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Blaser F, Bajka A, Grimm F, Metzler S, Herrmann D, Barthelmes D, Zweifel SA, Said S. Assessing PCR-Positive Acanthamoeba Keratitis-A Retrospective Chart Review. Microorganisms 2024; 12:1214. [PMID: 38930596 PMCID: PMC11205950 DOI: 10.3390/microorganisms12061214] [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: 05/20/2024] [Revised: 06/04/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Ophthalmologists' diagnostic and treatment competence in Acanthamoeba keratitis varies widely. This investigator-initiated, retrospective, single-center chart review examined the electronic patient files regarding PCR-positive Acanthamoeba keratitis. We included corneal and contact lens assessments. We further reviewed the patient's medical history, corneal scraping results regarding viral or fungal co-infections, and the duration from symptom onset to final diagnosis. We identified 59 eyes of 52 patients from February 2010 to February 2023, with 31 of 52 (59.6%) being female patients. The median (IQR, range) patient age was 33 (25.3 to 45.5 [13 to 90]) years, and the mean (SD, range) time to diagnosis after symptom onset was 18 (10.5 to 35 [3 to 70]) days. Overall, 7 of 52 (7.7%) patients displayed a bilateral Acanthamoeba infection, and 48 (92.3%) used contact lenses at symptom onset. Regarding other microbiological co-infections, we found virologic PCR testing in 45 of 52 (86.5%) patients, with 3 (6.7%) positive corneal scrapings. Fungal cultures were performed in 49 of 52 (94.2%) patients, with 5 (10.2%) positive corneal scrapings. The medical treatment success rate was 45/46 (97.8%). This study raises awareness of patient education in contact lens handling and screens for further microbial co-infections in suspected Acanthamoeba cases.
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Affiliation(s)
- Frank Blaser
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Felix Grimm
- Institute of Parasitology, University of Zurich, 8057 Zurich, Switzerland
| | - Simone Metzler
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Didier Herrmann
- Institute of Optometry, University of Applied Science, 4600 Olten, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
| | - Sadiq Said
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland (S.S.)
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Di Zazzo A, De Gregorio C, Coassin M. Novel Effective Medical Therapy for Acanthamoeba Keratitis. Eye Contact Lens 2024; 50:279-281. [PMID: 38709240 PMCID: PMC11101174 DOI: 10.1097/icl.0000000000001092] [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] [Accepted: 02/19/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To report first clinical use of novel medical treatment for Acanthamoeba keratitis. METHODS Interventional observational case series. Two patients with Acanthamoeba keratitis were unsuccessfully treated with polihexanide (PHMB) 0.02% and propamidine 0.1% for 6 weeks, then all were shifted in a compassionate use of PHMB 0.08% with novel standardized protocol. The postinterventional follow-up of patients was at least 7 months. RESULTS PHMB 0.08% eyedrops in a novel standardized protocol improved infection resolution and led to complete healing of the lesion after 4 weeks in the two cases. Corneal opacities and neovascularization decreased slowly, best-corrected visual acuity slightly improved and progressively increased in the further 7 months, and no infection recurrence occurred. CONCLUSIONS This preliminary report of two cases shows promising response to polihexanide 0.08% lowering drastically the illness duration, with reduced chance of recurrence, and mostly improving patients' quality of life.
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Affiliation(s)
- Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Chiara De Gregorio
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Marco Coassin
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
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Raghavan A, Rammohan R. Acanthamoeba keratitis - A review. Indian J Ophthalmol 2024; 72:473-482. [PMID: 38454853 PMCID: PMC11149514 DOI: 10.4103/ijo.ijo_2627_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/23/2023] [Indexed: 03/09/2024] Open
Abstract
This is a comprehensive review after a thorough literature search in PubMed-indexed journals, incorporating current information on the pathophysiology, clinical features, diagnosis, medical and surgical therapy, as well as outcomes of Acanthamoeba keratitis (AK). AK is a significant cause of ocular morbidity, and early diagnosis with timely institution of appropriate therapy is the key to obtaining good outcomes. The varied presentations result in frequent misdiagnosis, and co-infections can increase the morbidity of the disease. The first line of therapy continues to be biguanides and diamidines, with surgery as a last resort.
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Affiliation(s)
- Anita Raghavan
- Cornea & Refractive Surgery, Department of Microbiology, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Zhou YL, Jin WQ, Yang JW, Song HX, Chang F, Xia F, Zhang F, Lan WZ, Lu F. The efficacy of a device-based approach to microorganism disinfection and protein removal for orthokeratology lenses in varied clinical circumstances. Cont Lens Anterior Eye 2024; 47:102106. [PMID: 38105172 DOI: 10.1016/j.clae.2023.102106] [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: 07/14/2023] [Revised: 10/27/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE RigidCare is an electrolysis-based device that recently obtained approval from the US's FDA to sterilise microorganisms and remove proteins for orthokeratology (O-K) lenses. The study was conducted to investigate the device's performance in varied clinical circumstances. METHODS Trial lenses and private lenses were employed by O-K lens wearers from five hospitals for an evaluation of disinfection and sterilisation and an assessment of protein removal, respectively. Menicon multipurpose solution and protein remover were selected for use with the control group. Following the instructions, pre-cleaning lens samples, post-cleaning lens samples and residual solution samples of trial lenses of the experimental and control groups were collected for microorganism examinations by an experienced third-party testing organisation. The levels of protein deposition for these two approaches were rated by senior O-K experts. Categorical variables were analysed using statistical tests, such as the chi-squared test and Fisher's exact test. RESULTS The microbial positive rate detected from the pre-cleaning and post-cleaning lens samples and the residual solution of the trial lenses for the experimental and control group was 4/76 vs 1/74 (P = 0.37), 1/76 vs 0/74 (P = 1.00) and 0/76 vs 8/74 (P = 0.006), respectively. Following protein removal, the experimental group exhibited a significantly higher overall proportion of lenses rated as 'clean' or with a 'mild deposit' (96.4 %, 79/82) compared to the control group (85.7 %, 66/77), with a significant difference (P < 0.05). CONCLUSION This multi-center study demonstrated that RigidCare exhibited superior efficacy in disinfection, sterilisation and protein removal as compared to Menicon multipurpose solution and protein remover.
