of incubation, whereas the killing of T3 needed MCC of 77.44 mM at the same incubation time. Miltefosine showed statistically highly significant difference (P < 0.001) in comparison to non-treated control. Although our finding needs to confirm in animal models, this information may be the guideline for optimizing therapy or considered to combine with the other drugs for effective treatment.
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Affiliation(s)
- Malin Chao
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Thidarut Boonmars
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Neglected, Zoonosis and Vector-Borne Disease Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Porntip Laummaunwai
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Neglected, Zoonosis and Vector-Borne Disease Research Group, Khon Kaen University, Khon Kaen, Thailand
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Combination of tert-butyl hydroperoxide with vorinostat induces cell death of Acanthamoeba through cell cycle arrest. Exp Parasitol 2020; 210:107833. [PMID: 31935358 DOI: 10.1016/j.exppara.2020.107833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/06/2019] [Accepted: 01/10/2020] [Indexed: 11/20/2022]
Abstract
Safety precautions prior to contact lens usage is essential for preventing Acanthamoeba keratitis. Contact lens disinfecting solutions containing 3% hydrogen peroxide (H2O2) are known to exert amoebicidal effect against Acanthamoeba. Yet, these solutions need to be neutralized to prevent ocular irritation, which consequently may result in incomplete disinfection. In this study, amoebicidal effect of tert-butyl hydroperoxide (tBHP) was investigated and its efficacy was compared to those of hydrogen peroxide (H2O2). H2O2 and tBHP showed dose dependent amoebicidal effect, however high concentration of these compounds demonstrated cytotoxicity in human corneal epithelial (HCE) cells. To reduce their cytotoxicity, the concentrations of both compounds were diluted to 50 μM and subsequently combined with 10 μM vorinostat to enhance amoebicidal effect. Addition of vorinostat induced high amoebicidal effect against Acanthamoeba trophozoites, even at low concentrations of H2O2 or tBHP. Cellular damage induced by combined treatment of H2O2 or tBHP with vorinostat in Acanthamoeba were determined by assessing cell cycle arrest and apoptosis via FACS analysis. While 50 μM H2O2 combined with 10 μM vorinostat showed 36.26% cytotoxicity on HCE cells during 24 h exposure, 50 μM tBHP with 10 μM vorinostat did not show cytotoxicity on HCE cells. These findings suggest that the application of tBHP and vorinostat for Acanthamoeba keratitis treatment and contact lens disinfection system is highly plausible.
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Kératites interstitielles : prise en charge diagnostique et thérapeutiques. J Fr Ophtalmol 2020; 43:80-89. [DOI: 10.1016/j.jfo.2018.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022]
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34
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Papa V, Rama P, Radford C, Minassian DC, Dart JKG. Acanthamoeba keratitis therapy: time to cure and visual outcome analysis for different antiamoebic therapies in 227 cases. Br J Ophthalmol 2019; 104:575-581. [PMID: 31401556 DOI: 10.1136/bjophthalmol-2019-314485] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 11/03/2022]
Abstract
AIMS To test the hypothesis that Acanthamoeba keratitis (AK) outcomes differ for different topical antiamoebic therapies (AAT) and to provide the detailed patient outcome data. METHODS A retrospective cohort study of 227 patients developing AK between 25 July 1991 and 10 August 2012. Inclusion criteria required a complete record of AAT treatment for both the primary outcome of a medical cure rate at 12 months and the secondary outcome of Snellen visual acuity ≤6/24 and/or surgical intervention. Analysis used multivariable regression to control for differences in baseline disease characteristics for both primary and secondary outcomes with unadjusted analyses for other outcomes. Subjects were categorised for analysis both by the AAT used at baseline and also by mutually exclusive AAT (patients exposed to all the drugs in each group, and no others, for some period). AAT categories were PHMB monotherapy, PHMB+diamidine, PHMB+chlorhexidine+diamidine, diamidine monotherapy and other AAT. RESULTS Analysis by baseline AAT showed no notable difference between treatments for both a medical cure at 12 months in 60.79% (138/227) or for a poor outcome in 49.34% (112/227). When AATs were analysed by mutually exclusive groups, PHMB monotherapy provided the best outcomes. These findings are subject to bias requiring careful interpretation. Overall cure rates for the 214 subjects with resolved outcomes were 94.27% (214/227), median time to cure 5 months (IQR 3.25-9.00 months) and range 1-26.24 months. CONCLUSION PHMB 0.02% monotherapy for the initial treatment of AK is as effective as biguanide+diamidine combination therapy. Chlorhexidine monotherapy was too infrequent for comparison. The outcome data are the most detailed available.
