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Kamath MM, Adams EM, Lightfoot JD, Wells BL, Fuller KK. The mammalian Ire1 inhibitor, 4μ8C, exhibits broad anti- Aspergillus activity in vitro and in a treatment model of fungal keratitis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.08.08.607189. [PMID: 39149375 PMCID: PMC11326231 DOI: 10.1101/2024.08.08.607189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Objective The fungal unfolded protein response consists of a two-component relay in which the ER-bound sensor, IreA, splices and activates the mRNA of the transcription factor, HacA. Previously, we demonstrated that hacA is essential for Aspergillus fumigatus virulence in a murine model of fungal keratitis (FK), suggesting the pathway could serve as a therapeutic target. Here we investigate the antifungal properties of known inhibitors of the mammalian Ire1 protein both in vitro and in a treatment model of FK. Methods The antifungal activity of Ire1 inhibitors was tested against conidia of several A. fumigatus isolates by a microbroth dilution assay and against fungal biofilm by XTT reduction. The influence of 4μ8C on hacA mRNA splicing in A. fumigatus was assessed through gel electrophoresis and qRT-PCR of UPR regulatory genes. The toxicity and antifungal profile of 4μ8C in the cornea was assessed by applying drops to uninfected or A. fumigatus-infected corneas 3 times daily starting 4 hours post-inoculation. Corneas were evaluated daily through slit-lamp imaging and optical coherence tomography, or at endpoint through histology or fungal burden quantification via colony forming units. Results Among six Ire1 inhibitors screened, the endonuclease inhibitor 4μ8C displayed the strongest antifungal profile with an apparent fungicidal action. The compound both blocked conidial germination and hyphal metabolism of A. fumigatus Af293 in the same concentration range that blocked hacA splicing and UPR gene induction (60-120 μM). Topical treatment of sham-inoculated corneas with 0.5 and 2.5 mM 4μ8C did not impact corneal clarity, but did transiently inhibit epithelialization of corneal ulcers. Relative to vehicle-treated Af293-infected corneas, treatment with 0.5 and 2.5 mM drug resulted in a 50% and >90% reduction in fungal load, respectively, the latter of which corresponded to an absence of clinical signs of infection or corneal pathology. Conclusion The in vitro data suggest that 4μ8C displays antifungal activity against A. fumigatus through the specific inhibition of IreA. Topical application of the compound to the murine cornea can furthermore block the establishment of infection, suggesting this class of drugs can be developed as novel antifungals that improve visual outcomes in FK patients.
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Affiliation(s)
- Manali M. Kamath
- Department of Microbiology & Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Emily M. Adams
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jorge D. Lightfoot
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Becca L. Wells
- Department of Microbiology & Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Kevin K. Fuller
- Department of Microbiology & Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Voinescu A, Licker M, Muntean D, Musuroi C, Musuroi SI, Izmendi O, Vulpie S, Jumanca R, Munteanu M, Cosnita A. A Comprehensive Review of Microbial Biofilms on Contact Lenses: Challenges and Solutions. Infect Drug Resist 2024; 17:2659-2671. [PMID: 38947374 PMCID: PMC11214797 DOI: 10.2147/idr.s463779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 06/03/2024] [Indexed: 07/02/2024] Open
Abstract
Contact lenses (CL) have become an immensely popular means of vision correction, offering comfort to millions worldwide. However, the persistent issue of biofilm formation on lenses raises significant problems, leading to various ocular complications and discomfort. The aim of this review is to develop safer and more effective strategies for preventing and managing microbial biofilms on CL, improving the eye health and comfort of wearers. Taking these into consideration, the present study investigates the intricate mechanisms of biofilm formation, by exploring the interplay between microbial adhesion, the production of extracellular polymeric substances, and the properties of the lens material itself. Moreover, it emphasizes the diverse range of microorganisms involved, encompassing bacteria, fungi, and other opportunistic pathogens, elucidating their implications within lenses and other medical device-related infections and inflammatory responses. Going beyond the challenges posed by biofilms on CL, this work explores the advancements in biofilm detection techniques and their clinical relevance. It discusses diagnostic tools like confocal microscopy, genetic assays, and emerging technologies, assessing their capacity to identify and quantify biofilm-related infections. Finally, the paper delves into contemporary strategies and innovative approaches for managing and preventing biofilms development on CL. In Conclusion, this review provides insights for eye care practitioners, lens manufacturers, and microbiology researchers. It highlights the intricate interactions between biofilms and CL, serving as a foundation for the development of effective preventive measures and innovative solutions to enhance CL safety, comfort, and overall ocular health. Research into microbial biofilms on CL is continuously evolving, with several future directions being explored to address challenges and improve eye health outcomes as far as CL wearers are concerned.
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Affiliation(s)
- Adela Voinescu
- Doctoral School “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Clinical Laboratory, “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | - Monica Licker
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Clinical Laboratory, “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | - Delia Muntean
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Clinical Laboratory, “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | - Corina Musuroi
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Clinical Laboratory, “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | - Silvia Ioana Musuroi
- Doctoral School “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Oana Izmendi
- Doctoral School “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Silvana Vulpie
- Doctoral School “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Romanita Jumanca
- Romanian and Foreign Languages Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihnea Munteanu
- Department IX, Surgery and Ophthalmology “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrei Cosnita
- Department IX, Surgery and Ophthalmology “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
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Bisen AC, Mishra A, Agrawal S, Sanap SN, Biswas A, Verma SK, Bhatta RS. Codetermination of antimicrobial agents in rabbit tear fluid using LC-MS/MS assay: Insights into ocular pharmacokinetic study. JOURNAL OF MASS SPECTROMETRY : JMS 2024; 59:e5031. [PMID: 38726684 DOI: 10.1002/jms.5031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 08/24/2024]
Abstract
Managing ocular microbial infections typically requires pharmacotherapy using antibiotic eye drops, such as moxifloxacin hydrochloride (MFX), combined with an antifungal agent like amphotericin B (AB). We carried out and validated an LC-MS/MS assay to quantify these compounds in rabbit tear fluid in order to look into the pharmacokinetics of these two drugs. We employed a protein precipitation technique for the extraction of drugs under examination. A Waters Symmetry C18 column was used to separate the analytes and internal standard. The composition of the mobile phase was like (A) 0.1% v/v formic acid in water and (B) methanol. The detection of MFX and AB was accomplished through the utilization of positive ion electrospray ionization under multiple reaction monitoring mode. The linearity curves for both analytes exhibited an acceptable trendline across a concentration range of 2.34-300 ng/mL for MFX and 7.81-1000 ng/mL for AB in surrogate rabbit tear fluid. The lower limit of quantitation for MFX was 2.34 ng/mL, while for AB, it was 7.81 ng/mL. The approach was strictly validated, encompassing tests of selectivity, linearity (with r2 > 0.99), precision, accuracy, matrix effects, and stability. Consequently, we employed this method to evaluate the pharmacokinetics profiles of MFX and AB in rabbit tear fluid following single topical doses.
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Affiliation(s)
- Amol Chhatrapati Bisen
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Anjali Mishra
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Sristi Agrawal
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Sachin Nashik Sanap
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Arpon Biswas
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Sarvesh Kumar Verma
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Rabi Sankar Bhatta
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
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Rosenberg CR, Prajna V, Srinivasan MK, Lalitha PC, Krishnan T, Rajaraman R, Venugopal A, Acharya N, Seitzman GD, Rose-Nussbaumer J, Woodward MA, Lietman TM, Campbell JP, Keenan JD, Redd TK. Locality is the strongest predictor of expert performance in image-based differentiation of bacterial and fungal corneal ulcers from India. Indian J Ophthalmol 2024; 72:526-532. [PMID: 38454845 PMCID: PMC11149525 DOI: 10.4103/ijo.ijo_3396_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/21/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE This study sought to identify the sources of differential performance and misclassification error among local (Indian) and external (non-Indian) corneal specialists in identifying bacterial and fungal keratitis based on corneal photography. METHODS This study is a secondary analysis of survey data assessing the ability of corneal specialists to identify acute bacterial versus fungal keratitis by using corneal photography. One-hundred images of 100 eyes from 100 patients with acute bacterial or fungal keratitis in South India were previously presented to an international cohort of cornea specialists for interpretation over the span of April to July 2021. Each expert provided a predicted probability that the ulcer was either bacterial or fungal. Using these data, we performed multivariable linear regression to identify factors predictive of expert performance, accounting for primary practice location and surrogate measures to infer local fungal ulcer prevalence, including locality, latitude, and dew point. In addition, Brier score decomposition was used to determine experts' reliability ("calibration") and resolution ("boldness") and were compared between local (Indian) and external (non-Indian) experts. RESULTS Sixty-six experts from 16 countries participated. Indian practice location was the only independently significant predictor of performance in multivariable linear regression. Resolution among Indian experts was significantly better (0.08) than among non-Indian experts (0.01; P < 0.001), indicating greater confidence in their predictions. There was no significant difference in reliability between the two groups ( P = 0.40). CONCLUSION Local cornea experts outperformed their international counterparts independent of regional variability in tropical risk factors for fungal keratitis. This may be explained by regional characteristics of infectious ulcers with which local corneal specialists are familiar.
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Affiliation(s)
| | - Venkatesh Prajna
- Department of Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - Prajna C Lalitha
- Department of Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Tiru Krishnan
- Department of Ophthalmology, Aravind Eye Hospital, Pondicherry, Tamil Nadu, India
| | - Revathi Rajaraman
- Department of Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Anitha Venugopal
- Department of Ophthalmology, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Nisha Acharya
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Gerami D Seitzman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - John Peter Campbell
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Travis K Redd
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
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5
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Eleiwa TK, Youssef GH, Elsaadani IA, Abdelrahman SN, Khater AA. Debulking corneal biopsy with tectonic amniotic membrane transplantation in refractory clinically presumed fungal keratitis. Sci Rep 2024; 14:521. [PMID: 38177182 PMCID: PMC10767135 DOI: 10.1038/s41598-023-50987-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
The treatment of fungal keratitis (FK) is challenging due to the subacute indolent course, and initial misdiagnosis. In this retrospective case series, we highlight both the diagnostic and therapeutic roles of corneal biopsy together with amniotic membrane transplantation (AMT) in patients with refractory clinically presumed FK. Debulking biopsy and tectonic AMT were performed during the initial presentation. Biopsy specimens were sent for KOH smears and cultures. After KOH smears confirmed the presence of fungal elements, topical voriconazole 1% was prescribed for the first 72 h then tailored according to the clinical response and the culture results. The outcome measures were complete resolution of infection and restoration of corneal integrity. Cases associated with culture proven bacterial keratitis were excluded. Twelve cases were included in the study. KOH smears confirmed the presence of fungal growth in all specimens. Cultures grew Aspergillus in 6/12 cases, sensitive to voriconazole (5/6) and amphotericin (3/6); Fusarium (4/12), sensitive to both voriconazole and amphotericin; and no growth in 2/12 cases. Amphotericin 0.15% eye drops were added to the 7 cases with proven sensitivity and to the remaining 2 culture negative cases. Gradual resolution of infection was seen in all cases after 35.6 ± 7.8 days. In FK, a debulking biopsy simultaneously with AMT help decrease the microbial load, suppress the inflammatory process, support the corneal integrity, confirm the presence of fungal pathogen.
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Affiliation(s)
- Taher K Eleiwa
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University Hospitals, Benha University, Al-Sahaa Street, Diverted From Farid Nada St., Benha, 13511, Egypt.
| | - Gehad H Youssef
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University Hospitals, Benha University, Al-Sahaa Street, Diverted From Farid Nada St., Benha, 13511, Egypt
| | - Ibrahim Abdelkhalik Elsaadani
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University Hospitals, Benha University, Al-Sahaa Street, Diverted From Farid Nada St., Benha, 13511, Egypt
| | - Samar N Abdelrahman
- Department of Clinical Pathology, Benha University Hospitals, Benha University, Benha, Egypt
| | - Ahmed A Khater
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University Hospitals, Benha University, Al-Sahaa Street, Diverted From Farid Nada St., Benha, 13511, Egypt
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6
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Naeimi B, Safari F, Ahmadikia K, Ahmadipour MJ, Sadeghzadeh F, Kondori N, Ahmadi B. Screening Candida auris through a multiplex stepwise PCR algorithm directly from clinical samples of patients suspected of otomycosis in south of Iran; Detection of five cases. Mycoses 2024; 67:e13686. [PMID: 38214363 DOI: 10.1111/myc.13686] [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: 08/10/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Otomycosis is an infection of the external auditory canal caused by molds and yeasts with descending frequency. Laboratory diagnosis is usually confirmed by microscopy and culture. However, they are not specific enough to reliably differentiate the causative agents, especially for rare pathogens such as Candida auris. The purpose of the current study was to the molecular screening of C. auris species from direct clinical samples of patients with suspected otomycosis in Southern of Iran. MATERIALS AND METHODS A total of 221 ear aspirates collected from 221 patients with suspected otomycosis over a four-year period. All the ear aspirations were examined with pan-fungal primers, then those with a positive result was included in two separate reaction mixtures simultaneously to identify the most clinically relevant Aspergillus and Candida species. The validity of positive samples for C. auris was assessed by sequencing. RESULTS Of the 189 pan-fungal positive PCRs, 78 and 39 specimens contained Aspergillus spp. and Candida spp., respectively. Furthermore, 65 specimens showed simultaneous positive bands in both Candida and Aspergillus species-specific multiplex PCR including five samples/patients with positive result for C. auris (5/189; 2.6%). Four out of five cases with C. auris species-specific PCR were reconfirmed by sequencing, while none were positive for C. auris in culture. CONCLUSION Unfortunately, due to high treatment failure rates of antifungal classes against C. auris species, rapid and accurate identification of patients colonised with C. auris is critical to overcome the challenge of preventing transmission. This PCR assay can be successfully applied for rapid and accurate detection of C. auris directly in patient samples and is able to differentiate C. auris from closely related Candida species.
