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Cavassin FB, Magri MMC, Vidal JE, de Moraes Costa Carlesse FA, Falci DR, Baú-Carneiro JL, Breda GL, de Araújo Motta F, de Miranda Godoy CS, de Bastos Ascenço Soares R, De Oliveira CS, Mendes AVA, Morales HP, Montes PS, Taborda M, Rego CM, Félix MA, Katopodis PP, da Silva do Ó JR, Abrão MPL, Pereira TTT, Queiroz-Telles F. Effectiveness, Tolerability, and Safety of Different Amphotericin B Formulations in Invasive Fungal Infections: A Multicenter, Retrospective, Observational Study. Clin Ther 2024; 46:322-337. [PMID: 38403508 DOI: 10.1016/j.clinthera.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Data on the real-life use of amphotericin B lipid complex (ABLC) compared with other available formulations are limited. This study aimed to evaluate the effectiveness, tolerability, and safety of different amphotericin B (AMB) intravenously administered in the context of hospital practice for the treatment of invasive fungal infections (IFI) and to provide new insights into the profile of ABLC. METHODS This is a multicenter, retrospective, observational study conducted at 10 tertiary Brazilian hospitals. Patients first exposed to any formulation of AMB for treating endemic and opportunistic IFI who had received at least 2 intravenous doses were screened. Retrospective data (from January 2014 to December 2019) were extracted from the patients' medical records. Clinical parameters were examined pre- and post-treatment to determine effectiveness; acute infusion-related side effects (IRSE) and drug interruption to determine tolerability; and adverse events, toxicity, and treatment interruption were stated to analyze safety. FINDINGS Overall, 1879 medical records of patients were identified. The median (interquartile rate) duration of treatment was 14 (7-21) days. The overall success rate (95% confidence interval [CI]) was 65% (95% CI 60-65). ABLC proved to be effective among AMB formulations with 59% (95% CI 55.6-62.5) within complete response. This was significantly higher in patients who received the drug for a longer period, ≥4 weeks compared to <1 week treatment (P < 0.001). IRSE was observed in 446 (23.7%) patients. Eight cases (1.4%) of severe IRSE in pediatrics and 14 (1.1%) in adults resulted in treatment discontinuation. Regarding safety, 637 (33.9%) patients presented some alteration in creatinine levels during AMB exposure, and 89 (4.74%) had to interrupt or discontinue the drug within the first 14 days of therapy because of renal dysfunction. Overall mortality was 34%. IMPLICATIONS ABLC is an effective formulation for the treatment of invasive fungal infections, with few adverse events leading to drug discontinuation or lethal outcomes. Furthermore, this real-life study confirmed the comparative safety of AMB lipid formulations versus AMB deoxycholate.
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Affiliation(s)
| | | | | | | | | | | | - Giovanni Luís Breda
- Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, Brazil
| | | | | | | | | | | | | | - Patrícia Silva Montes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FAMUSP), São Paulo, Brazil
| | - Mariane Taborda
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FAMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | - Flávio Queiroz-Telles
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, Brazil
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Marques Borges GS, Santos TT, Pinto CM, Frézard F, Blanco VF, Ondei R, Rumbelow S, Miranda Ferreira LA, Gontijo de Aguiar MM, Castro Goulart GA. Distearoyl phosphatidylglycerol and dioleoyl phosphatidylglycerol increase the retention and reduce the toxicity of amphotericin B-loaded in nanoemulsions. Nanomedicine (Lond) 2024; 19:383-396. [PMID: 38293893 DOI: 10.2217/nnm-2023-0256] [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] [Indexed: 02/01/2024] Open
Abstract
Aim: To develop nanoemulsions (NEs) loading amphotericin B (AmB) and to evaluate the influence of different excipients on the stability and the supramolecular organization, retention and toxicity of AmB. Materials & methods: The NEs were developed from different oils, surfactants, external media and anionic lipids (disteaoryl phosphatidylglycerol [DSPG] and dioleoyl phosphatidylglycerol [DOPG]). Their impact on the size, pH, zeta potential, AmB encapsulation efficiency, AmB retention and hemolytic potential of the NEs was evaluated. Results & conclusion: The use of soybean oil (lipid matrix), Span 80 (surfactant), phosphate buffer (external phase) and DSPG or DOPG (hydrophobic ion pair) provided better NE stability, higher AmB retention within the NEs and a safer formulation profile in hemolysis tests.
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Affiliation(s)
- Gabriel Silva Marques Borges
- Departamento de Farmácia, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, 39100-000, Brazil
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | - Thais Tunes Santos
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | - Cristiane Monteiro Pinto
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | - Frédéric Frézard
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | | | - Roberta Ondei
- Croda do Brasil, Rua Croda, 580, Campinas, 13054-710, Brazil
| | - Stephen Rumbelow
- Croda Inc, Building 2, Suite 200, 777 Scudders Mill Road, Plainsboro, NJ 08540, USA
| | - Lucas Antônio Miranda Ferreira
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | - Marta Marques Gontijo de Aguiar
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | - Gisele Assis Castro Goulart
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, Brazil
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Mudenda S, Matafwali SK, Mukosha M, Daka V, Chabalenge B, Chizimu J, Yamba K, Mufwambi W, Banda P, Chisha P, Mulenga F, Phiri M, Mfune RL, Kasanga M, Sartelli M, Saleem Z, Godman B. Antifungal resistance and stewardship: a knowledge, attitudes and practices survey among pharmacy students at the University of Zambia; findings and implications. JAC Antimicrob Resist 2023; 5:dlad141. [PMID: 38130703 PMCID: PMC10733812 DOI: 10.1093/jacamr/dlad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Antifungal resistance (AFR) is a growing global public health concern. Little is currently known about knowledge, attitudes and practices regarding AFR and antifungal stewardship (AFS) in Zambia, and across the globe. To address this evidence gap, we conducted a study through a questionnaire design starting with pharmacy students as they include the next generation of healthcare professionals. Methods A cross-sectional study among 412 pharmacy students from June 2023 to July 2023 using a structured questionnaire. Multivariable analysis was used to determine key factors of influence. Results Of the 412 participants, 55.8% were female, with 81.6% aged between 18 and 25 years. Most students had good knowledge (85.9%) and positive attitudes (86.7%) but sub-optimal practices (65.8%) towards AFR and AFS. Overall, 30.2% of students accessed antifungals without a prescription. Male students were less likely to report a good knowledge of AFR (adjusted OR, AOR = 0.55, 95% CI: 0.31-0.98). Similarly, students residing in urban areas were less likely to report a positive attitude (AOR = 0.35, 95% CI: 0.13-0.91). Fourth-year students were also less likely to report good practices compared with second-year students (AOR = 0.48, 95% CI: 0.27-0.85). Conclusions Good knowledge and positive attitudes must translate into good practices toward AFR and AFS going forward. Consequently, there is a need to provide educational interventions where students have low scores regarding AFR and AFS. In addition, there is a need to implement strategies to reduce inappropriate dispensing of antifungals, especially without a prescription, to reduce AFR in Zambia.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka PO Box 50110, Zambia