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Affiliation(s)
| | - Paolo Rama
- Ophthalmol Cornea and Ocular Surface Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Cherry Radford
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - John K G Dart
- Corneal & External Diseaae, Moorfields Eye Hospital NHS Foundation Trust, London, UK .,Ocular Biology & Therapeutics, UCL Institute of Ophthalmology, London, UK
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35
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Evaluation of Oxasqualenoids from the Red Alga Laurencia viridis against Acanthamoeba. Mar Drugs 2019; 17:md17070420. [PMID: 31331002 PMCID: PMC6669608 DOI: 10.3390/md17070420] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 01/05/2023] Open
Abstract
Acanthamoeba genus is a widely distributed and opportunistic parasite with increasing importance worldwide as an emerging pathogen in the past decades. This protozoan has an active trophozoite stage, a cyst stage, and is dormant and very resistant. It can cause Acanthamoeba keratitis, an ocular sight-threatening disease, and granulomatous amoebic encephalitis, a chronic, very fatal brain pathology. In this study, the amoebicidal activity of sixteen Laurencia oxasqualenoid metabolites and semisynthetic derivatives were tested against Acanthamoeba castellanii Neff. The results obtained point out that iubol (3) and dehydrothyrsiferol (1) possess potent activities, with IC50 values of 5.30 and 12.83 µM, respectively. The hydroxylated congeners thyrsiferol (2) and 22-hydroxydehydrothyrsiferol (4), active in the same value range at IC50 13.97 and 17.00 µM, are not toxic against murine macrophages; thus, they are solid candidates for the development of new amoebicidal therapies.
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Magistrado-Coxen P, Aqeel Y, Lopez A, Haserick JR, Urbanowicz BR, Costello CE, Samuelson J. The most abundant cyst wall proteins of Acanthamoeba castellanii are lectins that bind cellulose and localize to distinct structures in developing and mature cyst walls. PLoS Negl Trop Dis 2019; 13:e0007352. [PMID: 31095564 PMCID: PMC6541295 DOI: 10.1371/journal.pntd.0007352] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/29/2019] [Accepted: 04/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background Acanthamoeba castellanii, which causes keratitis and blindness in under-resourced countries, is an emerging pathogen worldwide, because of its association with contact lens use. The wall makes cysts resistant to sterilizing reagents in lens solutions and to antibiotics applied to the eye. Methodology/Principal findings Transmission electron microscopy and structured illumination microscopy (SIM) showed purified cyst walls of A. castellanii retained an outer ectocyst layer, an inner endocyst layer, and conical ostioles that connect them. Mass spectrometry showed candidate cyst wall proteins were dominated by three families of lectins (named here Jonah, Luke, and Leo), which bound well to cellulose and less well to chitin. An abundant Jonah lectin, which has one choice-of-anchor A (CAA) domain, was made early during encystation and localized to the ectocyst layer of cyst walls. An abundant Luke lectin, which has two carbohydrate-binding modules (CBM49), outlined small, flat ostioles in a single-layered primordial wall and localized to the endocyst layer and ostioles of mature walls. An abundant Leo lectin, which has two unique domains with eight Cys residues each (8-Cys), localized to the endocyst layer and ostioles. The Jonah lectin and glycopolymers, to which it binds, were accessible in the ectocyst layer. In contrast, Luke and Leo lectins and the glycopolymers, to which they bind, were mostly inaccessible in the endocyst layer and ostioles. Conclusions/Significance The most abundant A. castellanii cyst wall proteins are three sets of lectins, which have carbohydrate-binding modules that are conserved (CBM49s of Luke), newly characterized (CAA of Jonah), or unique to Acanthamoebae (8-Cys of Leo). Cyst wall formation is a tightly choreographed event, in which lectins and glycopolymers combine to form a mature wall with a protected endocyst layer. Because of its accessibility in the ectocyst layer, an abundant Jonah lectin is an excellent diagnostic target. A half century ago, investigators identified cellulose in the Acanthamoeba cyst wall, which has two layers and conical ostioles that connect them. Here we showed cyst walls contain three large sets of cellulose-binding lectins, which localize to the ectocyst layer (a Jonah lectin) or to the endocyst layer and ostioles (Luke and Leo lectins). We used the lectins to establish a sequence for cyst wall assembly when trophozoites are starved and encyst. In the first stage, a Jonah lectin and glycopolymers were present in dozens of distinct vesicles. In the second stage, a primordial wall contained small, flat ostioles outlined by a Luke lectin. In the third stage, a Jonah lectin remained in the ectocyst layer, while Luke and Leo lectins moved to the endocyst layer and ostioles. A description of the major events during cyst wall development is a starting point for mechanistic studies of its assembly.