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Affiliation(s)
- Behrouz Naeimi
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Fatemeh Safari
- Department of Microbiology, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - Kazem Ahmadikia
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farzaneh Sadeghzadeh
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Nahid Kondori
- Department of Infectious Diseases, Institution of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bahram Ahmadi
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
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7
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Xie HT, Cheng SM, Wang JS, Xiao YT, Zhang MC. Botryosphaeria dothidea Mycotic Keratitis: A Novel Phytopathogen Causing Human Infection. Cornea 2024; 43:129-132. [PMID: 37733974 DOI: 10.1097/ico.0000000000003393] [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: 05/29/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE The aim of this study was to report the first case of mycotic keratitis caused by Botryosphaeria dothidea . METHODS A 29-year-old man developed a fungal infection after being hit with chestnut thorns in the left eye. In vivo confocal microscopy, microbial culture, and next-generation sequencing (NGS) were used in the diagnosis of mycotic keratitis. RESULTS The patient was provisionally diagnosed with mycotic keratitis based on IVCM and promptly received local and systemic antifungal treatment with voriconazole and amphotericin B. Although microbial culture failed to identify the pathogen, NGS revealed B. dothidea as the causative agent. Although the infection was quickly contained, corneal perforation still occurred. Owing to the lack of fresh donor corneas, the patient underwent multilayer amniotic membrane and conjunctival pedicle graft surgery. The infection was successfully controlled, and during the 6-month follow-up, the cornea remained clear in the inferotemporal optical zone. CONCLUSIONS We report a novel phytopathogen- B. dothidea -causing mycotic keratitis . Our case indicates that B. dothidea responds well to voriconazole and amphotericin therapy. This case broadens the spectrum of fungal keratitis and highlights the application of NGS in identifying molds.
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Affiliation(s)
- Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Shi-Ming Cheng
- Department of Ophthalmology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jia-Song Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Yu-Ting Xiao
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Ming-Chang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
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Ahmed MAEGES, Abbas HS, Kotakonda M. Fungal Diseases Caused by Serious Contamination of Pharmaceuticals and Medical Devices, and Rapid Fungal Detection Using Nano-Diagnostic Tools: A Critical Review. Curr Microbiol 2023; 81:10. [PMID: 37978091 PMCID: PMC10656328 DOI: 10.1007/s00284-023-03506-7] [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: 04/25/2023] [Accepted: 09/27/2023] [Indexed: 11/19/2023]
Abstract
Fungal-contaminated compounded pharmaceuticals and medical devices pose a public health problem. This review aimed to provide an organized overview of the literature on that critical issue. Firstly, it was found that compounding pharmacies can produce drugs that are contaminated with fungi, leading to outbreaks of severe fungal diseases. Secondly, inadequate sterile compounding techniques or storage conditions, or exceeding the limit of a fungal count, can result in fungal contamination. Lastly, nanotools can be used to rapidly detect fungi, thus improving fungal diagnostic procedures. To achieve this goal, we have reviewed the published data on PubMed, the CDC, and FDA Web sites, and a literature search was undertaken to identify severe fungal infections associated with compounding pharmacies outside of hospitals, limited by the dates 2003 to 2021. The "Preferred Reporting Items for Critical Reviews" were followed in searching, including, and excluding papers. Fungal outbreaks have been documented due to contaminated pharmaceuticals and medical devices. In 2013, 55 people died from fungal meningitis caused by contaminated steroid injections containing methylprednisolone acetate. Additionally, in 2021, Aspergillus penicillioides contamination was reported in ChloraPrep drugs, which was attributed to the storage conditions that were conducive to the growth of this fungus. These incidents have resulted in severe infectious diseases, such as invasive mycoses, cornea infections, Endophthalmitis, and intestinal and gastric mycosis. By implementing preventive measures and policies, it is possible to avoid these outbreaks. Creating Nano-diagnostics presents a major challenge, where promptly diagnosing fungal infections is required to determine the proper corrective and preventive measures.
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Affiliation(s)
- Mohamed Abd El-Gawad El-Sayed Ahmed
- Department of Microbiology and Immunology, Faculty of Pharmaceutical Science and Drug Manufacturing, Misr University for Science and Technology, Cairo, 6th of October City, Egypt
| | - Heba S Abbas
- Department of Microbiology and Immunology, Faculty of Pharmaceutical Science and Drug Manufacturing, Misr University for Science and Technology, Cairo, 6th of October City, Egypt.
- Microbiology Department, Egyptian Drug Authority, Previously National Organization for Drug Control and Research, Giza, Egypt.
| | - Muddukrishnaiah Kotakonda
- Department of Pharmaceutics, Jamia Salafiya Pharmacy College, Pulikkal, Malappuram District, Kerala, India
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9
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Bisen AC, Sanap SN, Biswas A, Agrawal S, Mishra A, Kumar M, Choudhury AD, R HG, Bhatta RS. A QbD-led simple and sensitive RP-UHPLC method for simultaneous determination of moxifloxacin, voriconazole, and pirfenidone: An application to pharmaceutical analysis. Biomed Chromatogr 2023; 37:e5681. [PMID: 37153940 DOI: 10.1002/bmc.5681] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
A novel, quick and precise RP-UHPLC analytical method for the simultaneous determination of moxifloxacin (MFX), voriconazole (VCZ) and pirfenidone (PIR) was developed and validated according to the International Conference on Harmonization guidelines using a QbD-driven response surface Box-Behnken design. The developed method was validated considering the selectivity, sensitivity, linearity, accuracy-precision, robustness, stability, limit of detection and limit of quantification, respectively. Resolution between MFX, VCZ and PIR was achieved using a gradient elution protocol against a Waters Symmetry Shield C18 column (150 × 4.6 mm2 , 5 μm) using an Agilent 1290, Infinity II series LC system. The method was applied to quantitatively estimate proprietary and in-house prepared pharmaceutical topical ophthalmic formulations containing MFX, VCZ and PIR at wavelength (λmax ) of 296, 260 and 316 nm. The method is sensitive enough to detect up to 0.1 ppm of analytes in the formulation. The method was further exploited to study and identify the possible degradation products of the analytes. The proposed chromatographic method is simple, economical, reliable and reproducible. In conclusion, the developed method could be applicable for routine quality control analysis of single or combined MFX, VCZ and PIR-containing units or bulk dosage forms in pharmaceutical industries and research organizations working on drug discovery and development.
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Affiliation(s)
- Amol Chhatrapati Bisen
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Sachin Nashik Sanap
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Arpon Biswas
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Sristi Agrawal
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Anjali Mishra
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Mukesh Kumar
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Abhijit Deb Choudhury
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Heamanth Ganesan R
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Rabi Sankar Bhatta
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
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10
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Berger T, Seitz B, Flockerzi F, Daas L. Recurrent Filamentous Fungal Keratitis Caused When the Primarily Selected Graft Diameter was Too Small. Klin Monbl Augenheilkd 2023; 240:1098-1102. [PMID: 35320860 DOI: 10.1055/a-1756-5147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To establish the importance of using a sufficiently large corneal graft in primary penetrating keratoplasty in order to prevent recurrence of fungal keratitis. OBERSERVATIONS A 58-year-old female patient underwent emergency penetrating keratoplasty (diameter 7.0 mm, double running suture) for therapy-resistant fungal keratitis (Fusarium solani) at an external eye clinic. Despite intensive antifungal therapy, new fungal infiltrates appeared in the host cornea after a few days. The patient was referred to our department for further treatment. On first presentation, circular infiltrates were seen around the corneal graft with anterior chamber involvement and therapy-resistant hypopyon. We performed an emergency penetrating repeat keratoplasty (diameter of 13.0 mm, 32 interrupted sutures) combined with anterior chamber lavage and intracameral and intrastromal drug injection. CONCLUSION AND IMPORTANCE Fungal keratitis sometimes has a frustrating clinical course. Therefore, early diagnosis with effective therapy initiation is of the utmost importance. In cases of penetrating keratoplasty, optimal planning and timing (before anterior chamber involvement) should be provided. Sufficient safety distance must be ensured in the choice of graft diameter, fixation with multiple interrupted sutures, and anterior chamber lavage, as well as intracameral and intrastromal drug administration. Incomplete excision carries a risk of recurrence and endophthalmitis in the course. Close postoperative control is necessary to detect early recurrences.
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Affiliation(s)
- Tim Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Fidelis Flockerzi
- Institut für Allgemeine und Spezielle Pathologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
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11
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Madaan K, Bari VK. Emerging Role of Sphingolipids in Amphotericin B Drug Resistance. Microb Drug Resist 2023. [PMID: 37327022 DOI: 10.1089/mdr.2022.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Invasive fungal infections in humans are common in people with compromised immune systems and are difficult to treat, resulting in high mortality. Amphotericin B (AmB) is one of the main antifungal drugs available to treat these infections. AmB binds with plasma membrane ergosterol, causing leakage of cellular ions and promoting cell death. The increasing use of available antifungal drugs to combat pathogenic fungal infections has led to the development of drug resistance. AmB resistance is not very common and is usually caused by changes in the amount or type of ergosterol or changes in the cell wall. Intrinsic AmB resistance occurs in the absence of AmB exposure, whereas acquired AmB resistance can develop during treatment. However, clinical resistance arises due to treatment failure with AmB and depends on multiple factors such as the pharmacokinetics of AmB, infectious fungal species, and host immune status. Candida albicans is a common opportunistic pathogen that can cause superficial infections of the skin and mucosal surfaces, thrush, to life-threatening systemic or invasive infections. In addition, immunocompromised individuals are more susceptible to systemic infections caused by Candida, Aspergillus, and Cryptococcus. Several antifungal drugs with different modes of action are used to treat systemic to invasive fungal infections and are approved for clinical use in the treatment of fungal diseases. However, C. albicans can develop a variety of defenses against antifungal medications. In fungi, plasma membrane sphingolipid molecules could interact with ergosterol, which can lead to the alteration of drug susceptibilities such as AmB. In this review, we mainly summarize the role of sphingolipid molecules and their regulators in AmB resistance.
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Affiliation(s)
- Kashish Madaan
- Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Bathinda, India
| | - Vinay Kumar Bari
- Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Bathinda, India
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12
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Bagga B, Das S, Tawde Y, Singh S, Shaw T, Sharma S, Ghosh A. Fusarium Keratitis From a Comprehensive Eye Health Care Facility in South India: Molecular Characterization by MALDI-TOF Versus PCR Sequencing, Species Complex Distribution, and Clinical Correlation. Cornea 2023; Publish Ahead of Print:00003226-990000000-00304. [PMID: 37267470 DOI: 10.1097/ico.0000000000003315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/20/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE Fusarium keratitis possesses significant diagnostic and therapeutic challenges. Medically relevant Fusaria belong to various species complexes and show prominent differences in their antifungal susceptibility profile which may influence the clinical outcome. Rapid diagnostic methods are warranted for precise identification of species complexes for prompt initiation of correct antifungals. The aim of the study was to compare between matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) and PCR sequencing for correct species-level identification and to analyze the clinical outcome among different Fusarium species complexes. METHODS Twenty-nine culture-proven Fusarium keratitis cases were included in this study. A phylogenetic tree was constructed after TEF1α gene sequencing and isolates were subjected to MALDI-TOF MS, followed by database expansion and identification. Clinical outcome and risk association among species complexes were analyzed retrospectively. RESULTS Maximum likelihood phylogeny categorized 68.9% isolates as Fusarium solani species complex (FSSC), 17.2% as Fusarium dimerum species complex (FDSC), followed by 13.7% as Fusarium fujikuroi species complex (FFSC). With extended database, MALDI-TOF MS could correctly speciate 96.5% (28/29) isolates. Previous antibiotic usage (P = 0.034) and preoperative antifungal treatment with natamycin, voriconazole, or ketoconazole (P = 0.025) were significantly higher in the FSSC group. The patients in the FFSC group had a significantly longer duration of symptoms at the time of clinical presentation to the clinic (15 days vs. 5 days, P = 0.030). Among 11 patients with a clinically poor outcome, 9 (31%) had FSSC infection. CONCLUSIONS Patients infected with the FSSC had more aggressive infection with poor prognosis. MALDI-TOF MS can serve as the best alternative method to conventional molecular identification with reduced turnaround time, which may help the ophthalmologists to consider the appropriate antifungals or early surgical intervention for improved outcome.