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
| | - Scott Kaba Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Moses Mukosha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka PO Box 50110, Zambia
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola PO Box 71191, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, Lusaka PO Box 31890, Zambia
| | - Joseph Chizimu
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
| | - Kaunda Yamba
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka PO Box 50110, Zambia
| | - Patrick Banda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka PO Box 50110, Zambia
| | - Patience Chisha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka PO Box 50110, Zambia
| | - Florence Mulenga
- Conservation Department, World Wide Fund For Nature (WWF Zambia Country Office), Lusaka PO Box 50551, Zambia
| | - McLawrence Phiri
- Department of Pharmacy, Maina Soko Medical Center, Woodlands, Lusaka PO Box 320091, Zambia
| | - Ruth Lindizyani Mfune
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Maisa Kasanga
- Department of Epidemiology and Biostatistics, Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan 450001, China
| | | | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
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Xie L, Ding L, Tang L, Yang Z, Wu D, Wang W, Mao J, Shi L, Liu C, Duan L, Xu J, Zhou Q, Sun J, Ding X. A real-world cost-effectiveness study of vancomycin versus linezolid for the treatment of late-onset neonatal sepsis in the NICU in China. BMC Health Serv Res 2023; 23:771. [PMID: 37468855 PMCID: PMC10357666 DOI: 10.1186/s12913-023-09628-9] [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: 11/09/2022] [Accepted: 05/31/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Currently, the detection rates of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS) in the blood cultures of neonates with sepsis exceed the national average drug resistance level, and vancomycin and linezolid are the primary antibacterial drugs used for these resistant bacteria according to the results of etiological examinations. However, a comprehensive evaluation of their costs and benefits in late-onset neonatal sepsis in a neonatal intensive care unit (NICU) has not been conducted. This study aimed to compare the cost and effectiveness of vancomycin and linezolid in treating neonatal sepsis in the NICU. METHODS A cost-effectiveness analysis of real-world data was carried out by retrospective study in our hospital, and the cost and effectiveness of vancomycin and linezolid were compared by establishing a decision tree model. The drug doses in the model were 0.6 g for linezolid and 0.5 g for vancomycin. The cost break down included cost of medical ward, NICU stay, intravenous infusion of vancomycin or linezolid, all monitoring tests, culture tests and drugs. The unit costs were sourced from hospital information systems. The effectiveness rates were obtained by cumulative probability analysis. One-way sensitivity analysis was used to analyze uncertain influencing factors. RESULTS The effectiveness rates of vancomycin and linezolid in treating neonatal sepsis in the NICU were 89.74% and 90.14%, respectively, with no significant difference. The average cost in the vancomycin group was ¥12261.43, and the average cost in the linezolid group was ¥17227.96. The incremental cost effectiveness was ¥12416.33 cost per additional neonate with treatment success in the linezolid group compared to vancomycin group at discharge. Factors that had the greatest influence on the sensitivity of the incremental cost-effectiveness ratio were the price of linezolid and the effectiveness rates. CONCLUSIONS The cost for treatment success of one neonate in linezolid group was ¥5449.17 more than that in vancomycin group, indicating that vancomycin was more cost-effective. Therefore, these results can provide a reference for a cost effectiveness treatment scheme for neonatal sepsis in the NICU.
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Affiliation(s)
- Linjun Xie
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Leyun Ding
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Lian Tang
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Zuming Yang
- Department of Neonatology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Dan Wu
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Wenjuan Wang
- Children's Hospital of Soochow University, Medical College of Soochow University, Soochow University, Suzhou, China
| | - Juehui Mao
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Lu Shi
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Chun Liu
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Lufen Duan
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jinhui Xu
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Qin Zhou
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
| | - Jiantong Sun
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
| | - Xinyuan Ding
- Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
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5
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Chan JC, Dear J, Palm C, Reagan K. Incidence of acute kidney injury in dogs with systemic mycotic infections treated with amphotericin B (1996-2020). J Vet Intern Med 2023; 37:1030-1037. [PMID: 37148178 PMCID: PMC10229337 DOI: 10.1111/jvim.16728] [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: 09/17/2022] [Accepted: 04/15/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Amphotericin-B (AmB) is an essential medication for the treatment of life-threatening systemic mycoses but the incidence and risk factors for acute kidney injury (AKI) after its administration are not known in dogs. OBJECTIVE Determine the incidence of and risk factors for AKI in dogs receiving AmB. ANIMALS Fifty-one client owned dogs receiving AmB for the treatment of systemic mycoses. METHODS Retrospective study. Signalment, potential risk factors, AKI development (creatinine ≥0.3 mg/dL from baseline), drug formulation (deoxycholate [AmB-D] or lipid complex [ABLC]), dose, and treatment duration were recorded. The probability of an AKI diagnosis was evaluated using a log-rank test. The incidence of AKI and odds ratios were calculated for potential risk factors. RESULTS Incidence of AKI was 5/12 (42%) for dogs receiving AmB-D and 14/39 (36%) for dogs receiving ABLC. Of the 19 dogs that developed AKI, 16 (84%) continued treatment after a pause in the planned dosing protocol. Fifty percent of dogs received a cumulative dose of 6.9 mg/kg for AmB-D and 22.5 mg/kg for ABLC (P < .01) at time of AKI diagnosis. ICU hospitalization (odds ratio [OR] 0.21, 95% confidence interval [CI]: 0.58-0.87) and inpatient status (OR 0.25, 95% CI: 0.07-0.86) were associated with decreased odds of AKI. CONCLUSIONS AND CLINICAL IMPORTANCE Incidence of AKI with AmB is common but does not always preclude continued treatment. The incidence of AKI is similar between AmB-D and ABLC, but dogs receiving ABLC tolerated a higher cumulative total dose before AKI diagnosis.
