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Rocha MF, Bain HDC, Stone N, Meya D, Darie L, Toma AK, Lunn MPT, Mehta AR, Coughlan C. Reframing the clinical phenotype and management of cryptococcal meningitis. Pract Neurol 2024:pn-2024-004133. [PMID: 38997136 DOI: 10.1136/pn-2024-004133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 07/14/2024]
Abstract
Cryptococcal meningitis is an important global health problem, resulting from infection with the yeast Cryptococcus, especially Cryptococcus neoformans and Cryptococcus gattii, which cause a spectrum of disease ranging from pulmonary and skin lesions to life-threatening central nervous system involvement. The diagnosis and management of cryptococcal meningitis have substantially changed in recent years. Cryptococcal meningitis often occurs in people living with advanced HIV infection, though in high-income countries with robust HIV detection and treatment programmes, it increasingly occurs in other groups, notably solid-organ transplant recipients, other immunosuppressed patients and even immunocompetent hosts. This review outlines the clinical presentation, management and prognosis of cryptococcal meningitis, including its salient differences in people living with HIV compared with HIV-negative patients. We discuss the importance of managing raised intracranial pressure and highlight the advantages of improved multidisciplinary team working involving neurologists, infectious disease specialists and neurosurgeons.
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Affiliation(s)
- Maria Francisca Rocha
- National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hamish D C Bain
- National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil Stone
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Lucia Darie
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ahmed K Toma
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michael P T Lunn
- National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arpan R Mehta
- National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
- MRC Protein Phosphorylation & Ubiquitylation Unit, School of Life Sciences, University of Dundee, Dundee, UK
| | - Charles Coughlan
- National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
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2
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Martins Oliveira-Brito PK, de Campos GY, Guimarães JG, Machado MP, Serafim LC, Lazo Chica JE, Roque-Barreira MC, da Silva TA. Adjuvant ArtinM favored the host immunity against Cryptococcus gattii infection in C57BL/6 mice. Immunotherapy 2024:1-16. [PMID: 38940276 DOI: 10.1080/1750743x.2024.2360384] [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: 01/15/2024] [Accepted: 05/22/2024] [Indexed: 06/29/2024] Open
Abstract
Aim: Cryptococcus gattii causes a severe fungal infection with high mortality rate among immunosuppressed and immunocompetent individuals. Due to limitation of current antifungal treatment, new immunotherapeutic approaches are explored. Methods: This study investigated an immunization strategy utilizing heat-inactivated C. gattii with ArtinM as an adjuvant. C57BL/6 mice were intranasally immunized with heat-killed C. gattii and ArtinM was administrated either before immunization or along with HK-C. gattii. Mice were infected with C. gattii and the efficacy of the immunization protocol was evaluated. Results: Mice that received ArtinM exhibited increased levels of IL-10 and relative expression of IL-23 in the lungs, reduced fungal burden and preserved tissue integrity post-infection. Conclusion: Adjuvant ArtinM improved immunization against C. gattii infection in C57BL/6 mice.
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Affiliation(s)
- Patrícia Kellen Martins Oliveira-Brito
- Department of Cell & Molecular Biology & Pathogenic Bioagents, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Gabriela Yamazaki de Campos
- Department of Cell & Molecular Biology & Pathogenic Bioagents, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Júlia Garcia Guimarães
- Department of Cell & Molecular Biology & Pathogenic Bioagents, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Michele Procópio Machado
- Department of Cell & Molecular Biology & Pathogenic Bioagents, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Letícia Costa Serafim
- Microbiology Postgraduate Program of the Microbiology Department of the Biomedical Sciences Institute (ICB) of University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Javier Emílio Lazo Chica
- Institute of Natural & Biological Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Maria Cristina Roque-Barreira
- Department of Cell & Molecular Biology & Pathogenic Bioagents, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Thiago Aparecido da Silva
- Department of Cell & Molecular Biology & Pathogenic Bioagents, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Clinical Hematology Lab, Department of Clinical Analysis, School of Pharmaceutical Sciences in Araraquara (FCFAR), Sao Paulo State University (UNESP), Araraquara, São Paulo, Brazil
- National Institute of Science & Technology in Human Pathogenic Fungi, School of Pharmaceutical Sciences of Ribeirao Preto, University of São Paulo, Ribeirão Preto, São Paulo,Brazil
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3
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de Sena ACVP, de Arruda JAA, Oliveira SR, Pereira NM, Faria LDS, Travassos DV, Silva TA. Orofacial Cryptococcosis: A Challenging Clinical Report and a Systematic Analysis of the Literature. Int J Surg Pathol 2024; 32:165-181. [PMID: 37143300 DOI: 10.1177/10668969231169048] [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] [Indexed: 05/06/2023]
Abstract
Cryptococcosis is a neglected fungal disease. The scarcity of studies on oral cryptococcosis is certainly due to rarity and/or underreporting of the disease, especially in Brazil. We describe an example of orofacial cryptococcosis affecting a 57-year-old man after heart transplantation, who presented with multiple erythematous ulcers and erosions distributed in the chin, nasal cavity, labial mucosa, hard palate, and buccal vestibule. Computed tomography revealed opacities and micronodules in the lungs. Histopathological features of the oral and pulmonary lesions were compatible with Cryptococcus spp. Amphotericin B and fluconazole were used for treatment during hospitalization and itraconazole for prolonged therapy after hospital discharge. The patient has been under follow up for 6 months without signs of disease. According to a review conducted in PubMed, Web of Science, Scopus, Embase, and LILACS for data analysis of oral cryptococcosis, 26 reports were described in the literature. Predilection for men was observed (85%), with a male:female ratio of 5.5:1. The mean age of the individuals was 49 ± 15.3 years. Oral cryptococcosis mostly presented as an ulcer (n = 17). The palate and tongue were the most affected sites (n = 9 for each). Amphotericin B was the primary therapy utilized in most patients. Seventeen (65%) individuals survived. Knowledge of the clinicodemographic aspects of oral cryptococcosis is important for clinicians in decision making and surveillance.
