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Marena GD, López A, Carvalho GC, Marín MDP, Pérez Ruiz MD, Pérez-Royo JM, Tormo-Mas MÁ, Bernabé P, Valentín E, Bauab TM, Chorilli M, Pemán J, Ruiz-Gaitán A. Sunflower Oil and Cholesterol Nanoemulsion: A Novel Carrier for Micafungin to Combat Multi-Resistant Candida auris. Pathogens 2024; 13:549. [PMID: 39057777 PMCID: PMC11279427 DOI: 10.3390/pathogens13070549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
Candida auris is an emerging, multidrug-resistant yeast that causes systemic infections, mainly in hospitalized or immunosuppressed patients. This pathogen has a high mortality and morbidity rate. This study aims to evaluate the antifungal potential of micafungin (MICA) encapsulated in a nanoemulsion (NEM) against four clades of C. auris and other non-C. auris species. The antifungal potential of MICA and NEM was evaluated by determining mature biofilm inhibition (0.78-50 µg/mL). The antifungal activities of MICA and NEM (5.92 mg/Kg) were evaluated using an in vivo model of Galleria mellonella. The results showed that NEM intensified the antibiofilm action of MICA, especially in 48 h mature biofilms. In vivo results displayed a higher effectiveness of NEM against all clades of C. auris tested, inhibiting the fungal load in the hemolymph and tissues of G. mellonella with a difference of 3 log10. In addition, C. auris infection caused granulomas surrounded by hemocytes, mainly at the lower and upper ends. Conversely, C. albicans developed pseudohyphae, biofilms, filaments, and chlamydospores. In conclusion, encapsulation of MICA in a nanoemulsion enhances its antifungal activity against mature biofilms of C. auris. This strategy may be considered a therapeutic approach for the control of infections and the dissemination of this new global health threat.
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Affiliation(s)
- Gabriel Davi Marena
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (G.D.M.); (A.L.); (J.M.P.-R.); (E.V.)
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil; (G.C.C.); (M.C.)
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil;
| | - Alejandro López
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (G.D.M.); (A.L.); (J.M.P.-R.); (E.V.)
| | - Gabriela Corrêa Carvalho
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil; (G.C.C.); (M.C.)
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil;
| | | | | | - Jose Manuel Pérez-Royo
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (G.D.M.); (A.L.); (J.M.P.-R.); (E.V.)
| | - María Ángeles Tormo-Mas
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (G.D.M.); (A.L.); (J.M.P.-R.); (E.V.)
| | - Patricia Bernabé
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (G.D.M.); (A.L.); (J.M.P.-R.); (E.V.)
| | - Eulogio Valentín
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (G.D.M.); (A.L.); (J.M.P.-R.); (E.V.)
- Department of Microbiology and Ecology, University of Valencia, 46010 Valencia, Spain
| | - Taís Maria Bauab
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil;
| | - Marlus Chorilli
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, SP, Brazil; (G.C.C.); (M.C.)
| | - Javier Pemán
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (G.D.M.); (A.L.); (J.M.P.-R.); (E.V.)
- Department of Medical Microbiology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Alba Ruiz-Gaitán
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (G.D.M.); (A.L.); (J.M.P.-R.); (E.V.)
- Department of Medical Microbiology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
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Marena GD, Carvalho GC, Ruiz-Gaitán A, Onisto GS, Bugalho BCM, Genezini LMV, Santos MOD, Blanco AL, Chorilli M, Bauab TM. Potential Activity of Micafungin and Amphotericin B Co-Encapsulated in Nanoemulsion against Systemic Candida auris Infection in a Mice Model. J Fungi (Basel) 2024; 10:253. [PMID: 38667924 PMCID: PMC11051191 DOI: 10.3390/jof10040253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
The Candida auris species is a multidrug-resistant yeast capable of causing systemic and lethal infections. Its virulence and increase in outbreaks are a global concern, especially in hospitals where outbreaks are more recurrent. In many cases, monotherapy is not effective, and drug combinations are opted for. However, resistance to antifungals has increased over the years. In view of this, nanoemulsions (NEs) may represent a nanotechnology strategy in the development of new therapeutic alternatives. Therefore, this study developed a co-encapsulated nanoemulsion with amphotericin B (AmB) and micafungin (MICA) (NEMA) for the control of infections caused by C. auris. NEs were developed in previous studies. Briefly, the NEs were composed of a mixture of 10% sunflower oil and cholesterol as the oil phase (5:1), 10% Polyoxyethylene (20) cetyl ether (Brij® 58) and soy phosphatidylcholine as surfactant/co-surfactant (2:1), and 80% PBS as the aqueous phase. The in vivo assay used BALB/c mice weighing between 25 and 28 g that were immunosuppressed (CEUA/FCF/CAr n° 29/2021) and infected with Candida auris CDC B11903. The in vivo results show the surprising potentiate of the antifungal activity of the co-encapsulated drugs in NE, preventing yeast from causing infection in the lung and thymus. Biochemical assays showed a higher concentration of liver and kidney enzymes under treatment with AmB and MICAmB. In conclusion, this combination of drugs to combat the infection caused by C. auris can be considered an efficient therapeutic option, and nanoemulsions contribute to therapeutic potentiate, proving to be a promising new alternative.
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Affiliation(s)
- Gabriel Davi Marena
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
- Department of Drug and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil;
| | - Gabriela Corrêa Carvalho
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
- Department of Drug and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil;
| | - Alba Ruiz-Gaitán
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain
- Department of Medical Microbiology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - Giovana Scaramal Onisto
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
| | - Beatriz Chiari Manzini Bugalho
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
| | - Letícia Maria Valente Genezini
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
| | - Maíra Oliveira Dos Santos
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
| | - Ana Lígia Blanco
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
| | - Marlus Chorilli
- Department of Drug and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil;
| | - Tais Maria Bauab
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800-903, Brazil; (G.D.M.); (G.C.C.); (G.S.O.); (B.C.M.B.); (L.M.V.G.); (M.O.D.S.); (A.L.B.)
