1
|
Orally Administered Amphotericin B Nanoformulations: Physical Properties of Nanoparticle Carriers on Bioavailability and Clinical Relevance. Pharmaceutics 2022; 14:pharmaceutics14091823. [PMID: 36145572 PMCID: PMC9505005 DOI: 10.3390/pharmaceutics14091823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
Amphotericin B is an effective polyene antifungal considered as a “gold standard” in the management of fungal infections. Currently, it is administered mainly by IV due to poor aqueous solubility, which precludes its delivery orally. Paradoxically, IV administration is akin to side effects that have not been fully eliminated even with more recent IV formulations. Thus, the need for alternative formulations/route of administration for amphotericin B remains crucial. The oral route offers the possibility of delivering amphotericin B systemically and with diminished side effects; however, enterocyte permeation remains a constraint. Cellular phagocytosis of submicron particles can be used to courier encapsulated drugs. In this regard, nanoparticulate delivery systems have received much attention in the past decade. This review examines the trajectory of orally delivered amphotericin B and discusses key physical factors of nanoformulations that impact bioavailability. The review also explores obstacles that remain and gives a window into the possibility of realizing an oral nanoformulation of amphotericin B in the near future.
Collapse
|
2
|
Sinha B, Staufenbiel S, Müller RH, Möschwitzer JP. Sub-50 nm ultra-small organic drug nanosuspension prepared by cavi-precipitation and its brain targeting potential. Int J Pharm 2021; 607:120983. [PMID: 34371150 DOI: 10.1016/j.ijpharm.2021.120983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to show whether it is possible to prepare sub 100 nm or preferably sub-50 nm drug nanosuspension (NS) of suitable quality for intravenous administration. Furthermore, we have studied how the brain targeting potential of such small size organic NS differs from relatively bigger size NS. Two combination technologies (cavi-precipitation, H96) and a standard high-pressure homogenization (HPH) technology were used to prepare drug NS of different sizes. The cavi-precipitation process generated the smallest AmB NS, i.e., 27 nm compared to 79 nm by H96 technology and 252 nm by standard HPH technology. Dialysis of the nanosuspension in the original dispersion media was found to be the most efficient solvent removal method without negatively affecting particle size. The removal of organic solvent was found to drastically improve the stability of the formulations. The protein adsorption pattern shows that the small size NS particles obtained by the cavi-precipitation process have the potential to circulate longer in the bloodstream and have the potential to be taken up by the blood-brain barrier. The cavi-precipitation process generated ultrafine NS particles, which fulfilled the quality requirements for intravenous administration and offer a potential solution for brain targeting.
Collapse
Affiliation(s)
- Biswadip Sinha
- Institute of Pharmacy, Dept. Of Pharmaceutics, Biopharmaceutics and Nutricosmetics, Freie University of Berlin, Kelchstrasse 31, 12169 Berlin, Germany
| | - Sven Staufenbiel
- Institute of Pharmacy, Dept. Of Pharmaceutics, Biopharmaceutics and Nutricosmetics, Freie University of Berlin, Kelchstrasse 31, 12169 Berlin, Germany
| | - Rainer H Müller
- Institute of Pharmacy, Dept. Of Pharmaceutics, Biopharmaceutics and Nutricosmetics, Freie University of Berlin, Kelchstrasse 31, 12169 Berlin, Germany
| | - Jan P Möschwitzer
- Institute of Pharmacy, Dept. Of Pharmaceutics, Biopharmaceutics and Nutricosmetics, Freie University of Berlin, Kelchstrasse 31, 12169 Berlin, Germany.