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Affiliation(s)
- Ana Carolina Velasco Pondé de Sena
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sicília Rezende Oliveira
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Nickolas Mendes Pereira
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa Dos Santos Faria
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Denise Vieira Travassos
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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4
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Miranda BA, Freitas GJC, Leocádio VAT, Costa MC, Emídio ECP, Ribeiro NQ, Carmo PHF, Gouveia-Eufrásio L, Hubner J, Tavares LP, Arifa RDN, Brito CB, Silva MF, Teixeira MM, Paixão TA, Peres NTA, Fagundes CT, Santos DA. Secondary Streptococcus pneumoniae infection increases morbidity and mortality during murine cryptococcosis. Immunology 2024; 171:92-103. [PMID: 37814467 DOI: 10.1111/imm.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
Microorganisms that cause pneumonia and translocate to the central nervous system (CNS) are responsible for high mortality worldwide. The fungus Cryptococcus gattii (Cg) and the bacteria Streptococcus pneumoniae (Sp) target the same infection organs. This study aimed to investigate the consequences of secondary Sp infection during murine cryptococcosis. Mice infected with Sp after Cg showed significantly increased lethality and a drop in scores of motor behaviour, neuropsychiatric status and autonomous function. Previous Cg infection favoured Sp multiplication in the lungs, causing intense inflammation and necrosis, with further increased bacterial translocation to the spleen, liver and brain. This phenotype was associated with increased platelet-activating factor receptor (Pafr) gene expression, reduced M1 macrophage recruitment, and high levels of proinflammatory mediators. Strategies to overcome early mortality (i.e., infection of Pafr-/- mice, treatment with IL-1 inhibitor or corticoid) were insufficient to revert this phenotype. These results suggest that Cg infection makes the lung microenvironment favourable for Sp colonization and dissemination. Altogether, it leads to an exacerbated and ineffective inflammatory response, decisive for the increased morbidity and mortality during coinfection. In conclusion, our results highlight the importance of more studies addressing coinfections and their consequences in the host, aiming to establish more effective therapeutical strategies.
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Affiliation(s)
- Bárbara A Miranda
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo J C Freitas
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Victor A T Leocádio
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marliete C Costa
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Elúzia C P Emídio
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Noelly Q Ribeiro
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paulo H F Carmo
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ludmila Gouveia-Eufrásio
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Josy Hubner
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luciana P Tavares
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Raquel D N Arifa
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Camila B Brito
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Monique F Silva
- Departamento de Patologia/Laboratório de Patologia Celular e Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mauro M Teixeira
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Tatiane A Paixão
- Departamento de Patologia/Laboratório de Patologia Celular e Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Nalu T A Peres
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Caio T Fagundes
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniel A Santos
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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5
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Kakizaki MIT, Melhem MDESC. CRYPTOCOCCOSIS: A bibliographic narrative review on antifungal resistance. AN ACAD BRAS CIENC 2023; 95:e20220862. [PMID: 37466540 DOI: 10.1590/0001-3765202320220862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/15/2022] [Indexed: 07/20/2023] Open
Abstract
Cryptococcosis is an infectious fungal disease widely studied for its epidemiological importance in the context of public health, given the high morbidity and mortality associated with this invasive fungal infection. Many cases of the disease present clinical resistance and progress to death, even in the presence of antifungal therapy. The prolonged use of triazole drugs to maintain the treatment of cryptococcosis in AIDS patients, can lead to selective pressure from mutant strains, among other resistance mechanisms, justifying the poor clinical evolution of some cases. In this study, a narrative review of the literature on the occurrence of antifungal resistance in cryptococcosis agents was performed. Publications from 2010 to 2022 that address this topic were selected using Google Scholars and Scopus website. Data from the studies were analyzed for the values of minimum inhibitory concentration (MIC) of drugs used in the management of cryptococcosis. The review showed that the highest MIC values occurred for voriconazole, especially against C. neoformans. It is concluded that there is a lack of studies with statistical analysis of the data obtained, in order to provide a better dimensioning of the resistance rates of cryptococcosis agents to different antifungal agents, both in geographical and temporal context.
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Affiliation(s)
- Maria Ismênia T Kakizaki
- Instituto de Assistência Médica ao Servidor Público Estadual: Iamspe, Setor de Oncologia e Hematologia, Rua Pedro de Toledo, 1800, Vila Clementino, 04039-901 São Paulo, SP, Brazil
| | - Marcia DE S C Melhem
- Departmento de Micologia, Associado de pesquisa sênior, Instituto Adolfo Lutz, Av. Dr. Arnaldo, 355, Cerqueira César, 01246-000 São Paulo, SP, Brazil
- Universidade Federal do Mato Grosso do Sul, Departamento de Medicina, Av. Costa e Silva, s/n, Pioneiros, 79070-900 Campo Grande, MS, Brazil
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6
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Rodrigues ML, Nosanchuk JD. Recognition of fungal priority pathogens: What next? PLoS Negl Trop Dis 2023; 17:e0011136. [PMID: 36893096 PMCID: PMC9997940 DOI: 10.1371/journal.pntd.0011136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Affiliation(s)
- Marcio L. Rodrigues
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil
- Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail: (MLR); (JDN)
| | - Joshua D. Nosanchuk
- Department of Medicine (Division of Infectious Diseases) and Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, New York, United States of America
- * E-mail: (MLR); (JDN)
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7
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Kabir Z, Cunningham C. The global burden of cryptococcosis-a neglected tropical disease? THE LANCET. INFECTIOUS DISEASES 2022; 22:1658-1660. [PMID: 36049487 DOI: 10.1016/s1473-3099(22)00516-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Zubair Kabir
- School of Public Health, University College Cork, Cork T12 XF62, Ireland.