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Affiliation(s)
- Jennifer C Chan
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Jonathan Dear
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Carrie Palm
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Krystle Reagan
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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de Oliveira H, Bezerra BT, Rodrigues ML. Antifungal Development and the Urgency of Minimizing the Impact of Fungal Diseases on Public Health. ACS BIO & MED CHEM AU 2023; 3:137-146. [PMID: 37101810 PMCID: PMC10125384 DOI: 10.1021/acsbiomedchemau.2c00055] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 04/28/2023]
Abstract
Fungal infections are a major public health problem resulting from the lack of public policies addressing these diseases, toxic and/or expensive therapeutic tools, scarce diagnostic tests, and unavailable vaccines. In this Perspective, we discuss the need for novel antifungal alternatives, highlighting new initiatives based on drug repurposing and the development of novel antifungals.
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Affiliation(s)
| | - Bárbara T. Bezerra
- Instituto
Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba81310-020, Brazil
| | - Marcio L. Rodrigues
- Instituto
Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba81310-020, Brazil
- Instituto
de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro, Rio de Janeiro21941-902, Brazil
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do Rosário Esteves Guimarães C, de Freitas HF, Barros TF. Candida albicans antibiofilm molecules: analysis based on inhibition and eradication studies. Braz J Microbiol 2023; 54:37-52. [PMID: 36576671 PMCID: PMC9944165 DOI: 10.1007/s42770-022-00876-1] [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: 09/22/2022] [Accepted: 11/14/2022] [Indexed: 12/29/2022] Open
Abstract
Biofilms are communities of microbial cells surrounded by an extracellular polysaccharide matrix, recognized as a fungal source for local and systemic infections and less susceptible to antifungal drugs. Thus, treatment of biofilm-related Candida spp. infections with popular antifungals such as fluconazole is limited and species-dependent and alternatively demands the use of expensive and high toxic drugs. In this sense, molecules with antibiofilm activity have been studied but without care regarding the use of important criteria such as antibiofilm concentration lower than antifungal concentration when considering the process of inhibition of formation and concentrations equal to or lower than 300 µM. Therefore, this review tries to gather the most promising molecules regarding the activity against the C. albicans biofilm described in the last 10 years, considering the activity of inhibition and eradication. From January 2011 to July 2021, articles were searched on Scopus, PubMed, and Science Direct, combining the keywords "antibiofilm," "candida albicans," "compound," and "molecule" with AND and OR operators. After 3 phases of selection, 21 articles describing 42 molecules were discussed in the review. Most of them were more promising for the inhibition of biofilm formation, with SM21 (24) being an interesting molecule for presenting inhibitory and eradication activity in biofilms with 24 and 48 h, as well as alizarin (26) and chrysazine (27), with concentrations well below the antifungal concentration. Despite the detection of these molecules and the attempts to determine the mechanisms of action by microscopic analysis and gene expression, no specific target has been determined. Thus, a gap is signaled, requiring further studies such as proteomic analyses to clarify it.
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Affiliation(s)
- Carolina do Rosário Esteves Guimarães
- Post-Graduation Program in Pharmacy, Pharmacy College, Federal University of Bahia, Barão de Geremoabo Street, 147, Ondina, Salvador, Bahia CEP, 40170115, Brazil
| | - Humberto Fonseca de Freitas
- Post-Graduation Program in Pharmacy, Pharmacy College, Federal University of Bahia, Barão de Geremoabo Street, 147, Ondina, Salvador, Bahia CEP, 40170115, Brazil
| | - Tânia Fraga Barros
- Post-Graduation Program in Pharmacy, Pharmacy College, Federal University of Bahia, Barão de Geremoabo Street, 147, Ondina, Salvador, Bahia CEP, 40170115, Brazil.
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Alves V, Araújo GR, Frases S. Off-label treatments as potential accelerators in the search for the ideal antifungal treatment of cryptococcosis. Future Microbiol 2023; 18:127-135. [PMID: 36688321 DOI: 10.2217/fmb-2022-0122] [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] [Indexed: 01/24/2023] Open
Abstract
Cryptococcosis is an opportunistic mycosis that mainly affects immunosuppressed patients. The treatment is a combination of three antifungal agents: amphotericin B, 5-flucytosine and fluconazole. However, these drugs have many disadvantages, such as high nephrotoxicity, marketing bans in some countries and fungal resistance. One of the solutions to find possible new drugs is pharmacological repositioning. This work presents repositioned drugs as an alternative for new antifungal therapies for cryptococcosis. All the studies here were performed in vitro or in animal models, except for sertraline, which reached phase III in humans. There is still no pharmacological repositioning approval for cryptococcosis in humans, though this review shows the potential of repurposing as a rapid approach to finding new agents to treat cryptococcosis.
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Affiliation(s)
- Vinicius Alves
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, 21941902, Brazil
| | - Glauber Rs Araújo
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, 21941902, Brazil
| | - Susana Frases
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, 21941902, Brazil
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9
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Valentim-Silva JR, de Barros NB, Macedo SRA, Ferreira ADS, Silva RS, Dill LSM, Zanchi FB, do Nascimento JR, do Nascimento FRF, Lourenzoni MR, Soares AM, Calderon LDA, Nicolete R. Antileishmanial activity, cytotoxicity and cellular response of amphotericin B in combination with crotamine derived from Crotalus durissus terrificus venom using in vitro and in silico approaches. Toxicon 2022; 217:96-106. [PMID: 35977615 DOI: 10.1016/j.toxicon.2022.08.009] [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: 05/26/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To investigate the in vitro activity, synergism, cytotoxicity and cellular immunological response, as well as the molecular affinity between amphotericin B (AmB) and crotamine (CTA), derived from Crotalus durissus terrificus venom against Leishmania amazonensis. METHODS This study performed the inhibition of promastigotes and amastigotes' growth under different concentrations of the drug and pharmacological combinations (AmB + CTA) based on the Berimbaum method (synergism study). The lactate dehydrogenase (LDH) quantification method was used to determine the cytotoxicity of the drug and combinations employing four cell lines (J774, HepG2, VERO, and C2C12). Following, the levels of Tumour Necrose Factor-alpha (TNF-α) and Interleukin-12 (IL-12) cytokines, using enzyme-linked immunosorbent assay (ELISA) and nitrites, as an indirect measure of Nitric Oxide (NO), using the Griess reaction were assessed in the supernatants of infected macrophages. In silico approach (molecular docking and dynamics) and binding affinity (surface plasmon resonance) between the drug and toxin were also investigated. RESULTS CTA enhanced AmB effect against promastigote and amastigote forms of L. amazonensis, decreased the drug toxicity in different cell lines and induced the production of important Th1-like cytokines and NO by infected macrophages. The pharmacological combination also displayed consistent molecular interactions with low energy of coupling and a concentration-dependent profile. CONCLUSION Our data suggest that this pharmacological approach is a promising alternative treatment against L. amazonensis infection due to the improved activity (synergistic effect) achieved against the parasites' forms and to the decreased cytotoxic effect.
