Effects of two different growth media on the postantifungal effect induced by polyenes on Candida species

Postantifungal Effect of Antifungal Drugs against Candida: What Do We Know and How Can We Apply This Knowledge in the Clinical Setting?

The study of the pharmacological properties of an antifungal agent integrates the drug pharmacokinetics, the fungal growth inhibition, the fungicidal effect and the postantifungal activity, laying the basis to guide optimal dosing regimen selection. The current manuscript reviews concepts regarding the postantifungal effect (PAFE) of the main classes of drugs used to treat Candida infections or candidiasis. The existence of PAFE and its magnitude are highly dependent on both the fungal species and the class of the antifungal agent. Therefore, the aim of this article was to compile the information described in the literature concerning the PAFE of polyenes, azoles and echinocandins against the Candida species of medical interest. In addition, the mechanisms involved in these phenomena, methods of study, and finally, the clinical applicability of these studies relating to the design of dosing regimens were reviewed and discussed. Additionally, different factors that could determine the variability in the PAFE were described. Most PAFE studies were conducted in vitro, and a scarcity of PAFE studies in animal models was observed. It can be stated that the echinocandins cause the most prolonged PAFE, followed by polyenes and azoles. In the case of the triazoles, it is worth noting the inconsistency found between in vitro and in vivo studies.

The Postantifungal Effect (PAFE) of Itraconazole, in Comparison with Those of Miconazole and Fluconazole, onCandidaSpecies

To study the postantifungal effect (PAFE) of itraconazole (ITCZ) against Candida species, we quantitated it using a newly introduced parameter T/C(T=time required for the drug-treated culture to reach 5-fold increase in turbidity; C=time required for the drug-free control culture to reach 5-fold increase in turbidity) referred as PAFE index and compared the results with those obtained for two other azole antifungal drugs fluconazole (FLCZ) and miconazole (MCZ). The mean values of PAFE index for ITCZ against three C. albicans strains were 1.28, 1.45, and 1.60 when exposed to the drug for 1 hr at concentrations of 1 x MIC, 2 x MIC and 4 x MIC, respectively. These values are similar to those for MCZ and appreciably higher than those for FLCZ. PAFE index values for ITCZ against each single strain of three non-albicans Candida species exposed to 2 x MIC of the drug for 1 hr were: 1.22 with C. glabrata, 1.63 with C. parapsilosis, and 3.90 with C. tropicalis. Again, comparable values were obtained for MCZ and lower values for FLCZ. The drug concentration for exposure and the duration of exposure only slightly or scarcely affected the PAFE of ITCZ, although the magnitude of the PAFE considerably varied among different strains or species tested. In general, ITCZ, as well as MCZ, produced greater extents of PAFE than those for FLCZ against C. albicans and several non-albicans Candida species.

Amphotericin B-induced in vitro postantifungal effect on Candida species of oral origin

OBJECTIVE

The aim of this investigation was to measure the postantifungal effect (PAFE) of 6 different oral Candida species following exposure to amphotericin B.

MATERIALS AND METHODS

Five oral isolates each of Candida albicans, Candida tropicalis, Candida krusei, Candida parapsilosis, Candida glabrata and Candida guilliermondii (total of 30 isolates) were examined for the presence of PAFE after 1 h of exposure to the minimum inhibitory concentration of amphotericin B. The PAFE was determined as the difference in time (hours) required for the growth of the drug-free control and the drug-exposed test cultures to increase to 0.05 absorbance level following removal of amphotericin B.

RESULTS

The mean duration of amphotericin B-induced PAFE was lowest for C. albicans (5.91 ± 0.31 h) and greatest for C. parapsilosis (12.72 ± 0.11 h), while C. guilliermondii (8.32 ± 0.33 h), C. glabrata (8.43 ± 0.21 h), C. krusei (9.68 ± 0.23 h) and C. tropicalis (10.98 ± 0.18 h) elicited intermediate values.

CONCLUSION

Even a limited exposure to sublethal concentrations of amphotericin B suppressed growth of Candida species of oral origin. The significant variation in amphotericin B-induced PAFE amongst different Candida species may have clinical implications in terms of amphotericin B regimens used in the management of oral candidiasis.

Comparison between E-test and CLSI broth microdilution method for antifungal susceptibility testing of Candida albicans oral isolates

Thirty Candida albicans isolated from oral candidosis patients and 30 C. albicans isolated from control individuals were studied. In vitro susceptibility tests were performed for amphotericin B, fluconazole, 5-flucytosine and itraconazole through the Clinical and Laboratorial Standards Institute (CLSI) reference method and E test system. The results obtained were analyzed and compared. MIC values were similar for the strains isolated from oral candidosis patients and control individuals. The agreement rate for the two methods was 66.67% for amphotericin B, 53.33% for fluconazole, 65% for flucytosine and 45% for itraconazole. According to our data, E test method could be an alternative to trial routine susceptibility testing due to its simplicity. However, it can not be considered a substitute for the CLSI reference method.