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Affiliation(s)
- Bhupesh Bagga
- Department of Cornea and Anterior Segment, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sourav Das
- Department of Medical Microbiology (Mycology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yamini Tawde
- Department of Medical Microbiology (Mycology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shreya Singh
- Department of Microbiology, Dr B. R. Ambedkar Institute of Medical Sciences (AIMS Mohali), Chandigarh, India
| | - Tushar Shaw
- Department of Life and Allied Health Sciences, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India; and
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anup Ghosh
- Department of Medical Microbiology (Mycology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Reginatto P, Agostinetto GDJ, Fuentefria RDN, Marinho DR, Pizzol MD, Fuentefria AM. Eye fungal infections: a mini review. Arch Microbiol 2023; 205:236. [PMID: 37183227 PMCID: PMC10183313 DOI: 10.1007/s00203-023-03536-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023]
Abstract
Ocular fungal infections annually affect more than one million individuals worldwide. The management of these infections is problematic, mainly due to the limited availability of effective antifungal agents. Thus, ocular infections are increasingly recognized as important causes of morbidity and blindness, especially keratitis and endophthalmitis. Thus, this review aims to demonstrate the importance of fungal eye infections through the description of the main related aspects, with emphasis on the treatment of these infections. For this purpose, a search for scientific articles was conducted in databases, such as Medline, published from 2000 onwards, addressing important aspects involving fungal eye infections. In addition, this work highlighted the limited therapeutic arsenal available and the severity associated with these infections. Thus, highlighting the importance of constantly updating knowledge about these pathologies, as it contributes to agility in choosing the available and most appropriate therapeutic alternatives, aiming at positive and minimally harmful results for that particular patient.
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Affiliation(s)
- Paula Reginatto
- Laboratório de Pesquisa em Micologia Aplicada, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Giovanna de Jesus Agostinetto
- Laboratório de Pesquisa em Micologia Aplicada, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Melissa Dal Pizzol
- Serviço de Oftalmologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Alexandre Meneghello Fuentefria
- Laboratório de Pesquisa em Micologia Aplicada, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Bisen AC, Agrawal S, Sanap SN, Mishra A, Biswas A, Verma SK, Bhatta RS. Simultaneous estimation of voriconazole, moxifloxacin, and pirfenidone in rabbit lacrimal matrix using LC-MS/MS: an application to preclinical ocular pharmacokinetics. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2023; 15:2234-2243. [PMID: 37128739 DOI: 10.1039/d3ay00317e] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Dynamic emergence of microbial keratitis (MK) requires a promising therapeutic arsenal of antifungal and antibacterial agents like voriconazole (VCZ) and moxifloxacin (MOXI), respectively. Parallelly, another paradigm of MK associated with ulcerative wounds cannot be left unnoticed and requires antifibrotic remedy (pirfenidone, PIR) as an authalic antimicrobial to retain the primordial vision. For designing an effective clinical cure, a combination of these three agents is required at a therapeutic dosage regimen. Following the quest, we have developed a simple and sensitive LC-MS/MS bioanalytical method for simultaneous quantification of VCZ, MOXI, and PIR in rabbit lacrimal fluid. The method was validated as per US-FDA norms using ketoconazole as an internal standard for linearity, accuracy-precision, matrix effect, dilution integrity, selectivity, and stability. The five minutes chromatographic set-up includes isocratic elution with a C18 column using MeOH (80%, v/v) and ultrapure water containing 0.2% formic acid (20%, v/v), respectively. The MS-based analyte detection was achieved in ESI+ multiple reaction monitoring mode. The sample extraction was performed using the protein precipitation method with minimal sample size. The validated methodology was employed to determine the ocular pharmacokinetics profile of marketed formulations containing VCZ, MOXI, and PIR in rabbit lacrimal matrix.
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Affiliation(s)
- Amol Chhatrapati Bisen
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension Sitapur Road, Lucknow, Uttar Pradesh, 226031, India.
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Sristi Agrawal
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension Sitapur Road, Lucknow, Uttar Pradesh, 226031, India.
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Sachin Nashik Sanap
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension Sitapur Road, Lucknow, Uttar Pradesh, 226031, India.
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Anjali Mishra
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension Sitapur Road, Lucknow, Uttar Pradesh, 226031, India.
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Arpon Biswas
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension Sitapur Road, Lucknow, Uttar Pradesh, 226031, India.
| | - Sarvesh Kumar Verma
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension Sitapur Road, Lucknow, Uttar Pradesh, 226031, India.
| | - Rabi Sankar Bhatta
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, B.S. 10/1, Sector 10, Jankipuram Extension Sitapur Road, Lucknow, Uttar Pradesh, 226031, India.
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
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15
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Sitnova A, Svetozarskiy S. Modern Technologies in Diagnosis of Fungal Keratitis (Review). Sovrem Tekhnologii Med 2023; 15:73-84. [PMID: 37389020 PMCID: PMC10306968 DOI: 10.17691/stm2023.15.2.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Indexed: 07/01/2023] Open
Abstract
Traumas and infectious diseases of the eye play a leading role in the development of corneal blindness responsible for 1.5-2 million cases of vision loss per year. To date, the issue of reducing the incidence of fungal keratitis is acute and needs to be solved worldwide. Trauma as a risk factor for corneal fungal disease is thought to be prevalent in developing countries due to agricultural involvement, while in developed countries the onset of the disease is predisposed by medical advances such as contact vision correction and modern ophthalmic surgery. Thorough analysis of the pathogenesis gives the possibility to describe the action of fungal enzymes, biofilm formation, and the resistance mechanism, which on the one hand explains the aggressive course of the disease and difficulties in its diagnosis, and on the other hand, it encourages searching for new methods of diagnosis and treatment. The non-specific clinical picture of fungal keratitis, the variety and availability of antibiotics nowadays become an obstacle for rapid detection of this pathology. Low public awareness and late visit to an ophthalmologist are also a barrier to successful combating the increasing incidence of fungal keratitis. Belated diagnosis, increasing resistance of fungi to antibiotics, and lack of registered antifungal ophthalmic drugs justify poor treatment efficacy resulting in decreased visual acuity or vision loss. Existing diagnostic methods need systematization and detailed comparison, identifying the advantages and disadvantages of each. This review considers causative agents and their influence on pathogenesis of the disease, describes difficulties of fungal keratitis diagnosis and possible ways of overcoming these problems using new developments, and also outlines further prospects of research in this direction.
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Affiliation(s)
- A.V. Sitnova
- 6-year Student, Medical Faculty; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - S.N. Svetozarskiy
- Ophthalmologist; Privolzhsky District Medical Center of the Federal Medico-Biological Agency (FMBA), 14 Ilyinskaya St., Nizhny Novgorod, 603000, Russia Tutor, Department of Eye Diseases; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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16
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Camposampiero D, Fasolo A, Saccon G, Donisi PM, Zanetti E, Ponzin D. Gram stain and addition of amphotericin B to improve the microbial safety of human donor corneas. Cell Tissue Bank 2022; 23:707-715. [PMID: 34791554 PMCID: PMC9675658 DOI: 10.1007/s10561-021-09981-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/07/2021] [Indexed: 12/19/2022]
Abstract
To determine the effectiveness of two methods to improve the microbial safety of human corneas preserved in organ culture. We compared the number of positive preservation solutions of corneas in organ culture in which the initial short-term hypothermic corneal maintenance solution was supplemented with amphotericin B 2.5 µg/mL and the historical data of microbial test results (2015-2019). In addition, we appraised the efficacy of Gram stain to detect bacterial or fungal contamination in the organ culture solutions of corneas from at-risk donors compared to the culture tests of corneas from not-at-risk donors. Statistical analysis was performed using STATA and statistical significance set at p < 0.05. The number of positive culture tests after preservation was 15 (0.5%) in 2020 compared to a mean of 37 (1.2%) in the period 2015-2019 (p < 0.01), with 10 (1.0%) positive samples in the cohort of 998 corneas from at-risk donors and 5 (0.2%) in the 2046 corneas from not-at-risk donors (p < 0.01). All corneas from at-risk donors tested positive at Gram stain and the results were available 1-3 days before those of the conventional culture tests. Amphotericin B supplementation in the short-term maintenance solution markedly reduced the number of positive microbial tests after organ culture and the early detection of contaminants, including slow-growing microorganisms, by Gram stain before the standard culture results. This meant fewer corneas being discarded and a greater likelihood of preventing post-graft infections.
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Affiliation(s)
- Davide Camposampiero
- The Veneto Eye Bank Foundation, Padiglione. G. Rama, Via Paccagnella 11, Zelarino, 30174 Venice, Italy
| | - Adriano Fasolo
- The Veneto Eye Bank Foundation, Padiglione. G. Rama, Via Paccagnella 11, Zelarino, 30174 Venice, Italy
| | - Giuseppe Saccon
- The Veneto Eye Bank Foundation, Padiglione. G. Rama, Via Paccagnella 11, Zelarino, 30174 Venice, Italy
| | - Pietro M. Donisi
- Pathological Anatomy Unit, SS. Giovanni e Paolo Hospital, Aulss3 Serenissima, Venice, Italy
| | - Elisa Zanetti
- The Veneto Eye Bank Foundation, Padiglione. G. Rama, Via Paccagnella 11, Zelarino, 30174 Venice, Italy
| | - Diego Ponzin
- The Veneto Eye Bank Foundation, Padiglione. G. Rama, Via Paccagnella 11, Zelarino, 30174 Venice, Italy
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17
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Khare P, Chogale MM, Kakade P, Patravale VB. Gellan gum-based in situ gelling ophthalmic nanosuspension of Posaconazole. Drug Deliv Transl Res 2022; 12:2920-2935. [PMID: 35538191 PMCID: PMC9089292 DOI: 10.1007/s13346-022-01155-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 12/16/2022]
Abstract
The formulation and delivery of highly hydrophobic drugs in an optimized dosage form is challenging to formulation scientists. Posaconazole has shown promising action in case studies against fungal keratitis. Biological macromolecules like gellan gum would aid in enhancing the availability of such drugs by increasing the contact time of the formulation. Herein, we propose a transmucosal ocular delivery system of Posaconazole by developing a gellan gum-based in situ gelling nanosuspension. The HPLC method for Posaconazole was developed and validated as per ICH guidelines. The nanosuspension was prepared by microfluidization and optimized by Quality by Design. The gellan gum concentration selected was 0.4% w/v based on the viscosity and mucoadhesion measurements. A greater zone of inhibition of ~ 15 mm was observed for the prepared nanosuspension as compared to ~ 11 mm for the marketed itraconazole nanosuspension. A potential irritancy score of 0.85, considered to be non-irritant, was observed for the developed nanosuspension. Higher drug release of ~ 35% was noted for the nanosuspension compared to about ~ 10% for the coarse suspension. Ex vivo corneal retention studies on excised goat cornea demonstrated ~ 70% drug retention in the tissue. Graphical abstract depicting the central hypothesis of the work.
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Affiliation(s)
- Purva Khare
- Institute of Chemical Technology, Department of Pharmaceutical Sciences and Technology, Nathalal Parekh Marg, Matunga, Mumbai-400019 Maharashtra India
| | - Manasi M. Chogale
- Institute of Chemical Technology, Department of Pharmaceutical Sciences and Technology, Nathalal Parekh Marg, Matunga, Mumbai-400019 Maharashtra India
| | - Pratik Kakade
- Institute of Chemical Technology, Department of Pharmaceutical Sciences and Technology, Nathalal Parekh Marg, Matunga, Mumbai-400019 Maharashtra India
| | - Vandana B. Patravale
- Institute of Chemical Technology, Department of Pharmaceutical Sciences and Technology, Nathalal Parekh Marg, Matunga, Mumbai-400019 Maharashtra India
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18
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Man M, Zhu Y, Liu L, Luo L, Han X, Qiu L, Li F, Ren M, Xing Y. Defense Mechanisms of Cotton Fusarium and Verticillium Wilt and Comparison of Pathogenic Response in Cotton and Humans. Int J Mol Sci 2022; 23:12217. [PMID: 36293072 PMCID: PMC9602609 DOI: 10.3390/ijms232012217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Cotton is an important economic crop. Fusarium and Verticillium are the primary pathogenic fungi that threaten both the quality and sustainable production of cotton. As an opportunistic pathogen, Fusarium causes various human diseases, including fungal keratitis, which is the most common. Therefore, there is an urgent need to study and clarify the resistance mechanisms of cotton and humans toward Fusarium in order to mitigate, or eliminate, its harm. Herein, we first discuss the resistance and susceptibility mechanisms of cotton to Fusarium and Verticillium wilt and classify associated genes based on their functions. We then outline the characteristics and pathogenicity of Fusarium and describe the multiple roles of human neutrophils in limiting hyphal growth. Finally, we comprehensively compare the similarities and differences between animal and plant resistance to Fusarium and put forward new insights into novel strategies for cotton disease resistance breeding and treatment of Fusarium infection in humans.