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Affiliation(s)
- João R Valentim-Silva
- Post-Doctoral Fellow in Health Sciences, Federal University of Acre (UFAC), Rio Branco, AC, Brazil; Physical Education Department of Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil; Oswaldo Cruz Foundation (Fiocruz Rondônia), Porto Velho, RO, Brazil
| | | | | | | | - Rodrigo S Silva
- Center of Study of Biomolecules Applied in Medicine (CEBio), Oswaldo Cruz Foundation (Fiocruz Rondônia) and Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
| | - Leandro S M Dill
- Center of Study of Biomolecules Applied in Medicine (CEBio), Oswaldo Cruz Foundation (Fiocruz Rondônia) and Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
| | - Fernando B Zanchi
- Center of Study of Biomolecules Applied in Medicine (CEBio), Oswaldo Cruz Foundation (Fiocruz Rondônia) and Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
| | - Johnny R do Nascimento
- Immunophysiology Laboratory, Department of Pathology, Center for Biological and Health Sciences, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | - Flávia R F do Nascimento
- Immunophysiology Laboratory, Department of Pathology, Center for Biological and Health Sciences, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | | | - Andreimar M Soares
- Center of Study of Biomolecules Applied in Medicine (CEBio), Oswaldo Cruz Foundation (Fiocruz Rondônia) and Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil; eCentro Universitário São Lucas (UniSL), Porto Velho, RO, Brazil
| | - Leonardo de A Calderon
- Center of Study of Biomolecules Applied in Medicine (CEBio), Oswaldo Cruz Foundation (Fiocruz Rondônia) and Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
| | - Roberto Nicolete
- Oswaldo Cruz Foundation (Fiocruz Rondônia), Porto Velho, RO, Brazil; Oswaldo Cruz Foundation (Fiocruz Ceará), Eusébio, CE, Brazil.
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10
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Trushina DB, Borodina TN, Belyakov S, Antipina MN. Calcium carbonate vaterite particles for drug delivery: Advances and challenges. MATERIALS TODAY. ADVANCES 2022; 14:100214. [PMID: 36785703 PMCID: PMC9909585 DOI: 10.1016/j.mtadv.2022.100214] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/01/2022] [Indexed: 06/01/2023]
Abstract
The recent successful application of lipid-based nanoparticles as delivery vehicles in COVID-19 vaccines demonstrated the superior potential of nanoparticle-based technology for targeted drug delivery in biomedicine. Among novel, rapidly advancing delivery platforms, the inorganic nano/microparticles gradually reach new heights and attract well-deserved attention among scientists and clinicians. Calcium carbonate in its vaterite form is used as a biocompatible carrier for a progressively increasing number of biomedical applications. Its growing popularity is conferred by beneficial porosity of particles, high mechanical stability, biodegradability under certain physiological conditions, ability to provide a continuous steady release of bioactives, preferential safety profile, and low cost, which make calcium carbonate a suitable entity of highly efficacious formulations for controlled drug delivery and release. The focal point of the current review is the success of the recent vaterite applications in the delivery of various diagnostics and therapeutic drugs. The manuscript highlights the nuances of drug loading in vaterite particles, connecting it with particle morphology, size, and charge of the loaded molecules, payload concentration, mono- or multiple drug loading. The manuscript also depicts recent successful methods of increasing the loading capacity developed for vaterite carriers. In addition, the review describes the various administration routes for vaterite particles with bioactive payloads, which were reported in recent years. Special attention is given to the multi-drug-loaded vaterite particles ("molecular cocktails") and reports on their successful delivery in vitro and in vivo.
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Affiliation(s)
- Daria B Trushina
- A.V. Shubnikov Institute of Crystallography of Federal Research Centre "Crystallography and Photonics" of Russian Academy of Sciences, Russian Academy of Sciences, Moscow, 119333, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Tatiana N Borodina
- A.V. Shubnikov Institute of Crystallography of Federal Research Centre "Crystallography and Photonics" of Russian Academy of Sciences, Russian Academy of Sciences, Moscow, 119333, Russia
| | - Sergei Belyakov
- Theracross Technologies Pte Ltd, 251 Pasir Panjang Rd, Singapore, 118610, Singapore
| | - Maria N Antipina
- Singapore Institute of Food and Biotechnology Innovation A∗STAR, 31 Biopolis Way, #01-02 Nanos, Singapore, 138669, Singapore
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11
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de Oliveira HC, Castelli RF, Alves LR, Nosanchuk JD, Salama EA, Seleem M, Rodrigues ML. Identification of 4 compounds from the Pharmakon library with antifungal activity against Candida auris and species of Cryptococcus. Med Mycol 2022; 60:6586341. [PMID: 35575621 DOI: 10.1093/mmy/myac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/11/2022] [Accepted: 05/12/2022] [Indexed: 11/14/2022] Open
Abstract
There is an urgent need to develop novel antifungals. In this study, we screened 1600 compounds for antifungal activity against Cryptococcus neoformans and Candida auris. We evaluated 4 promising compounds against 24 additional isolates of C. neoformans, C. auris, Cryptococcus deuterogattii, and Cryptococcus gattii. The 4 compounds, dequalinium chloride (DQC), bleomycin sulfate (BMS), pentamidine isethionate salt (PIS), and clioquinol (CLQ), varied in their efficacy against these pathogens but were generally more effective against cryptococci. The compounds exerted their antifungal effect via multiple mechanisms including interference with the capsule of cryptococci and induction of hyphal-like morphology in C. auris. Our results indicate that DQC, BMS, PIS, and CLQ represent potential prototypes for the future development of antifungals.