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Affiliation(s)
- Pamela Magistrado-Coxen
- Department of Molecular and Cell Biology, Boston University Goldman School of Dental Medicine, Boston, Massachusetts, United States of America
| | - Yousuf Aqeel
- Department of Molecular and Cell Biology, Boston University Goldman School of Dental Medicine, Boston, Massachusetts, United States of America
| | - Angelo Lopez
- Department of Molecular and Cell Biology, Boston University Goldman School of Dental Medicine, Boston, Massachusetts, United States of America
- Department of Biochemistry, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - John R. Haserick
- Department of Molecular and Cell Biology, Boston University Goldman School of Dental Medicine, Boston, Massachusetts, United States of America
- Department of Biochemistry, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Breeanna R. Urbanowicz
- Complex Carbohydrate Research Center, University of Georgia, Athens, Georgia, United States of America
| | - Catherine E. Costello
- Department of Biochemistry, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - John Samuelson
- Department of Molecular and Cell Biology, Boston University Goldman School of Dental Medicine, Boston, Massachusetts, United States of America
- * E-mail:
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Teuchner B, Wibmer ID, Schaumann P, Seifarth C, Walochnik J, Nagl M. N-chlorotaurine Inactivates Acanthamoeba and Candida albicans in the Porcine Ex Vivo Corneal Infection Model. Cornea 2019; 38:1011-1016. [DOI: 10.1097/ico.0000000000001927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Box Behnken design of siRNA-loaded liposomes for the treatment of a murine model of ocular keratitis caused by Acanthamoeba. Colloids Surf B Biointerfaces 2018; 173:725-732. [PMID: 30384269 DOI: 10.1016/j.colsurfb.2018.10.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/22/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
Abstract
Acanthamoeba keratitis is an ophthalmic disease with no specific treatment that specially affects contact lens users. The silencing of serine phosphatase (SP) and glycogen phosphorylase (GP) proteins produced by Acanthamoeba has been shown to significantly reduce the cytopathic effect, although no vehicle was proposed yet to deliver the siRNA sequences to the trophozoites. In this study, PEGylated cationic liposomes were proposed and optimized using Box-Behnken design. The influence of DOTAP:DOPE ratio, DSPE-PEG concentration, and siRNA/DOTAP charge ratio were evaluated over both biological response and physicochemical properties of liposomes. The ratio of DOTAP:DOPE had an effect in the trophozoite activity whereas the charge ratio influenced both size and protease activity. The predicted values were very close to the observed values, yielding a formulation with good activity and toxicity profile, which was used in the following experiments. A murine model of ocular keratitis was treated with siGP + siSP-loaded liposomes, as well as their respective controls, and combined treatment of liposomes and chlorhexidine. After 15 days of eight daily administrations, the liposomal complex combined with chlorhexidine was the only treatment able to reverse the more severe lesions associated with keratitis. There was 60% complete regression in corneal damage, with histological sections demonstrating the presence of an integral epithelium, without lymphocytic infiltrate. The set of results demonstrate the efficacy of a combined therapy based on siRNA with classical drugs for a better prognosis of keratitis caused by Acanthamoeba.