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Affiliation(s)
- Mingwu Man
- Zhengzhou Research Base, State Key Laboratory of Cotton Biology, School of Agricultural Sciences, Zhengzhou University, Zhengzhou 450001, China
- State Key Laboratory of Cotton Biology, Institute of Cotton Research, Chinese Academy of Agricultural Sciences, Anyang 455000, China
| | - Yaqian Zhu
- Zhengzhou Research Base, State Key Laboratory of Cotton Biology, School of Agricultural Sciences, Zhengzhou University, Zhengzhou 450001, China
- State Key Laboratory of Cotton Biology, Institute of Cotton Research, Chinese Academy of Agricultural Sciences, Anyang 455000, China
| | - Lulu Liu
- Zhengzhou Research Base, State Key Laboratory of Cotton Biology, School of Agricultural Sciences, Zhengzhou University, Zhengzhou 450001, China
- State Key Laboratory of Cotton Biology, Institute of Cotton Research, Chinese Academy of Agricultural Sciences, Anyang 455000, China
| | - Lei Luo
- Zhengzhou Research Base, State Key Laboratory of Cotton Biology, School of Agricultural Sciences, Zhengzhou University, Zhengzhou 450001, China
- State Key Laboratory of Cotton Biology, Institute of Cotton Research, Chinese Academy of Agricultural Sciences, Anyang 455000, China
| | - Xinpei Han
- State Key Laboratory of Cotton Biology, Institute of Cotton Research, Chinese Academy of Agricultural Sciences, Anyang 455000, China
| | - Lu Qiu
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-Sen University, Shenzhen 518107, China
| | - Fuguang Li
- Zhengzhou Research Base, State Key Laboratory of Cotton Biology, School of Agricultural Sciences, Zhengzhou University, Zhengzhou 450001, China
- State Key Laboratory of Cotton Biology, Institute of Cotton Research, Chinese Academy of Agricultural Sciences, Anyang 455000, China
- Hainan Yazhou Bay Seed Laboratory, Sanya 572000, China
| | - Maozhi Ren
- Zhengzhou Research Base, State Key Laboratory of Cotton Biology, School of Agricultural Sciences, Zhengzhou University, Zhengzhou 450001, China
- Hainan Yazhou Bay Seed Laboratory, Sanya 572000, China
- Institute of Urban Agriculture, Chinese Academy of Agricultural Sciences, Chengdu 610000, China
| | - Yadi Xing
- Zhengzhou Research Base, State Key Laboratory of Cotton Biology, School of Agricultural Sciences, Zhengzhou University, Zhengzhou 450001, China
- State Key Laboratory of Cotton Biology, Institute of Cotton Research, Chinese Academy of Agricultural Sciences, Anyang 455000, China
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19
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Chitosan/HPMC-based mucoadhesive film co-loaded with fluconazole and ofloxacin for management of polymicrobial keratitis. Int J Biol Macromol 2022; 222:2785-2795. [DOI: 10.1016/j.ijbiomac.2022.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
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Braga GÚL, Silva-Junior GJ, Brancini GTP, Hallsworth JE, Wainwright M. Photoantimicrobials in agriculture. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2022; 235:112548. [PMID: 36067596 DOI: 10.1016/j.jphotobiol.2022.112548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/30/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Classical approaches for controlling plant pathogens may be impaired by the development of pathogen resistance to chemical pesticides and by limited availability of effective antimicrobial agents. Recent increases in consumer awareness of and/or legislation regarding environmental and human health, and the urgent need to improve food security, are driving increased demand for safer antimicrobial strategies. Therefore, there is a need for a step change in the approaches used for controlling pre- and post-harvest diseases and foodborne human pathogens. The use of light-activated antimicrobial substances for the so-called antimicrobial photodynamic treatment is known to be effective not only in a clinical context, but also for use in agriculture to control plant-pathogenic fungi and bacteria, and to eliminate foodborne human pathogens from seeds, sprouted seeds, fruits, and vegetables. Here, we take a holistic approach to review and re-evaluate recent findings on: (i) the ecology of naturally-occurring photoantimicrobials, (ii) photodynamic processes including the light-activated antimicrobial activities of some plant metabolites, and (iii) fungus-induced photosensitization of plants. The inhibitory mechanisms of both natural and synthetic light-activated substances, known as photosensitizers, are discussed in the contexts of microbial stress biology and agricultural biotechnology. Their modes-of-antimicrobial action make them neither stressors nor toxins/toxicants (with specific modes of poisonous activity), but a hybrid/combination of both. We highlight the use of photoantimicrobials for the control of plant-pathogenic fungi and quantify their potential contribution to global food security.
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Affiliation(s)
- Gilberto Ú L Braga
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14040-903, Brazil.
| | | | - Guilherme T P Brancini
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14040-903, Brazil.
| | - John E Hallsworth
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, 19 Chlorine Gardens, Belfast BT9 5DL, Northern Ireland, United Kingdom.
| | - Mark Wainwright
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
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Jakka D, Matadh AV, Shankar VK, Shivakumar HN, Narasimha Murthy S. Polymer Coated Polymeric (PCP) Microneedles for Controlled Delivery of Drugs (Dermal and Intravitreal). J Pharm Sci 2022; 111:2867-2878. [PMID: 35662543 PMCID: PMC10775835 DOI: 10.1016/j.xphs.2022.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
Microneedles are used to deliver drugs topically across the skin and mucous membranes. Dissolvable microneedles are made using soluble polymers, which disintegrates in the tissue and release the entire payload instantaneously including the polymer construct. Often, a slow release of drug into the tissue is desirable to overcome the severity of side effects at the site of administration as well as systemic adverse effects. In addition, controlled release of active pharmaceutical ingredient (API) only (not the excipients) is safe and effective particularly when the drug delivery is intended to sensitive organs like the eye. In this project, the feasibility of fabricating polymer coated polymeric (PCP) microneedles to achieve a gradual release of only the active ingredient from the device was investigated. The potential application of such PCP microneedles in the dermal and intravitreal drug delivery was also explored using animal tissue models. The PCP microneedles were found to be intact even after prolonged contact with the release medium. The time at which 50% (T50%) of dextran (10 K) was released in case of microneedles prepared using 20% of core polymer (PVP-K30) was about 15 min versus less than 5 min in the case of uncoated microneedles. Whereas when the core polymer concentration was increased to 50%, the T50% was increased to 90 min. The rate of release depended on the polymer molecular weight grade. The rate of drug release was not influenced by the total amount of concentration of dextran. The PCP microneedles of lidocaine hydrochloride could constantly release the drug for up to 9 h in the skin tissue. Likewise, the PCP microneedles infused voriconazole, intravitreally for 6 h.
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Affiliation(s)
- Deeksha Jakka
- Department of Pharmaceutics and Drug Delivery, The University of Mississippi, University, MS, USA
| | - Anusha V Matadh
- Institute for Drug Delivery and Biomedical Research, Bengaluru 560086, India
| | - Vijay Kumar Shankar
- Department of Pharmaceutics and Drug Delivery, The University of Mississippi, University, MS, USA
| | - H N Shivakumar
- Institute for Drug Delivery and Biomedical Research, Bengaluru 560086, India; KLE College of Pharmacy, Bengaluru, 560010, India
| | - S Narasimha Murthy
- Institute for Drug Delivery and Biomedical Research, Bengaluru 560086, India; Topical Products Testing LLC, Oxford, MS 38655, USA.
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22
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Yang J, Liang Z, Lu P, Song F, Zhang Z, Zhou T, Li J, Zhang J. Development of a Luliconazole Nanoemulsion as a Prospective Ophthalmic Delivery System for the Treatment of Fungal Keratitis: In Vitro and In Vivo Evaluation. Pharmaceutics 2022; 14:2052. [PMID: 36297487 PMCID: PMC9608689 DOI: 10.3390/pharmaceutics14102052] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 11/25/2022] Open
Abstract
Luliconazole (LCZ), a novel imidazole drug, has broad-spectrum and potential antifungal effects, which makes it a possible cure for fungal keratitis; nevertheless, its medical use in ocular infections is hindered by its poor solubility. The purpose of this study was to design and optimize LCZ nanoemulsion (LCZ-NE) formulations using the central composite design-response surface methodology, and to investigate its potential in improving bioavailability following ocular topical administration. The LCZ-NE formulation was composed of Capryol 90, ethoxylated hydrogenated castor oil, Transcutol® P and water. The shape of LCZ-NE was spherical and uniform, with a droplet size of 18.43 ± 0.05 nm and a low polydispersity index (0.070 ± 0.008). The results of an in vitro release of LCZ study demonstrated that the LCZ-NE released more drug than an LCZ suspension (LCZ-Susp). Increases in the inhibition zone indicated that the in vitro antifungal activity of the LCZ-NE was significantly improved. An ocular irritation evaluation in rabbits showed that the LCZ-NE had a good tolerance in rabbit eyes. Ocular pharmacokinetics analysis revealed improved bioavailability in whole eye tissues that were treated with LCZ-NE, compared with those treated with LCZ-Susp. In conclusion, the optimized LCZ-NE formulation exhibited excellent physicochemical properties, good tolerance, enhanced antifungal activity and bioavailability in eyes. This formulation would be safe, and shows promise in effectively treating ocular fungal infections.
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Affiliation(s)
| | | | | | | | | | | | | | - Junjie Zhang
- Henan Eye Hospital, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou 450003, China
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23
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Ferguson TJ, Downes RA, Isada CM, Goshe JM. High-Dose Oral Posaconazole for the Treatment of Recalcitrant Fungal Keratitis. Cornea 2022; 41:852-856. [PMID: 34469337 DOI: 10.1097/ico.0000000000002832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/04/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the successful treatment of 3 cases of recalcitrant fungal keratitis (FK) with high-dose oral posaconazole. METHODS This is a series of 3 patients from a single academic center with a culture-positive FK who were treated with oral posaconazole after failing to respond to conventional treatments. RESULTS All 3 patients had a history of contact lens wear. Two of the 3 cases were culture positive for Fusarium and the other for Paecilomyces . The infections of all 3 failed to respond to conventional antifungal therapies including varying combinations of topical, systemic, and intraocular antifungal therapies. All 3 cases rapidly responded to high-dose oral posaconazole ranging from 500 to 600 mg once daily. In 1 case, multiple courses of high-dose therapy were required to treat delayed recurrences of a latent infection. There were no significant adverse effects with the elevated dose, and treatment was administered with the guidance of an infectious disease specialist. CONCLUSIONS In cases of recalcitrant FK failing to respond to conventional therapies, high-dose posaconazole, in the delayed-release tablet formulation, can be an effective treatment option.
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Affiliation(s)
| | | | - Carlos M Isada
- Department of Infectious Disease, Cleveland Clinic, Cleveland, OH
| | - Jeff M Goshe
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH; and
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24
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Martinez PS, Whitley RD, Plummer CE, Richardson RL, Hamor RE, Wellehan JFX. In vitro antifungal susceptibility of Fusarium species and Aspergillus fumigatus cultured from eleven horses with fungal keratitis. Vet Ophthalmol 2022; 25:376-384. [PMID: 35684950 DOI: 10.1111/vop.12995] [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: 10/21/2021] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the relationship between Minimum Inhibitory Concentration (MICs) and response to therapy of 6 Fusarium spp. and 5 Aspergillus fumigatus isolated from equine ulcerative keratitis cases. PROCEDURE Fungi were identified by morphology and Internal Transcribed Spacer (ITS) polymerase chain reaction (PCR) with sequencing and evaluated at the University of Texas Fungal Testing Laboratory for susceptibility to three azole antifungals (miconazole, voriconazole, posaconazole), natamycin, and two echinocandins (anidulafungin, caspofungin). A Mann-Whitney rank sum test was used for the comparison of time to heal between infections of different fungal genera and in vitro susceptibility to the drug administered. RESULTS Fusarium spp. were resistant to azole antifungals in 6/6 cases (100%). Fusarium spp. were susceptible to echinocandins and natamycin in all cases. A. fumigatus was resistant to anidulafungin in 1/5 cases (20%) and posaconazole in 1/5 cases (20%) The remainder of A. fumigatus isolates were susceptible to all antifungal agents tested. Fusarium isolates were treated with antifungals to which they were not susceptible; however, all cases of A. fumigatus were treated with antifungals to which they were susceptible. All Fusarium cases and A. fumigatus cases experienced clinical resolution, regardless of surgical intervention. There was no statistical correlation between fungal genus and time to heal (p < .082). CONCLUSIONS The in vitro susceptibility indicated that all cases of Fusarium spp. were resistant to azole antifungal drugs which were used as treatment. Clinical outcomes, however, showed that all cases healed despite resistance to antifungals.
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Affiliation(s)
- Paoul S Martinez
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | - R David Whitley
- Department of Small Animal Clinical Sciences, Professor Emeritus, University of Florida, Gainesville, Florida, USA
| | - Caryn E Plummer
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA.,Department of Large Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | - Rebecca L Richardson
- Clinical Microbiology, Parasitology and Serology, University of Florida, Gainesville, Florida, USA
| | - Ralph E Hamor
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | - James F X Wellehan
- Department of Comparative, Diagnostic & Population Medicine, University of Florida, Gainesville, Florida, USA
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25
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Yu B, Li C, Gu L, Zhang L, Wang Q, Zhang Y, Lin J, Hu L, Jia Y, Yin M, Zhao G. Eugenol protects against Aspergillus fumigatus keratitis by inhibiting inflammatory response and reducing fungal load. Eur J Pharmacol 2022; 924:174955. [DOI: 10.1016/j.ejphar.2022.174955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/26/2022] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
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26
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Ji X, Peng X, Long X, Zhang Y, Lin J, Yin J, Zhang R, Zhao G. Laccase-mediated functionalization of natamycin by gallic acids for the therapeutic effect on Aspergillus fumigatus keratitis. Eur J Pharmacol 2022; 926:175041. [PMID: 35597265 DOI: 10.1016/j.ejphar.2022.175041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
To improve the therapeutic effect of natamycin on fungal keratitis (FK), the grafted derivatives of natamycin and gallic acid were obtained, and the effects of the grafted derivatives on Aspergillus fumigatus (A. fumigatus) keratitis were investigated. The structure of natamycin grafted with gallic acid was identified by FT-IR and UV-Vis, and the successful synthesis of Gallic-Natamycin (GA-NAT) was proved. CCK-8 and the Draize eye test showed that GA-NAT had less cytotoxicity. Then, through in vitro antibacterial experiments such as minimum inhibitory concentration (MIC), adhesion, biofilm formation, and calcium fluorescence staining and in vivo experiments such as clinical score and plate counting, the results showed that GA-NAT had similar antifungal activity to natamycin, but had a better therapeutic effect than natamycin. Myeloperoxidase assay and immunofluorescence staining also showed that GA-NAT significantly inhibited neutrophil recruitment and activity. Moreover, It was further found that GA-NAT could inhibit the mRNA and protein expressions of LOX-1, TNF-α, and IL-1β. These results indicated that GA-NAT inhibited the fungal growth, reduced the neutrophil infiltration into cornea, and down-regulated the expression of inflammatory factors in lesions, which provides a new choice for FK treatment.