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Affiliation(s)
| | - Rafael F Castelli
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil.,Programa de Pós-Graduação em Biologia Parasitária, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Lysangela R Alves
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil
| | - Joshua D Nosanchuk
- Departments of Medicine (Division of Infectious Diseases) and Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ehab A Salama
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Mohamed Seleem
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Marcio L Rodrigues
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil.,Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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12
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13
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Wang X, Mohammad IS, Fan L, Zhao Z, Nurunnabi M, Sallam MA, Wu J, Chen Z, Yin L, He W. Delivery strategies of amphotericin B for invasive fungal infections. Acta Pharm Sin B 2021; 11:2585-2604. [PMID: 34522599 PMCID: PMC8424280 DOI: 10.1016/j.apsb.2021.04.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/18/2021] [Accepted: 03/15/2021] [Indexed: 12/11/2022] Open
Abstract
Invasive fungal infections (IFIs) represent a growing public concern for clinicians to manage in many medical settings, with substantial associated morbidities and mortalities. Among many current therapeutic options for the treatment of IFIs, amphotericin B (AmB) is the most frequently used drug. AmB is considered as a first-line drug in the clinic that has strong antifungal activity and less resistance. In this review, we summarized the most promising research efforts on nanocarriers for AmB delivery and highlighted their efficacy and safety for treating IFIs. We have also discussed the mechanism of actions of AmB, rationale for treating IFIs, and recent advances in formulating AmB for clinical use. Finally, this review discusses some practical considerations and provides recommendations for future studies in applying AmB for combating IFIs.
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Key Words
- ABCD, AmB colloidal dispersion
- AIDS, acquired immunodeficiency syndrome
- AP, antisolvent precipitation
- ARDS, acute respiratory distress syndrome
- AmB, amphotericin B
- AmB-GCPQ, AmB-encapsulated N-palmitoyl-N-methyl-N,N-dimethyl-N,N,N-trimethyl-6-O-glycol-chitosan nanoparticles
- AmB-IONP, AmB-loaded iron oxide nanoparticles
- AmB-PM, AmB-polymeric micelles
- AmB-SD, AmB sodium deoxycholate
- AmBd, AmB deoxycholate
- Amphotericin B
- Aspergillus fumigatus, A. fumigatus
- BBB, blood‒brain barrier
- BCS, biopharmaceutics classification system
- BDDE, butanediol diglycidyl ether
- BSA, bovine serum albumin
- BUN, blood urea nitrogen
- C. Albicans, Candida Albicans
- CFU, colony-forming unit
- CLSM, confocal laser scanning microscope
- CMC, carboxymethylated l-carrageenan
- CP, chitosan-polyethylenimine
- CS, chitosan
- Conjugates
- DDS, drug delivery systems
- DMPC, dimyristoyl phosphatidyl choline
- DMPG, dimyristoyl phosphatidylglycerole
- DMSA, dimercaptosuccinic acid
- Drug delivery
- GNPs, gelatin nanoparticles
- HPH, high-pressure homogenization
- HPMC, hydroxypropyl methylcellulose
- ICV, intensive care unit
- IFIs, invasive fungal infections
- Invasive fungal infections
- L-AmB, liposomal AmB
- LNA, linolenic acid
- MAA, methacrylic acid
- MFC, minimum fungicidal concentrations
- MIC, minimum inhibitory concentration
- MN, microneedles
- MOP, microneedle ocular patch
- MPEG-PCL, monomethoxy poly(ethylene glycol)-poly(epsilon-caprolactone)
- NEs, nanoemulsions
- NLC, nanostructured lipid carriers
- NPs, nanoparticles
- Nanoparticles
- P-407, poloxamer-407
- PAM, polyacrylamide
- PCL, polycaprolactone
- PDA, poly(glycolic acid)
- PDLLA, poly(d,l-lactic acid)
- PDLLGA, poly(d,l-lactic-co-glycolic acid)
- PEG, poly(ethylene glycol)
- PEG-DSPE, PEG-lipid poly(ethylene glycol)-distearoylphosphatidylethanolamine
- PEG-PBC, phenylboronic acid-functionalized polycarbonate/PEG
- PEG-PUC, urea-functionalized polycarbonate/PEG
- PGA-PPA, poly(l-lysine-b-l-phenylalanine) and poly(l-glutamic acid-b-l-phenylalanine)
- PLA, poly(lactic acid)
- PLGA, polyvinyl alcohol poly(lactic-co-glycolic acid)
- PLGA-PLH-PEG, PLGA-b-poly(l-histidine)-b-poly(ethylene glycol)
- PMMA, poly(methyl methacrylate)
- POR, porphyran
- PVA, poly(vinyl alcohol)
- PVP, polyvinylpyrrolidone
- Poor water-solubility
- RBCs, red blood cells
- RES, reticuloendothelial system
- ROS, reactive oxygen species
- SEM, scanning electron microscope
- SL-AmB, sophorolipid-AmB
- SLNs, solid lipid nanoparticles
- Topical administration
- Toxicity
- γ-CD, γ-cyclodextrin
- γ-PGA, γ-poly(gamma-glutamic acid
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Affiliation(s)
- Xiaochun Wang
- Department of Pharmaceutics, China Pharmaceutical University, Nanjing 211198, China
| | - Imran Shair Mohammad
- School of Pharmaceutical Sciences, Sun Yat-sen University, University Town, Guangzhou 510006, China
| | - Lifang Fan
- Jiangsu Aosaikang Pharmaceutical Co., Ltd., Nanjing 211112, China
| | - Zongmin Zhao
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Md Nurunnabi
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Texas at El Paso, El Paso, TX 79902, USA
| | - Marwa A. Sallam
- Department of Industrial Pharmacy, Faculty of Pharmacy, Alexandria University, Alexandria 21521, Egypt
| | - Jun Wu
- Department of Geriatric Cardiology, Jiangsu Provincial Key Laboratory of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhongjian Chen
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China
| | - Lifang Yin
- Department of Pharmaceutics, China Pharmaceutical University, Nanjing 211198, China
| | - Wei He
- Department of Pharmaceutics, China Pharmaceutical University, Nanjing 211198, China
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Silva VKA, May RC, Rodrigues ML. Pyrifenox, an ergosterol inhibitor, differentially affects Cryptococcus neoformans and Cryptococcus gattii. Med Mycol 2021; 58:928-937. [PMID: 31915833 DOI: 10.1093/mmy/myz132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/26/2019] [Accepted: 12/20/2019] [Indexed: 12/25/2022] Open
Abstract
Cryptococcosis is a life-threatening fungal infection. New therapeutic approaches are necessary to combat cryptococcosis, as the currently available therapeutic protocols are expensive and generally result in deleterious side effects. Pyrifenox is an antifungal compound that affects phytopathogens by inhibiting the biosynthesis of ergosterol. In this study, we investigated the effects of pyrifenox on Cryptococcus neoformans and Cryptococcus gattii growth, capsule architecture and export of the major capsule component, glucuroxylomannan (GXM). Pyrifenox inhibited the growth of C. neoformans, but was significantly less effective against C. gattii. The resistance of C. gattii to pyrifenox was associated with the expression of efflux pump genes, particularly AFR1 and AFR2, since mutant cells lacking expression of these genes became sensitive to pyrifenox. Analysis of the cryptococcal capsule by India ink counterstaining, immunofluorescence, and scanning electron microscopy showed that pyrifenox affected capsular dimensions in both species. However, GXM fibers were shorter and uniformly distributed in C. neoformans, whereas in C. gattii the number of fibers was reduced. Pyrifenox-treated C. gattii developed unusually long chains of undivided cells. The secretion of GXM was markedly reduced in both species after treatment with pyrifenox. Altogether, the results indicated that pyrifenox differently affects C. neoformans and C. gattii. In addition, it highlights a potential role for pyrifenox as an inhibitor of GXM export in experimental models involving pathogenic cryptococci.