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Affiliation(s)
- Yong-Li Zhou
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, P.R. China
| | - Wan-Qing Jin
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ji-Wen Yang
- Liaoning Aier Eye Hospital, Shenyang, Liaoning, China
| | - Hong-Xin Song
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Feng Chang
- Department of Ophthalmology, General Hospital of the Central Theater Command of the People's Liberation Army of China, Wuhan, Hubei, China
| | - Fangfang Xia
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fen Zhang
- Department of Ophthalmology, General Hospital of the Central Theater Command of the People's Liberation Army of China, Wuhan, Hubei, China
| | - Wei-Zhong Lan
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, P.R. China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, Hunan, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, Hunan, China.
| | - Fan Lu
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Qi X, Mao H, Liu J, Dong Y, Du M, Liu T, Zhang T, Lu X, Gao H. Comparison of therapeutic effects between big-bubble deep anterior lamellar keratoplasty and penetrating keratoplasty for medically unresponsive Acanthamoeba keratitis. BMC Infect Dis 2024; 24:276. [PMID: 38438857 PMCID: PMC10910827 DOI: 10.1186/s12879-024-09147-w] [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: 07/31/2023] [Accepted: 02/16/2024] [Indexed: 03/06/2024] Open
Abstract
PURPOSE To compare the outcomes of big-bubble deep anterior lamellar keratoplasty (BB-DALK) and penetrating keratoplasty (PKP) in the management of medically unresponsive Acanthamoeba keratitis (AK). METHODS This retrospective study included 27 eyes of BB-DALK and 24 eyes of PKP from a tertiary ophthalmology care centre. Glucocorticoid eye drops were subsequently added to the treatment plan 2 months postoperatively based on the evaluation using confocal laser scanning microscopy. The clinical presentations, best-corrected visual acuity (BCVA), postoperative refractive outcomes, graft survival, and Acanthamoeba recurrence were analyzed. RESULTS The AK patients included in the study were in stage 2 or stage 3, and the percentage of patients in stage 3 was higher in the PKP group (P = 0.003). Clinical presentations were mainly corneal ulcers and ring infiltrates, and endothelial plaques, hypopyon, uveitis and glaucoma were more common in the PKP group (P = 0.007). The BCVA and the graft survival rate showed no statistically significant differences between the two groups at 1 year after surgery. However, 3 years postoperatively, the BCVA of 0.71 ± 0.64 logMAR, the graft survival rate of 89.5%, and the endothelial cell density of 1899 ± 125 cells per square millimeter in the BB-DALK group were significantly better than those of the PKP group (P = 0.010, 0.046, and 0.032, respectively). 3 eyes (11.1%) in the BB-DALK group and 2 eyes (8.3%) in the PKP group experienced Acanthamoeba recurrence, but the rates showed no statistically significant difference between the two groups (P = 1.000). In the PKP group, immune rejection and elevated intraocular pressure were observed in 5 and 6 eyes, respectively. CONCLUSION Corneal transplantation is recommended for AK patients unresponsive to antiamoebic agents. The visual acuity and graft survival can be maintained after BB-DALK surgery. Acanthamoeba recurrence is not related to the surgical approach performed, whereas complete dissection of the infected corneal stroma and delayed prescribing of glucocorticoid eye drops were important to prevent recurrence.
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Affiliation(s)
- Xiaolin Qi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Huilin Mao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Jinhui Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Yanling Dong
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Man Du
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Ting Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Ting Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Shandong First Medical University, Jinan, China
| | - Xiuhai Lu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China
| | - Hua Gao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.
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Latifi A, Esmaeili F, Mohebali M, Yasami-Khiabani S, Rezaeian M, Soleimani M, Kazemirad E, Amani A. Chitosan nanoparticles improve the effectivity of miltefosine against Acanthamoeba. PLoS Negl Trop Dis 2024; 18:e0011976. [PMID: 38527059 PMCID: PMC10962830 DOI: 10.1371/journal.pntd.0011976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 02/07/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Acanthamoeba keratitis (AK) is a corneal sight-threatening infection caused by the free-living amoebae of the genus Acanthamoeba. Early and appropriate treatment significantly impacts visual outcomes. Mucoadhesive polymers such as chitosan are a potential strategy to prolong the residence time and bioavailability of the encapsulated drugs in the cornea. Regarding the recent administration of miltefosine (MF) for treating resistant AK, in the present study, we synthesized miltefosine-loaded chitosan nanoparticles (MF-CS-NPs) and evaluated them against Acanthamoeba. METHODOLOGY/PRINCIPAL FINDINGS Chitosan nanoparticles (CNPs) were prepared using the ionic gelation method with negatively charged tripolyphosphate (TPP). The zeta-potential (ZP) and the particle size of MF-CS-NPs were 21.8±3.2 mV and 46.61±18.16 nm, respectively. The release profile of MF-CS-NPs indicated linearity with sustained drug release. The cytotoxicity of MF-CS-NPs on the Vero cell line was 2.67 and 1.64 times lower than free MF at 24 and 48 hours. This formulation exhibited no hemolytic activity in vitro and ocular irritation in rabbit eyes. The IC50 of MF-CS-NPs showed a significant reduction by 2.06 and 1.69-fold in trophozoites at 24 and 48 hours compared to free MF. Also, the MF-CS-NPs IC50 in the cysts form was slightly decreased by 1.26 and 1.21-fold at 24 and 48 hours compared to free MF. CONCLUSIONS The MF-CS-NPs were more effective against the trophozoites and cysts than free MF. The nano-chitosan formulation was more effective on trophozoites than the cysts form. MF-CS-NPs reduced toxicity and improved the amoebicidal effect of MF. Nano-chitosan could be an ideal carrier that decreases the cytotoxicity of miltefosine. Further analysis in animal settings is needed to evaluate this nano-formulation for clinical ocular drug delivery.
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Affiliation(s)
- Alireza Latifi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Esmaeili
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mostafa Rezaeian
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Department of Ocular Trauma and Emergency, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Kazemirad
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Amani
- Natural products and medicinal plants Research center, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Dart JKG, Papa V, Rama P, Knutsson KA, Ahmad S, Hau S, Sanchez S, Franch A, Birattari F, Leon P, Fasolo A, Kominek EM, Jadczyk-Sorek K, Carley F, Hossain P, Minassian DC. The Orphan Drug for Acanthamoeba Keratitis (ODAK) Trial: PHMB 0.08% (Polihexanide) and Placebo versus PHMB 0.02% and Propamidine 0.1. Ophthalmology 2024; 131:277-287. [PMID: 37802392 DOI: 10.1016/j.ophtha.2023.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023] Open
Abstract
PURPOSE To compare topical PHMB (polihexanide) 0.02% (0.2 mg/ml)+ propamidine 0.1% (1 mg/ml) with PHMB 0.08% (0.8 mg/ml)+ placebo (PHMB 0.08%) for Acanthamoeba keratitis (AK) treatment. DESIGN Prospective, randomized, double-masked, active-controlled, multicenter phase 3 study (ClinicalTrials.gov identifier, NCT03274895). PARTICIPANTS One hundred thirty-five patients treated at 6 European centers. METHODS Principal inclusion criteria were 12 years of age or older and in vivo confocal microscopy with clinical findings consistent with AK. Also included were participants with concurrent bacterial keratitis who were using topical steroids and antiviral and antifungal drugs before randomization. Principal exclusion criteria were concurrent herpes or fungal keratitis and use of antiamebic therapy (AAT). Patients were randomized 1:1 using a computer-generated block size of 4. This was a superiority trial having a predefined noninferiority margin. The sample size of 130 participants gave approximately 80% power to detect 20-percentage point superiority for PHMB 0.08% for the primary outcome of the medical cure rate (MCR; without surgery or change of AAT) within 12 months, cure defined by clinical criteria 90 days after discontinuing anti-inflammatory agents and AAT. A prespecified multivariable analysis adjusted for baseline imbalances in risk factors affecting outcomes. MAIN OUTCOME MEASURES The main outcome measure was MCR within 12 months, with secondary outcomes including best-corrected visual acuity and treatment failure rates. Safety outcomes included adverse event rates. RESULTS One hundred thirty-five participants were randomized, providing 127 in the full-analysis subset (61 receiving PHMB 0.02%+ propamidine and 66 receiving PHMB 0.08%) and 134 in the safety analysis subset. The adjusted MCR within 12 months was 86.6% (unadjusted, 88.5%) for PHMB 0.02%+ propamidine and 86.7% (unadjusted, 84.9%) for PHMB 0.08%; the noninferiority requirement for PHMB 0.08% was met (adjusted difference, 0.1 percentage points; lower one-sided 95% confidence limit, -8.3 percentage points). Secondary outcomes were similar for both treatments and were not analyzed statistically: median best-corrected visual acuity of 20/20 and an overall treatment failure rate of 17 of 127 patients (13.4%), of whom 8 of 127 patients (6.3%) required therapeutic keratoplasty. No serious drug-related adverse events occurred. CONCLUSIONS PHMB 0.08% monotherapy may be as effective (or at worse only 8 percentage points less effective) as dual therapy with PHMB 0.02%+ propamidine (a widely used therapy) with medical cure rates of more than 86%, when used with the trial treatment delivery protocol in populations with AK with similar disease severity. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- John K G Dart