| | - Colette Cunningham
- School of Public Health, University College Cork, Cork T12 XF62, Ireland
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8
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de Oliveira HC, Castelli RF, Alves LR, Nosanchuk JD, Salama EA, Seleem M, Rodrigues ML. Identification of 4 compounds from the Pharmakon library with antifungal activity against Candida auris and species of Cryptococcus. Med Mycol 2022; 60:6586341. [PMID: 35575621 DOI: 10.1093/mmy/myac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/11/2022] [Accepted: 05/12/2022] [Indexed: 11/14/2022] Open
Abstract
There is an urgent need to develop novel antifungals. In this study, we screened 1600 compounds for antifungal activity against Cryptococcus neoformans and Candida auris. We evaluated 4 promising compounds against 24 additional isolates of C. neoformans, C. auris, Cryptococcus deuterogattii, and Cryptococcus gattii. The 4 compounds, dequalinium chloride (DQC), bleomycin sulfate (BMS), pentamidine isethionate salt (PIS), and clioquinol (CLQ), varied in their efficacy against these pathogens but were generally more effective against cryptococci. The compounds exerted their antifungal effect via multiple mechanisms including interference with the capsule of cryptococci and induction of hyphal-like morphology in C. auris. Our results indicate that DQC, BMS, PIS, and CLQ represent potential prototypes for the future development of antifungals.
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Affiliation(s)
| | - Rafael F Castelli
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil.,Programa de Pós-Graduação em Biologia Parasitária, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Lysangela R Alves
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil
| | - Joshua D Nosanchuk
- Departments of Medicine (Division of Infectious Diseases) and Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ehab A Salama
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Mohamed Seleem
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Marcio L Rodrigues
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil.,Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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9
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Oliveira EAM, Ferreira GF, Lang KL. Drug repositioning of benzimidazole anthelmintics in the treatment of cryptococcosis: a review. Med Chem Res 2021. [DOI: 10.1007/s00044-021-02824-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Freitas GJC, Santos DA. Cryptococcus gattii polysaccharide capsule: An insight on fungal-host interactions and vaccine studies. Eur J Immunol 2021; 51:2206-2209. [PMID: 34396521 DOI: 10.1002/eji.202149349] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/27/2021] [Indexed: 11/07/2022]
Abstract
Cryptococcus neoformans and C. gattii complexes are the main causative agents of cryptococcosis, a neglected disease with high lethality. The capsule, composed predominantly of the capsular polysaccharide (CP) GXM, is the main virulence factor of this pathogen. The role of CP is well described for C. neoformans and; however, there is a scarcity of studies focused on C. gattii, especially in the context of the fungal-host interaction. Understanding how the immune system recognizes C. gattii can generate meaningful information for diagnosing, preventing, and treating cryptococcosis. In the current issue of the European Journal of Immunology [Eur. J. Immunol. 2021. 51: 2281-2295], Ueno et al. demonstrate that CP inhibits C. gattii recognition by CD11b. In this commentary, we highlight the importance of deeply understanding the role of C. gattii CP during infection and how this knowledge would influence the strategies to develop new vaccines against cryptococcosis.
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Affiliation(s)
- Gustavo J C Freitas
- Departament of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniel A Santos
- Departament of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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11
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Pullen MF, Hullsiek KH, Rhein J, Musubire AK, Tugume L, Nuwagira E, Abassi M, Ssebambulidde K, Mpoza E, Kiggundu R, Akampurira A, Nabeta HW, Schutz C, Evans EE, Rajasingham R, Skipper CP, Pastick KA, Williams DA, Morawski BM, Bangdiwala AS, Meintjes G, Muzoora C, Meya DB, Boulware DR. Cerebrospinal Fluid Early Fungicidal Activity as a Surrogate Endpoint for Cryptococcal Meningitis Survival in Clinical Trials. Clin Infect Dis 2021; 71:e45-e49. [PMID: 31912875 DOI: 10.1093/cid/ciaa016] [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: 10/25/2019] [Accepted: 01/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In cryptococcal meningitis phase 2 clinical trials, early fungicidal activity (EFA) of Cryptococcus clearance from cerebrospinal fluid (CSF) is used as a surrogate endpoint for all-cause mortality. The Food and Drug Administration allows for using surrogate endpoints for accelerated regulatory approval, but EFA as a surrogate endpoint requires further validation. We examined the relationship between rate of CSF Cryptococcus clearance (EFA) and mortality through 18 weeks. METHODS We pooled individual-level CSF data from 3 sequential cryptococcal meningitis clinical trials conducted during 2010-2017. All 738 subjects received amphotericin + fluconazole induction therapy and had serial quantitative CSF cultures. The log10-transformed colony-forming units (CFUs) per mL CSF were analyzed by general linear regression versus day of culture over the first 10 days. RESULTS Mortality through 18 weeks was 37% for EFA > = 0.60 (n = 170), 36% for 0.40-0.59 (n = 182), 39% for 0.30-0.39 (n = 112), 35% for 0.20-0.29 (n = 87), and 50% for those with EFA < 0.20 CFU/mL/day (n = 187). The hazard ratio for 18-week mortality, comparing those with EFA < 0.20 to those with EFA > = 0.20, was 1.60 (95% confidence interval, 1.25, 2.04; P = .002). The lowest EFA group had lower median CD4 T-cell counts (P < .01) and lower proportion of patients with CSF pleocytosis (P < .001). CONCLUSIONS EFA is associated with all-cause mortality in cryptococcal meningitis. An EFA threshold of > = 0.20 log10 CFU/mL/day was associated with similar 18-week mortality (37%) compared to 50% mortality with EFA < 0.20. This EFA threshold may be considered a target for a surrogate endpoint. This builds upon existing studies to validate EFA as a surrogate endpoint.
