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Junior HLDA, Assis TDM, Faria EC, Costa LRK, Ibaldo BM. Piedraia hortae: biofilm formation and its importance in the pathogenesis of Piedra nigra (black piedra). An Bras Dermatol 2024:S0365-0596(24)00141-7. [PMID: 39033083 DOI: 10.1016/j.abd.2023.12.005] [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: 11/14/2023] [Revised: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Little is known about the ultrastructure of Piedraia hortae. OBJECTIVE To examine a P. hortae colony with scanning electron microscopy and investigate possible contributions to its pathogenesis. RESULTS On low magnifications, two distinct aspects of the colony are identified, a compact area and a filamentous area. Analysis of the filamentous area demonstrates hyphae adhered by a thin reticular substance. A recurring finding is the adhesion between the fungal filaments in parallel. On high magnifications, the micro fibrillar substance adhering the hyphae to each other becomes very evident. Examination of the compact area shows the hyphae embedded in the reticular matrix forming a biofilm and the colony well adhered. On high magnification, it can be observed that the hyphae are within this fibrillar matrix, which has the same appearance as the filamentous substance that adheres the hyphae to each other. STUDY LIMITATIONS Only one strain was examined. CONCLUSIONS The formation of biofilm with fungal structures and reticulated extracellular substance is important in the pathogenesis of Piedra nigra.
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Affiliation(s)
- Hiram Larangeira de Almeida Junior
- Postgraduation in Health and Behavior, Universidade Católica de Pelotas; Department of Dermatology, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
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2
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Veiga FF, Marcomini EK, Salvador A, Chiavelli LUR, Barros ILE, de Castro LV, Lucca DL, Ochikubo LMK, Baesso ML, Pomini AM, Svidzinski TIE, Negri M. Detection of 2-ethyl-1-hexanol and its modulating effect in biofilm of Fusarium oxysporum. Mol Microbiol 2023. [PMID: 38038143 DOI: 10.1111/mmi.15194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/12/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
In immunocompetent individuals, Fusarium spp. stands out as the causative agent of onychomycosis, among the non-dermatophyte molds. Despite evidence indicating that Fusarium oxysporum organizes itself in the form of a biofilm causing onychomycosis, there is little literature on the etiopathogenesis of the biofilm on the nail, specifically the signaling molecules present, known as quorum sensing (QS). Thus, this study detected the presence of a molecule related to QS from the ex vivo biofilm of F. oxysporum on human nail and investigated its effect on preformed biofilm in vitro. The detection and physicochemical characterization of a QS molecule, from the extracellular matrix (ECM), was carried out by Fourier transform infrared (FTIR) spectroscopy with an attenuated total reflectance (ATR) accessory and by headspace gas chromatography coupled to mass spectrometry (GC-MS) analyses. Determination of viable cells, cell activity, total biomass, ECM components and scanning electron microscopy (SEM) were performed to evaluate the influence of the QS molecule on the in vitro biofilm of F. oxysporum. The beginning, in the ex vivo biofilm of F. oxysporum on human nails, the volatile organic compound 2-ethyl-1-hexanol (2EH) was detected as a component of QS. Thereafter in vitro analyses, synthetic 2EH was able to modulate the biofilm by stimulating its filament, increasing total biomass and ECM production in terms of total carbohydrates, but with a reduction in total proteins and nucleic acids. We thus evidence, for the first time, the presence of 2EH in the biofilm of F. oxysporum, developed on the human nail, and the in vitro action of this compound as a QS molecule.
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Affiliation(s)
- Flavia Franco Veiga
- Clinical Analysis Department, Universidade Estadual de Maringá, Maringá, Brazil
| | | | - Alana Salvador
- Clinical Analysis Department, Universidade Estadual de Maringá, Maringá, Brazil
| | | | | | | | - Diego Luis Lucca
- Department of Chemistry, Universidade Estadual de Maringá, Maringá, Brazil
| | | | | | | | | | - Melyssa Negri
- Clinical Analysis Department, Universidade Estadual de Maringá, Maringá, Brazil
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3
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Ramage G, Borghi E, Rodrigues CF, Kean R, Williams C, Lopez-Ribot J. Our current clinical understanding of Candida biofilms: where are we two decades on? APMIS 2023; 131:636-653. [PMID: 36932821 DOI: 10.1111/apm.13310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
Clinically we have been aware of the concept of Candida biofilms for many decades, though perhaps without the formal designation. Just over 20 years ago the subject emerged on the back of progress made from the bacterial biofilms, and academic progress pace has continued to mirror the bacterial biofilm community, albeit at a decreased volume. It is apparent that Candida species have a considerable capacity to colonize surfaces and interfaces and form tenacious biofilm structures, either alone or in mixed species communities. From the oral cavity, to the respiratory and genitourinary tracts, wounds, or in and around a plethora of biomedical devices, the scope of these infections is vast. These are highly tolerant to antifungal therapies that has a measurable impact on clinical management. This review aims to provide a comprehensive overight of our current clinical understanding of where these biofilms cause infections, and we discuss existing and emerging antifungal therapies and strategies.