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research, Moorfields Biomedical Research Centre, London, United Kingdom
| | | | - Paolo Rama
- Cornea and Ocular Surface Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Saj Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research, Moorfields Biomedical Research Centre, London, United Kingdom
| | - Scott Hau
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research, Moorfields Biomedical Research Centre, London, United Kingdom
| | - Sara Sanchez
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | - Pia Leon
- Ophthalmic Unit, Ospedale SS Giovanni e Paolo, Venice, Italy
| | - Adriano Fasolo
- Research Unit, The Veneto Eye Bank Foundation, Venice, Italy
| | - Ewa Mrukwa Kominek
- Professor K. Gibiński University Clinical Center of Medical University of Silesia in Katowice, Katowice, Poland; Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Katarzyna Jadczyk-Sorek
- Professor K. Gibiński University Clinical Center of Medical University of Silesia in Katowice, Katowice, Poland; Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Fiona Carley
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Parwez Hossain
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton & University Hospitals Southampton NHS Trust, Southampton, United Kingdom; National Institute of Health Research (NIHR), Southampton Clinical Research Facility, Southampton, United Kingdom
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Chantra S, Jittreprasert S, Chotcomwongse P, Amornpetchsathaporn A. Estimated direct and indirect health care costs of severe infectious keratitis by cultured organisms in Thailand: An 8-year retrospective study. PLoS One 2023; 18:e0288442. [PMID: 37437049 DOI: 10.1371/journal.pone.0288442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE To evaluate the economic impact of treating severe infectious keratitis (IK) at one tertiary referral center in Thailand by analyzing the direct costs of treatment and estimating the indirect costs, and to determine whether cultured organisms had any effect on treatment expenditure. METHODS A retrospective study was conducted of patients with severe IK who had been hospitalized between January 2014 and December 2021 in Rajavithi Hospital. Data from medical records were collected from the time of the patients' admission until the point at which they were discharged and treated in the outpatient department and their IK was completely healed, or until evisceration/enucleation was performed. The direct costs of treatment included fees for services, medical professionals and investigation, as well as for operative and non-operative treatment. The indirect costs consisted of patients' loss of wages, and costs of travel and food. RESULTS A total of 335 patients were studied. The median direct, indirect and total costs were US$65.2, range US$ 6.5-1,119.1, US$314.5, range US$50.8-1,067.5, and US$426.1, range 57.5-1,971.5 respectively. There was no statistically significant difference between direct, indirect, or total treatment costs for culture-negative and culture-positive patients. Among those who were positive, fungal infections entailed the highest total cost of treatment, and this difference was statistically significant (p<0.001). In terms of direct and indirect costs, patients with fungal infections had the greatest direct costs, and this figure was statistically significant (p = 0.001); however, those with parasitic infections had the highest indirect treatment costs, and this was also statistically significant (p<0.001). CONCLUSION Severe IK can cause serious vision impairment or blindness. Indirect costs represented the majority of the expense at 73.8%. There was no difference between direct, indirect, and total treatment costs for patients who were culture-negative or positive. Among the latter, fungal infections resulted in the highest total cost of treatment.
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Affiliation(s)
- Somporn Chantra
- Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
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Abdullah Hamad A. In vitro Evaluation the Efficacy of Some Nnew Plant Extracts and Biocides on the Viability of Acanthamoeba castellanii. Protist 2023; 174:125966. [PMID: 37229821 DOI: 10.1016/j.protis.2023.125966] [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: 08/21/2022] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
The purpose of this study was to assess the efficacy of certain plant extracts and to compare them with current biocides on the viability of Acanthamoeba castellanii cysts and trophozoites in vitro. Amoebicidal and cysticidal assays were performed against both trophozoites and cysts of Acanthamoeba castellanii (ATCC 50370). Ten plant extracts were evaluated alongside the current agents included polyhexamethylene biguanide (PHMB), octenidine and chlorhexidine digluconate. A. castellanii (ATCC 50370) was treated to serial two-fold dilutions of the test compounds and extracts in microtitre plate wells to investigate the effect on trophozoites and cysts of A. castellanii (ATCC 50370). Furthermore, the toxicity of each of the test compounds and extracts were assessed towards a mammalian cell line. Minimum trophozoite inhibitory concentration (MTIC), minimum trophozoite amoebicidal concentration (MTAC), and minimum cysticidal concentration (MCC) were used to establish A. castellanii (ATCC 50370) in vitro sensitivity. The findings of this research revealed that the biguanides PHMB, chlorhexidine, and octenidine all had excellent effectiveness against trophozoites and cysts of A. castellanii (ATCC 50370). The plant extracts testing results showed that, great activity against trophozoites and cysts ofA. castellanii (ATCC 50370) at lower concentrations. This is the first study to demonstrate that the Proskia plant extract had the lowest MCC value, which was 3.9 µg/mL. The time kill experiment confirmed this finding, as this extract reduced cysts of A. castellanii (ATCC 50370) by more than 3-log at 6 hour and by 4-log after 24 hour. The anti-amoebic efficacy of new plant extracts on the viability of A. castellanii (ATCC 50370) cysts and trophozoites was comparable to existing biocide treatments and was not toxic when tested on a mammalian cell line. This could be a promising novel Acanthamoeba treatment by using the tested plant extracts as a monotherapy against trophozoites and cysts.
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Affiliation(s)
- Anas Abdullah Hamad
- University of Fallujah, College of Veterinary Medicine, Branch of Microbiology, Iraq, AL Anbar, Fallujah, Iraq.
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Patel NV, Mathur U, Sawant S, Acharya M, Gandhi A. Three Consecutive Cases of Ocular Polyhexamethylene Biguanide (PHMB) Toxicity Due to Compounding Error. Cureus 2023; 15:e38540. [PMID: 37273361 PMCID: PMC10239261 DOI: 10.7759/cureus.38540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Acanthamoeba keratitis is treated with long-term biguanide therapy, and the treatment itself can lead to ocular side effects. Knowledge of possible toxic complications can help in the better titration of the treatment regimen. Here, we describe the toxic side effects of polyhexamethylene biguanide (PHMB), which occurred in three consecutive patients treated with in-house compounded PHMB. There was an error in compounding the solution, with the resultant concentration of PHMB being around 0.2%. Patients developed ocular toxicity like conjunctival inflammation, persistent epithelial defect, and large pigment clumps on endothelium within six weeks of initiation of therapy. All of them developed rapidly progressive cataract and mydriatic pupil within three months. PHMB has the potential to cause irreversible damage to ocular structures, and the toxicity is time and concentration-dependent.