| |
Collapse
|
3
|
do Carmo Silva L, de Oliveira AA, de Souza DR, Barbosa KLB, Freitas e Silva KS, Carvalho Júnior MAB, Rocha OB, Lima RM, Santos TG, Soares CMDA, Pereira M. Overview of Antifungal Drugs against Paracoccidioidomycosis: How Do We Start, Where Are We, and Where Are We Going? J Fungi (Basel) 2020; 6:jof6040300. [PMID: 33228010 PMCID: PMC7712482 DOI: 10.3390/jof6040300] [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: 09/23/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
Paracoccidioidomycosis is a neglected disease that causes economic and social impacts, mainly affecting people of certain social segments, such as rural workers. The limitations of antifungals, such as toxicity, drug interactions, restricted routes of administration, and the reduced bioavailability in target tissues, have become evident in clinical settings. These factors, added to the fact that Paracoccidioidomycosis (PCM) therapy is a long process, lasting from months to years, emphasize the need for the research and development of new molecules. Researchers have concentrated efforts on the identification of new compounds using numerous tools and targeting important proteins from Paracoccidioides, with the emphasis on enzymatic pathways absent in humans. This review aims to discuss the aspects related to the identification of compounds, methodologies, and perspectives when proposing new antifungal agents against PCM.
Collapse
Affiliation(s)
- Lívia do Carmo Silva
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
- Correspondence: (L.d.C.S.); (M.P.); Tel./Fax: +55-62-3521-1110 (M.P.)
| | - Amanda Alves de Oliveira
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Dienny Rodrigues de Souza
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Katheryne Lohany Barros Barbosa
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Kleber Santiago Freitas e Silva
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Marcos Antonio Batista Carvalho Júnior
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Olívia Basso Rocha
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Raisa Melo Lima
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Thaynara Gonzaga Santos
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Célia Maria de Almeida Soares
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Maristela Pereira
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Correspondence: (L.d.C.S.); (M.P.); Tel./Fax: +55-62-3521-1110 (M.P.)
| |
Collapse
|
4
|
Kamiński DM. Recent progress in the study of the interactions of amphotericin B with cholesterol and ergosterol in lipid environments. EUROPEAN BIOPHYSICS JOURNAL: EBJ 2014; 43:453-67. [PMID: 25173562 PMCID: PMC4212203 DOI: 10.1007/s00249-014-0983-8] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/08/2014] [Accepted: 08/19/2014] [Indexed: 11/12/2022]
Abstract
In the past decade substantial progress has been made in understanding the organization and biological activity of amphotericin B (AmB) in the presence of sterols in lipid environments. This review concentrates mainly on interactions of AmB with lipids and sterols, AmB channel formation in membranes, AmB aggregation, AmB modifications important for understanding its biological activity, and AmB models explaining its mechanism of action. Most of the reviewed studies concern monolayers at the water–gas interface, monolayers deposited on a solid substrate by use of the Langmuir–Blodgett technique, micelles, vesicles, and multi-bilayers. Liposomal AmB formulations and drug delivery are intentionally omitted, because several reviews dedicated to this subject are already available.
Collapse
Affiliation(s)
- Daniel Michał Kamiński
- Department of Chemistry, University of Life Sciences in Lublin, Akademicka 15, 20-950, Lublin, Poland,
| |
Collapse
|
5
|
Cesaro S, Cecchetto G, De Corti F, Dodero P, Giacchino M, Caviglia I, Fagioli F, Livadiotti S, Salin F, Caselli D, Castagnola E. Results of a multicenter retrospective study of a combined medical and surgical approach to pulmonary aspergillosis in pediatric neutropenic patients. Pediatr Blood Cancer 2007; 49:909-13. [PMID: 17154183 DOI: 10.1002/pbc.21089] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Invasive aspergillosis (IA) is a serious problem in patients suffering from hematological malignancies. Surgical resection has been reported to improve disease control and patient survival. There are few reports describing the role of surgery in children with pulmonary IA. PROCEDURE From October 1998 to September 2005, 21 patients fulfilled the inclusion criteria. Demographic and clinical data, as well as type and duration of antifungal therapy; surgery and related complications; time elapsing from surgery to resumption of chemotherapy were collected retrospectively through a specially designed form filled in by each investigator. RESULTS Eleven males and 10 females, aged between 2 and 17 years underwent one or more surgical lung resections for diagnostic and therapeutic purposes. Surgical complications were reported in three patients. Two patients, who underwent a wedge resection and a lobectomy, respectively, had no fungal lesions detected at surgery. Seventeen of 20 patients with malignancy resumed chemotherapy after a median of 19 days from surgery, range 7-81, and 11 of them underwent hematopoietic stem cell transplantation after a median time of 60 days from surgery, range 19-110. After a median follow-up of 1.7 years, 12 patients are alive while 9 patients have died from progression of their underlying disease. CONCLUSIONS This study suggests that the combination of medical antifungal therapy and early surgical excision is a feasible and an effective strategy in pediatric patients with IA. In order to avoid unnecessary surgical procedures, we advise checking the response to antifungal therapy by chest-computed tomography immediately before the date of surgery.