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Jaromin A, Zarnowski R, Markowski A, Zagórska A, Johnson CJ, Etezadi H, Kihara S, Mota-Santiago P, Nett JE, Boyd BJ, Andes DR. Liposomal formulation of a new antifungal hybrid compound provides protection against Candida auris in the ex vivo skin colonization model. Antimicrob Agents Chemother 2024; 68:e0095523. [PMID: 38092678 PMCID: PMC10777852 DOI: 10.1128/aac.00955-23] [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: 07/30/2023] [Accepted: 10/28/2023] [Indexed: 01/11/2024] Open
Abstract
The newly emerged pathogen, Candida auris, presents a serious threat to public health worldwide. This multidrug-resistant yeast often colonizes and persists on the skin of patients, can easily spread from person to person, and can cause life-threatening systemic infections. New antifungal therapies are therefore urgently needed to limit and control both superficial and systemic C. auris infections. In this study, we designed a novel antifungal agent, PQA-Az-13, that contains a combination of indazole, pyrrolidine, and arylpiperazine scaffolds substituted with a trifluoromethyl moiety. PQA-Az-13 demonstrated antifungal activity against biofilms of a set of 10 different C. auris clinical isolates, representing all four geographical clades distinguished within this species. This compound showed strong activity, with MIC values between 0.67 and 1.25 µg/mL. Cellular proteomics indicated that PQA-Az-13 partially or completely inhibited numerous enzymatic proteins in C. auris biofilms, particularly those involved in both amino acid biosynthesis and metabolism processes, as well as in general energy-producing processes. Due to its hydrophobic nature and limited aqueous solubility, PQA-Az-13 was encapsulated in cationic liposomes composed of soybean phosphatidylcholine (SPC), 1,2-dioleoyloxy-3-trimethylammonium-propane chloride (DOTAP), and N-(carbonyl-methoxypolyethylene glycol-2000)-1,2-distearoyl-sn-glycero-3-phosphoethanolamine, sodium salt (DSPE-PEG 2000), and characterized by biophysical and spectral techniques. These PQA-Az-13-loaded liposomes displayed a mean size of 76.4 nm, a positive charge of +45.0 mV, a high encapsulation efficiency of 97.2%, excellent stability, and no toxicity to normal human dermal fibroblasts. PQA-Az-13 liposomes demonstrated enhanced antifungal activity levels against both C. auris in in vitro biofilms and ex vivo skin colonization models. These initial results suggest that molecules like PQA-Az-13 warrant further study and development.
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Affiliation(s)
- Anna Jaromin
- Department of Lipids and Liposomes, Faculty of Biotechnology, University of Wrocław, Wrocław, Poland
| | - Robert Zarnowski
- Department of Medicine, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Microbiology, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Adam Markowski
- Department of Lipids and Liposomes, Faculty of Biotechnology, University of Wrocław, Wrocław, Poland
| | - Agnieszka Zagórska
- Department of Medicinal Chemistry, Jagiellonian University Medical College, Cracow, Poland
| | - Chad J. Johnson
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Haniyeh Etezadi
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Shinji Kihara
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | | | - Jeniel E. Nett
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin, Madison, Wisconsin, USA
| | - Ben J. Boyd
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University (Parkville Campus), Victoria, Australia
| | - David R. Andes
- Department of Medicine, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Microbiology, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Cristina ML, Spagnolo AM, Sartini M, Carbone A, Oliva M, Schinca E, Boni S, Pontali E. An Overview on Candida auris in Healthcare Settings. J Fungi (Basel) 2023; 9:913. [PMID: 37755021 PMCID: PMC10532978 DOI: 10.3390/jof9090913] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023] Open
Abstract
Candida auris has become a major concern in critical care medicine due to the increasing number of immunocompromised patients and candidiasis is the most frequent cause of fungal infections. C. auris and other fungal pathogens are responsible for at least 13 million infections and 1.5 million deaths globally per year. In immunocompromised patients, infections can quickly become severe, causing wound infections, otitis and candidemia, resulting in high morbidity and mortality. The clinical presentation of C. auris is often non-specific and similar to other types of systemic infections; in addition, it is harder to identify from cultures than other, more common types of Candida spp. Some infections are particularly difficult to treat due to multi-resistance to several antifungal agents, including fluconazole (and other azoles), amphotericin B and echinocandins. This entails treatment with more drugs and at higher doses. Even after treatment for invasive infections, patients generally remain colonized for long periods, so all infection control measures must be followed during and after treatment of the C. auris infection. Screening patients for C. auris colonization enables facilities to identify individuals with C. auris colonization and to implement infection prevention and control measures. This pathogenic fungus shows an innate resilience, enabling survival and persistence in healthcare environment and the ability to rapidly colonize the patient's skin and be easily transmitted within the healthcare setting, thus leading to a serious and prolonged outbreak.
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Affiliation(s)
- Maria Luisa Cristina
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
- Hospital Hygiene Unit, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
- Hospital Hygiene Unit, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Marina Sartini
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
- Hospital Hygiene Unit, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Alessio Carbone
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
| | - Martino Oliva
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
| | - Elisa Schinca
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (A.M.S.); (E.S.)
- Hospital Hygiene Unit, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Silvia Boni
- Infectious Disease Unit, Galliera Hospital, 16128 Genoa, Italy
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