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Affiliation(s)
- Nikunj V Patel
- Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, IND
| | - Umang Mathur
- Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, IND
| | - Sanil Sawant
- Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, IND
| | - Manisha Acharya
- Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, IND
| | - Arpan Gandhi
- Department of Laboratory Services, Dr. Shroff's Charity Eye Hospital, New Delhi, IND
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11
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Zhang T, Xie L, Dong Y, Cheng J. Therapeutic keratoplasty for severe Acanthamoeba keratitis: risk factors, clinical features, and outcomes of postoperative recurrence. Graefes Arch Clin Exp Ophthalmol 2022; 261:1299-1309. [PMID: 36367557 DOI: 10.1007/s00417-022-05883-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the effect of therapeutic keratoplasty (TKP) in patients with severe Acanthamoeba keratitis (AK) and to analyse the clinical features and risk factors for recurrence. METHODS Clinical data of patients with severe AK treated with lamellar keratoplasty (LK) or penetrating keratoplasty (PK) due to ineffective drug therapy were analysed in this retrospective study. The effects of keratoplasty, clinical features, and risk factors for recurrence were analysed. RESULTS The cohort comprised of 58 patients (59 eyes). Of these, 36 eyes were treated with PK and 23 were treated with LK. The probabilities of successful globe salvage were 91.7% and 91.3%, respectively. The final visual acuity (VA) was ≥ 20/60 in 14 eyes (38.9%) that underwent PK and 15 eyes (65.2%) that underwent LK. Postoperative recurrence of Acanthamoeba infection was detected in 10 eyes; 6 eyes (16.7%) showed recurrence after PK, and 4 eyes (17.4%) showed recurrence after LK. Recurrence occurred between 3 and 80 days (median, 14.5 days) after the operation. The risk factors for recurrence after LK were topical corticosteroid use before diagnosis (p = 0.040) and hypopyon (p = 0.009), while those after PK were topical corticosteroid use before diagnosis (p = 0.045). Clinical manifestations of postoperative recurrence include greyish-white infiltration of the recipient bed, anterior chamber inflammation, graft oedema, and keratic precipitate. CONCLUSION TKP is a treatment option for severe AK that responds poorly to antiamoebic therapy (AAT), although Acanthamoeba infection may relapse, and the visual prognosis is guarded. Topical corticosteroid use before AAT and hypopyon is the two risk factors for recurrence.
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Affiliation(s)
- Ting Zhang
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute of Shandong First Medical University, Qingdao, China
| | - Lixin Xie
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute of Shandong First Medical University, Qingdao, China
| | - Yanling Dong
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute of Shandong First Medical University, Qingdao, China
| | - Jun Cheng
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute of Shandong First Medical University, Qingdao, China.
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McCoy C, Patel S, Thulasi P. Update on the Management of Acanthamoeba Keratitis. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Eldeek HE, Farrag HMM, Tolba MEM, El-Deek HE, Ali MO, Ibraheim ZZ, Bayoumi SA, Hassanin ESA, Alkhalil SS, Huseein EAEHM. Amoebicidal effect of Allium cepa against Allovahlkampfia spelaea: A keratitis model. Saudi Pharm J 2022; 30:1120-1136. [PMID: 36164578 PMCID: PMC9508644 DOI: 10.1016/j.jsps.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/10/2022] [Indexed: 11/27/2022] Open
Abstract
Allovahlkampfia spelaea (A. spelaea) is a free-living amoeba, proved to cause Acanthamoeba-like keratitis with quite difficult treatment. This study aimed to evaluate the amoebicidal effect of Allium cepa (A. cepa) on A. spelaea trophozoites and cysts both in vitro and in vivo using Chinchilla rabbits as an experimental model of this type of keratitis. Chemical constituents of the aqueous extract of A. cepa were identified using Liquid Chromatography-mass Spectrometry (LC-MS). In vitro, A. cepa showed a significant inhibitory effect on trophozoites and cysts compared to the reference drug, chlorhexidine (CHX) as well as the non-treated control (P < 0.05) with statistically different effectiveness in terms of treatment durations and concentrations. No cytotoxic effect of A. cepa on corneal cell line was found even at high concentrations (32 mg/ml) using agar diffusion method. The in vivo results confirmed the efficacy of A. cepa where the extract enhanced keratitis healing with complete resolution of corneal ulcers in 80% of the infected animals by day 14 (post infection)pi compared to 70% recovery with CHX after 20 treatment days. The therapeutic effect was also approved at histological, immune-histochemical, and parasitological levels. Our findings support the potential use of A. cepa as an effective agent against A. spelaea keratitis.
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Ferreira MDS, Mendoza SR, Gonçalves DDS, Rodríguez-de la Noval C, Honorato L, Nimrichter L, Ramos LFC, Nogueira FCS, Domont GB, Peralta JM, Guimarães AJ. Recognition of Cell Wall Mannosylated Components as a Conserved Feature for Fungal Entrance, Adaptation and Survival Within Trophozoites of Acanthamoeba castellanii and Murine Macrophages. Front Cell Infect Microbiol 2022; 12:858979. [PMID: 35711659 PMCID: PMC9194641 DOI: 10.3389/fcimb.2022.858979] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/28/2022] [Indexed: 01/09/2023] Open
Abstract
Acanthamoeba castellanii (Ac) is a species of free-living amoebae (FLAs) that has been widely applied as a model for the study of host-parasite interactions and characterization of environmental symbionts. The sharing of niches between Ac and potential pathogens, such as fungi, favors associations between these organisms. Through predatory behavior, Ac enhances fungal survival, dissemination, and virulence in their intracellular milieu, training these pathogens and granting subsequent success in events of infections to more evolved hosts. In recent studies, our group characterized the amoeboid mannose binding proteins (MBPs) as one of the main fungal recognition pathways. Similarly, mannose-binding lectins play a key role in activating antifungal responses by immune cells. Even in the face of similarities, the distinct impacts and degrees of affinity of fungal recognition for mannose receptors in amoeboid and animal hosts are poorly understood. In this work, we have identified high-affinity ligands for mannosylated fungal cell wall residues expressed on the surface of amoebas and macrophages and determined the relative importance of these pathways in the antifungal responses comparing both phagocytic models. Mannose-purified surface proteins (MPPs) from both phagocytes showed binding to isolated mannose/mannans and mannosylated fungal cell wall targets. Although macrophage MPPs had more intense binding when compared to the amoeba receptors, the inhibition of this pathway affects fungal internalization and survival in both phagocytes. Mass spectrometry identified several MPPs in both models, and in silico alignment showed highly conserved regions between spotted amoeboid receptors (MBP and MBP1) and immune receptors (Mrc1 and Mrc2) and potential molecular mimicry, pointing to a possible convergent evolution of pathogen recognition mechanisms.