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Affiliation(s)
- Xiaoyue Ji
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University NO. 16 Jiangsu Road, Qingdao, Shandong Province, 266000, China.
| | - Xudong Peng
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University NO. 16 Jiangsu Road, Qingdao, Shandong Province, 266000, China; Department of Ophthalmology, University of Washington, Seattle, WA, 98104, USA.
| | - Xiaojing Long
- State Key Laboratory of Bio-fibers and Eco-textiles, Institute of Marine Biobased Materials, College of Materials Science and Engineering, Qingdao University, Qingdao, Shandong Province, 266071, China.
| | - Yingxue Zhang
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, 40201, USA.
| | - Jing Lin
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University NO. 16 Jiangsu Road, Qingdao, Shandong Province, 266000, China.
| | - Jiao Yin
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University NO. 16 Jiangsu Road, Qingdao, Shandong Province, 266000, China.
| | - Ranran Zhang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University NO. 16 Jiangsu Road, Qingdao, Shandong Province, 266000, China.
| | - Guiqiu Zhao
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University NO. 16 Jiangsu Road, Qingdao, Shandong Province, 266000, China.
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27
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Bakken IM, Jackson CJ, Utheim TP, Villani E, Hamrah P, Kheirkhah A, Nielsen E, Hau S, Lagali NS. The use of in vivo confocal microscopy in fungal keratitis - Progress and challenges. Ocul Surf 2022; 24:103-118. [PMID: 35278721 DOI: 10.1016/j.jtos.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 01/02/2023]
Abstract
Fungal keratitis (FK) is a serious and sight-threatening corneal infection with global reach. The need for prompt diagnosis is paramount, as a delay in initiation of treatment could lead to irreversible vision loss. Current "gold standard" diagnostic methods, namely corneal smear and culture, have limitations due to diagnostic insensitivity and their time-consuming nature. PCR is a newer, complementary method used in the diagnosis of fungal keratitis, whose results are also sample-dependent. In vivo confocal microscopy (IVCM) is a promising complementary diagnostic method of increasing importance as it allows non-invasive real-time direct visualization of potential fungal pathogens and manifesting infection directly in the patient's cornea. In numerous articles and case reports, FK diagnosis by IVCM has been evaluated, and different features, approaches, sensitivity/specificity, and limitations have been noted. Here, we provide an up-to-date, comprehensive review of the current literature and present the authors' combined recommendations for fungal identification in IVCM images, while also looking to the future of FK assessment by IVCM using artificial intelligence methods.
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Affiliation(s)
- Ingvild M Bakken
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Catherine J Jackson
- Ifocus Eye Clinic, Haugesund, Norway; Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tor P Utheim
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Department of Health and Nursing Science, The Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Edoardo Villani
- Department of Clinical Science and Community Health, University of Milan, Italy; Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Pedram Hamrah
- Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Esben Nielsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Scott Hau
- Department of External Disease, NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - Neil S Lagali
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Division of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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28
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Suriyaamporn P, Opanasopit P, Rangsimawong W, Ngawhirunpat T. Optimal Design of Novel Microemulsions-Based Two-Layered Dissolving Microneedles for Delivering Fluconazole in Treatment of Fungal Eye Infection. Pharmaceutics 2022; 14:pharmaceutics14030472. [PMID: 35335855 PMCID: PMC8951261 DOI: 10.3390/pharmaceutics14030472] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/06/2023] Open
Abstract
The optimal design of novel microneedles (MNs) for the ocular delivery system is necessary and useful for improving the effectiveness of medication. The objective of this study was to design and develop the optimal fluconazole (FLUZ)-microemulsions (MEs)-loaded two-layered dissolving MNs as a potential treatment for fungal eye infection. The experimental designs using the simplex-lattice design were used to select the optimal formulation. The two-layered dissolving MNs were fabricated from 3% chitosan and 20% polyvinyl alcohol (PVA) in a weight ratio of 1:4 as an outer layer and FLUZ-loaded MEs containing eugenol, tween 80, PEG400, and water as an inner layer. The physical appearance, mechanical properties, penetration ability, dissolution time, in vitro/ex vivo ocular drug delivery, and antifungal activity were evaluated. From the results, the optimal two-layered dissolving MNs exhibited good physical properties, complete insertion, minimally invasive ocular tissue, and high stability at 4 °C and 25 °C for 3 months. Moreover, the optimal two-layered dissolving MNs showed significantly higher FLUZ permeation into the ocular tissue than other formulations, while providing highly potential antifungal activity. In conclusion, the optimal MEs-loaded two-layered MNs’ formulation had appropriate properties for ocular delivery of FLUZ, resulting in an improvement of fungal keratitis treatment.
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Affiliation(s)
- Phuvamin Suriyaamporn
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand; (P.S.); (P.O.)
| | - Praneet Opanasopit
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand; (P.S.); (P.O.)
| | - Worranan Rangsimawong
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
- Correspondence: (W.R.); (T.N.); Tel.: +66-(045)-353605 (W.R.); +66-(034)-255800 (T.N.); Fax: +66-(045)-353626 (W.R.); +66-(034)-255801 (T.N.)
| | - Tanasait Ngawhirunpat
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand; (P.S.); (P.O.)
- Correspondence: (W.R.); (T.N.); Tel.: +66-(045)-353605 (W.R.); +66-(034)-255800 (T.N.); Fax: +66-(045)-353626 (W.R.); +66-(034)-255801 (T.N.)
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29
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Shivaji S, Jayasudha R, Prashanthi GS, Arunasri K, Das T. Fungi of the human eye: Culture to mycobiome. Exp Eye Res 2022; 217:108968. [PMID: 35120870 DOI: 10.1016/j.exer.2022.108968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/02/2021] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Abstract
The focus of the current review is multi-fold and compares the diversity and abundance of fungi on the ocular surface by the conventional culture-based method with the more sensitive, high throughput, culture-independent NGS method. The aim is to highlight the existence of a core ocular mycobiome and explore the transition of the ocular fungal microbiota from the normal eye to the diseased eye. PubMed, Google Scholar and Medline were used to search for publications and reviews related to cultivable fungi and the mycobiome of the normal and diseased eye. The conventional cultivable approach and the NGS approach confirm that the eye has its own mycobiome and several confounding factors (age, gender, ethnicity etc.) influence the mycobiome. Further, dysbiosis in the mycobiome appears to be associated with ocular diseases and thus impacts the health of the human eye. Considering that the mycobiome of the eye is influenced by several confounding factors and also varies with respect to the disease status of the eye there is a need to extensively explore the mycobiome under different physiological conditions, different ethnicities, geographical regions etc. Such studies would unravel the diversity and abundance of the mycobiomes and contribute to our understanding of ocular health. Research focused on ocular mycobiomes may eventually help to build a targeted and individualized treatment.
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Affiliation(s)
- Sisinthy Shivaji
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Rajagopalaboopathi Jayasudha
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Gumpili Sai Prashanthi
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Kotakonda Arunasri
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
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30
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Sanap SN, Mishra A, Bisen AC, Agrawal S, Biswas A, Verma SK, Kumar M, Bhatta RS. Simultaneous determination of fluconazole and ofloxacin in rabbit tear fluid by LC-MS/MS: Application to ocular pharmacokinetic studies. J Pharm Biomed Anal 2022; 208:114463. [PMID: 34798393 DOI: 10.1016/j.jpba.2021.114463] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/14/2021] [Accepted: 11/02/2021] [Indexed: 12/20/2022]
Abstract
The expansion of polymicrobial keratomycosis (PMK) requires dynamic pharmacotherapy of antimycotics along with antibacterial agents such as fluconazole (FCZ) and ofloxacin (OFX). To effective clinical cure, different microbes require different dosage regimens. A responsive, selective, and fast method for estimation of FCZ and OFX in rabbit tears using high-performance liquid chromatography together with tandem mass spectrometry (LC-MS/MS) was established and validated using ketoconazole as an internal standard (IS). An isocratic separation was achieved using a C18 column with methanol and aqueous 0.2% formic acid (80:20, v/v) as a mobile phase with a total run time and flow rate of 4 min and 400 µL/ min, respectively. The FCZ and OFX were detected utilizing positive ion electrospray ionization (ESI) in multiple reactions monitoring mode. The tear sample extraction was carried out using simple deproteination using methanol. The systematic method validation was carried out according to USFDA regulatory guidelines for selectivity, linearity (r2>0.99), intra-day and inter-day precision and accuracy, matrix effect, dilution integrity, and stability. The validated bioanalytical method was successfully pertained to determine the pharmacokinetics profile of FCZ and OFX marketed formulation in preclinical rabbit tears.
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Affiliation(s)
- Sachin Nashik Sanap
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Anjali Mishra
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Amol Chhatrapati Bisen
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Sristi Agrawal
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Arpon Biswas
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow 226031, India; Jawaharlal Nehru University, New Delhi 110067, India
| | - Sarvesh Kumar Verma
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow 226031, India; Jawaharlal Nehru University, New Delhi 110067, India
| | - Mukesh Kumar
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow 226031, India; Jawaharlal Nehru University, New Delhi 110067, India
| | - Rabi Sankar Bhatta
- Pharmaceutics and Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow 226031, India.
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31
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Rapidly dissolving microneedle patch of amphotericin B for intracorneal fungal infections. Drug Deliv Transl Res 2022; 12:931-943. [PMID: 34302273 PMCID: PMC8888497 DOI: 10.1007/s13346-021-01032-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 12/29/2022]
Abstract
Chronic fungal infection of the cornea could lead to blindness if not treated properly. Topical amphotericin B (AMP-B) is considered the first treatment of choice for ocular fungal infection. However, factors related to its poor solubility and penetration through intact cornea lead to poor bioavailability. Microneedles (MNs) are emerging as a minimally invasive method to enhance ocular drug delivery. This study aims to investigate the potential use of biodegradable poly(vinylpyrrolidone) (PVP) and hyaluronic acid (HA)-based rapidly dissolving MNs for delivery of AMP-B to treat fungal infection. The data obtained illustrates PVP/HA MN arrays' reproducibility, good mechanical strength, and faster dissolution with 100% drug recovery. Multiphoton microscopic results revealed that MNs successfully penetrate the corneal tissue and enhance AMP-B permeation through corneal layers. Furthermore, PVP/HA MN arrays showed high solubility. Both PVP and HA successfully decreased AMP-B cytotoxicity when compared to free drug. More interestingly, the biocompatible MN formulations preserved the antifungal activity of AMP-B, as demonstrated by significant inhibition of fungal growth. Therefore, this study shows the feasibility of ocular delivery of the poorly soluble AMP-B using a fast-dissolving MN patch.
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32
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Farah N, Chin VK, Chong PP, Lim WF, Lim CW, Basir R, Chang SK, Lee TY. Riboflavin as a promising antimicrobial agent? A multi-perspective review. CURRENT RESEARCH IN MICROBIAL SCIENCES 2022; 3:100111. [PMID: 35199072 PMCID: PMC8848291 DOI: 10.1016/j.crmicr.2022.100111] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 12/29/2022] Open
Abstract
Riboflavin demonstrates antioxidant and photosensitizing properties. Riboflavin is able to induce ROS and modulate immune response. Riboflavin possesses potent antimicrobial activity when used alone or combined with other anti-infectives. The riboflavin biosynthesis pathway serves as an ideal drug target against microbes. UVA combination with riboflavin exhibits remarkable antimicrobial effects.
Riboflavin, or more commonly known as vitamin B2, forms part of the component of vitamin B complex. Riboflavin consisting of two important cofactors, flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD), which are involved in multiple oxidative-reduction processes and energy metabolism. Besides maintaining human health, different sources reported that riboflavin can inhibit or inactivate the growth of different pathogens including bacteria, viruses, fungi and parasites, highlighting the possible role of riboflavin as an antimicrobial agent. Moreover, riboflavin and flavins could produce reactive oxygen species (ROS) when exposed to light, inducing oxidative damage in cells and tissues, and thus are excellent natural photosensitizers. Several studies have illustrated the therapeutic efficacy of photoactivated riboflavin against nosocomial infections and multidrug resistant bacterial infections as well as microbial associated biofilm infections, revealing the potential role of riboflavin as a promising antimicrobial candidate, which could serve as one of the alternatives in fighting the global crisis of the emergence of antimicrobial resistance seen in different pathogenic microbes. Riboflavin could also be involved in modulating host immune responses, which might increase the pathogen clearance from host cells and increase host defense against microbial infections. Thus, the dual effects of riboflavin on both pathogens and host immunity, reflected by its potent bactericidal effect and alleviation of inflammation in host cells further imply that riboflavin could be a potential candidate for therapeutic intervention in resolving microbial infections. Hence, this review aimed to provide some insights on the promising role of riboflavin as an antimicrobial candidate and also a host immune-modulator from a multi-perspective view as well as to discuss the application and challenges on using riboflavin in photodynamic therapy against various pathogens and microbial biofilm-associated infections.