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Affiliation(s)
- Gordon Ramage
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Study Group for Biofilms (ESGB), European Society for Clinical Microbiology and Infectious Disease, Basel, Switzerland
| | - Elisa Borghi
- Study Group for Biofilms (ESGB), European Society for Clinical Microbiology and Infectious Disease, Basel, Switzerland
- Department of Health Sciences, San Paolo Medical School, Università Degli Studi di Milano, Milan, Italy
| | - Célia Fortuna Rodrigues
- Study Group for Biofilms (ESGB), European Society for Clinical Microbiology and Infectious Disease, Basel, Switzerland
- LEPABE-Department of Chemical Engineering, Faculty of Engineering, Cooperativa de Ensino Superior Politécnico e Universitário-CESPU, Gandra, Portugal
- ALiCE-Associate Laboratory in Chemical Engineering, Faculty of Engineering, Cooperativa de Ensino Superior Politécnico e Universitário-CESPU, Gandra, Portugal
- TOXRUN-Toxicology Research Unit, Cooperativa de Ensino Superior Politécnico e Universitário-CESPU, Gandra, Portugal
| | - Ryan Kean
- Study Group for Biofilms (ESGB), European Society for Clinical Microbiology and Infectious Disease, Basel, Switzerland
- Department of Biological Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Craig Williams
- Study Group for Biofilms (ESGB), European Society for Clinical Microbiology and Infectious Disease, Basel, Switzerland
- Microbiology Department, Morecambe Bay NHS Trust, Lancaster, UK
| | - Jose Lopez-Ribot
- Department of Biology and the South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
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4
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Salvador A, Veiga FF, Svidzinski TIE, Negri M. Case of Mixed Infection of Toenail Caused by Candida parapsilosis and Exophiala dermatitidis and In Vitro Effectiveness of Propolis Extract on Mixed Biofilm. J Fungi (Basel) 2023; 9:jof9050581. [PMID: 37233292 DOI: 10.3390/jof9050581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/12/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
Onychomycosis is a chronic fungal nail infection caused by several filamentous and yeast-like fungi, such as the genus Candida spp., of great clinical importance. Black yeasts, such as Exophiala dermatitidis, a closely related Candida spp. species, also act as opportunistic pathogens. Fungi infectious diseases are affected by organisms organized in biofilm in onychomycosis, making treatment even more difficult. This study aimed to evaluate the in vitro susceptibility profile to propolis extract and the ability to form a simple and mixed biofilm of two yeasts isolated from the same onychomycosis infection. The yeasts isolated from a patient with onychomycosis were identified as Candida parapsilosis sensu stricto and Exophiala dermatitidis. Both yeasts were able to form simple and mixed (in combination) biofilms. Notably, C. parapsilosis prevailed when presented in combination. The susceptibility profile of propolis extract showed action against E. dermatitidis and C. parapsilosis in planktonic form, but when the yeasts were in mixed biofilm, we only observed action against E. dermatitidis, until total eradication.