Dormancy of Candida albicans cells in the presence of the polyene antibiotic amphotericin B: simple demonstration by flow cytometry

Flow cytometry light scattering was used to monitor size increase of Candida albicans (isolate ATCC 10231) cells in the presence or absence of the antifungal drug amphotericin B (AmB). This non-invasive and descriptive method allowed for the differentiation of dead and dormant sub-populations of cells. When inoculated into a growth medium without AmB, a progressive increase in light scattering was observed over a period of approximately 4 h, but without proliferation of the yeast. After this period, the light scattering distribution regressed to baseline level, whereas cell proliferation started. In the presence of AmB, all the cells shrank in size within approximately 4 h and proliferation was temporarily halted. However, in the presence of 0.4 microM AmB, a progressive increase of light scattering occurred after 21 h which was similar to that observed within the first 4 h in the absence of the antifungal. After approximately 24 h of incubation at this concentration of AmB, proliferation resumed. These observations indicate that this renewed cell proliferation was due to the reawakening of dormant cells in the presence of AmB (45% in the presence of 0.4 microM AmB) rather than the result of the development of viable cells that had escaped detection. This simple descriptive approach could be extended to other fungal strains or species, to other antifungal drugs and possibly to bacteria.

Virulence factors and antifungal susceptibility of Candida albicans isolates from oral candidosis patients and control individuals

Sixty isolates of Candida albicans, 30 obtained from the oral cavity of denture wearers presenting signs of candidosis and 30 obtained from the oral cavity of denture wearers with normal palatal mucosa were assayed for phospholipase and proteinase production, as well as for adherence to buccal epithelial cells. Likewise, susceptibility of the isolates to antifungals was determined by the NCCLS reference method and the E-test method. Proteinase activity was increased among the strains obtained from oral candidosis patients. In contrast, no significant differences between the two groups of isolates were observed in their adherence ability in vitro, in phospholipase production, and susceptibility to antifungal drugs.

Characterization of switch phenotypes in Candida albicans biofilms

The aim of this study was to characterize switch phenotypes in Candida albicans biofilms. Cells of Candida albicans 192887g biofilms (24 h) were resuspended and these together with their planktonic counterparts were separately inoculated on Lee's medium agar supplemented with arginine and zinc, at 25 degrees C for 9 days, for colony formation. The different switch phenotypes, as reflected by varying colony morphologies, were then examined for their (i) stability under various growth conditions, (ii) carbohydrate assimilation profiles, (iii) susceptibility to the polyene antifungal, nystatin, (iv) adhering and biofilm-forming ability, (v) filamentation, and (vi) growth rate in yeast nitrogen base medium supplemented with 100 mM glucose. Our data showed that the frequency of phenotypic switching in C. albicans biofilms was approximately 1%. Compared with the planktonic yeasts, cells derived from candidal biofilms generated one of the phenotypes less frequently (Chi-square-tests: P = 0.017). The five phenotypes derived from the biofilm growth demonstrated differing profiles for carbohydrate assimilation, adhesion, biofilm formation, filamentation, and growth rate. These findings reported here, for the first time, imply that phenotypic switching in the candidal biofilms differs from that in the planktonic growth, and affects multiple biological attributes.

Sublethal injury and resuscitation of Candida albicans after amphotericin B treatment

Amphotericin B treatment was previously shown to inhibit Candida albicans reproduction and reduce the fluorescence of vitality-specific dyes without causing a corresponding increase in the fluorescence of the mortality-specific dyes bis-(1,3-dibutylbarbituric acid)trimethine oxonol and SYBR Green I. In the present study, we have confirmed these results and have shown that the numbers of CFU are reduced by 99.9% by treatment with 0.5 micro g of amphotericin B per ml for 10 h at 35 degrees C. This reduction was not due to fungal cell death. First, the level of reduction of the tetrazolium salt 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl]-2H-tetrazolium hydroxide increased in the presence of concentrations of amphotericin B that caused greater than 90% reductions in the numbers of CFU. Second, fungal cells treated with amphotericin B at a concentration of 0.5 micro g/ml were resuscitated by further incubation at 22 degrees C for 15 h in the continued presence of amphotericin B. Third, recovery of the ability to replicate was prevented by sequential treatment with 20 micro g of miconazole per ml, which also increased the fluorescence of mortality-specific dyes to near the maximal levels achieved with 0.9 micro g of amphotericin B per ml. Sequential treatment with fluconazole and flucytosine did not increase the levels of staining with the mortality-specific dyes. Itraconazole was less effective than ketoconazole, which was less effective than miconazole. The practice of equating the loss of the capacity of C. albicans to form colonies with fungal cell death may give incorrect results in assays with amphotericin B, and the results of assays with caution with other antifungal agents that are lipophilic or that possess significant postantifungal effects may need to be interpreted.