1
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Hamed K, Debonnett L. Tobramycin inhalation powder for the treatment of pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis: a review based on clinical evidence. Ther Adv Respir Dis 2017; 11:193-209. [PMID: 28470103 PMCID: PMC5933546 DOI: 10.1177/1753465817691239] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Chronic airway infection with Pseudomonas aeruginosa is a major cause of increased morbidity and mortality in patients with cystic fibrosis (CF). The development and widespread use of nebulized antibacterial therapies, including tobramycin inhalation solution (TIS), has led to improvements in lung function and quality of life. However, the use of nebulizers is associated with various challenges, including extended administration times and the need for frequent device cleaning and disinfection. Multiple therapies are required for patients with CF, which poses a considerable burden to patients, and adherence to the recommended treatments remains a challenge. Tobramycin inhalation powder (TIP), delivered via the T-326 Inhaler, has been shown to have similar clinical efficacy and safety as compared to TIS, with improved patient convenience, satisfaction, and treatment adherence. Long-term safety studies have shown that TIP was well tolerated with no unexpected adverse events in patients with CF. This review of the TIP pivotal and postmarketing studies reinforces the well-established efficacy and safety profile of TIP and its ease of use.
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Affiliation(s)
| | - Laurie Debonnett
- Novartis Pharmaceuticals Corporation, One Health
Plaza, East Hanover, NJ 07936-1080, USA
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2
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Waryah CB, Wells K, Ulluwishewa D, Chen-Tan N, Gogoi-Tiwari J, Ravensdale J, Costantino P, Gökçen A, Vilcinskas A, Wiesner J, Mukkur T. In Vitro Antimicrobial Efficacy of Tobramycin Against Staphylococcus aureus Biofilms in Combination With or Without DNase I and/or Dispersin B: A Preliminary Investigation. Microb Drug Resist 2016; 23:384-390. [PMID: 27754780 DOI: 10.1089/mdr.2016.0100] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Staphylococcus aureus in biofilms is highly resistant to the treatment with antibiotics, to which the planktonic cells are susceptible. This is likely to be due to the biofilm creating a protective barrier that prevents antibiotics from accessing the live pathogens buried in the biofilm. S. aureus biofilms consist of an extracellular matrix comprising, but not limited to, extracellular bacterial DNA (eDNA) and poly-β-1, 6-N-acetyl-d-glucosamine (PNAG). Our study revealed that despite inferiority of dispersin B (an enzyme that degrades PNAG) to DNase I that cleaves eDNA, in dispersing the biofilm of S. aureus, both enzymes were equally efficient in enhancing the antibacterial efficiency of tobramycin, a relatively narrow-spectrum antibiotic against infections caused by gram-positive and gram-negative pathogens, including S. aureus, used in this investigation. However, a combination of these two biofilm-degrading enzymes was found to be significantly less effective in enhancing the antimicrobial efficacy of tobramycin than the individual application of the enzymes. These findings indicate that combinations of different biofilm-degrading enzymes may compromise the antimicrobial efficacy of antibiotics and need to be carefully assessed in vitro before being used for treating medical devices or in pharmaceutical formulations for use in the treatment of chronic ear or respiratory infections.
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Affiliation(s)
- Charlene Babra Waryah
- 1 School of Biomedical Sciences, Faculty of Health Science, Curtin Health Innovation Research Institute, Curtin University , Perth, Western Australia.,2 Department of Medicine, Albert Einstein College of Medicine , Bronx, New York.,3 Department of Cell Biology, Albert Einstein College of Medicine , Bronx, New York
| | - Kelsi Wells
- 1 School of Biomedical Sciences, Faculty of Health Science, Curtin Health Innovation Research Institute, Curtin University , Perth, Western Australia
| | - Dulantha Ulluwishewa
- 1 School of Biomedical Sciences, Faculty of Health Science, Curtin Health Innovation Research Institute, Curtin University , Perth, Western Australia
| | - Nigel Chen-Tan
- 4 Curtin Electron Microscope Facility, John de Laeter Centre, Faculty of Science and Engineering, Curtin University , Perth, Western Australia
| | - Jully Gogoi-Tiwari
- 1 School of Biomedical Sciences, Faculty of Health Science, Curtin Health Innovation Research Institute, Curtin University , Perth, Western Australia
| | - Joshua Ravensdale
- 1 School of Biomedical Sciences, Faculty of Health Science, Curtin Health Innovation Research Institute, Curtin University , Perth, Western Australia
| | - Paul Costantino
- 1 School of Biomedical Sciences, Faculty of Health Science, Curtin Health Innovation Research Institute, Curtin University , Perth, Western Australia
| | - Anke Gökçen
- 5 Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology , Gießen, Germany
| | - Andreas Vilcinskas
- 5 Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology , Gießen, Germany
| | - Jochen Wiesner
- 5 Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology , Gießen, Germany
| | - Trilochan Mukkur
- 1 School of Biomedical Sciences, Faculty of Health Science, Curtin Health Innovation Research Institute, Curtin University , Perth, Western Australia
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3