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Affiliation(s)
- Marina da Silva Ferreira
- Laboratório de Bioquímica e Imunologia das Micoses, Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
- Pós-Graduação em Imunologia e Inflamação, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Susana Ruiz Mendoza
- Laboratório de Bioquímica e Imunologia das Micoses, Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
- Pós-Graduação em Imunologia e Inflamação, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diego de Souza Gonçalves
- Laboratório de Bioquímica e Imunologia das Micoses, Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
- Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia Rodríguez-de la Noval
- Laboratório de Bioquímica e Imunologia das Micoses, Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Leandro Honorato
- Programa de Pós-Graduação em Ciências (Microbiologia), Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratório de Glicobiologia de Eucariotos, Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Nimrichter
- Laboratório de Glicobiologia de Eucariotos, Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Rede Micologia RJ - FAPERJ, Rio de Janeiro, Brazil
| | - Luís Felipe Costa Ramos
- Laboratório de Química de Proteínas, Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fábio C. S. Nogueira
- Laboratório de Química de Proteínas, Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto B. Domont
- Laboratório de Química de Proteínas, Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Mauro Peralta
- Departamento de Imunologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Allan J. Guimarães
- Laboratório de Bioquímica e Imunologia das Micoses, Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
- Pós-Graduação em Imunologia e Inflamação, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Rede Micologia RJ - FAPERJ, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Microbiologia e Parasitologia Aplicadas, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
- *Correspondence: Allan J. Guimarães,
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15
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Kaufman AR, Tu EY. Advances in the management of Acanthamoeba keratitis: A review of the literature and synthesized algorithmic approach. Ocul Surf 2022; 25:26-36. [DOI: 10.1016/j.jtos.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 01/01/2023]
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16
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Wang X, Jacobs DS. An Update on the Initial Treatment of Acanthamoeba Keratitis. Int Ophthalmol Clin 2022; 62:101-110. [PMID: 35325913 DOI: 10.1097/iio.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Carvalho Clímaco M, de Oliveira YLM, Ramos ACS, Ramos-de-Souza J, Silva ARST, Jain S, Rott MB, Scher R, Correa CB, Barbosa AAT, Dolabella SS. Nisin Induces Cell-Cycle Arrest in Free-Living Amoebae Acanthamoeba castellanii. Acta Parasitol 2022; 67:511-517. [PMID: 34156633 DOI: 10.1007/s11686-021-00436-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Acanthamoeba spp. are free-living amoebas with worldwide distribution and play an important role as disease-causing agents in humans. Drug inability to completely eradicate these parasites along with their toxic effects suggest urgent need for new antimicrobials. Nisin is a natural antimicrobial peptide produced by Lactococcus lactis. Nisin is also the only bacteriocin approved for use in food preservation. In this work, we analyzed the effect of nisin on the growth of Acanthamoeba castellanii trophozoites. METHODS A total of 8 × 104 trophozoites were exposed to increasing concentrations of nisin to determine its activity. Changes in cell membrane and cellular cycle of trophozoites were investigated by flow cytometry, and nisin cytotoxicity in mammalian cells was evaluated in L929 cells by MTT method. RESULTS After 24 h exposure to increasing nisin concentrations, an IC50 of 4493.2 IU mL-1 was obtained for A. castellanii trophozoites. However, after 72 h a recovery in amoebic growth was observed, and it was no longer possible to determine IC50. Flow cytometry analysis showed that nisin has no effect on the membrane integrity. Treatment with nisin induced cell-cycle arrest during G1 and S phases in A. castellanii trophozoites, which recovered their growth after 72 h. CONCLUSION This is one of the first studies showing the effect of internationally approved nisin against A. castellanii trophozoites. Nisin caused cell-cycle arrest in trophozoites, momentarily interfering with the DNA replication process. The data highlight the amoebostatic activity of nisin, and suggest its use as an adjuvant for the treatment of infections caused by Acanthamoeba spp.
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18
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Therapeutic Corneal Transplantation in Acanthamoeba Keratitis: Penetrating Versus Lamellar Keratoplasty. Cornea 2021; 41:396-401. [PMID: 34690262 DOI: 10.1097/ico.0000000000002880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article was to compare clinical outcomes between therapeutic penetrating keratoplasty (TPK), therapeutic deep anterior lamellar keratoplasty (TDALK), and optical penetrating keratoplasty (OPK) in Acanthamoeba keratitis. METHODS A literature search was conducted in online libraries from 1980 to 2021. The primary end points were best-corrected visual acuity (VA), graft survival, and infection recurrence. In addition, we enrolled 35 consecutive patients with AK from our practice evaluating best-corrected VA and high-order aberrations. RESULTS A total of 359 AK eyes from 33 published studies were retrieved from 175 publications screened. One hundred sixty-five eyes (73%) that underwent TPK and 39 eyes (84%) treated with TDALK had a clear graft at the last follow-up visit. Only the patients treated with OPK had 82 clear grafts (94%) during the follow-up period. Forty-seven (21%) of TPK patients reached VA ≥20/30, compared with 11 (25%) of TDALK patients and 35 (40%) of OPK patients. Acanthamoeba infection recurrence occurred in 38 eyes (16.8%) that underwent TPK, 9 (19%) that underwent TDALK, and 8 (9.5%) that underwent OPK. In our series, best-corrected visual acuity in nonsurgically treated patients was 1 ± 0.50 logMAR compared with 0 logMAR of surgically treated patients. High-order aberrations were significantly lower in surgically treated eyes after AK resolution, particularly in TDALK when compared with TPK patients. Best-corrected visual acuity was better in TDALK patients compared with TPK patients. CONCLUSIONS After AK resolution by 6 to 12 months of medical treatment, OPK seems to be the best surgical choice in patients with AK. If AK could not be eradicated by medical therapy, TDALK may be chosen in the early disease stage and TPK in later stages.
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Ahmed U, Anwar A, Ong SK, Anwar A, Khan NA. Applications of medicinal chemistry for drug discovery against Acanthamoeba infections. Med Res Rev 2021; 42:462-512. [PMID: 34472107 DOI: 10.1002/med.21851] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 07/13/2021] [Accepted: 08/17/2021] [Indexed: 01/16/2023]
Abstract
Acanthamoeba is a genus of free-living amoebae, pervasively found in the environment. Most of its pathogenic species are the causative agent of sight-threatening Acanthamoeba keratitis and fatal granulomatous amoebic encephalitis. Despite the advancements in the field of chemotherapy, treating Acanthamoeba infections is still challenging due to incomplete knowledge of the complicated pathophysiology. In case of infection, the treatment regimen for the patients is often ineffective due to delayed diagnosis, poor specificity, and side-effects. Besides the resistance of Acanthamoeba cysts to most of the drugs, the recurrence of infection further complicates the recovery. Thus, it is necessary to develop an effective treatment which can eradicate these rare, but serious infections. Based on various computational and in vitro studies, it has been established that the synthetic scaffolds such as heterocyclic compounds may act as potential drug leads for the development of antiamoebic drugs. In this review, we report different classes of synthetic compounds especially heterocyclic compounds which have shown promising results against Acanthamoeba. Moreover, the antiamoebic activities of synthetic compounds with their possible mode of actions against Acanthamoeba, have been summarized and discussed in this review.