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Affiliation(s)
- Nuratiqah Farah
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, UPM, 43400, Serdang, Selangor, Malaysia
| | - Voon Kin Chin
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, UPM, 43400, Serdang, Selangor, Malaysia
| | - Pei Pei Chong
- School of Biosciences, Taylor's University, No 1, Jalan Taylor's, 47500 Subang Jaya, Selangor, Malaysia
| | - Wai Feng Lim
- Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia
| | - Chee Woei Lim
- Department of Medicine, Faculty of Medicine and Health Sciences, UPM, 43400, Serdang, Selangor, Malaysia
| | - Rusliza Basir
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, UPM, 43400, Serdang, Selangor, Malaysia
| | - Sui Kiat Chang
- Department of Horticulture, Key Laboratory of South China Agricultural Plant Molecular Analysis and Genetic Improvement, Key Laboratory of Post-Harvest Handling of Fruits, Ministry of Agriculture. South China Botanical Garden, Chinese Academy of Sciences. Guangzhou, 510650 China
| | - Tze Yan Lee
- Perdana University School of Liberal Arts, Science and Technology (PUScLST), Suite 9.2, 9th Floor, Wisma Chase Perdana, Changkat Semantan, Damansara Heights, 50490 Kuala Lumpur, Malaysia
- Corresponding author.
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Kumar M, Tiwari A, Asdaq SMB, Nair AB, Bhatt S, Shinu P, Al Mouslem AK, Jacob S, Alamri AS, Alsanie WF, Alhomrani M, Tiwari V, Devi S, Pathania A, Sreeharsha N. Itraconazole loaded nano-structured lipid carrier for topical ocular delivery: Optimization and evaluation. Saudi J Biol Sci 2022; 29:1-10. [PMID: 35002390 PMCID: PMC8717166 DOI: 10.1016/j.sjbs.2021.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/23/2021] [Accepted: 11/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & OBJECTIVES Low penetration efficiency and retention time are the main therapeutic concerns that make it difficult for most of the drugs to be delivered to the intraocular tissues. These challenging issues are often related to those drugs, which have low or poor solubility and low permeability. The goal of this study was designed to develop nanostructured lipid carriers (NLCs) loaded with itraconazole (ITZ) with the objective of enhancing topical ocular permeation and thereby improving clinical efficacy. MATERIALS AND METHODS ITZ-loaded NLCs were fabricated by a high-speed homogenization technique using surfactant (Poloxamer 407), and lipids (stearic acid and oleic acid). Optimization of formulations was performed by 3 level factorial design and the selected formulation (F6) was evaluated by differential scanning calorimetry and transmission electron microscopy. Antifungal activity was assessed by measuring the zone of inhibition and irritation potential using the HET-CAM test. RESULTS The independent variables (lipid ratio-X1 and percentage of emulsifier-X2) have a positive impact on percentage entrapment efficiency (Y2) and percentage release (Y3) but have a negative impact on particle size (Y1). Based on the better entrapment efficiency (94.65%), optimum particle size (150.67 nm), and percentage cumulative drug release (68.67%), batch F6 was selected for further evaluation. Electron microscopic images revealed that the prepared particles are spherical and have nano size. Antifungal studies demonstrated enhancement in the zone of inhibition by formulation F6 as compared to a commercial eye drop. The non-irritancy of optimized formulation (F6) was confirmed with a zero score. INTERPRETATION & CONCLUSION In summary, the optimized NLCs seem to be a potent carrier for the effective delivery of itraconazole in ocular therapy.
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Affiliation(s)
- Manish Kumar
- M.M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana 133207, India
| | - Abhishek Tiwari
- Department of Pharmacy, Devsthali Vidyapeeth College of Pharmacy, Lalpur, Rudrapur (Udham Singh Nagar), Uttrakhand 263148 India
| | | | - Anroop B. Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Shailendra Bhatt
- Department of Pharmacy, School of Medical and Allied Sciences, G.D. Goenka University, Gurugram, Haryana 122103, India
| | - Pottathil Shinu
- Department of Biomedical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Abdulaziz K. Al Mouslem
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Shery Jacob
- Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, Ajman 4184, United Arab Emirates
| | - Abdulhakeem S. Alamri
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabi
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Saudi Arabia
| | - Walaa F. Alsanie
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabi
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Saudi Arabia
| | - Majid Alhomrani
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabi
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Saudi Arabia
| | - Varsha Tiwari
- Department of Pharmacy, Devsthali Vidyapeeth College of Pharmacy, Lalpur, Rudrapur (Udham Singh Nagar), Uttrakhand 263148 India
| | - Sheetal Devi
- M.M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana 133207, India
| | - Ajay Pathania
- M.M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana 133207, India
| | - Nagaraja Sreeharsha
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Department of Pharmaceutics, Vidya Siri College of Pharmacy, Off Sarjapura Road, Bangalore, 560035, India
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Liang W, Liu C, Zhang X, Li L, Dou Z, Li D, Li X, Wu B, Wang M, Li S. Continuous administration of voriconazole enhances therapeutic effect for recalcitrant fungal keratitis. Eur J Ophthalmol 2021; 32:2688-2694. [PMID: 34918555 DOI: 10.1177/11206721211068628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the therapeutic effect of incorporating continuous administration of voriconazole in the treatment of recalcitrant fungal keratitis. METHODS In this prospective case study, 5 consecutive patients (5 eyes) with fungal keratitis were treated with a standard protocol after the failing maximal conventional medical treatment. The protocol involved continuous lavage of the ulcer with 1% voriconazole through an irrigator for 2 h, twice a day, combined with local and systemic antifungals. Visual acuity, slit lamp findings of the ulcer, and fungal hyphae density by confocal microscope were documented, respectively. RESULTS In 4 patients, the clinical symptoms and slit lamp examination were significantly improved after only 3 days of treatment. The hyphae were shown to decrease in number and morphologically fragmented in corneal stroma by confocal microscopy. After the infection was controlled, 2 cases required further keratoplasty. In one case, the treatment was deemed ineffective and a conjunctival flap had to be created to help control the infection. In all 5 patients, the best spectacle-corrected visual acuity had improved after treatment. With more than 3 months of follow-up, no recurrence of infection was seen in any cases. CONCLUSION Our treatment protocol demonstrated improvement in the treatment of clinically resistant fungal keratitis. Continuous lavage of voriconazole is easy to be implemented and well-tolerated by patients. Modification of the current protocol should be further explored to optimize the therapeutic effectiveness in future.
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Affiliation(s)
- Weiyan Liang
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China
| | - Chang Liu
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,Aier Cornea Institute, Beijing, China
| | - Xiansen Zhang
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China
| | - Ling Li
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,Aier Cornea Institute, Beijing, China
| | - Zexia Dou
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,Aier Cornea Institute, Beijing, China
| | - Dandan Li
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China
| | - Xinxin Li
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,506624Aier School of Ophthalmology, Central South University, Changsha, Hunan, P.R. China
| | - Bowen Wu
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,506624Aier School of Ophthalmology, Central South University, Changsha, Hunan, P.R. China
| | - Mingwu Wang
- Aier Cornea Institute, Beijing, China.,NeuVision Medical Institute, Arizona, USA.,Department of Ophthalmology and Visual Science, College of Medicine, 12216University of Arizona, Arizona, USA
| | - Shaowei Li
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,Aier Cornea Institute, Beijing, China.,506624Aier School of Ophthalmology, Central South University, Changsha, Hunan, P.R. China
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Shivshetty N, Swift T, Pinnock A, Pownall D, Neil SM, Douglas I, Garg P, Rimmer S. Evaluation of ligand modified poly (N-Isopropyl acrylamide) hydrogel for etiological diagnosis of corneal infection. Exp Eye Res 2021; 214:108881. [PMID: 34871569 PMCID: PMC9012892 DOI: 10.1016/j.exer.2021.108881] [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: 08/15/2021] [Revised: 11/20/2021] [Accepted: 11/30/2021] [Indexed: 12/11/2022]
Abstract
Corneal ulcers, a leading cause of blindness in the developing world are treated inappropriately without prior microbiology assessment because of issues related to availability or cost of accessing these services. In this work we aimed to develop a device for identifying the presence of Gram-positive or Gram-negative bacteria or fungi that can be used by someone without the need for a microbiology laboratory. Working with branched poly (N-isopropyl acrylamide) (PNIPAM) tagged with Vancomycin, Polymyxin B, or Amphotericin B to bind Gram-positive bacteria, Gram-negative bacteria and fungi respectively, grafted onto a single hydrogel we demonstrated specific binding of the organisms. The limit of detection of the microbes by these polymers was between 10 and 4 organisms per high power field (100X) for bacteria and fungi binding polymers respectively. Using ex vivo and animal cornea infection models infected with bacteria, fungi or both we than demonstrated that the triple functionalised hydrogel could pick up all 3 organisms after being in place for 30 min. To confirm the presence of bacteria and fungi we used conventional microbiology techniques and fluorescently labelled ligands or dyes. While we need to develop an easy-to-use either a colorimetric or an imaging system to detect the fluorescent signals, this study presents for the first time a simple to use hydrogel system, which can be applied to infected eyes and specifically binds different classes of infecting agents within a short space of time. Ultimately this diagnostic system will not require trained microbiologists for its use and will be used at the point-of-care. Functionalised branched Poly N-isopropyl acrylamide binds corneal ulcer causing microorganisms. The functionalised polymers demonstrated specific binding to gram positive, gram negative and fungi. Grafting three different polymers on a single hydrogel retained this specific binding for microorganisms. Triple functionalised hydrogels were effective in picking up microorganisms in ex-vivo and animal cornea infection models. Application for a duration of 30 min was sufficient to pick up enough organisms for subsequent identification.
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Affiliation(s)
- Nagaveni Shivshetty
- Kallam Anji Reddy Campus, LV Prasad Eye Institute, Banjara Hills, Hyderabad, 500034, Telangana, India.
| | - Thomas Swift
- Polymer and Biomaterial Chemistry Laboratories, School of Chemistry and Biosciences, University of Bradford, Bradford, BD7 1DP, UK
| | - Abigail Pinnock
- Department of Materials Science and Engineering, Kroto Research Institute, University of Sheffield, Sheffield, S3 7HQ, UK
| | - David Pownall
- Department of Materials Science and Engineering, Kroto Research Institute, University of Sheffield, Sheffield, S3 7HQ, UK
| | - Sheila Mac Neil
- Department of Materials Science and Engineering, Kroto Research Institute, University of Sheffield, Sheffield, S3 7HQ, UK
| | - Ian Douglas
- School of Dentistry, University of Sheffield, Sheffield, S10 2TA, UK
| | - Prashant Garg
- Kallam Anji Reddy Campus, LV Prasad Eye Institute, Banjara Hills, Hyderabad, 500034, Telangana, India.
| | - Stephen Rimmer
- Polymer and Biomaterial Chemistry Laboratories, School of Chemistry and Biosciences, University of Bradford, Bradford, BD7 1DP, UK
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Hosny KM, Rizg WY, Alkhalidi HM, Abualsunun WA, Bakhaidar RB, Almehmady AM, Alghaith AF, Alshehri S, El Sisi AM. Nanocubosomal based in situ gel loaded with natamycin for ocular fungal diseases: development, optimization, in-vitro, and in-vivo assessment. Drug Deliv 2021; 28:1836-1848. [PMID: 34515597 PMCID: PMC8439233 DOI: 10.1080/10717544.2021.1965675] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 02/04/2023] Open
Abstract
Natamycin (NT) is a synthetic broad-spectrum antifungal used in eye drops. However, it has low solubility and high molecular weight, limiting its permeation, and generally causes eye discomfort or irritation when administered. Therefore, the present study aimed to develop an ophthalmic in situ gel formulation with NT-loaded cubosomes to enhance ocular permeation, improve antifungal activity, and prolong the retention time within the eye. The NT-loaded cubosome (NT-Cub) formula was first optimized using an I-optimal design utilizing phytantriol, PolyMulse, and NT as the independent formulation factors and particle size, entrapment efficiency %, and inhibition zone as responses. Phytantriol was found to increase particle size and entrapment efficiency %. Higher levels of PolyMulse slightly increased the inhibition zone whereas a decrease in particle size and EE% was observed. Increasing the NT level initially increased the entrapment efficiency % and inhibition zone. The optimized NT-Cub formulation was converted into an in situ gel system using 1.5% Carbopol 934. The optimum formula showed a pH-sensitive increase in viscosity, favoring prolonged retention in the eye. The in vitro release of NT was found to be 71 ± 4% in simulated tear fluid. The optimum formulation enhanced the ex vivo permeation of NT by 3.3 times compared to a commercial formulation and 5.2 times compared to the NT suspension. The in vivo ocular irritation test proved that the optimum formulation is less irritating than a commercial formulation of NT. This further implies that the developed formulation produces less ocular irritation and can reduce the required frequency of administration.
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Affiliation(s)
- Khaled M. Hosny
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
- Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Waleed Y. Rizg
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
- Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hala M. Alkhalidi
- Department of Clinical Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Walaa A. Abualsunun
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rana B. Bakhaidar
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alshaimaa M. Almehmady
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel F. Alghaith
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Amani M. El Sisi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni -Suef, Egypt
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Koyama A, Miyazaki D, Nakagawa Y, Ayatsuka Y, Miyake H, Ehara F, Sasaki SI, Shimizu Y, Inoue Y. Determination of probability of causative pathogen in infectious keratitis using deep learning algorithm of slit-lamp images. Sci Rep 2021; 11:22642. [PMID: 34811468 PMCID: PMC8608802 DOI: 10.1038/s41598-021-02138-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022] Open
Abstract
Corneal opacities are important causes of blindness, and their major etiology is infectious keratitis. Slit-lamp examinations are commonly used to determine the causative pathogen; however, their diagnostic accuracy is low even for experienced ophthalmologists. To characterize the “face” of an infected cornea, we have adapted a deep learning architecture used for facial recognition and applied it to determine a probability score for a specific pathogen causing keratitis. To record the diverse features and mitigate the uncertainty, batches of probability scores of 4 serial images taken from many angles or fluorescence staining were learned for score and decision level fusion using a gradient boosting decision tree. A total of 4306 slit-lamp images including 312 images obtained by internet publications on keratitis by bacteria, fungi, acanthamoeba, and herpes simplex virus (HSV) were studied. The created algorithm had a high overall accuracy of diagnosis, e.g., the accuracy/area under the curve for acanthamoeba was 97.9%/0.995, bacteria was 90.7%/0.963, fungi was 95.0%/0.975, and HSV was 92.3%/0.946, by group K-fold validation, and it was robust to even the low resolution web images. We suggest that our hybrid deep learning-based algorithm be used as a simple and accurate method for computer-assisted diagnosis of infectious keratitis.