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Meijer L, Nelson DJ, Riazanski V, Gabdoulkhakova AG, Hery-Arnaud G, Le Berre R, Loaëc N, Oumata N, Galons H, Nowak E, Gueganton L, Dorothée G, Prochazkova M, Hall B, Kulkarni AB, Gray RD, Rossi AG, Witko-Sarsat V, Norez C, Becq F, Ravel D, Mottier D, Rault G. Modulating Innate and Adaptive Immunity by (R)-Roscovitine: Potential Therapeutic Opportunity in Cystic Fibrosis. J Innate Immun 2016; 8:330-49. [PMID: 26987072 PMCID: PMC4800827 DOI: 10.1159/000444256] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 12/17/2022] Open
Abstract
(R)-Roscovitine, a pharmacological inhibitor of kinases, is currently in phase II clinical trial as a drug candidate for the treatment of cancers, Cushing's disease and rheumatoid arthritis. We here review the data that support the investigation of (R)-roscovitine as a potential therapeutic agent for the treatment of cystic fibrosis (CF). (R)-Roscovitine displays four independent properties that may favorably combine against CF: (1) it partially protects F508del-CFTR from proteolytic degradation and favors its trafficking to the plasma membrane; (2) by increasing membrane targeting of the TRPC6 ion channel, it rescues acidification in phagolysosomes of CF alveolar macrophages (which show abnormally high pH) and consequently restores their bactericidal activity; (3) its effects on neutrophils (induction of apoptosis), eosinophils (inhibition of degranulation/induction of apoptosis) and lymphocytes (modification of the Th17/Treg balance in favor of the differentiation of anti-inflammatory lymphocytes and reduced production of various interleukins, notably IL-17A) contribute to the resolution of inflammation and restoration of innate immunity, and (4) roscovitine displays analgesic properties in animal pain models. The fact that (R)-roscovitine has undergone extensive preclinical safety/pharmacology studies, and phase I and II clinical trials in cancer patients, encourages its repurposing as a CF drug candidate.
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Affiliation(s)
- Laurent Meijer
- Centre de Perharidy, ManRos Therapeutics, Roscoff, France
| | - Deborah J. Nelson
- Department of Pharmacological and Physiological Sciences, The University of Chicago, Chicago, Ill., USA
| | - Vladimir Riazanski
- Department of Pharmacological and Physiological Sciences, The University of Chicago, Chicago, Ill., USA
| | - Aida G. Gabdoulkhakova
- Department of Pharmacological and Physiological Sciences, The University of Chicago, Chicago, Ill., USA
| | - Geneviève Hery-Arnaud
- Unité de Bactériologie, Hôpital de la Cavale Blanche, CHRU Brest, Brest, France
- EA3882-LUBEM, Université de Brest, UFR de Médecine et des Sciences de la Santé, Brest, France
| | - Rozenn Le Berre
- EA3882-LUBEM, Université de Brest, UFR de Médecine et des Sciences de la Santé, Brest, France
- Département de Médecine Interne et Pneumologie, CHRU Brest, Brest, France
| | - Nadège Loaëc
- Centre de Perharidy, ManRos Therapeutics, Roscoff, France
| | - Nassima Oumata
- Centre de Perharidy, ManRos Therapeutics, Roscoff, France
| | - Hervé Galons
- Unité de Technologies Chimiques et Biologiques pour la Santé, Université Paris Descartes UMR-S 1022 INSERM, Paris, France
| | - Emmanuel Nowak
- Hôpital de la Cavale Blanche, CHRU Brest, Centre d'Investigation Clinique, INSERM CIC 1412, Brest, France
| | | | - Guillaume Dorothée
- Immune System, Neuroinflammation and Neurodegenerative Diseases Laboratory, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), CdR Saint-Antoine, INSERM, UMRS 938, Paris, France
- Hôpital Saint-Antoine, CdR Saint-Antoine, UMRS 938, UPMC University Paris 06, Sorbonne Universités, Paris, France
| | - Michaela Prochazkova
- Functional Genomics Section, Laboratory of Cell and Developmental Biology, National Institute of Dental and Craniofacial Research, NIH, Bethesda, Md., USA
| | - Bradford Hall
- Functional Genomics Section, Laboratory of Cell and Developmental Biology, National Institute of Dental and Craniofacial Research, NIH, Bethesda, Md., USA
| | - Ashok B. Kulkarni
- Functional Genomics Section, Laboratory of Cell and Developmental Biology, National Institute of Dental and Craniofacial Research, NIH, Bethesda, Md., USA
| | - Robert D. Gray
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh Medical School, Edinburgh, UK
| | - Adriano G. Rossi
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh Medical School, Edinburgh, UK
| | | | - Caroline Norez
- Laboratoire Signalisation et Transports Ioniques Membranaires, CNRS, Université de Poitiers, Poitiers, France
| | - Frédéric Becq
- Laboratoire Signalisation et Transports Ioniques Membranaires, CNRS, Université de Poitiers, Poitiers, France
| | | | - Dominique Mottier
- Hôpital de la Cavale Blanche, CHRU Brest, Centre d'Investigation Clinique, INSERM CIC 1412, Brest, France
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Murphy MP, Caraher E. Current and Emerging Therapies for the Treatment of Cystic Fibrosis or Mitigation of Its Symptoms. Drugs R D 2016; 16:1-17. [PMID: 26747453 PMCID: PMC4767716 DOI: 10.1007/s40268-015-0121-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Clinical presentation of the chronic, heritable condition cystic fibrosis (CF) is complex, with a diverse range of symptoms often affecting multiple organs with varying severity. The primary source of morbidity and mortality is due to progressive destruction of the airways attributable to chronic inflammation arising from microbial colonisation. Antimicrobial therapy combined with practises to remove obstructive mucopurulent deposits form the cornerstone of current therapy. However, new treatment options are emerging which offer, for the first time, the opportunity to effect remission from the underlying cause of CF. Here, we discuss these therapies, their mechanisms of action, and their successes and failures in order to illustrate the shift in the nature of how CF will likely be managed into the future.