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Affiliation(s)
- Usman Ahmed
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Selangor, Malaysia
| | - Ayaz Anwar
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Selangor, Malaysia
| | - Seng-Kai Ong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Selangor, Malaysia
| | - Areeba Anwar
- Faculty of Defence Science and Technology, National Defence University of Malaysia, Kuala Lampur, Malaysia
| | - Naveed Ahmed Khan
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
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Abstract
The red eye is one of the most common cause encountered in ophthalmic practice but a red eye is not always related to eye diseases, instead, it may be a clinical sign of several systemic diseases which may the alarmin signal of sight-threatening or life-threatening condition. Frequently, GPs, pediatricians, immunologists, and rheumatologists are the first landing of patients with a "red eye." This paper is addressed to non-ophthalmic specialists who may be faced with patients having a red eye. Inspection of the external eye under standard office lighting or with a bright light can be easily and accurately made by a general practitioner. Three major caveats should alert the GPs to promptly refer the patient to the ophthalmologist: the presence of pain; the loss of the natural corneal transparency and specular reflex; and any patient-described reduction of visual acuity. In most cases, a red eye is due to occasional and mild ocular surface reaction as consequence of exposure of the external eye to irritants and naturally occurring environmental agents. In these cases washing the eye with a tear lubricant may help in relief of symptoms. If this treatment fails within a few days, a consultation with an ophthalmologist is suggested. The role of the general physician is crucial in the decision making to judge the severity of the ocular condition. Managing a red eye often requires the support of other specialists. Our goal is not only to preserve vision but to globally cure the patient health.
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Affiliation(s)
- Stefano Bonini
- Department of Ophthalmology, University of Rome Campus BioMedico, Rome, Italy
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21
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Raghavan A, Nair AV, N K, Venkatapathy N, Rammohan R. Voriconazole in the successful management of a case of Acanthamoeba-Cladosporium keratitis. Am J Ophthalmol Case Rep 2021; 22:101107. [PMID: 33981917 PMCID: PMC8085662 DOI: 10.1016/j.ajoc.2021.101107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/02/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Acanthamoeba and fungal infections can be recalcitrant to therapy - more so when the deeper layers of the corneas are involved. We describe the diagnosis and successful management strategies employed in a case of deep keratitis due to co-infection with Acanthamoeba and Cladosporium sp. Observations Once the diagnosis of co-infection with both Acanthamoeba and Cladosporium was made, treatment was initiated with a combination of PHMB, chlorhexidine, natamycin, and voriconazole; to which the response was favorable. Signs of relapse with spread of the infection to the deeper plane and the presence of endothelial exudates were noted at 5 weeks. This was attributed to poor compliance. Though the response to re-initiation of therapy under direct supervision was once again favorable; it was only after the introduction of intrastromal voriconazole repeated at timely intervals that rapid and complete resolution was obtained. Conclusions Severe keratitis due to fungi or Acanthamoeba very often requires surgical intervention. Complete resolution with medical therapy was obtained only after the introduction of intrastromal voriconazole; thereby avoiding a therapeutic keratoplasty. The addition of voriconzole both topically and particularly intrastromally facilitated faster resolution as well as restricted the duration of therapy with more toxic drugs such as phmb and chlorhexidine.
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Affiliation(s)
- Anita Raghavan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Arjun Velayudhan Nair
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Kavitha N
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Narendran Venkatapathy
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Ram Rammohan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
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Dušeková A, Garajová M, Lukáč M, Mrva M. Derivatisation of metronidazole enhances cytotoxic effect against Acanthamoeba genotype T4 isolates and leads to cytomorphological changes in trophozoites. Acta Trop 2021; 216:105830. [PMID: 33465352 DOI: 10.1016/j.actatropica.2021.105830] [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: 09/03/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/25/2022]
Abstract
Amoebae of the genus Acanthamoeba are worldwide distributed causative agents of serious human infections such as granulomatous amoebic encephalitis (GAE) and Acanthamoeba keratitis (AK). To date, treatment of these infections is non-uniform and frequently unsuccessful. Recently, the phosphonium salts were studied for their high levels of antimicrobial activity. This work was aimed to investigate the cytotoxic effect of metronidazole and two phosphonium salts (PS1, PS2) on two clinical Acanthamoeba isolates. The isolates showed distinctly higher susceptibility to both phosphonium salts than to metronidazole. The highest susceptibility was noted to PS1 after 48 h of incubation. Metronidazole derivate PS2 showed higher susceptibility than metronidazole. The values of EC50 of PS2 were approximately twenty times lower than EC50 of metronidazole for Acanthamoeba lugdunensis strain and sixteen times lower for Acanthamoeba quina strain after 48 h. Although the therapeutic effect of metronidazole in Acanthamoeba infections is usually insufficient, its derivatisation can result in a significantly higher amoebicidal effect. Cytomorphological changes of trophozoites after exposure to tested compounds included rounding up of the cells, damage of membrane integrity, presence of pathological protrusions, elongation of the cells or pseudocyst-like stages. Obtained results indicate possible therapeutic potential of studied phosphonium salts.
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Carnt NA, Pang I, Burdon KP, Calder V, Dart JK, Subedi D, Hardcastle AJ. Innate and Adaptive Gene Single Nucleotide Polymorphisms Associated With Susceptibility of Severe Inflammatory Complications in Acanthamoeba Keratitis. Invest Ophthalmol Vis Sci 2021; 62:33. [PMID: 33755043 PMCID: PMC7991962 DOI: 10.1167/iovs.62.3.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Over a third of patients with Acanthamoeba keratitis (AK) experience severe inflammatory complications (SICs). This study aimed to determine if some contact lens (CL) wearers with AK were predisposed to SICs due to variations in key immune genes. Methods CL wearers with AK who attended Moorfields Eye Hospital were recruited prospectively between April 2013 and October 2014. SICs were defined as scleritis and/or stromal ring infiltrate. Genomic DNA was processed with an Illumina Low Input Custom Amplicon assay of 58 single nucleotide polymorphism (SNP) targets across 18 genes and tested for association in PLINK. Results Genomic DNA was obtained and analyzed for 105 cases of AK, 40 (38%) of whom experienced SICs. SNPs in the CXCL8 gene encoding IL-8 was significantly associated with protection from SICs (chr4: rs1126647, odds ratio [OR] = 0.3, P = 0.005, rs2227543, OR = 0.4, P = 0.007, and rs2227307, OR = 0.4, P = 0.02) after adjusting for age, sex, steroids prediagnosis, and herpes simplex keratitis (HSK) misdiagnosis. Two TLR-4 SNPs were associated with increased risk of SICs (chr9: rs4986791 and rs4986790, both OR = 6.9, P = 0.01). Th-17 associated SNPs (chr1: IL-23R rs11209026, chr2: IL-1β rs16944, and chr12: IL-22 rs1179251) were also associated with SICs. Conclusions The current study identifies biologically relevant genetic variants in patients with AK with SICs; IL-8 is associated with a strong neutrophil response in the cornea in AK, TLR-4 is important in early AK disease, and Th-17 genes are associated with adaptive immune responses to AK in animal models. Genetic screening of patients with AK to predict severity is viable and this would be expected to assist disease management.