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Contact lens-related polymicrobial keratitis: Acanthamoeba spp. genotype T4 and Candida albicans. Parasitol Res 2018; 117:3431-3436. [PMID: 30094541 DOI: 10.1007/s00436-018-6037-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
A 31-year-old female daily user of contact lenses sought medical attention, reporting blurred vision and irritation of the left eye. Slit-lamp examination revealed hyperemia and an irregular corneal epithelium surface, and empirical treatment was started. A corneal scrape was obtained and examined for the presence of fungi, bacteria, and Acanthamoeba spp. The results of the microbial culture revealed growth of Acanthamoeba spp. and Candida albicans. The Acanthamoeba isolate was characterized by cyst morphology as belonging to group II according to Pussard and Pons. Sequencing of the diagnostic fragment 3 (DF3) region located on the 18S ribosomal DNA identified the isolate as genotype T4. The patient was treated with chlorhexidine 0.02% and polyhexamethylene biguanide (PHMB) 0.02% drops for 5 months until the infection resolved. Lately, rare cases of polymicrobial keratitis associated with Acanthamoeba and Candida albicans have been reported. Cases of co-infection are more difficult to treat, since the specific treatment depends on precise identification of the agents involved.
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Alfonso-Muñoz EA, Roig-Revert MJ, Fernández-López E, Hernández-Díaz M, Araujo-Miranda R, Peris-Martínez C. A report of 10 patients with Acanthamoeba keratitis. ACTA ACUST UNITED AC 2018; 93:497-502. [PMID: 29885816 DOI: 10.1016/j.oftal.2018.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/30/2018] [Accepted: 04/04/2018] [Indexed: 11/18/2022]
Abstract
CLINICAL CASES Cases are presented of 10 patients with Acanthamoeba keratitis treated between 2008 and 2017. All were contact lens wearers. All of them received treatment with a biguanide combined with a diamidine. In 3 cases the infestation did not exceed the superficial stroma, responding to topical treatment. In 7, the infection reached the deep stroma, with 6 of these cases requiring penetrating keratoplasty (PKP), 3 of them therapeutic PKP because of perforation risk or ocular spreading. The visual acuity improved in all the cases. CONCLUSION The infestation depth at the time of diagnosis appears to be the main risk factor for requiring a PKP.
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Affiliation(s)
- E A Alfonso-Muñoz
- FISABIO-Oftalmología Médica (FOM), Unidad de Córnea y Enfermedades del Segmento Anterior, Valencia, España.
| | - M J Roig-Revert
- FISABIO-Oftalmología Médica (FOM), Unidad de Córnea y Enfermedades del Segmento Anterior, Valencia, España
| | - E Fernández-López
- FISABIO-Oftalmología Médica (FOM), Unidad de Córnea y Enfermedades del Segmento Anterior, Valencia, España
| | - M Hernández-Díaz
- FISABIO-Oftalmología Médica (FOM), Unidad de Córnea y Enfermedades del Segmento Anterior, Valencia, España
| | - R Araujo-Miranda
- FISABIO-Oftalmología Médica (FOM), Unidad de Córnea y Enfermedades del Segmento Anterior, Valencia, España
| | - C Peris-Martínez
- FISABIO-Oftalmología Médica (FOM), Unidad de Córnea y Enfermedades del Segmento Anterior, Valencia, España
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The Brief Case: A "Fresh" Pair of Contact Lenses. J Clin Microbiol 2018; 56:56/5/e00790-17. [PMID: 29695542 DOI: 10.1128/jcm.00790-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Taravaud A, Loiseau PM, Pomel S. In vitro evaluation of antimicrobial agents on Acanthamoeba sp. and evidence of a natural resilience to amphotericin B. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2017; 7:328-336. [PMID: 28918001 PMCID: PMC5604952 DOI: 10.1016/j.ijpddr.2017.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 09/01/2017] [Accepted: 09/07/2017] [Indexed: 12/11/2022]
Abstract
The free-living amoeba (FLA) Acanthamoeba sp. is an opportunistic pathogen that can cause amoebic keratitis (AK) or granulomatous amoebic encephalitis (GAE). While current treatments of AK are long with some relapses, no consensus therapy has been developed for GAE remaining lethal in 90% of the cases. In this context, efficient antiacanthamoebal drugs have to be identified. In this work, 15 drugs used in the treatment of AK or GAE or in other parasitic diseases were evaluated for their in vitro activity on A. castellanii. Hexamidine, voriconazole and clotrimazole exhibited the highest activities with IC50 values at 0.05 μM, 0.40 μM and 0.80 μM, respectively, while rifampicin, metronidazole and cotrimoxazole were inactive. Among 15 drug associations evaluated, no synergistic effect was observed, and one antagonism was determined between hexamidine and chlorhexidine. Interestingly, amphotericin B was the only drug presenting an increase of IC50 as a function of treatment duration. The amoebae susceptibility to amphotericin B cultured in the presence of 250 μM of the drug was similar to the one of a naive control, revealing that no resistant strain could be selected. However, the amoebae susceptibility always returned to an initial level at each passage. This natural and non-acquired adaptation to amphotericin B, qualified as resilience, was observed in several strains of A. castellanii and A. polyphaga. Using a pharmacological approach with effectors of different cellular mechanisms or transports, and an ultrastructural analysis of amphotericin B-treated amoebae, the involvement of several mitochondria-dependent pathways as well as multidrug resistant transporters was determined in amphotericin B resilience. Based on the observations from this study, the relevance of using amphotericin B in GAE treatments may be reconsidered, while the use of some other drugs, such as rifampicin or cotrimoxazole, is not relative to intrinsic antiacanthamoebal activity. In vitro evaluation of 15 antimicrobial agents on Acanthamoeba castellanii. Best activity for hexamidine and inefficiency of rifampicin and cotrimoxazole. Antagonism of the combination chlorhexidine/hexamidine. Natural resilience of Acanthamoeba sp. for amphotericin B. Involvement of mitochondria-dependent pathways and MDR in amphotericin B resilience.