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Affiliation(s)
- Matthew F Pullen
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Huppler Hullsiek
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joshua Rhein
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA.,Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Abdu K Musubire
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Lillian Tugume
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Edwin Nuwagira
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mahsa Abassi
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Edward Mpoza
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Ruben Kiggundu
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Henry W Nabeta
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Charlotte Schutz
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, South Africa
| | - Emily E Evans
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Radha Rajasingham
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Caleb P Skipper
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Katelyn A Pastick
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Darlisha A Williams
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA.,Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Bozena M Morawski
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ananta S Bangdiwala
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, South Africa
| | - Conrad Muzoora
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - David B Meya
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA.,Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
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12
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Bhattarai K, Bhattarai K, Kabir ME, Bastola R, Baral B. Fungal natural products galaxy: Biochemistry and molecular genetics toward blockbuster drugs discovery. ADVANCES IN GENETICS 2021; 107:193-284. [PMID: 33641747 DOI: 10.1016/bs.adgen.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Secondary metabolites synthesized by fungi have become a precious source of inspiration for the design of novel drugs. Indeed, fungi are prolific producers of fascinating, diverse, structurally complex, and low-molecular-mass natural products with high therapeutic leads, such as novel antimicrobial compounds, anticancer compounds, immunosuppressive agents, among others. Given that these microorganisms possess the extraordinary capacity to secrete diverse chemical scaffolds, they have been highly exploited by the giant pharma companies to generate small molecules. This has been made possible because the isolation of metabolites from fungal natural sources is feasible and surpasses the organic synthesis of compounds, which otherwise remains a significant bottleneck in the drug discovery process. Here in this comprehensive review, we have discussed recent studies on different fungi (pathogenic, non-pathogenic, commensal, and endophytic/symbiotic) from different habitats (terrestrial and marines), the specialized metabolites they biosynthesize, and the drugs derived from these specialized metabolites. Moreover, we have unveiled the logic behind the biosynthesis of vital chemical scaffolds, such as NRPS, PKS, PKS-NRPS hybrid, RiPPS, terpenoids, indole alkaloids, and their genetic mechanisms. Besides, we have provided a glimpse of the concept behind mycotoxins, virulence factor, and host immune response based on fungal infections.
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Affiliation(s)
- Keshab Bhattarai
- Pharmaceutical Institute, Department of Pharmaceutical Biology, University of Tübingen, Tübingen, Germany
| | - Keshab Bhattarai
- Central Department of Chemistry, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Md Ehsanul Kabir
- Animal Health Research Division, Bangladesh Livestock Research Institute, Savar, Dhaka, Bangladesh
| | - Rina Bastola
- Spinal Cord Injury Association-Nepal (SCIAN), Pokhara, Nepal
| | - Bikash Baral
- Department of Biochemistry, University of Turku, Turku, Finland.
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13
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Silva Zatti M, Domingos Arantes T, Cordeiro Theodoro R. Isothermal nucleic acid amplification techniques for detection and identification of pathogenic fungi: A review. Mycoses 2020; 63:1006-1020. [PMID: 32648947 DOI: 10.1111/myc.13140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fungal infections have increased during the last years due to the AIDS epidemic and immunosuppressive therapies. The available diagnostic methods, such as culture, histopathology and serology, have several drawbacks regarding sensitivity, specificity and time-consuming, while molecular methods are still expensive and dependent on many devices. In order to overcome these challenges, isothermal nucleic acid amplification techniques (INAT) arose as promising diagnostic methods for infectious diseases. OBJECTIVE This review aimed to present and discuss the main contributions of the isothermal nucleic acid amplification techniques applied in medical mycology. METHODS Papers containing terms for each INAT (NASBA, RCA, LAMP, CPA, SDA, HAD or PSR) and the terms 'mycoses' or 'disease, fungal' were obtained from National Center for Biotechnology Information database until August 2019. RESULTS NASBA, RCA, LAMP and PSR are the INAT reported in the literature for detection and identification of pathogenic fungi. Despite the need of a previous conventional PCR, the RCA technique might also be used for genotyping or cryptic species differentiation, which may be important for the treatment of certain mycoses; nevertheless, LAMP is the most used INAT for pathogen detection. CONCLUSION Among all INATs herein reviewed, LAMP seems to be the most appropriate method for fungal detection, since it is affordable, sensitive, specific, user-friendly, rapid, robust, equipment-free and deliverable to end-users, fulfilling all ASSURED criteria of the World Health Organization for an ideal diagnostic method.
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Affiliation(s)
- Matheus Silva Zatti
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Thales Domingos Arantes
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiás, Brazil
| | - Raquel Cordeiro Theodoro
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte, Natal, Brazil
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14
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Rodrigues ML, Nosanchuk JD. Fungal diseases as neglected pathogens: A wake-up call to public health officials. PLoS Negl Trop Dis 2020; 14:e0007964. [PMID: 32078635 PMCID: PMC7032689 DOI: 10.1371/journal.pntd.0007964] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Marcio L. Rodrigues
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil
- Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joshua D. Nosanchuk
- Department of Medicine (Division of Infectious Diseases) and Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, New York, United States of America
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15
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Krummenauer ME, Lopes W, Garcia AWA, Schrank A, Gnoatto SCB, Kawano DF, Vainstein MH. A Highly Active Triterpene Derivative Capable |of Biofilm Damage to Control Cryptococcus spp. Biomolecules 2019; 9:E831. [PMID: 31817559 PMCID: PMC6995603 DOI: 10.3390/biom9120831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/13/2022] Open
Abstract
Cryptococcus neoformans is an encapsulated yeast responsible for more than 180,000 deaths per year. The standard therapeutic approach against cryptococcosis is a combination of amphotericin B with flucytosine. In countries where cryptococcosis is most prevalent, 5-fluorocytosine is rarely available, and amphotericin B requires intravenous administration. C. neoformans biofilm formation is related to increased drug resistance, which is an important outcome for hospitalized patients. Here, we describe new molecules with anti-cryptococcal activity. A collection of 66 semisynthetic derivatives of ursolic acid and betulinic acid was tested against mature biofilms of C. neoformans at 25 µM. Out of these, eight derivatives including terpenes, benzazoles, flavonoids, and quinolines were able to cause damage and eradicate mature biofilms. Four terpene compounds demonstrated significative growth inhibition of C. neoformans. Our study identified a pentacyclic triterpenoid derived from betulinic acid (LAFIS13) as a potential drug for anti-cryptococcal treatment. This compound appears to be highly active with low toxicity at minimal inhibitory concentration and capable of biofilm eradication.