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Affiliation(s)
- Alana Salvador
- Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá (UEM), Avenida Colombo, 5790, Maringá CEP 87020-900, PR, Brazil
| | - Flávia Franco Veiga
- Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá (UEM), Avenida Colombo, 5790, Maringá CEP 87020-900, PR, Brazil
| | - Terezinha Inez Estivalet Svidzinski
- Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá (UEM), Avenida Colombo, 5790, Maringá CEP 87020-900, PR, Brazil
| | - Melyssa Negri
- Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá (UEM), Avenida Colombo, 5790, Maringá CEP 87020-900, PR, Brazil
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5
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Costa-Orlandi CB, Bila NM, Bonatti JLC, Vaso CO, Santos MB, Polaquini CR, Santoni Biasioli MM, Herculano RD, Regasini LO, Fusco-Almeida AM, Mendes-Giannini MJS. Membranolytic Activity Profile of Nonyl 3,4-Dihydroxybenzoate: A New Anti-Biofilm Compound for the Treatment of Dermatophytosis. Pharmaceutics 2023; 15:pharmaceutics15051402. [PMID: 37242644 DOI: 10.3390/pharmaceutics15051402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 05/28/2023] Open
Abstract
The ability of dermatophytes to live in communities and resist antifungal drugs may explain treatment recurrence, especially in onychomycosis. Therefore, new molecules with reduced toxicity that target dermatophyte biofilms should be investigated. This study evaluated nonyl 3,4-dihydroxybenzoate (nonyl) susceptibility and mechanism of action on planktonic cells and biofilms of T. rubrum and T. mentagrophytes. Metabolic activities, ergosterol, and reactive oxygen species (ROS) were quantified, and the expression of genes encoding ergosterol was determined by real-time PCR. The effects on the biofilm structure were visualized using confocal electron microscopy, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). T. rubrum and T. mentagrophytes biofilms were susceptible to nonyl and resistant to fluconazole, griseofulvin (all strains), and terbinafine (two strains). The SEM results revealed that nonyl groups seriously damaged the biofilms, whereas synthetic drugs caused little or no damage and, in some cases, stimulated the development of resistance structures. Confocal microscopy showed a drastic reduction in biofilm thickness, and transmission electron microscopy results indicated that the compound promoted the derangement and formation of pores in the plasma membrane. Biochemical and molecular assays indicated that fungal membrane ergosterol is a nonyl target. These findings show that nonyl 3,4-dihydroxybenzoate is a promising antifungal compound.
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Affiliation(s)
- Caroline B Costa-Orlandi
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Níura M Bila
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
- Department of Para-Clinic, School of Veterinary, Eduardo Modlane University (UEM), Maputo 257, Mozambique
| | - Jean Lucas C Bonatti
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Carolina O Vaso
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Mariana B Santos
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (U.N.E.S.P.), Sao Jose do Rio Preto 15054-000, SP, Brazil
| | - Carlos R Polaquini
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (U.N.E.S.P.), Sao Jose do Rio Preto 15054-000, SP, Brazil
| | - Mariana M Santoni Biasioli
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Rondinelli D Herculano
- Department of Bioprocesses and Biotechnology, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Luis O Regasini
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (U.N.E.S.P.), Sao Jose do Rio Preto 15054-000, SP, Brazil
| | - Ana Marisa Fusco-Almeida
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Maria José S Mendes-Giannini
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
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6
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Medeiros Silva RN, Nóbrega da Rocha MA, Silva EP, Moura-Mendes J, Ribeiro-Filho J, de Sousa GR, de Souza-Ferrari J, Barbosa-Filho JM, de Oliveira Pereira F. In vitro and ex vivo antibiofilm activity of riparin 1, and its nor and dinor homologs, against dermatophytes. Mycologia 2023; 115:206-215. [PMID: 36848618 DOI: 10.1080/00275514.2023.2170209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Dermatophytosis is one of the most frequent superficial mycoses in the world. They are mainly caused by the dermatophytes Trichophyton rubrum and Microsporum canis. Biofilm production is an essential factor in the pathogenesis of dermatophytes; it confers drug resistance and significantly impairs antifungal effectiveness. Therefore, we evaluated the antibiofilm activity of an alkamide-type alkaloid called riparin 1 (RIP1) against clinically relevant dermatophytes. We also produced synthetic nor (NOR1) and dinor (DINOR1) homologs for pharmacological evaluation, with a 61-70% yield. We used in vitro (96-well polystyrene plates) and ex vivo (hair fragments) models to verify the effects of these compounds on the formation and viability of biofilms. RIP1 and NOR1 showed antifungal activity against strains of T. rubrum and M. canis, but DINOR1 showed no significant antifungal activity against the dermatophytes. Furthermore, RIP1 and NOR1 significantly reduced the viability of biofilms in vitro and ex vivo (P < 0.05). RIP1 was more potent than NOR1, possibly due to the distance between the p-methoxyphenyl and the phenylamide moieties in these compounds. Due to the significant antifungal and antibiofilm activities observed for RIP1 and NOR1, we suggest that they could be useful in the treatment of dermatophytosis.