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Affiliation(s)
- Nicole A Carnt
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, Australia.,Westmead Institute for Medical Research, Westmead, New South Wales, Australia.,University College London (UCL) Institute of Ophthalmology, London, United Kingdom
| | - Ignatius Pang
- School of Biotechnology and Biomolecular Sciences, University of New South Wales (UNSW), Sydney, Australia
| | - Kathryn P Burdon
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Virginia Calder
- University College London (UCL) Institute of Ophthalmology, London, United Kingdom
| | - John K Dart
- University College London (UCL) Institute of Ophthalmology, London, United Kingdom.,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Dinesh Subedi
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, Australia.,School of Biological Sciences, Monash University, Clayton, Australia
| | - Alison J Hardcastle
- University College London (UCL) Institute of Ophthalmology, London, United Kingdom
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Establishment of an Acanthamoeba keratitis mouse model confirmed by amoebic DNA amplification. Sci Rep 2021; 11:4183. [PMID: 33603075 PMCID: PMC7892866 DOI: 10.1038/s41598-021-83738-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/04/2021] [Indexed: 11/08/2022] Open
Abstract
Acanthamoeba castellanii, the causative agent of Acanthamoeba keratitis (AK), occurs mainly in contact lens users with poor eye hygiene. The findings of many in vitro studies of AK, as well as the testing of therapeutic drugs, need validation in in vivo experiments. BALB/c mice were used in this study to establish in vivo AK model. A. castellanii cell suspensions (equal mixtures of trophozoites and cysts) were loaded onto 2-mm contact lens pieces and inserted into mouse eyes that were scratched using an ophthalmic surgical blade under anesthesia and the eyelids of the mice were sutured. The AK signs were grossly observed and PCR was performed using P-FLA primers to amplify the Acanthamoeba 18S-rRNA gene from mouse ocular tissue. The experimental AK mouse model was characterized by typical hazy blurring and melting of the mouse cornea established on day 1 post-inoculation. AK was induced with at least 0.3 × 105 A. castellanii cells (optimal number, 5 × 104), and the infection persisted for two months. The PCR products amplified from the extracted mouse eye DNA confirmed the development of Acanthamoeba-induced keratitis during the infection periods. In conclusion, the present AK mouse model may serve as an important in vivo model for the development of various therapeutic drugs against AK.
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25
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Papa V, van der Meulen I, Rottey S, Sallet G, Overweel J, Asero N, Minassian DC, Dart JKG. Safety and tolerability of topical polyhexamethylene biguanide: a randomised clinical trial in healthy adult volunteers. Br J Ophthalmol 2020; 106:190-196. [PMID: 33239413 DOI: 10.1136/bjophthalmol-2020-317848] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/01/2020] [Accepted: 10/21/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS Polyhexamethyl biguanide (PHMB), a widely used topical treatment for Acanthamoeba keratitis (AK), is unlicensed with no formal safety assessment. This study evaluated its safety and tolerability. METHODS A prospective, randomised, double-masked controlled trial in 90 healthy volunteers. Subjects were treated with topical 0.04%, 0.06%, 0.08% PHMB or placebo (vehicle) 12× daily for 7 days, then 6× daily for 7 days. The rates of dose-limiting adverse events (DLAEs) leading to interruption of dosing, mild adverse events (AEs) (not dose limiting) and incidental AEs (unrelated to treatment) were compared. The primary outcome was the difference between treatments for DLAE rates. RESULTS 5/90 subjects developed DLAE within <1-4 days of starting treatment; 2/5 using PHMB 0.06% and 3/5 PHMB 0.08%. These resolved within 1-15 days. There were no significant differences in DLAE between treatment groups. Mild AEs occurred in 48/90 subjects (including placebo). There was no trend for an increased incidence of any AE with increasing concentrations of PHMB, except for corneal punctate keratopathy with PHMB 0.08%, which fully resolved within 7-14 days. CONCLUSION These findings are reassuring for PHMB 0.02% users. They also suggest that higher PHMB concentrations may show acceptable levels of tolerance and toxicity in AK subjects, whose susceptibility to AE may be greater than for the normal eyes in this study. Given the potential benefits of higher PHMB concentrations for treating deep stromal invasion in AK, we think that the use of PHMB 0.08% is justified in treatment trials. TRIAL REGISTRATION NUMBER NCT02506257.
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Affiliation(s)
- Vincenzo Papa
- SIFI S.p.A., 36, via Ercole Patti, 95025 Lavinaio (Catania), Italy, Lavinaio, Italy
| | | | | | | | | | | | | | - John K G Dart
- Corneal & External Disease, Moorfields Eye Hospital NHS Foundation Trust, London, UK .,Ocular Biology & Therapeutics, UCL Institute of Ophthalmology, London, UK
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26
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Rocha-de-Lossada C, Cano-Ortiz A, Naveria Torres-Quiroga M, Rodríguez-Calvo-de-Mora M. Need for real availability of topical anti-fungal and anti-amoeba eye drugs in the Spanish Health System. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:e81-e82. [PMID: 32675036 DOI: 10.1016/j.oftal.2020.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Affiliation(s)
- C Rocha-de-Lossada
- Departamento de Córnea y Segmento Anterior, Hospital Clínic de Barcelona, Barcelona, España.
| | - A Cano-Ortiz
- Departamento de Superficie, Córnea y Cirugía Refractiva, Hospital la Arruzafa, Córdoba, España
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27
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Khan SA, Lee CS. Recent progress and strategies to develop antimicrobial contact lenses and lens cases for different types of microbial keratitis. Acta Biomater 2020; 113:101-118. [PMID: 32622052 DOI: 10.1016/j.actbio.2020.06.039] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022]
Abstract
Although contact lenses are widely used for vision correction, they are also the primary cause of a number of ocular diseases such as microbial keratitis (MK), etc. and inflammatory events such as infiltrative keratitis (IK), contact lens acute red eye (CLARE), contact lens-induced peripheral ulcer (CLPU), etc. These diseases and infiltrative events often result from microbial contamination of lens care solutions and lens cases that can be exacerbated by unsanitary lens care and extended lens wear. The treatment of microbial biofilms (MBs) on lens cases and contact lenses are complicated and challenging due to their resistance to conventional antimicrobial lens care solutions. More importantly, MK caused by MBs can lead to acute visual damage or even vision impairment. Therefore, the development of lens cases, lens care solutions, and contact lenses with effective antimicrobial performance against MK will contribute to the safe use of contact lenses. This review article summarizes and discusses different chemical approaches for the development of antimicrobial contact lenses and lens cases employing passive surface modifications, antimicrobial peptides, free-radical fabricating agents, quorum sensing quenchers, antibiotics, antifungal drugs and various metals and coatings with antimicrobial nanomaterials. The benefits and shortcomings of these approaches are assessed, and alternative solutions for future developments are discussed.
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Affiliation(s)
- Shakeel Ahmad Khan
- Center of Super-Diamond and Advanced Films (COSDAF), Department of Chemistry, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon, Hong Kong
| | - Chun-Sing Lee
- Center of Super-Diamond and Advanced Films (COSDAF), Department of Chemistry, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon, Hong Kong.