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Affiliation(s)
- Ayumi Koyama
- Department of Ophthalmology, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan
| | - Dai Miyazaki
- Department of Ophthalmology, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan.
| | | | | | - Hitomi Miyake
- Department of Ophthalmology, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan
| | - Fumie Ehara
- Department of Ophthalmology, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan
| | - Shin-Ichi Sasaki
- Department of Ophthalmology, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan
| | - Yumiko Shimizu
- Department of Ophthalmology, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan
| | - Yoshitsugu Inoue
- Department of Ophthalmology, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan
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Varol K, Koç AN, Çakır Bayram L, Arda H, Keleş İ, Ünlü M, Güneş V, Ekinci G, Karaca Bekdik İ, Atalay MA. Studies on the Effectiveness of Ozone Therapy on the Treatment of Experimentally Induced Keratitis with Candida albicans in Rabbits. Semin Ophthalmol 2021; 37:253-264. [PMID: 34693871 DOI: 10.1080/08820538.2021.1995006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE In the present study, antifungal activity of ozonated olive oil (OZO) and ozonated distilled water (ODW) in the treatment of experimentally induced keratitis with C. albicans in rabbits were investigated. METHODS The Groups were composed of as 1, 2, 3, 4, 5, 7 (n = 5 rabbits, 10 eyes/in each group) and Group 6 (n = 10 rabbits, 20 eyes/in the group). Fourty-eight hours after C. albicans inoculation; Group 1 received fluconazle (FLU)+OZO drops, Group 2 received FLU drop, Group 3 received OZO drop, Group 4 received FLU+ODW drops, Group 5 received ODW drop, Group 6 (infected control group) and Group 7 received PBS drop (negative control group). Treatment continued in all groups for 22 days for every 8 hours. RESULTS Cornea cultures made 24 days post inoculation revealed statistically significant differences (p < 0,05) with concern to C. albicans amounts between Group 6 and Group 1-5. Statistical comparison of corneal opacity and corneal ulcer and conjunctivitis values among the Group 6 and Group 1-5 were also different significantly (p < 0,05) on days 20 and 24 post inoculation. CONCLUSION OZO and ODW were found to be effective in treating C. albicans keratitis in the present study. It has also been proven by this study that ODW contain 26 μg/ml was the most effective in the treatment of C. albicans keratitis.
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Affiliation(s)
- Kemal Varol
- Department of Veterinary, Food, Agriculture and Livestock Vocational College of Burdur, University of Burdur Mehmet Akif Ersoy, Burdur, Turkey
| | - Ayşe Nedret Koç
- Department of Microbiology, Medical Faculty, Erciyes University, Kayseri, Turkey
| | - Latife Çakır Bayram
- Department of Pathology, Faculty of Veterinary Medicine, University of Erciyes, Kayseri, Turkey
| | - Hatice Arda
- Department of Ophthalmology, Medical Faculty, Erciyes University, Kayseri, Turkey
| | - İhsan Keleş
- Department of Internal Medicine, Faculty of Veterinary Medicine, Erciyes University, Kayseri, Turkey
| | - Metin Ünlü
- Department of Ophthalmology, Medical Faculty, Erciyes University, Kayseri, Turkey
| | - Vehbi Güneş
- Department of Internal Medicine, Faculty of Veterinary Medicine, Erciyes University, Kayseri, Turkey
| | - Gencay Ekinci
- Department of Internal Medicine, Faculty of Veterinary Medicine, Erciyes University, Kayseri, Turkey
| | - İlknur Karaca Bekdik
- Department of Internal Medicine, Faculty of Veterinary Medicine, Erciyes University, Kayseri, Turkey
| | - Mustafa Altay Atalay
- Department of Microbiology, Medical Faculty, Erciyes University, Kayseri, Turkey
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Abdelbari MA, El-Mancy SS, Elshafeey AH, Abdelbary AA. Implementing Spanlastics for Improving the Ocular Delivery of Clotrimazole: In vitro Characterization, Ex vivo Permeability, Microbiological Assessment and In vivo Safety Study. Int J Nanomedicine 2021; 16:6249-6261. [PMID: 34531656 PMCID: PMC8439980 DOI: 10.2147/ijn.s319348] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/24/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose The aim of this study was to encapsulate clotrimazole (CLT), an antifungal drug with poor water solubility characteristics, into spanlastics (SPs) to provide a controlled ocular delivery of the drug. Methods Span 60 was used in the formulation of SPs with Tween 80, Pluronic F127, or Kolliphor RH40 as an edge activator (EA). The presence of EA offers more elasticity to the membrane of the vesicles which is expected to increase the corneal permeation of CLT. SPs were prepared using ethanol injection method applying 32 complete factorial design to study the effect of formulation variables (ratio of Span 60: EA (w/w) and type of EA) on SPs characteristics (encapsulation efficiency percent (EE%), average vesicle size (VS), polydispersity index (PDI) and zeta potential (ZP)). Design-Expert software was used to determine the optimum formulation for further investigations. Results The optimum formulation determined was S1, which contains 20 mg of Tween 80 used as an EA and 80 mg of Span 60. S1 exhibited EE% = 66.54 ± 7.57%, VS = 206.20 ± 4.95 nm, PDI = 0.39 ± 0.00 and ZP = −29.60 ± 0.99 mV. S1 showed highly elastic sphere-shaped vesicles. Furthermore, S1 displayed a sustained release profile and a higher ex vivo permeation across rabbit cornea relative to CLT suspension. Also, S1 revealed superior inhibition of Candida albicans development compared to CLT suspension applying 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) reduction technique. Moreover, in vivo histopathological examination assured the safety of S1 after ophthalmic application in mature male albino rabbits. Conclusion Overall, the outcomes revealed the marked efficacy of SPs for ocular delivery of CLT.
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Affiliation(s)
- Manar Adel Abdelbari
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, October 6 University, Giza, Egypt
| | - Shereen Sameh El-Mancy
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, October 6 University, Giza, Egypt
| | - Ahmed Hassen Elshafeey
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Aly Ahmed Abdelbary
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt.,School of Life and Medical Sciences, University of Hertfordshire Hosted by Global Academic Foundation, Cairo, Egypt
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Epidermal Growth Factor Receptor Expression in the Corneal Epithelium. Cells 2021; 10:cells10092409. [PMID: 34572058 PMCID: PMC8470622 DOI: 10.3390/cells10092409] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 01/12/2023] Open
Abstract
A properly functioning cornea is critical to clear vision and healthy eyes. As the most anterior portion of the eye, it plays an essential role in refracting light onto the retina and as an anatomical barrier to the environment. Proper vision requires that all layers be properly formed and fully intact. In this article, we discuss the role of the epidermal growth factor receptor (EGFR) in maintaining and restoring the outermost layer of the cornea, the epithelium. It has been known for some time that the addition of epidermal growth factor (EGF) promotes the restoration of the corneal epithelium and patients using EGFR inhibitors as anti-cancer therapies are at increased risk of corneal erosions. However, the use of EGF in the clinic has been limited by downregulation of the receptor. More recent advances in EGFR signaling and trafficking in corneal epithelial cells have provided new insights in how to overcome receptor desensitization. We examine new strategies for overcoming the limitations of high ligand and receptor expression that alter trafficking of the ligand:receptor complex to sustain receptor signaling.
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Argüeso P, Woodward AM, AbuSamra DB. The Epithelial Cell Glycocalyx in Ocular Surface Infection. Front Immunol 2021; 12:729260. [PMID: 34497615 PMCID: PMC8419333 DOI: 10.3389/fimmu.2021.729260] [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: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 12/30/2022] Open
Abstract
The glycocalyx is the main component of the transcellular barrier located at the interface between the ocular surface epithelia and the external environment. This barrier extends up to 500 nm from the plasma membrane and projects into the tear fluid bathing the surface of the eye. Under homeostatic conditions, defense molecules in the glycocalyx, such as transmembrane mucins, resist infection. However, many pathogenic microorganisms have evolved to exploit components of the glycocalyx in order to gain access to epithelial cells and consequently exert deleterious effects. This manuscript reviews the implications of the ocular surface epithelial glycocalyx to bacterial, viral, fungal and parasitic infection. Moreover, it presents some ongoing controversies surrounding the functional relevance of the epithelial glycocalyx to ocular infectious disease.
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Affiliation(s)
- Pablo Argüeso
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Ashley M Woodward
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Dina B AbuSamra
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
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Soleimani M, Haydar AA. Fungal keratitis after small incision lenticule extraction (SMILE): a case report and review of the literature. J Ophthalmic Inflamm Infect 2021; 11:25. [PMID: 34476600 PMCID: PMC8413420 DOI: 10.1186/s12348-021-00256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/01/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose To report a case of perforated fungal keratitis after small incision lenticule extraction (SMILE) treated with penetrating keratoplasty (PKP). Methods Case report and literature review. Results A 41-year-old woman presented with culture-proven unilateral fungal keratitis 4 days after uneventful SMILE. Her visual acuity was hand motion. The patient was treated with voriconazole irrigation (50 μm/0.1 ml) of the pocket and intrastromal voriconazole injection, in addition to systemic and topical antifungals. Despite aggressive management and decreased infiltration, the cornea was perforated and subsequently treated with PKP. Conclusions Infectious keratitis after SMILE is unusual. To our knowledge, this is the first report of perforated fungal keratitis post-SMILE. PKP eradicated the infection.
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Affiliation(s)
- Mohammad Soleimani
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran
| | - Ali A Haydar
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran.
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Mallela LS, Sharma P, Rao TSR, Roy S. Recombinant IL-22 promotes protection in a murine model of Aspergillus flavus keratitis and mediates host immune responses in human corneal epithelial cells. Cell Microbiol 2021; 23:e13367. [PMID: 34029434 DOI: 10.1111/cmi.13367] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/23/2022]
Abstract
Aspergillus flavus is a leading cause of corneal infections in India and worldwide, resulting in severe visual impairment. We studied the host immune response towards A. flavus in immortalised human corneal epithelial cells (HCEC) and found increased expression of Toll-like receptors, antimicrobial peptides and proinflammatory cytokines like IL-6 and IL-8. Differential expressions of antimicrobial peptides were determined in corneal scrapings from A. flavus keratitis patients with significantly increased expression of LL-37, S100A12 and RNase 7. Increased levels of IL-22 expression were observed both in patients with A. flavus keratitis and in experimental mice model of corneal infections along with IL-17, IL-23 and IL-18. IL-22 is an important mediator of inflammation during microbial infections, and acts primarily on fibroblasts and epithelial cells. We observed constitutive expression of IL-22 receptors in HCEC, and IL-22 mediated activation of NF-κB, MAPK pathways and STAT3, along with increased expression of antimicrobial peptides in these cells. IL-22 also efficiently lessened cell deaths in corneal epithelial cells during A. flavus infection in vitro. Furthermore, recombinant IL-22 reduced fungal burden and corneal opacity in an experimental murine model of A. flavus keratitis.
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Affiliation(s)
| | - Prerana Sharma
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
- Department of Animal Sciences, University of Hyderabad, Hyderabad, India
| | | | - Sanhita Roy
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
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Ahmadikia K, Aghaei Gharehbolagh S, Fallah B, Naeimi Eshkaleti M, Malekifar P, Rahsepar S, Getso MI, Sharma S, Mahmoudi S. Distribution, Prevalence, and Causative Agents of Fungal Keratitis: A Systematic Review and Meta-Analysis (1990 to 2020). Front Cell Infect Microbiol 2021; 11:698780. [PMID: 34513726 PMCID: PMC8428535 DOI: 10.3389/fcimb.2021.698780] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives This study aims to provide an overview of the prevalence, distribution, and causative agents of fungal keratitis. Methods All the articles with data on the prevalence of fungal keratitis among various patient groups from January 1, 1990 to May 27, 2020 were retrieved through a systematic search in PubMed, Scopus, Web of Science, and Google Scholar. Data were extracted, and the pooled estimated prevalence of fungal keratitis, yeast/mold infection, the spectrum and frequency of various causative agents, and the pooled estimated prevalence of mixed infections were calculated in general and in various countries (wherever possible) using meta-analysis. Results From 11,235 articles retrieved in the primary search step, 169 met the inclusion criteria. The 169 eligible articles were divided into six groups and analyzed separately. The pooled prevalence of fungal keratitis was variable with values ranging from 0.05% among postkeratoplasty patients to 43.01% among patients with a clinical suspicion of fungal keratitis. There was also a country-dependent variation in the prevalence (Paraguay: 50.1% (95% CI, 35.11, 65.00); Ireland: 1.1% (95% CI, 0.03, 6.04)). Except for postkeratoplasty cases (yeast: 51.80%), in all patient groups, molds were more common than yeasts. Although more than 50 distinct species of fungi have been found to cause fungal keratitis, Fusarium species followed by Aspergillus species were the most common causes of the disease. In general, 9.29% (95% CI, 6.52, 12.38) of fungal keratitis cases were mixed with bacterial agents. Conclusion The prevalence of fungal keratitis can vary dramatically depending on the patient groups and geographical origin; however, the dominant causative agents are generally similar.