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Affiliation(s)
- Risley Nikael Medeiros Silva
- Fungi Research Group, Biochemistry Laboratory, Academic Unit of Health, Education and Health Center, Federal University of Campina Grande, Cuité, Brazil
| | - Marcelo Antônio Nóbrega da Rocha
- Fungi Research Group, Biochemistry Laboratory, Academic Unit of Health, Education and Health Center, Federal University of Campina Grande, Cuité, Brazil
| | - Emanuel Pereira Silva
- Fungi Research Group, Biochemistry Laboratory, Academic Unit of Health, Education and Health Center, Federal University of Campina Grande, Cuité, Brazil
| | - Juliana Moura-Mendes
- Centro Multidisciplinario de Investigaciones Tecnológicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Gabriela Ribeiro de Sousa
- Postgraduate Program in Natural and Synthetic Bioactive Products, Department of Pharmaceutical Sciences, Federal University of Paraiba, João Pessoa, Brazil
| | | | - José Maria Barbosa-Filho
- Postgraduate Program in Natural and Synthetic Bioactive Products, Department of Pharmaceutical Sciences, Federal University of Paraiba, João Pessoa, Brazil
| | - Fillipe de Oliveira Pereira
- Fungi Research Group, Biochemistry Laboratory, Academic Unit of Health, Education and Health Center, Federal University of Campina Grande, Cuité, Brazil
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7
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Falotico JM, Lipner SR. Updated Perspectives on the Diagnosis and Management of Onychomycosis. Clin Cosmet Investig Dermatol 2022; 15:1933-1957. [PMID: 36133401 PMCID: PMC9484770 DOI: 10.2147/ccid.s362635] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022]
Abstract
Onychomycosis is the most common nail disease encountered in clinical practice and can cause pain, difficulty with ambulation, and psycho-social problems. A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis. Several approaches are available for definitive diagnostic testing, including potassium hydroxide and microscopy, fungal culture, histopathology, polymerase chain reaction, or a combination of techniques. Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies. There are several different therapeutic options available, including oral and topical medications as well as device-based treatments. Oral antifungals are generally recommended for moderate to severe onychomycosis and have higher cure rates, while topical antifungals are recommended for mild to moderate disease and have more favorable safety profiles. Oral terbinafine, itraconazole, and griseofulvin and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for treatment of onychomycosis in the United States and amorolfine 5% nail lacquer is approved in Europe. Laser treatment is approved in the United States for temporary increases in clear nail, but clinical results are suboptimal. Oral fluconazole is not approved in the United States for onychomycosis treatment, but is frequently used off-label with good efficacy. Several novel oral, topical, and over-the-counter therapies are currently under investigation. Physicians should consider the disease severity, infecting pathogen, medication safety, efficacy and cost, and patient age, comorbidities, medication history, and likelihood of compliance when determining management plans. Onychomycosis is a chronic disease with high recurrence rates and patients should be counseled on an appropriate plan to minimize recurrence risk following effective antifungal therapy.
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Affiliation(s)
- Julianne M Falotico
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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8
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Al-Obaidi H, Petraityte I, Hibbard T, Majumder M, Kalgudi R, Zariwala MG. Antifungal nanosuspensions with surfactants and silver for the treatment of onychomycosis. Eur J Pharm Biopharm 2022; 179:194-205. [PMID: 36099971 DOI: 10.1016/j.ejpb.2022.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/04/2022] [Accepted: 09/05/2022] [Indexed: 11/04/2022]
Abstract
Fungal nail infection (Onychomycosis) often requires prolonged treatment and is associated with a high risk of resistance to treatment. Here in this contribution, we introduce a novel approach to enhance penetration and antifungal activity of the antifungal drug griseofulvin (GF). Solid dispersions were prepared with hydroxypropyl methylcellulose acetate succinate (HPMCAS) and combined with surfactant (either sodium dodecyl sulphate (SDS), dodecyl trimethylammonium bromide (DTAB), or Pluronic F127) using mechanochemical activation. The prepared powders were then suspended with spray-dried silica-coated silver nanoparticles and applied onto infected bovine hooves to assess permeability and antifungal activity. The results showed that the prepared nanosuspensions significantly suppressed fungal activity causing disruption of fungal biofilms. Raman mapping showed enhanced permeation while dynamic vapor sorption (DVS), and particle size measurements showed varied effects depending on the type of surfactant and milling conditions. The prepared nanosuspensions displayed enhanced solubility of the poorly soluble drug reaching approximately 1.2 mg/mL. The results showed that the dispersions that contained DTAB displayed maximum efficacy while the inclusion of colloidal silver did not seem to significantly improve the antifungal activity compared to other formulations.