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28
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Drug Discovery against Acanthamoeba Infections: Present Knowledge and Unmet Needs. Pathogens 2020; 9:pathogens9050405. [PMID: 32456110 PMCID: PMC7281112 DOI: 10.3390/pathogens9050405] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
Although major strides have been made in developing and testing various anti-acanthamoebic drugs, recurrent infections, inadequate treatment outcomes, health complications, and side effects associated with the use of currently available drugs necessitate the development of more effective and safe therapeutic regimens. For any new anti-acanthamoebic drugs to be more effective, they must have either superior potency and safety or at least comparable potency and an improved safety profile compared to the existing drugs. The development of the so-called 'next-generation' anti-acanthamoebic agents to address this challenge is an active area of research. Here, we review the current status of anti-acanthamoebic drugs and discuss recent progress in identifying novel pharmacological targets and new approaches, such as drug repurposing, development of small interfering RNA (siRNA)-based therapies and testing natural products and their derivatives. Some of the discussed approaches have the potential to change the therapeutic landscape of Acanthamoeba infections.
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29
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Hendiger EB, Padzik M, Sifaoui I, Reyes-Batlle M, López-Arencibia A, Rizo-Liendo A, Bethencourt-Estrella CJ, San Nicolás-Hernández D, Chiboub O, Rodríguez-Expósito RL, Grodzik M, Pietruczuk-Padzik A, Stępień K, Olędzka G, Chomicz L, Piñero JE, Lorenzo-Morales J. Silver Nanoparticles as a Novel Potential Preventive Agent against Acanthamoeba Keratitis. Pathogens 2020; 9:pathogens9050350. [PMID: 32380785 PMCID: PMC7281428 DOI: 10.3390/pathogens9050350] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022] Open
Abstract
Free living, cosmopolitan amoebae from Acanthamoeba genus present a serious risk to human health. As facultative human parasites, these amoebae may cause Acanthamoeba keratitis (AK). Acanthamoeba keratitis is a severe, vision-threatening corneal infection with non-specific symptoms. The number of reported AK cases worldwide has been increasing every year. Moreover, 90% of Acanthamoeba keratitis cases are related to contact lens use. Wearing and storage contact lenses not in accordance with the physicians and manufacturers recommendations are the primary key risk factors of this disease. Amoebae can easily adhere to the contact lens surface and transmit to the corneal epithelium. Preventing amoebae adhesion to the contact lens surface could significantly decrease the number of AK infections. Until now, the effective therapy against AK is still under development. Currently proposed therapies are mainly limited to the chlorhexidine digluconate combined with propamidine isethionate or hexamidine applications, which are insufficient and very toxic to the eye. Due to lack of effective treatment, looking for new potential preventive agents is crucial to decrease the number of Acanthamoeba keratitis infections, especially among contact lens users. Nanoparticles have been already included in several novel therapies against bacteria, viruses, fungi, and protist. However, their anti-amoebic potential has not been fully tested yet. The aim of this study was to assess silver nanoparticles (AgNPs) and platinum nanoparticles (PtNPs) anti-amoebic activity and influence on the amoebae adhesion to the surface of four different groups of contact lenses-classified according to the Food and Drugs Administration (FDA) guidelines. The obtained results show that both tested nanoparticles were effective against Acanthamoeba trophozoites and decreased the amoebae adhesion to the contact lens surface. AgNPs showed better anti-amoebic activity to cytotoxicity dependence and reduced amoebae adhesion in a wider spectrum of the tested contact lenses. Our studies also confirmed that ionization next to hydration of the contact lens material is a crucial parameter influencing the Acanthamoeba adhesion to the contact lens surface. In conclusion, silver nanoparticles might be considered as a novel preventive agent against Acanthamoeba keratitis infection.
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Affiliation(s)
- Edyta B. Hendiger
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
- Department of Medical Biology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland; (G.O.); (L.C.)
| | - Marcin Padzik
- Department of Medical Biology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland; (G.O.); (L.C.)
- Correspondence: ; Tel.: +48-503-151-318
| | - Ines Sifaoui
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - María Reyes-Batlle
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Atteneri López-Arencibia
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Aitor Rizo-Liendo
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Carlos J. Bethencourt-Estrella
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Desirée San Nicolás-Hernández
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Olfa Chiboub
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
- Laboratoire Matériaux-Molécules et Applications, La Marsa, University of Carthage, 2070 Carthage, Tunisia
| | - Rubén L. Rodríguez-Expósito
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Marta Grodzik
- Department of Nanobiotechnology and Experimental Ecology, Institute of Biology, Warsaw University of Life Sciences, 02-787 Warsaw, Poland;
| | - Anna Pietruczuk-Padzik
- Department of Pharmaceutical Microbiology, Centre for Preclinical Research and Technology (CePT), Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland; (A.P.-P.); (K.S.)
| | - Karolina Stępień
- Department of Pharmaceutical Microbiology, Centre for Preclinical Research and Technology (CePT), Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland; (A.P.-P.); (K.S.)
| | - Gabriela Olędzka
- Department of Medical Biology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland; (G.O.); (L.C.)
| | - Lidia Chomicz
- Department of Medical Biology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland; (G.O.); (L.C.)
| | - José E. Piñero
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
| | - Jacob Lorenzo-Morales
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias and Departamento de Obstetricia, Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna. Av. Astrofísico Francisco Sánchez S/N, 38203 Tenerife, Spain; (E.B.H.); (I.S.); (M.R.-B.); (A.L.-A.); (A.R.-L.); (C.J.B.-E.); (D.S.N.-H.); (O.C.); (R.L.R.-E.); (J.E.P.); (J.L.-M.)
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30
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Lim CC, Peng IC, Huang YH. Safety of intrastromal injection of polyhexamethylene biguanide and propamidine isethionate in a rabbit model. J Adv Res 2020; 22:1-6. [PMID: 31956437 PMCID: PMC6961213 DOI: 10.1016/j.jare.2019.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 01/12/2023] Open
Abstract
Intrastromal Injection can be considered in deep Acanthamoeba keratitis (AK). Intrastromal injection of 0.01% PHMB or 0.05% propamidine isethionate is safe. This model system could help to determine the toxic effect of other agents. Further experiments may determine the toxicity of multiple intrastromal injection. AK animal model is required to evaluate the true effect of intrastromal injection.
Acanthamoeba keratitis (AK) is difficult to treat, especially when the corneal deep stroma is involved. Intrastromal injection of antimicrobial agents is an effective adjuvant therapy for deep recalcitrant microbial keratitis; however, it has not been used to treat AK due to suspected drug toxicity. The purpose of this study was to evaluate the toxicity of corneal intrastromal injection of polyhexamethylene biguanide (PHMB) and propamidine isethionate (Brolene®, Sanofi) in New Zealand white rabbits. We performed intrastromal injections of PHMB (0.02 or 0.01%) and propamidine isethionate (0.1 or 0.05%) into the rabbits’ right corneas. The left corneas were injected with phosphate-buffered saline as controls. The rabbits were sacrificed on the 7th day after injection, and the corneal buttons were harvested for further evaluation by slit lamp microscopy, specular microscopy, hematoxylin and eosin staining, scanning electron microscopy, terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling assays, and WST-1 assays. We found that intrastromal injection of 0.02% PHMB or 0.1% propamidine isethionate resulted in corneal epithelial erosion, corneal edema, and severe neovascularization. However, 0.01% PHMB or 0.05% propamidine isethionate did not induce obvious cornea toxicity. In conclusion, intrastromal injection of 0.01% PHMB or 0.05% propamidine isethionate may be promising adjunctive treatments for deep stromal AK.
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Affiliation(s)
- Chen-Chee Lim
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Chen Peng
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Hsun Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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