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Affiliation(s)
- Kazem Ahmadikia
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Aghaei Gharehbolagh
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Fallah
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mahsa Naeimi Eshkaleti
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pooneh Malekifar
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Rahsepar
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Muhammad I. Getso
- Department of Medical Microbiology and Parasitology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L. V. Prasad Eye Institute, Hyderabad, India
| | - Shahram Mahmoudi
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Jadi PK, Sharma P, Bhogapurapu B, Roy S. Alternative Therapeutic Interventions: Antimicrobial Peptides and Small Molecules to Treat Microbial Keratitis. Front Chem 2021; 9:694998. [PMID: 34458234 PMCID: PMC8386189 DOI: 10.3389/fchem.2021.694998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/02/2021] [Indexed: 01/10/2023] Open
Abstract
Microbial keratitis is a leading cause of blindness worldwide and results in unilateral vision loss in an estimated 2 million people per year. Bacteria and fungus are two main etiological agents that cause corneal ulcers. Although antibiotics and antifungals are commonly used to treat corneal infections, a clear trend with increasing resistance to these antimicrobials is emerging at rapid pace. Extensive research has been carried out to determine alternative therapeutic interventions, and antimicrobial peptides (AMPs) are increasingly recognized for their clinical potential in treating infections. Small molecules targeted against virulence factors of the pathogens and natural compounds are also explored to meet the challenges and growing demand for therapeutic agents. Here we review the potential of AMPs, small molecules, and natural compounds as alternative therapeutic interventions for the treatment of corneal infections to combat antimicrobial resistance. Additionally, we have also discussed about the different formats of drug delivery systems for optimal administration of drugs to treat microbial keratitis.
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Affiliation(s)
- Praveen Kumar Jadi
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Prerana Sharma
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
- Department of Animal Sciences, University of Hyderabad, Hyderabad, India
| | - Bharathi Bhogapurapu
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Sanhita Roy
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
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Yousry C, Zikry PM, Salem HM, Basalious EB, El-Gazayerly ON. Integrated nanovesicular/self-nanoemulsifying system (INV/SNES) for enhanced dual ocular drug delivery: statistical optimization, in vitro and in vivo evaluation. Drug Deliv Transl Res 2021; 10:801-814. [PMID: 31989414 DOI: 10.1007/s13346-020-00716-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ocular drug administration is usually problematic and suffers low bioavailability due to several physiological and biological factors that hinder their effective treatment. Terconazole (TZ) is considered as one of the effective ocular antifungal agents that is usually administrated intravitreally for higher efficacy. The aim of the work in this study is to formulate a TZ-loaded ocular drug delivery system with high efficiency and good tolerability. First, TZ-loaded bile-based nanovesicles (BBNV) were prepared and the formulation variables (namely, Span 60, cholesterol, and sodium deoxycholate levels) were optimized based on the results of the entrapment efficiency (EE%), particle size (PS), and zeta potential (ZP) using Box-Behnken statistical design. The optimized system was formulated using 73.59 mg Span 60, 1.28 mg cholesterol, and 3.11 mg sodium deoxycholate. The formulated system showed vesicles with PS of 526 nm, - 42.2 mV ZP, and 93.86% EE%. TZ release, cellular uptake, and cytotoxicity of the optimized system were evaluated in vitro. In addition, in vivo assessment of its safety was conducted histopathologically and via ocular irritation test to ensure the ocular tolerance of the system. Afterwards, the optimized TZ-loaded BBNV was integrated into a self-nanoemulsifying system (SNES) to allow faster TZ release for immediate antifungal effect, enhanced ocular residence, and improved ocular permeation. TZ release study revealed more than 2 folds increment in drug release rate from the integrated system compared to BBNV alone. Finally, this integrated system was assessed for its antifungal activity in vivo where it demonstrated higher antifungal activity against induced Candida albicans infection. Graphical abstract.
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Affiliation(s)
- Carol Yousry
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, 11562, Egypt.
| | - Pakinam M Zikry
- Department of Pharmaceutics, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), October City, Egypt
| | - Heba M Salem
- Department of Poultry Diseases, Faculty of Veterinary Medicine, Cairo University, Giza square, Giza, Egypt
| | - Emad B Basalious
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, 11562, Egypt
| | - Omaima N El-Gazayerly
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, 11562, Egypt
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Jagadeesh N, Belur S, Ballal S, Roy S, Inamdar SR. Cephalosporium curvulum lectin causes mycotic keratitis by initiating infection through MyD88 dependent cellular proliferation and apoptosis in human corneal epithelial cells. Glycoconj J 2021; 38:509-516. [PMID: 34146213 DOI: 10.1007/s10719-021-10004-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/08/2020] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
Physiological role of a core fucose specific lectin from Cephalosporium curvulum isolated from mycotic keratitis patient in mediating pathogenesis was reported earlier. CSL has opposite effects on HCECs, at the initiation of infection when lectin concentration is low, CSL induces proinflammatory response and at higher concentration it inhibits growth as the infection progresses. Here we delineate detailed mechanism of opposing effects of CSL by confirming the binding of CSL and anti TLR 2 and 4 antibodies to TLRs 2 and 4 purified from HCECs using Galectin-3 Sepharose 4B column. Further, the expression of signaling proteins were monitored by Western blotting and apoptosis assay. At concentration of 0.3 µg/ml, CSL induced the activation of TLR-2,-4 and adapter protein MyD88. CSL also induced the expression of transcription factors NFkB, C-Jun and proinflammatory cytokines like interleukins -6 and -8 essential in maintaining cell proliferation. In contrast at higher concentrations i.e. 5 µg/ml CSL induces apoptotic effect as evidenced by increase in early and late apoptotic population as demonstrated by Annexin V-PI assay. Western blotting revealed that CSL treated HCECs at higher concentration lead to MyD88 dependent expression of apoptotic proteins like FADD, Caspase -8 and -3. All these results are in line with and substantiate our earlier results that indeed CSL is involved in mediating host pathogen interactions by interacting with cell surface TLRs, activating downstream signaling pathways leading to pathogenesis. Findings are of clinical significance in developing carbohydrate based therapeutic strategy to control infection and the disease.
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Affiliation(s)
| | - Shivakumar Belur
- Department of Studies in Biochemistry, Karnatak University, Dharwad, 580003, India
| | - Suhas Ballal
- Department of Studies in Biochemistry, Karnatak University, Dharwad, 580003, India
| | - Sanhita Roy
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Shashikala R Inamdar
- Department of Studies in Biochemistry, Karnatak University, Dharwad, 580003, India.
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Fungal Keratitis in Northern Thailand: Spectrum of Agents, Risk Factors and Putative Virulence Factors. J Fungi (Basel) 2021; 7:jof7060475. [PMID: 34208353 PMCID: PMC8231135 DOI: 10.3390/jof7060475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
Fungal keratitis (FK) is a serious ocular infection that can result in various degrees of vision loss, including blindness. The aim of the study was to identify and retrospectively review all FK cases diagnosed between August 2012 and December 2020 at a tertiary care hospital in northern Thailand with a specific focus on epidemiologic features, including season, patient sex and age, the spectrum of pathogens, and presence of certain putative virulence factors. Of 1237 patients with corneal ulcers, 294 (23.8%) were confirmed by direct microscopic examination and/or fungal culture. For the positive cases, direct examinations of Calcofluor white (CW) stains and KOH mounts were found in 97.3% (286/294) and 76.5% (225/294), respectively (p < 0.05). Of the cases diagnosed by microscopy and culture, fungi were isolated in 152 (51.7%), with Fusarium spp. being the most frequently identified (n = 69, 45.5%) followed by dematiaceous fungi (n = 45, 29.6%) and Aspergillus spp. (n = 18, 11.8%). The incidence of FK was higher in the rainy season of July to October. The mean age was 54.4 ± 14.4 (SD) years, with a range of 9–88 years. Males (75.8%) were affected significantly more than females (24.2%) (p < 0.05). Of 294 patients, 132 (44.9%) were middle-aged adults (41–60 years) and 107 (36.4%) were older than 60 years. Trauma to the eye by soil or vegetative matter were the most common preceding factors (188/294; 64.0%). We assessed two virulence factors. First, 142 of the 152 culture-positive FK cases were due to molds, indicating that hyphal morphogenesis is extremely important in disease. We also demonstrated that fungal melanization occurs in the molds during the course of FK by applying a melanin-specific monoclonal antibody (MAb) that labeled fungal elements in corneal samples of patients, and melanin particles derived from the hyphae were also recovered after treatment of the samples with proteolytic enzymes, denaturant and hot concentrated acid. In summary, we demonstrate that northern Thailand has a high rate of FK that is influenced by season and males engaged in outside activities are at highest risk for disease. Moulds are significantly more commonly responsible for FK, in part due to their capacity to form hyphae and melanins. Future studies will examine models of fungal corneal interactions and assess additional factors of virulence, such as secreted enzymes, to more deeply decipher the pathogenesis of FK.
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Wang L, Zhu J, Zhang Y, Wu J, Guo H, Wu X. Thymic stromal lymphopoietin participates in the TLR2-and TLR4-dependent immune response triggered by Aspergillus fumigatus in human corneal cells. Exp Eye Res 2021; 209:108644. [PMID: 34081998 DOI: 10.1016/j.exer.2021.108644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 12/16/2022]
Abstract
Fungal keratitis constitutes a serious vision-threatening disease. Toll-like receptors (TLRs) comprise key mediators of innate immunity triggered by Aspergillus fumigatus (AF) in the cornea, but the messenger between innate and adaptive immunity remained unknown. Thymic stromal lymphopoietin (TSLP) represents a critical factor of adaptive immunity. Here we investigated the expression of TSLP in corneal epithelial and stromal cells challenged by AF and its relationship with TLRs. We stimulated corneal cells with TLR ligands zymosan or lipopolysaccharide (LPS), human recombinant TSLP, or AF hyphae for various periods, with or without prior TLR2, TLR4, or TSLP inhibition. TLR2, TLR4, TSLP, IL-8, and TNF-α release and expression were measured via enzyme-linked immunosorbent analysis, quantitative polymerase chain reaction, or western blot. Corneal cell stimulation with zymosan or LPS induced up-regulated TSLP expression. Enhanced TSLP expression was associated with AF treatment in human corneal cells; TLR2 or TLR4 inhibition impaired the AF-induced TSLP levels. Human recombinant TSLP augmented TLR2 and TLR4 expression; RNA interference of TSLP attenuated TLR, IL-8, and TNF-α expression stimulated by AF hyphae. These findings indicated that TSLP participates in the immune response of corneal cells triggered by AF, which is closely related to TLR function, and the innate immunity mediated by TLRs could be enhanced by TSLP. Innate immunity may therefore transmit inflammatory signals to adaptive immunity through activation of TSLP; in turn, adaptive immunity likely exerts certain regulatory effects on innate immunity via TSLP. That is, TSLP could interact with innate immunity mediated by TLR2 and TLR4 in human corneal cells challenged by AF and thus may serve as a messenger between the innate and adaptive immune responses in AF keratitis.
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Affiliation(s)
- Leyi Wang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, PR China; Key Laboratory of Cardiovascular Remodeling and Function Research, Shandong University, Jinan, 250012, PR China.
| | - Jing Zhu
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, PR China; Key Laboratory of Cardiovascular Remodeling and Function Research, Shandong University, Jinan, 250012, PR China.
| | - Yuting Zhang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, PR China; Key Laboratory of Cardiovascular Remodeling and Function Research, Shandong University, Jinan, 250012, PR China.
| | - Jiayin Wu
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, PR China; Key Laboratory of Cardiovascular Remodeling and Function Research, Shandong University, Jinan, 250012, PR China.
| | - Hui Guo
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, PR China; Key Laboratory of Cardiovascular Remodeling and Function Research, Shandong University, Jinan, 250012, PR China.
| | - Xinyi Wu
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, PR China.
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Sha XY, Shi Q, Liu L, Zhong JX. Update on the management of fungal keratitis. Int Ophthalmol 2021; 41:3249-3256. [PMID: 33929644 DOI: 10.1007/s10792-021-01873-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/19/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this article is to introduce the recent advance on the studies of fungal keratitis published over past 5 years. METHODS We performed literature review of articles published on PubMed, Google Scholar, CNKI and Web of Science relevant to the diagnosis, pathogenesis and novel treatment of fungal keratitis. RESULTS Excessive inflammation can lead to stromal damage and corneal opacification, hence the research on immune mechanism provides many potential therapeutic targets for fungal keratitis. Many researchers discussed the importance of earlier definitive diagnosis and were trying to find rapid and accurate diagnostic methods of pathogens. Develop new drug delivery systems and new routes of administration with better corneal penetration, prolonged ocular residence time, and better mucoadhesive properties is also one of the research hotspots. Additionally, many novel therapeutic agents and methods have been gradually applied in clinical ophthalmology. CONCLUSION The diagnosis and treatment of fungal keratitis are still a challenge for ophthalmologist, and many researches provide new methods to conquer these problems.
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Affiliation(s)
- Xiao-Yuan Sha
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qi Shi
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lian Liu
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Jing-Xiang Zhong
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
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