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Affiliation(s)
- Maria E. Krummenauer
- Centro de Biotecnologia, PPGBCM, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul 91501-970, Brazil; (M.E.K.); (W.L.); (A.W.A.G.); (A.S.)
| | - William Lopes
- Centro de Biotecnologia, PPGBCM, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul 91501-970, Brazil; (M.E.K.); (W.L.); (A.W.A.G.); (A.S.)
| | - Ane W. A. Garcia
- Centro de Biotecnologia, PPGBCM, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul 91501-970, Brazil; (M.E.K.); (W.L.); (A.W.A.G.); (A.S.)
| | - Augusto Schrank
- Centro de Biotecnologia, PPGBCM, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul 91501-970, Brazil; (M.E.K.); (W.L.); (A.W.A.G.); (A.S.)
| | - Simone C. B. Gnoatto
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul 90610-000, Brazil;
| | - Daniel F. Kawano
- Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas, Campinas, São Paulo 13083-871, Brazil;
| | - Marilene H. Vainstein
- Centro de Biotecnologia, PPGBCM, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul 91501-970, Brazil; (M.E.K.); (W.L.); (A.W.A.G.); (A.S.)
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Lopes JP, Stylianou M, Backman E, Holmberg S, Ekoff M, Nilsson G, Urban CF. Cryptococcus neoformans Induces MCP-1 Release and Delays the Death of Human Mast Cells. Front Cell Infect Microbiol 2019; 9:289. [PMID: 31456952 PMCID: PMC6700240 DOI: 10.3389/fcimb.2019.00289] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/26/2019] [Indexed: 01/09/2023] Open
Abstract
Cryptococcosis, caused by the basidiomycete Cryptococcus neoformans, is a life-threatening disease affecting approximately one million people per year worldwide. Infection can occur when C. neoformans cells are inhaled by immunocompromised people. In order to establish infection, the yeast must bypass recognition and clearance by immune cells guarding the tissue. Using in vitro infections, we characterized the role of mast cells (MCs) in cryptococcosis. We found that MCs recognize C. neoformans and release inflammatory mediators such as tryptase and cytokines. From the latter group MCs released mainly CCL-2/MCP-1, a strong chemoattractant for monocytic cells. We demonstrated that supernatants of infected MCs recruit monocytes but not neutrophils. During infection with C. neoformans, MCs have a limited ability to kill the yeast depending on the serotype. C. neoformans, in turn, modulates the lifespan of MCs both, by presence of its polysaccharide capsule and by secreting soluble modulators. Taken together, MCs might have important contributions to fungal clearance during early stages of cryptocococis where these cells regulate recruitment of monocytes to mucosal tissues.
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Affiliation(s)
- José Pedro Lopes
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden.,Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.,Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Marios Stylianou
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden.,Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.,Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Emelie Backman
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden.,Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.,Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Sandra Holmberg
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden.,Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.,Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Maria Ekoff
- Immunology and Allergy Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Nilsson
- Immunology and Allergy Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Constantin F Urban
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden.,Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.,Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
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17
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Affiliation(s)
- Joseph N Jarvis
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
- Botswana Harvard AIDS Institute Partnership, Gaborone
- Botswana UPenn Partnership, Gaborone
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Thomas S Harrison
- Centre for Global Health, Institute for Infection and Immunity, St George’s University of London, United Kingdom
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18
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Silva FB, Santos JRN, da Silva LC, Gomes WC, Villis PCM, Gomes EDS, Pinheiro EDAD, Azevedo CDMPESD, Dias RDS, Monteiro CDA, Santos JRA. Climate drivers of hospitalizations for mycoses in Brazil. Sci Rep 2019; 9:6902. [PMID: 31061460 PMCID: PMC6502841 DOI: 10.1038/s41598-019-43353-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 04/18/2019] [Indexed: 01/26/2023] Open
Abstract
Climate can modulate human health at large spatial scales, but the influence of global, regional, and local environments remains poorly understood, especially for neglected diseases, such as mycoses. In this work, we present the correlation between climatic variables and hospitalizations for mycoses in Brazilian state capitals, evaluating the period of 2008 to 2016 at different time scales. The results indicate that climate modulates the hospitalizations for mycoses differently at annual and monthly time scales, with minimum temperature as a key climatic variable during periods of high prevalence in the 10 Brazilian capitals with the highest hospitalizations for mycoses rates. The greatest number of hospitalizations coincided with La Niña events, while a reduction was observed during El Niño events, thereby demonstrating the influence of the Pacific Interdecadal Climate Oscillation on the prevalence of mycoses in Brazil. At a regional scale, the mycoses burden in Brazil appears to respond differently to local and global climatic drivers.
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Affiliation(s)
- Fabrício Brito Silva
- Mestrado em Meio Ambiente - Universidade CEUMA (UNICEUMA), São Luís, Maranhão, Brazil
| | | | | | - Wolia Costa Gomes
- Mestrado em Meio Ambiente - Universidade CEUMA (UNICEUMA), São Luís, Maranhão, Brazil
| | | | - Eliane Dos Santos Gomes
- Discente do Curso de Engenharia Ambiental - Universidade CEUMA (UNICEUMA), São Luís, Maranhão, Brazil
| | - Edilene de Araújo Diniz Pinheiro
- Mestrado em Meio Ambiente - Universidade CEUMA (UNICEUMA), São Luís, Maranhão, Brazil.,Discente do Curso de Biomedicina - Universidade CEUMA (UNICEUMA), São Luís, Maranhão, Brazil
| | | | - Rosane da Silva Dias
- Mestrado em Gestão de Programas e Serviços de Saúde - Universidade CEUMA (UNICEUMA), São Luís, Maranhão, Brazil
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Almeida F, Rodrigues ML, Coelho C. The Still Underestimated Problem of Fungal Diseases Worldwide. Front Microbiol 2019; 10:214. [PMID: 30809213 PMCID: PMC6379264 DOI: 10.3389/fmicb.2019.00214] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/25/2019] [Indexed: 12/19/2022] Open
Abstract
In the past few years, fungal diseases caused estimated over 1.6 million deaths annually and over one billion people suffer from severe fungal diseases (Brown et al., 2012; Anonymous, 2017b). Public health surveillance of fungal diseases is generally not compulsory, suggesting that most estimates are conservative (Casadevall, 2017; Anonymous, 2017a). Fungal disease can also damage plants and crops, causing major losses in agricultural activities and food production (Savary et al., 2012). Animal pathogenic fungi are threatening bats, amphibians and reptiles with extinction (Casadevall, 2017). It is estimated that fungi are the highest threat for animal-host and plant-host species, representing the major cause (approximately 65%) of pathogen-driven host loss (Fisher et al., 2012). In this complex scenario, it is now clear that the global warming and accompanying climate changes have resulted in increased incidence of many fungal diseases (Garcia-Solache and Casadevall, 2010). On the basis of all these factors, concerns on the occurrence of a pandemic of fungal origin in a near future have been raised (Casadevall, 2017). In this context, to stop forgetting and underestimating fungal diseases is mandatory.