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Affiliation(s)
- Vanessa K A Silva
- Programa de Pós-Graduação em Biologia Parasitária, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Robin C May
- Institute of Microbiology and Infection and School of Biosciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Marcio L Rodrigues
- Instituto Carlos Chagas (ICC), Fundação Oswaldo Cruz (FIOCRUZ), Curitiba, Brazil.,Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Brazil
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15
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de Sousa HR, de Frazão S, de Oliveira Júnior GP, Albuquerque P, Nicola AM. Cryptococcal Virulence in Humans: Learning From Translational Studies With Clinical Isolates. Front Cell Infect Microbiol 2021; 11:657502. [PMID: 33968804 PMCID: PMC8097041 DOI: 10.3389/fcimb.2021.657502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/31/2021] [Indexed: 01/17/2023] Open
Abstract
Cryptococcosis, an invasive mycosis caused by Cryptococcus spp, kills between 20% and 70% of the patients who develop it. There are no vaccines for prevention, and treatment is based on a limited number of antifungals. Studying fungal virulence and how the host responds to infection could lead to new therapies, improving outcomes for patients. The biggest challenge, however, is that experimental cryptococcosis models do not completely recapitulate human disease, while human experiments are limited due to ethical reasons. To overcome this challenge, one of the approaches used by researchers and clinicians is to: 1) collect cryptococcal clinical isolates and associated patient data; 2) study the set of isolates in the laboratory (virulence and host-pathogen interaction variables, molecular markers); 3) correlate the laboratory and patient data to understand the roles fungal attributes play in the human disease. Here we review studies that have shed light on the cryptococcosis pathophysiology using these approaches, with a special focus on human disease. Isolates that more effectively evade macrophage responses, that secrete more laccase, melanize faster and have larger capsules in the cerebrospinal fluid are associated with poorer patient outcomes. Additionally, molecular studies have also shown that cryptococcal clades vary in virulence, with clinical impact. Limitations of those studies include the use of a small number of isolates or retrospectively collected clinical data. The fact that they resulted in very important information is a reflection of the impact this strategy has in understanding cryptococcosis and calls for international collaboration that could boost our knowledge.
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Affiliation(s)
- Herdson Renney de Sousa
- Microbiology, Immunology and Biotechnology Laboratory, Faculty of Medicine, University of Brasília, Brasília, Brazil
| | - Stefânia de Frazão
- Laboratory of Molecular Biology of Pathogenic Fungi, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Getúlio Pereira de Oliveira Júnior
- Division of Allergy and Inflammation, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Patrícia Albuquerque
- Microbiology, Immunology and Biotechnology Laboratory, Faculty of Medicine, University of Brasília, Brasília, Brazil
- Laboratory of Molecular Biology of Pathogenic Fungi, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
- Faculty of Ceilândia, University of Brasília, Brasília, Brazil
| | - André Moraes Nicola
- Microbiology, Immunology and Biotechnology Laboratory, Faculty of Medicine, University of Brasília, Brasília, Brazil
- Graduate Program in Genomic Sciences and Biotechnology, Catholic University of Brasília, Brasília, Brazil
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16
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Cordeiro R, Moura S, Castelo-Branco D, Rocha MF, Lima-Neto R, Sidrim JJ. Coccidioidomycosis in Brazil: Historical Challenges of a Neglected Disease. J Fungi (Basel) 2021; 7:85. [PMID: 33513773 PMCID: PMC7911456 DOI: 10.3390/jof7020085] [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: 12/05/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
Coccidioidomycosis is a deep-seated fungal infection that occurs exclusively in semiarid areas in the Americas. In Brazil, coccidioidomycosis occurs exclusively in rural areas in the northeast region and affects counties that are hit by recurrent droughts, poverty and economic stagnation. Since 1978, approximately 136 cases of the disease have been reported in Brazil, according to scientific publications. However, a lack of governmental epidemiological data as well as a similarity to tuberculosis have led scientists and experts to assume that a greater number of cases occur in the country, which are not diagnosed and/or reported. In this review, general characteristics of coccidioidomycosis are presented, followed by a description of the main clinical and epidemiological data of cases in Brazil. The purpose of this article is to discuss the inclusion of coccidioidomycosis in the list of neglected tropical diseases. We believe that the adoption of coccidioidomycosis as a neglected tropical disease will enable the creation of an effective epidemiological surveillance system and the development of feasible public health solutions for its control in vulnerable populations.