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Affiliation(s)
- Hisham Al-Obaidi
- The School of Pharmacy, University of Reading, Reading RG6 6AD, United Kingdom.
| | - Ieva Petraityte
- The School of Pharmacy, University of Reading, Reading RG6 6AD, United Kingdom
| | - Thomas Hibbard
- The School of Pharmacy, University of Reading, Reading RG6 6AD, United Kingdom
| | - Mridul Majumder
- M2M Pharmaceuticals Ltd, The Gateway Building, 1 Collegiate Square, Thames Valley Science Park (TVSP), Reading RG2 9LH, United Kingdom
| | - Rachith Kalgudi
- Faculty of Science & Technology, University of Westminster, 115 New Cavendish Street, London W1W 6UW, United Kingdom
| | - Mohammed Gulrez Zariwala
- Faculty of Science & Technology, University of Westminster, 115 New Cavendish Street, London W1W 6UW, United Kingdom
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Gupta AK, Wang T, Cooper EA. Dermatophytomas: Clinical Overview and Treatment. J Fungi (Basel) 2022; 8:jof8070742. [PMID: 35887497 PMCID: PMC9323405 DOI: 10.3390/jof8070742] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023] Open
Abstract
Dermatophytomas are characterized as a hyperkeratotic fungal mass in the subungual space, showing as dense white or yellow, typically in longitudinal streaks or patches. Masses can be visualized by traditional microscopy or histology. Newer technologies such as dermoscopy and optical coherence tomography also provide visual features for dermatophytoma diagnosis. The density of fungal mass, and lack of adherence to the nail structures, as well as possible biofilm development, may play a role in the reduction in drug penetration and subsequent lack of efficacy with traditional oral therapies such as terbinafine and itraconazole. A combination of drug treatment with mechanical or chemical debridement/avulsion has been recommended to increase efficacy. The topical antifungal solutions such as tavaborole, efinaconazole, and luliconazole may reach the dermatophytoma by both the transungual and subungual routes, due to low affinity for keratin and low surface tension. Current data indicates these topicals may provide efficacy for dermatophytoma treatment without debridement/avulsion. Similarly, fosravuconazole (F-RVCZ) has an improved pharmacological profile versus ravuconazole and may be an improved treatment option versus traditional oral therapies. The availability of improved treatments for dermatophytomas is crucial, as resistance to traditional therapies is on the increase.
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Affiliation(s)
- Aditya K. Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
- Mediprobe Research Inc., 645 Windermere Road, London, ON N5X 2P1, Canada; (T.W.); (E.A.C.)
- Correspondence: ; Tel.: +1-519-851-9715; Fax: +1-519-657-4233
| | - Tong Wang
- Mediprobe Research Inc., 645 Windermere Road, London, ON N5X 2P1, Canada; (T.W.); (E.A.C.)
| | - Elizabeth A. Cooper
- Mediprobe Research Inc., 645 Windermere Road, London, ON N5X 2P1, Canada; (T.W.); (E.A.C.)
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10
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Babu CK, Shubhra, Ghouse SM, Singh PK, Khatri DK, Nanduri S, Singh SB, Madan J. Luliconazole topical dermal drug delivery for superficial fungal infections: Penetration hurdles and role of functional nanomaterials. Curr Pharm Des 2022; 28:1611-1620. [PMID: 35747957 DOI: 10.2174/1381612828666220623095743] [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: 12/28/2021] [Accepted: 05/17/2022] [Indexed: 11/22/2022]
Abstract
Luliconazole is the first and only anti-fungal agent approved for the short-term treatment of superficial fungal infections. However, commercially available conventional topical dermal drug delivery cargo of luliconazole is associated with certain limitations like lower skin permeation and shorter skin retention of drug. Therefore, present review is an attempt to decode the penetration hurdles in luliconazole topical dermal drug delivery. Moreover, we also summarized the activity of functional nanomaterials based drug delivery systems employed by the scientific fraternity to improve luliconazole efficacy in superficial fungal infections on case-to-case basis. In addition, efforts have also been made to unbox the critically acclaimed mechanism of action of luliconazole against fungal cells. Under the framework of future prospects, we have analyzed the combination of luliconazole with isoquercetin using in-silico docking technique for offering synergistic antifungal activity. Isoquercetin exhibited a good affinity for superoxide dismutase (SOD), a fungal target owing to the formation of hydrogen bond with Glu132, Glu133, and Arg143, in addition to few hydrophobic interactions. On the other hand, luliconazole inhibited lanosterol-14α-demethylase and consequently blocked ergosterol. In addition, nanotechnology and artificial neural network (ANN) derived integrated drug delivery systems may also be explored for augmenting the luliconazole therapeutic efficacy in topical fungal infections. Synergy of ANN models along with topical nanoscaled drug delivery may help to achieve critical quality attributes (CQA) to gain commercial success.