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Affiliation(s)
- Fausto Almeida
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcio L. Rodrigues
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil
- Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carolina Coelho
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
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20
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Santos-Gandelman J, Machado-Silva A. Drug development for cryptococcosis treatment: what can patents tell us? Mem Inst Oswaldo Cruz 2019; 114:e180391. [PMID: 30726342 PMCID: PMC6358010 DOI: 10.1590/0074-02760180391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/02/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cryptococcosis is one of the most devastating fungal infections in humans. Despite the disease's clinical importance, current therapy is based on limited antifungals that are either toxic, inefficient, unavailable worldwide, or that quickly lead to resistance. OBJECTIVES The goal of this study was to provide insight into the future of cryptococcosis treatment by describing the patent scenario in this field. METHODS We identified and analysed patent documents revealing compounds with anti-cryptococcal activity supported by experimental evidence. FINDINGS Patenting in this field has been historically low, with an overall tendency of increase since 2012. Most applications are single filings, suggesting that they do not encompass strategic inventions requiring broad protection. Research and development essentially took place in China and the United States, which also represent the main countries of protection. Both academic and corporate institutions contributed to patenting in this field. Universities are the leading actors, with the highest patent family counts. CONCLUSION The low number of patents in this field indicates that efforts to mitigate the unmet needs for cryptococcosis treatment remain insufficient. Without investment to drive research and innovation, patients will likely continue to face inadequate assistance. Given the current scenario characterised by poor funding and low interest for technological development, drug repurposing may be the best alternative for cryptococcosis treatment.
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Affiliation(s)
- Juliana Santos-Gandelman
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Ciência e Tecnologia de Gestão da Inovação em Doenças Negligenciadas, Centro de Desenvolvimento Tecnológico em Saúde, Rio de Janeiro, RJ, Brasil
| | - Alice Machado-Silva
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Ciência e Tecnologia de Gestão da Inovação em Doenças Negligenciadas, Centro de Desenvolvimento Tecnológico em Saúde, Rio de Janeiro, RJ, Brasil.,Fundação Oswaldo Cruz-Fiocruz, Instituto René Rachou, Belo Horizonte, MG, Brasil
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21
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Santos-Gandelman J, Rodrigues ML, Machado Silva A. Future perspectives for cryptococcosis treatment. Expert Opin Ther Pat 2018; 28:625-634. [PMID: 30084284 DOI: 10.1080/13543776.2018.1503252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Cryptococcosis is one of the most devastating human fungal infections. Despite its impact, none of the standard antifungals were developed after 1990. New, improved, less toxic, affordable and widely available treatment is, therefore, imperative. AREAS COVERED This review offers an insight into technological developments for cryptococcosis disclosed in patent literature. From a broad search of patent documents claiming cryptococcosis treatment and having earliest priority between 1995 and 2015, we selected and summarized compounds/molecules (i) revealed in documents disclosing in vivo activity against Cryptococcus spp. or (ii) found in the pipeline of companies that appeared as assignees in our patent search. This information was complemented with data on compounds under development for this indication from the database Integrity (Clarivate Analytics). EXPERT OPINION This review demonstrates that drug development against cryptococcosis is discrete. However, it also shows that the existing development is not focused on a single class of molecules, but on different types of molecules with distinct fungal targets, reflecting the complexity of generating novel anti-cryptococcal tools. Given the intrinsic difficulties and high costs of drug development and the evident market failure in this field, we consider drug repurposing the most promising avenue for cryptococcosis treatment.