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Affiliation(s)
- Rossana Cordeiro
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
| | - Santiago Moura
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
| | - Débora Castelo-Branco
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
| | - Marcos Fábio Rocha
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
- Postgraduate Program in Veterinary Sciences, School of Veterinary Medicine, Ceará State University, Fortaleza 60740-000, Brazil
| | - Reginaldo Lima-Neto
- Center of Medical Sciences, Department of Tropical Medicine, Federal University of Pernambuco (UFPE), Recife-PE 50740-600, Brazil
| | - José Júlio Sidrim
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
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17
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Pereira TC, de Menezes RT, de Oliveira HC, de Oliveira LD, Scorzoni L. In vitro synergistic effects of fluoxetine and paroxetine in combination with amphotericin B against Cryptococcus neoformans. Pathog Dis 2021; 79:6070654. [PMID: 33417701 DOI: 10.1093/femspd/ftab001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/05/2021] [Indexed: 12/16/2022] Open
Abstract
Cryptococcus neoformans is a yeast that mainly affects immunocompromised individuals and causes meningoencephalitis depending on the immune status of the host. The present study aimed to validate the efficacy of selective serotonin reuptake inhibitors, fluoxetine hydrochloride (FLH) and paroxetine hydrochloride (PAH), alone and in combination with amphotericin B (AmB) against C. neoformans. Susceptibility tests were conducted using the broth microdilution method and synergistic effects of combining FLH and PAH with AmB were analyzed using the checkerboard assay. Effects of minimum inhibitory concentration (MIC) and synergistic concentration were evaluated in biofilms by quantifying the biomass, measuring the viability by counting the colony-forming units (CFU/mL) and examining the size of the induced capsules. Cryptococcus neoformans was susceptible to FLH and PAH and the synergistic effect of FLH and PAH in combination with AmB reduced the MIC of AmB by up to 8-fold. The isolated substances and combination with AmB were able to reduce biofilm biomass and biofilm viability. In addition, FLH and PAH alone or in combination with AmB significantly decreased the size of the yeast capsules. Collectively, our results indicate the use of FLH and PAH as a promising prototype for the development of anti-cryptococcal drugs.
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Affiliation(s)
- Thaís Cristine Pereira
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo, 777 São José dos Campos, São Paulo 12245-000, Brazil
| | - Raquel Teles de Menezes
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo, 777 São José dos Campos, São Paulo 12245-000, Brazil
| | - Haroldo Cesar de Oliveira
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Rua Prof. Algacyr Munhoz Mader, 3775 Curitiba, PR 81350-010, Brazil
| | - Luciane Dias de Oliveira
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo, 777 São José dos Campos, São Paulo 12245-000, Brazil
| | - Liliana Scorzoni
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo, 777 São José dos Campos, São Paulo 12245-000, Brazil
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18
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Fenbendazole Controls In Vitro Growth, Virulence Potential, and Animal Infection in the Cryptococcus Model. Antimicrob Agents Chemother 2020; 64:AAC.00286-20. [PMID: 32253211 DOI: 10.1128/aac.00286-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022] Open
Abstract
The human diseases caused by the fungal pathogens Cryptococcus neoformans and Cryptococcus gattii are associated with high indices of mortality and toxic and/or cost-prohibitive therapeutic protocols. The need for affordable antifungals to combat cryptococcal disease is unquestionable. Previous studies suggested benzimidazoles as promising anticryptococcal agents combining low cost and high antifungal efficacy, but their therapeutic potential has not been demonstrated so far. In this study, we investigated the antifungal potential of fenbendazole, the most effective anticryptococcal benzimidazole. Fenbendazole was inhibitory against 17 different isolates of C. neoformans and C. gattii at a low concentration. The mechanism of anticryptococcal activity of fenbendazole involved microtubule disorganization, as previously described for human parasites. In combination with fenbendazole, the concentrations of the standard antifungal amphotericin B required to control cryptococcal growth were lower than those required when this antifungal was used alone. Fenbendazole was not toxic to mammalian cells. During macrophage infection, the anticryptococcal effects of fenbendazole included inhibition of intracellular proliferation rates and reduced phagocytic escape through vomocytosis. Fenbendazole deeply affected the cryptococcal capsule. In a mouse model of cryptococcosis, the efficacy of fenbendazole to control animal mortality was similar to that observed for amphotericin B. These results indicate that fenbendazole is a promising candidate for the future development of an efficient and affordable therapeutic tool to combat cryptococcosis.
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Rodrigues ML, Nosanchuk JD. Fungal diseases as neglected pathogens: A wake-up call to public health officials. PLoS Negl Trop Dis 2020; 14:e0007964. [PMID: 32078635 PMCID: PMC7032689 DOI: 10.1371/journal.pntd.0007964] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Marcio L. Rodrigues
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil
- Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joshua D. Nosanchuk
- Department of Medicine (Division of Infectious Diseases) and Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, New York, United States of America
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Faustino C, Pinheiro L. Lipid Systems for the Delivery of Amphotericin B in Antifungal Therapy. Pharmaceutics 2020; 12:pharmaceutics12010029. [PMID: 31906268 PMCID: PMC7023008 DOI: 10.3390/pharmaceutics12010029] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022] Open
Abstract
Amphotericin B (AmB), a broad-spectrum polyene antibiotic in the clinic for more than fifty years, remains the gold standard in the treatment of life-threatening invasive fungal infections and visceral leishmaniasis. Due to its poor water solubility and membrane permeability, AmB is conventionally formulated with deoxycholate as a micellar suspension for intravenous administration, but severe infusion-related side effects and nephrotoxicity hamper its therapeutic potential. Lipid-based formulations, such as liposomal AmB, have been developed which significantly reduce the toxic side effects of the drug. However, their high cost and the need for parenteral administration limit their widespread use. Therefore, delivery systems that can retain or even enhance antimicrobial efficacy while simultaneously reducing AmB adverse events are an active area of research. Among those, lipid systems have been extensively investigated due to the high affinity of AmB for binding lipids. The development of a safe and cost-effective oral formulation able to improve drug accessibility would be a major breakthrough, and several lipid systems for the oral delivery of AmB are currently under development. This review summarizes recent advances in lipid-based systems for targeted delivery of AmB focusing on non-parenteral nanoparticulate formulations mainly investigated over the last five years and highlighting those that are currently in clinical trials.