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Affiliation(s)
- Chanti Katta Babu
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Shubhra
- Department of Pharmacy, Birla Institute of Technology and Science, Hyderabad, Telangana, India
| | - Shaik Mahammad Ghouse
- Department of Chemical Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Pankaj Kumar Singh
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Dharmendra Kumar Khatri
- Department of Biological Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Srinivas Nanduri
- Department of Chemical Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Shashi Bala Singh
- Department of Biological Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Jitender Madan
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
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11
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Costa PDS, Mendes V, Veiga FF, Negri M, Svidzinski TIE. Relevant insights into onychomycosis' pathogenesis related to the effectiveness topical treatment. Microb Pathog 2022; 169:105640. [PMID: 35716926 DOI: 10.1016/j.micpath.2022.105640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 01/14/2023]
Abstract
Onychomycosis (OM) is a fungal infection, responsible for about 50% of nail diseases. OM has been attributed to the ability of fungi to naturally organize themselves into biofilms on nail surfaces. However, little is known about the exact role of the biofilm in the etiopathogenesis of OM, as well as its influence in the permeation of a topical treatment. The objectives of this study were to review the literature for topical OM treatments in clinical trials, assess the efficiency of these treatments, and discuss factors that could affect the success of these treatments. First, a systematic search of articles published in the MEDLINE database (PubMed) between January 2010 and December 2019 was conducted, focusing on drugs under clinical trials for the topical treatment of OM. Of the publications selected, it was clear that none of them had considered the fungi organized in biofilm. Therefore, we reflected on some important variables involved in OM, such as the nail structure and the mechanism of fungal invasion. Some methods, such as histopathologic analysis and spectroscopy techniques, were found to be effective in the detection of nail biofilm, and could be used in future drug permeation studies. This review allowed us to conclude that novel antifungals for the topical treatment of OM must consider the drug to permeate through biofilm. Natural products, such as propolis, seem strong candidates in this respect.
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Affiliation(s)
- Polyana de Souza Costa
- Postgraduate Program in Health Sciences, State University of Maringá (UEM), Colombo Avenue, 5790, Maringá, Paraná, 87020-900, Brazil
| | - Vanessa Mendes
- Postgraduate Program in Health Sciences, State University of Maringá (UEM), Colombo Avenue, 5790, Maringá, Paraná, 87020-900, Brazil
| | - Flávia Franco Veiga
- Postgraduate Program in Health Sciences, State University of Maringá (UEM), Colombo Avenue, 5790, Maringá, Paraná, 87020-900, Brazil
| | - Melyssa Negri
- Postgraduate Program in Health Sciences, State University of Maringá (UEM), Colombo Avenue, 5790, Maringá, Paraná, 87020-900, Brazil
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12
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Printing Drugs onto Nails for Effective Treatment of Onychomycosis. Pharmaceutics 2022; 14:pharmaceutics14020448. [PMID: 35214182 PMCID: PMC8879958 DOI: 10.3390/pharmaceutics14020448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023] Open
Abstract
Inkjet printing (IJP) is an emerging technology for the precision dosing of medicines. We report, for the first time, the printing of the antifungal drug terbinafine hydrochloride directly onto nails for the treatment of onychomycosis. A commercial cosmetic nail printer was modified by removing the ink from the cartridge and replacing it with an in-house prepared drug-loaded ink. The drug-loaded ink was designed so that it was comparable to the commercial ink for key printability properties. Linear drug dosing was shown by changing the lightness of the colour selected for printing (R2 = 0.977) and by printing multiple times (R2 = 0.989). The drug loads were measured for heart (271 µg), world (205 µg) and football (133 µg) shapes. A disc diffusion assay against Trpytophan rubrum showed inhibition of fungal growth with printed-on discs. In vitro testing with human nails showed substantial inhibition with printed-on nails. Hence, this is the first study to demonstrate the ability of a nail printer for drug delivery, thereby confirming its potential for onychomycosis treatment.