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Affiliation(s)
- Juliana Santos-Gandelman
- a Instituto Nacional de Ciência e Tecnologia de Inovação em Doenças Negligenciadas (INCT-IDN), Centro de Desenvolvimento Tecnológico em Saúde (CDTS) , Fundação Oswaldo Cruz (Fiocruz) , Rio de Janeiro/RJ , Brazil
| | - Márcio Lourenço Rodrigues
- b Instituto Carlos Chagas (ICC) , Fundação Oswaldo Cruz - Fiocruz. Rua Prof , Algacyr Munhoz Mader, Curitiba/PR , Brazil.,c Instituto de Microbiologia Paulo de Góes , Universidade Federal do Rio de Janeiro - UFRJ , Av. Carlos Chagas Filho, Rio de Janeiro/RJ , Brazil
| | - Alice Machado Silva
- a Instituto Nacional de Ciência e Tecnologia de Inovação em Doenças Negligenciadas (INCT-IDN), Centro de Desenvolvimento Tecnológico em Saúde (CDTS) , Fundação Oswaldo Cruz (Fiocruz) , Rio de Janeiro/RJ , Brazil.,d Instituto René Rachou , Fundação Oswaldo Cruz - Fiocruz Minas , Av. Augusto de Lima, Belo Horizonte , MG , Brazil
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22
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Rodrigues ML, Albuquerque PC. Searching for a change: The need for increased support for public health and research on fungal diseases. PLoS Negl Trop Dis 2018; 12:e0006479. [PMID: 29902170 PMCID: PMC6001980 DOI: 10.1371/journal.pntd.0006479] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Marcio L. Rodrigues
- Instituto Carlos Chagas (ICC), Oswaldo Cruz Foundation (Fiocruz), Curitiba, Brazil
- Instituto de Microbiologia Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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23
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Rodrigues ML. Neglected disease, neglected populations: the fight against Cryptococcus and cryptococcosis. Mem Inst Oswaldo Cruz 2018; 113:e180111. [PMID: 29668824 PMCID: PMC5909085 DOI: 10.1590/0074-02760180111] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Macedo PMD, Almeida-Paes R, Almeida MDA, Coelho RA, Andrade HB, Ferreira ABTBC, Zancopé-Oliveira RM, Valle ACFD. Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 plus HIV co-infection. Mem Inst Oswaldo Cruz 2018; 113:167-172. [PMID: 29412355 PMCID: PMC5804308 DOI: 10.1590/0074-02760170310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/11/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Paracoccidioidomycosis (PCM) is one of the most important systemic mycoses in
Latin America and the leading fungal cause of mortality in non-immunosuppressed
individuals in Brazil. However, HIV/PCM co-infection can increase the clinical
severity in these co-infected patients. This co-infection is rarely reported in
the literature mainly because of the different epidemiological profiles of these
infections. Furthermore, PCM is a neglected and non-notifiable disease, which may
underestimate the real importance of this disease. The advent of molecular studies
on the species of the genus Paracoccidioides has expanded the
knowledge regarding the severity and the clinical spectrum in PCM. In this
context, the development of studies to describe the association of the
Paracoccidioides phylogenetic cryptic species in vulnerable
populations, such as HIV-infected patients, appears relevant. OBJECTIVE To describe the clinical, epidemiological, therapeutic and prognostic aspects in
HIV/PCM co-infected patients, along with the molecular identification of the
Paracoccidioides species involved in these cases. METHODS The investigators performed a molecular and clinical retrospective study involving
HIV/PCM co-infected patients, from a reference centre for PCM care in the endemic
area of Rio de Janeiro, Brazil, from 1998 to 2015. Molecular identification of the
fungal strains was done by amplification of partial sequences of
arf and gp43 genes. FINDINGS Of 89 patients diagnosed with PCM by fungal isolation in the culture, a viable
isolate was recovered for molecular analysis from 44 patients. Of these 44
patients, 28 (63.6%) had their serum samples submitted for enzyme immunoassay
tests for screening of HIV antibodies, and 5 (17.9%) had a positive result. All
cases were considered severe, with a variable clinical presentation, including
mixed, acute/subacute clinical forms and a high rate of complications, requiring
combination therapy. Paracoccidioides brasiliensis S1 was the
species identified in all cases. CONCLUSIONS HIV/PCM co-infection can change the natural history of this fungal disease. The
authors reinforce the need to include HIV screening diagnostic tests routinely for
patients with PCM.
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Affiliation(s)
- Priscila Marques de Macedo
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
| | - Rodrigo Almeida-Paes
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Marcos de Abreu Almeida
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Rowena Alves Coelho
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Hugo Boechat Andrade
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Departamento de Assistência a Pacientes Internados, Fiocruz, Rio de Janeiro, RJ, Brasil
| | | | - Rosely Maria Zancopé-Oliveira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Antonio Carlos Francesconi do Valle
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
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Santos JRA, Ribeiro NQ, Bastos RW, Holanda RA, Silva LC, Queiroz ER, Santos DA. High-dose fluconazole in combination with amphotericin B is more efficient than monotherapy in murine model of cryptococcosis. Sci Rep 2017; 7:4661. [PMID: 28680034 PMCID: PMC5498649 DOI: 10.1038/s41598-017-04588-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/17/2017] [Indexed: 12/26/2022] Open
Abstract
Cryptococcus spp., the causative agents of cryptococcosis, are responsible for deaths of hundreds of thousands of people every year worldwide. The drawbacks of available therapeutic options are aggravated by the increased resistance of yeast to the drugs, resulting in inefficient therapy. Also, the antifungal 5FC is not available in many countries. Therefore, a combination of antifungal drugs may be an interesting option, but in vitro and theoretical data point to the possible antagonism between the main antifungals used to treat cryptococcosis, i.e., fluconazole (FLC), and amphotericin B (AMB). Therefore, in vivo studies are necessary to test the above hypothesis. In this study, the efficacy of FLC and AMB at controlling C. gattii infection was evaluated in a murine model of cryptococcosis caused by C. gattii. The infected mice were treated with FLC + AMB combinations and showed a significant improvement in survival as well as reduced morbidity, reduced lung fungal burden, and the absence of yeast in the brain when FLC was used at higher doses, according to the Tukey test and principal component analysis. Altogether, these results indicate that combinatorial optimization of antifungal therapy can be an option for effective control of cryptococcosis.
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Affiliation(s)
- Julliana Ribeiro Alves Santos
- Mestrado em Biologia Parasitária - Universidade CEUMA (UNICEUMA), São Luís, Maranhão, Brazil. .,Mestrado em Meio Ambiente - Universidade CEUMA (UNICEUMA), São Luís, Maranhão, Brazil.