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Affiliation(s)
- Alexandre Taravaud
- Chimiothérapie Antiparasitaire, UMR CNRS 8076, BioCIS, Université Paris-Sud, Université Paris-Saclay, 5 rue Jean-Baptiste Clément, 92290 Châtenay-Malabry, France
| | - Philippe M Loiseau
- Chimiothérapie Antiparasitaire, UMR CNRS 8076, BioCIS, Université Paris-Sud, Université Paris-Saclay, 5 rue Jean-Baptiste Clément, 92290 Châtenay-Malabry, France
| | - Sébastien Pomel
- Chimiothérapie Antiparasitaire, UMR CNRS 8076, BioCIS, Université Paris-Sud, Université Paris-Saclay, 5 rue Jean-Baptiste Clément, 92290 Châtenay-Malabry, France.
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Sant'Ana VP, Foronda AS, de Freitas D, Carrijo-Carvalho LC, de Souza Carvalho FR. Sensitivity of Enzymatic Toxins from Corneal Isolate of Acanthamoeba Protozoan to Physicochemical Parameters. Curr Microbiol 2017; 74:1316-1323. [PMID: 28755026 DOI: 10.1007/s00284-017-1319-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 07/25/2017] [Indexed: 11/30/2022]
Abstract
Acanthamoeba is a free-living amoeba that causes severe corneal infection (Acanthamoeba keratitis) and produces a variety of extracellular enzymes, called exoproteome. Since physicochemical characters are suggested being associated with therapeutic profile and clinical severity of the infection, we investigated the physicochemical properties of proteolysis mediated by amoebic exoproteome. Corneal scraping was collected from a patient who showed typical symptoms of acute Acanthamoeba keratitis. Axenic amoeba was phylogenetically identified by 18S rDNA sequencing analysis. Effects of pH, temperature and diamidines on proteolysis mediated by exoproteome were assessed using zymography assays. Proteolytic enzymes were most active at pH 7.0 and 37 °C. Calcium ions decreased enzymatic activity. The main components of amoebic exoproteome were characterized as serine proteases. We demonstrated for the first time that commercial antimicrobial diamidines used for Acanthamoeba keratitis therapy inhibit enzymatic activity of amoebic exoproteome. Results showed the thermostability of Acanthamoeba proteases, which suggest a long-term effect of these virulence factors at the central and peripheral cornea with possible role in degradation of extracellular matrix components. Our findings open new perspectives about the complementary and unreported properties of antimicrobial compounds of the diamidine class on the inhibition of enzymatic activity and presumptive control of amoebic infection in the cornea.
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Affiliation(s)
- Viviane P Sant'Ana
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo, Botucatu Street, 821, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil
| | - Annette S Foronda
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo, Botucatu Street, 821, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil
| | - Denise de Freitas
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo, Botucatu Street, 821, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil
| | - Linda C Carrijo-Carvalho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo, Botucatu Street, 821, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.,Centro Universitário do Espírito Santo (UNESC), Colatina, Espirito Santo, Brazil
| | - Fábio Ramos de Souza Carvalho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo, Botucatu Street, 821, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil. .,Centro Universitário do Espírito Santo (UNESC), Colatina, Espirito Santo, Brazil.
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