Collapse
Affiliation(s)
- Simone Cesaro
- Clinic of Pediatric Hematology Oncology, Department of Pediatrics, University of Padua, Padua, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Loiseau PM, Bories C. Recent strategies for the chemotherapy of visceral leishmaniasis. Curr Opin Infect Dis 2007; 12:559-64. [PMID: 17035822 DOI: 10.1097/00001432-199912000-00006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Visceral leishmaniasis is a widespread and deadly disease. First-line drugs are antimonials, but amphotericin B and its lipid formulations B is used for treating visceral leishmaniasis that is unresponsive to antimony. New therapeutic approaches are being actively developed, including the following: use of drug carriers targeted specifically to the parasite location, thus reduce adverse effects of drug; use of immunomodulating drugs; evaluation of natural products; pharmacokinetic studies; and drug combinations. Recent clinical trials with paromomycin and miltefosine were successful and these drugs appear to be promising for the future therapy of visceral leishmaniasis. Furthermore, identification and therapeutic evaluation of specific targets in the Leishmania organism could lead to new compounds, such as antileishmanial drugs and reversal agents of drug resistance.
Collapse
Affiliation(s)
- P M Loiseau
- Biologie et Contrôle des Organismes Parasites, UPRES-EA 398, Faculté de Pharmacie, Université de Paris XI, 3 Rue Jean-Baptiste Clément, F-92296 Châtenay-Malabry Cedex, France.
| | | |
Collapse
|
7
|
|
8
|
Polak A. Antifungal therapy--state of the art at the beginning of the 21st century. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 2003; Spec No:59-190. [PMID: 12675476 DOI: 10.1007/978-3-0348-7974-3_4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The most relevant information on the present state of the art of antifungal chemotherapy is reviewed in this chapter. For dermatomycoses a variety of topical antifungals are available, and safe and efficacious systemic treatment, especially with the fungicidal drug terbinafine, is possible. The duration of treatment can be drastically reduced. Substantial progress in the armamentarium of drugs for invasive fungal infections has been made, and a new class of antifungals, echinocandins, is now in clinical use. The following drugs in oral and/or intravenous formulations are available: the broad spectrum polyene amphotericin B with its new "clothes"; the sterol biosynthesis inhibitors fluconazole, itraconazole, and voriconazole; the glucan synthase inhibitor caspofungin; and the combination partner flucytosine. New therapy schedules have been studied; combination therapy has found a significant place in the treatment of severely compromised patients, and the field of prevention and empiric therapy is fast moving. Guidelines exist nowadays for the treatment of various fungal diseases and maintenance therapy. New approaches interfering with host defenses or pathogenicity of fungal cells are being investigated, and molecular biologists are looking for new targets studying the genomics of pathogenic fungi.