| | - Noelly Queiroz Ribeiro
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rafael Wesley Bastos
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Letícia Chagas Silva
- Mestrado em Meio Ambiente - Universidade CEUMA (UNICEUMA), São Luís, Maranhão, Brazil
| | - Estela Rezende Queiroz
- Departamento de Química, Universidade Federal de Lavras (UFLA), Campus 17 Universitário, Lavras- MG, Brazil
| | - Daniel Assis Santos
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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26
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Molloy SF, Chiller T, Greene GS, Burry J, Govender NP, Kanyama C, Mfinanga S, Lesikari S, Mapoure YN, Kouanfack C, Sini V, Temfack E, Boulware DR, Dromer F, Denning DW, Day J, Stone NRH, Bicanic T, Jarvis JN, Lortholary O, Harrison TS, Jaffar S, Loyse A. Cryptococcal meningitis: A neglected NTD? PLoS Negl Trop Dis 2017; 11:e0005575. [PMID: 28662028 PMCID: PMC5490932 DOI: 10.1371/journal.pntd.0005575] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Síle F. Molloy
- Centre for Global Health, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
- * E-mail:
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gregory S. Greene
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica Burry
- Medecins Sans Frontières Access Campaign, Médecins Sans Frontières, Geneva, Switzerland
| | - Nelesh P. Govender
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), Johannesburg, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Sayoki Mfinanga
- National Institute of Medial Research, Muhimbili Medical Research Centre, Dar Es Salaam, Tanzania
| | - Sokoine Lesikari
- National Institute of Medial Research, Muhimbili Medical Research Centre, Dar Es Salaam, Tanzania
| | | | - Charles Kouanfack
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Victor Sini
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | | | - David R. Boulware
- Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Francoise Dromer
- Institut Pasteur, Molecular Mycology—CNRS URA3012, Department of Mycology, Paris, France
| | - David W. Denning
- Global Action Fund for Fungal Infections (GAFFI), Geneva, Switzerland
| | - Jeremy Day
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme Vietnam, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Neil R. H. Stone
- Centre for Global Health, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Tihana Bicanic
- Centre for Global Health, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Joseph N. Jarvis
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Botswana–University of Pennsylvania Partnership, Gaborone, Botswana
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Olivier Lortholary
- Institut Pasteur, Molecular Mycology—CNRS URA3012, Department of Mycology, Paris, France
| | - Thomas S. Harrison
- Centre for Global Health, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Shabbar Jaffar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Angela Loyse
- Centre for Global Health, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
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27
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Joffe LS, Schneider R, Lopes W, Azevedo R, Staats CC, Kmetzsch L, Schrank A, Del Poeta M, Vainstein MH, Rodrigues ML. The Anti-helminthic Compound Mebendazole Has Multiple Antifungal Effects against Cryptococcus neoformans. Front Microbiol 2017; 8:535. [PMID: 28400768 PMCID: PMC5368277 DOI: 10.3389/fmicb.2017.00535] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/14/2017] [Indexed: 11/24/2022] Open
Abstract
Cryptococcus neoformans is the most lethal pathogen of the central nervous system. The gold standard treatment of cryptococcosis, a combination of amphotericin B with 5-fluorocytosine, involves broad toxicity, high costs, low efficacy, and limited worldwide availability. Although the need for new antifungals is clear, drug research and development (R&D) is costly and time-consuming. Thus, drug repurposing is an alternative to R&D and to the currently available tools for treating fungal diseases. Here we screened a collection of compounds approved for use in humans seeking for those with anti-cryptococcal activity. We found that benzimidazoles consist of a broad class of chemicals inhibiting C. neoformans growth. Mebendazole and fenbendazole were the most efficient antifungals showing in vitro fungicidal activity. Since previous studies showed that mebendazole reaches the brain in biologically active concentrations, this compound was selected for further studies. Mebendazole showed antifungal activity against phagocytized C. neoformans, affected cryptococcal biofilms profoundly and caused marked morphological alterations in C. neoformans, including reduction of capsular dimensions. Amphotericin B and mebendazole had additive anti-cryptococcal effects. Mebendazole was also active against the C. neoformans sibling species, C. gattii. To further characterize the effects of the drug a random C. gattii mutant library was screened and indicated that the antifungal activity of mebendazole requires previously unknown cryptococcal targets. Our results indicate that mebendazole is as a promising prototype for the future development of anti-cryptococcal drugs.
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Affiliation(s)
- Luna S Joffe
- Laboratório de Biologia Celular de Leveduras Patogênicas, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro Rio de Janeiro, Brazil
| | - Rafael Schneider
- Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil
| | - William Lopes
- Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil
| | - Renata Azevedo
- Fundação Oswaldo Cruz - Fiocruz, Centro de Desenvolvimento Tecnológico em Saúde Rio de Janeiro, Brazil
| | - Charley C Staats
- Centro de Biotecnologia, Universidade Federal do Rio Grande do SulPorto Alegre, Brazil; Departamento de Biologia Molecular e Biotecnologia, Universidade Federal do Rio Grande do SulPorto Alegre, Brazil
| | - Lívia Kmetzsch
- Centro de Biotecnologia, Universidade Federal do Rio Grande do SulPorto Alegre, Brazil; Departamento de Biologia Molecular e Biotecnologia, Universidade Federal do Rio Grande do SulPorto Alegre, Brazil
| | - Augusto Schrank
- Centro de Biotecnologia, Universidade Federal do Rio Grande do SulPorto Alegre, Brazil; Departamento de Biologia Molecular e Biotecnologia, Universidade Federal do Rio Grande do SulPorto Alegre, Brazil
| | - Maurizio Del Poeta
- Veterans Administration Medical Center, NorthportNY, USA; Department of Molecular Genetics and Microbiology, Stony Brook University, Stony BrookNY, USA
| | - Marilene H Vainstein
- Centro de Biotecnologia, Universidade Federal do Rio Grande do SulPorto Alegre, Brazil; Departamento de Biologia Molecular e Biotecnologia, Universidade Federal do Rio Grande do SulPorto Alegre, Brazil
| | - Marcio L Rodrigues
- Laboratório de Biologia Celular de Leveduras Patogênicas, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil; Fundação Oswaldo Cruz - Fiocruz, Centro de Desenvolvimento Tecnológico em SaúdeRio de Janeiro, Brazil
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28
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Abstract
Extracellular vesicles (EVs) are produced by virtually all cell types. Within the past few years, work in this field has revealed more information about fungal EVs. Fungal EVs have been shown to carry proteins, lipids, pigments, polysaccharides, and RNA; these components are known virulence factors, a fact which supports the hypothesis that fungal EVs concentrate pathogenic determinants. Additionally, recent studies have demonstrated that fungal EVs stimulate the host immune system. In this review, putative roles of fungal EVs are discussed, including their potential as vaccination tools and their possible contribution to pathogenesis in invasive fungal diseases.
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