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Affiliation(s)
| | - Lídia Pinheiro
- Correspondence: ; Tel.: +351-21-7946-400; Fax: +351-21-7946-470
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21
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Kumar P, Shivam P, Mandal S, Prasanna P, Kumar S, Prasad SR, Kumar A, Das P, Ali V, Singh SK, Mandal D. Synthesis, characterization, and mechanistic studies of a gold nanoparticle-amphotericin B covalent conjugate with enhanced antileishmanial efficacy and reduced cytotoxicity. Int J Nanomedicine 2019; 14:6073-6101. [PMID: 31686803 PMCID: PMC6709383 DOI: 10.2147/ijn.s196421] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/10/2019] [Indexed: 12/24/2022] Open
Abstract
Background Amphotericin B (AmB) as a liposomal formulation of AmBisome is the first line of treatment for the disease, visceral leishmaniasis, caused by the parasite Leishmania donovani. However, nephrotoxicity is very common due to poor water solubility and aggregation of AmB. This study aimed to develop a water-soluble covalent conjugate of gold nanoparticle (GNP) with AmB for improved antileishmanial efficacy and reduced cytotoxicity. Methods Citrate-reduced GNPs (~39 nm) were functionalized with lipoic acid (LA), and the product GNP-LA (GL ~46 nm) was covalently conjugated with AmB using carboxyl-to-amine coupling chemistry to produce GNP-LA-AmB (GL-AmB ~48 nm). The nanoparticles were characterized by dynamic light scattering, transmission electron microscopy (TEM), and spectroscopic (ultraviolet–visible and infrared) methods. Experiments on AmB uptake of macrophages, ergosterol depletion of drug-treated parasites, cytokine ELISA, fluorescence anisotropy, flow cytometry, and gene expression studies established efficacy of GL-AmB over standard AmB. Results Infrared spectroscopy confirmed the presence of a covalent amide bond in the conjugate. TEM images showed uniform size with smooth surfaces of GL-AmB nanoparticles. Efficiency of AmB conjugation was ~78%. Incubation in serum for 72 h showed <7% AmB release, indicating high stability of conjugate GL-AmB. GL-AmB with AmB equivalents showed ~5-fold enhanced antileishmanial activity compared with AmB against parasite-infected macrophages ex vivo. Macrophages treated with GL-AmB showed increased immunostimulatory Th1 (IL-12 and interferon-γ) response compared with standard AmB. In parallel, AmB uptake was ~5.5 and ~3.7-fold higher for GL-AmB-treated (P<0.001) macrophages within 1 and 2 h of treatment, respectively. The ergosterol content in GL-AmB-treated parasites was ~2-fold reduced compared with AmB-treated parasites. Moreover, GL-AmB was significantly less cytotoxic and hemolytic than AmB (P<0.01). Conclusion GNP-based delivery of AmB can be a better, cheaper, and safer alternative than available AmB formulations.
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Affiliation(s)
- Prakash Kumar
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER) - Hajipur, Vaishali, India
| | - Pushkar Shivam
- Department of Microbiology, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Saptarshi Mandal
- Department of Chemistry, Indian Institute of Technology Patna, Patna, India
| | - Pragya Prasanna
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER) - Hajipur, Vaishali, India
| | - Saurabh Kumar
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER) - Hajipur, Vaishali, India
| | - Surendra Rajit Prasad
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER) - Hajipur, Vaishali, India
| | - Ashish Kumar
- Department of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Prolay Das
- Department of Chemistry, Indian Institute of Technology Patna, Patna, India
| | - Vahab Ali
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Shubhankar Kumar Singh
- Department of Microbiology, Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Debabrata Mandal
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER) - Hajipur, Vaishali, India
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22
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Bueno PSA, Rodrigues-Vendramini FAV, Toplak M, Macheroux P, Kioshima ÉS, Seixas FAV. New inhibitors of chorismate synthase present antifungal activity against Paracoccidioides brasiliensis. Future Microbiol 2019; 14:969-980. [DOI: 10.2217/fmb-2019-0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: A structural model of chorismate synthase (CS) from the pathogenic fungus Candida albicans was used for virtual screening simulations. Methods: Docking, molecular dynamics, cell growth inhibition and protein binding assays were used for search and validation. Results: Two molecules termed CS8 and CaCS02 were identified. Further studies of the minimal inhibitory concentration demonstrated fungicidal activity against Paracoccidioides brasiliensis with a minimal inhibitory concentration and minimal fungicidal concentration of 512 and 32 μg·ml-1 for CS8 and CaCS02, respectively. In addition, CaCS02 showed a strong synergistic effect in combination with amphotericin B without cytotoxic effects. In vitro studies using recombinant CS from P. brasiliensis showed IC50 of 29 μM for CaCS02 supporting our interpretation that inhibition of CS causes the observed fungicidal activity.
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Affiliation(s)
- Paulo SA Bueno
- Department of Technology, Universidade Estadual de Maringá, Av. Ângelo Moreira da Fonseca, 1800, 87506–370 Umuarama, PR, Brazil
| | | | - Marina Toplak
- Institute of Biochemistry, Graz University of Technology, Petersgasse 12/2, 8010, Graz, Austria
| | - Peter Macheroux
- Institute of Biochemistry, Graz University of Technology, Petersgasse 12/2, 8010, Graz, Austria
| | - Érika S Kioshima
- Department of Clinical Analysis & Biomedicine, Universidade Estadual de Maringá, Av. Colombo 5790, 87020–900 Maringá, PR, Brazil
| | - Flavio AV Seixas
- Department of Technology, Universidade Estadual de Maringá, Av. Ângelo Moreira da Fonseca, 1800, 87506–370 Umuarama, PR, Brazil
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23
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Yu Y, Peng L, Liao G, Chen Z, Li C. Noncovalent Complexation of Amphotericin B with Poly(β-Amino Ester) Derivates for Treatment of C. Neoformans Infection. Polymers (Basel) 2019; 11:polym11020270. [PMID: 30960254 PMCID: PMC6419036 DOI: 10.3390/polym11020270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 01/15/2023] Open
Abstract
Our goal was to improve treatment outcomes for C. neoformans infection by designing nanocarriers that enhance drug-encapsulating capacity and stability. Thus, a noncovalent complex of methoxy poly(ethylene glycol)-poly(lactide)-poly(β-amino ester) (MPEG-PLA-PAE) and amphotericin B (AMB) was developed and characterized. The MPEG-PLA-PAE copolymer was synthesized by a Michael-type addition reaction; the copolymer was then used to prepare the AMB-loaded nanocomplex. AMB was in a highly aggregated state within complex cores. A high encapsulation efficiency (>90%) and stability of the AMB-loaded nanocomplex were obtained via electrostatic interaction between AMB and PAE blocks. This nanocomplex retained drug activity against C. neoformans in vitro. Compared with micellar AMB, the AMB nanocomplex was more efficient in terms of reducing C. neoformans burden in lungs, liver, and spleen, based on its improved biodistribution. The AMB/MPEG-PLA-PAE complex with enhanced drug-loading capacity and stability can serve as a platform for effective treatment of C. neoformans infection.
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Affiliation(s)
- Yang Yu
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China.
| | - Li Peng
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China.
| | - Guojian Liao
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China.
| | - Zhangbao Chen
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China.
| | - Chong Li
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China.
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