Collapse
|
9
|
Andrès E, Tiphine M, Letscher-Bru V, Herbrecht R. [New lipid formulations of amphotericin B. Review of the literature]. Rev Med Interne 2001; 22:141-50. [PMID: 11234672 DOI: 10.1016/s0248-8663(00)00304-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Amphotericin B (amB) remains the gold standard for treatment of invasive fungal infections. Lipid formulations of amB have been developed in an attempt to improve both efficacy and tolerability (especially renal toxicity): amB lipid complex (ABLC), liposomal amB (AmBisome), amB colloidal dispersion (ABCD) and amB in lipid emulsion (Intralipid). This review analyzes the data available in the literature. CURRENT KNOWLEDGE AND KEY POINTS ABLC, AmBisome and ABCD are effective in various fungal infections, including invasive aspergillosis, systemic candidiasis, cryptococcal meningitis, mucormycosis and fusariosis. These formulations are also effective in persistent febrile neutropenia and in leishmaniosis. The three formulations show little renal toxicity and are safer than conventional amB in this respect. Preliminary data are available on amB in Intralipid: infusion-related adverse effects are reduced, but few data are available on efficacy in documented mycoses. FUTURE PROSPECTS AND PROJECTS Large-scale comparative clinical trials may clarify issues of relative efficacy in various forms of fungal infections.
Collapse
Affiliation(s)
- E Andrès
- Service de médecine interne et nutrition, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France.
| | | | | | | |
Collapse
|
10
|
Tiphine M, Letscher-Bru V, Herbrecht R. Amphotericin B and its new formulations: pharmacologic characteristics, clinical efficacy, and tolerability. Transpl Infect Dis 1999; 1:273-83. [PMID: 11428998 DOI: 10.1034/j.1399-3062.1999.010406.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Amphotericin B (amB) remains the gold standard for the treatment of invasive fungal infections. However, the efficacy is limited, with response rates from 10% to 80%. Moreover, amB is toxic, especially for the kidneys. New formulations have been developed in an attempt to improve both efficacy and tolerability. In an attempt to reduce toxicity, a number of investigators have reconstituted amB in a lipid emulsion, but few data are available on efficacy in documented infections. An improvement in immediate and renal tolerance was obtained with equivalent daily dose regimens, but the therapeutic index does not appear to be improved. This approach cannot be recommended at present. Three lipid formulations have been developed and are now available in most countries: amB colloidal dispersion (ABCD), amB lipid complex (ABLC), and liposomal amB (AmBisome). The efficacy of ABCD on various fungal infections has been assessed in open trials, with a response rate of 49% in aspergillosis, 70% in candidiasis, and 67% in mucormycosis. In two randomized trials comparing ABCD with amB in invasive aspergillosis and in persistent febrile neutropenia, the response rates were equivalent. ABCD was less nephrotoxic. In contrast, immediate reactions to ABCD were as frequent and severe as with amB. These immediate effects are more frequent during the first infusions and lessen as treatment continues. The recommended dose is 3-4 mg/kg/day. ABLC appeared to be effective as rescue therapy in various types of invasive mycoses, with a response rate of 42% in aspergillosis, 67% in candidiasis, and 82% in fusariosis. Efficacy identical to that of amB was demonstrated in a comparative randomized trial involving patients with invasive candidiasis. General and renal tolerability is improved compared with amB. The recommended dose regimen is 5 mg/kg/day. Liposomal amB (AmBisome) is the only truly liposomal formulation. The response rates in preliminary trials were 66% in aspergillosis and 81% in candidiasis. Several comparative studies have confirmed that this formulation has similar or superior efficacy relative to amB in various fungal infections and also in the empirical treatment of febrile neutropenia. Renal and general tolerability is excellent. The optimal dosing remains unclear but is generally between 3 and 5 mg/kg/day. A double-blind trial comparing the tolerance of liposomal amB and ABLC demonstrated that both infusion-related events and nephrotoxicity were significantly lower for liposomal amB. In sum, the new lipid formulations of amB are effective in various invasive fungal infections. The three formulations exhibit reduced nephrotoxicity compared with conventional amB. Large-scale comparative clinical trials may clarify issues of relative efficacy in various forms of mycotic infections.
Collapse
Affiliation(s)
- M Tiphine
- Pharmacie, Centre de Traumatologie et d'Orthopédie, Illkirch-Graffenstaden, France
| | | | | |
Collapse
|