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Affiliation(s)
- Mark P Murphy
- Centre for Microbial-Host Interactions, Centre of Applied Science for Health, Institute of Technology Tallaght, Dublin 24, Ireland.
| | - Emma Caraher
- Centre for Microbial-Host Interactions, Centre of Applied Science for Health, Institute of Technology Tallaght, Dublin 24, Ireland.
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5
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Ciprofloxacin-eluting nanofibers inhibits biofilm formation by Pseudomonas aeruginosa and a methicillin-resistant Staphylococcus aureus. PLoS One 2015; 10:e0123648. [PMID: 25853255 PMCID: PMC4390291 DOI: 10.1371/journal.pone.0123648] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/27/2015] [Indexed: 11/25/2022] Open
Abstract
Pseudomonas aeruginosa and Staphylococcus aureus are commonly associated with hospital-acquired infections and are known to form biofilms. Ciprofloxacin (CIP), which is normally used to treat these infections, is seldom effective in killing cells in a biofilm. This is mostly due to slow or weak penetration of CIP to the core of biofilms. The problem is accentuated by the release of CIP below MIC (minimal inhibitory concentration) levels following a rapid (burst) release. The aim of this study was to develop a drug carrier that would keep CIP above MIC levels for an extended period. Ciprofloxacin was suspended into poly(D,L-lactide) (PDLLA) and poly(ethylene oxide) (PEO), and electrospun into nanofibers (CIP-F). All of the CIP was released from the nanofibers within 2 h, which is typical of a burst release. However, 99% of P. aeruginosa PA01 cells and 91% of S. aureus Xen 30 cells (a methicillin-resistant strain) in biofilms were killed when exposed to CIP-F. CIP levels remained above MIC for 5 days, as shown by growth inhibition of the cells in vitro. The nanofibers were smooth in texture with no bead formation, as revealed by scanning electron and atomic force microscopy. A single vibration peak at 1632 cm-1, recorded with Fourier transform infrared spectroscopy, indicated that CIP remained in crystal form when incorporated into PDLLA: PEO. No abnormalities in the histology of MCF-12A breast epithelial cells were observed when exposed to CIP-F. This is the first report of the inhibition of biofilm formation by CIP released from PDLLA: PEO nanofibers.
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Dalhoff A. Pharmacokinetics and pharmacodynamics of aerosolized antibacterial agents in chronically infected cystic fibrosis patients. Clin Microbiol Rev 2014; 27:753-82. [PMID: 25278574 PMCID: PMC4187638 DOI: 10.1128/cmr.00022-14] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Bacteria adapt to growth in lungs of patients with cystic fibrosis (CF) by selection of heterogeneously resistant variants that are not detected by conventional susceptibility testing but are selected for rapidly during antibacterial treatment. Therefore, total bacterial counts and antibiotic susceptibilities are misleading indicators of infection and are not helpful as guides for therapy decisions or efficacy endpoints. High drug concentrations delivered by aerosol may maximize efficacy, as decreased drug susceptibilities of the pathogens are compensated for by high target site concentrations. However, reductions of the bacterial load in sputum and improvements in lung function were within the same ranges following aerosolized and conventional therapies. Furthermore, the use of conventional pharmacokinetic/pharmacodynamic (PK/PD) surrogates correlating pharmacokinetics in serum with clinical cure and presumed or proven eradication of the pathogen as a basis for PK/PD investigations in CF patients is irrelevant, as minimization of systemic exposure is one of the main objectives of aerosolized therapy; in addition, bacterial pathogens cannot be eradicated, and chronic infection cannot be cured. Consequently, conventional PK/PD surrogates are not applicable to CF patients. It is nonetheless obvious that systemic exposure of patients, with all its sequelae, is minimized and that the burden of oral treatment for CF patients suffering from chronic infections is reduced.
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Affiliation(s)
- Axel Dalhoff
- University Medical Center Schleswig-Holstein, Institute for Infection Medicine, Kiel, Germany
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