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13
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Vyas HKN, Xia B, Mai-Prochnow A. Clinically relevant in vitro biofilm models: A need to mimic and recapitulate the host environment. Biofilm 2022; 4:100069. [PMID: 36569981 PMCID: PMC9782257 DOI: 10.1016/j.bioflm.2022.100069] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 12/27/2022] Open
Abstract
Biofilm-associated infections are difficult to treat and eradicate because of their increased antimicrobial tolerance. In vitro biofilm models have enabled the high throughput testing of an array of differing novel antimicrobials and treatment strategies. However, biofilms formed in these oftentimes basic in vitro systems do not resemble biofilms seen in vivo. As a result, translatability from the lab to the clinic is poor or limited. To improve translatability, in vitro models must better recapitulate the host environment. This review describes and critically evaluates new and innovative in vitro models that better mimic the environments of a variety of clinically important, biofilm-associated infections of the skin, oropharynx, lungs, and infections related to indwelling implants and medical devices. This review highlights that many of these models represent considerable advances in the field of biofilm research and help to translate laboratory findings into the clinical practice.
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14
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Rhodotorula sp. and Trichosporon sp. are more Virulent After a Mixed Biofilm. Mycopathologia 2021; 187:85-93. [PMID: 34855103 DOI: 10.1007/s11046-021-00606-5] [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: 06/16/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
Rhodotorula spp. and Trichosporon spp. are opportunistic pathogens, and although an association between these two species in the same infection appears to be uncommon, it has been reported. This is the first study that aimed to evaluate the pathogenesis of a co-infection by R. mucilaginosa and T. asahii, using a new in vivo model, the Zophobas morio larvae. Suspensions from planktonic and biofilm-recovered cells were injected in the larvae as in monospecies as mixed (a ratio of 1:1 for both agents of a of 105 inoculum). Individual and mixed biofilms of R. mucilaginosa and T. asahii were produced for 24 and 48 h, and they were partially characterized by crystal violet and reduction of tetrazolium salt. When evaluating the impact of the planktonic suspension in vivo we verified that the fungi in monoculture were more able to kill the larvae than those from planktonic mixed suspension. On the other hand, regarding biofilm-recovered cells, there was an increase in the death of larvae infected for mixed suspensions. Moreover, the death rate was more pronounced when the larvae were infected with 48 h biofilm-recovered cells than the 24 h ones. T. asahii was the best producer of total biomass, mainly in 48 h. The metabolic activity for both yeasts organized in biofilm maintained the same pattern between 24 and 48 h. The present study proves a synergistic interaction between R. mucilaginosa and T. asahii after an experience in a mixed biofilm. Our results suggest that both species were benefited from this interaction, acquiring a greater potential for virulence after passing through the biofilm and this ability was acquired by the cells released from the biofilm.
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15
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Wang S, Song Y, Wan Z, Chen W, Wang R, Li R. Characterisation of the nail microbiome in psoriatic and nonpsoriatic patients with onychomycosis. Mycoses 2021; 65:35-44. [PMID: 34549836 DOI: 10.1111/myc.13372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Onychomycosis (OM) is the most common infectious nail disease, and it occurs frequently in patients with psoriasis. Microbial community shifts have been suggested to play a role in psoriasis and fungal infection occurrence. OBJECTIVES To investigate and compare nail microbial community compositions in psoriatic and nonpsoriatic patients with OM. METHODS Toenail samples were collected from nonpsoriatic patients with OM, psoriatic patients with nail psoriasis (NP) and OM, patients with only NP and healthy controls. Bacterial and fungal community compositions were analysed by amplicon sequencing of the V3-V4 regions of the 16S rDNA gene and the ITS1 region, respectively. RESULTS Psoriatic OM patients had higher bacterial and fungal alpha diversities. Taxonomic analysis revealed a significantly lower relative abundance of Trichophyton rubrum (32.88% vs 82.18%, p < .001) and an increased trend of the abundance of Candida in psoriatic patients with OM than in nonpsoriatic patients. Nonpsoriatic patients with OM had a higher abundance of Staphylococcus than healthy controls (59.66% vs 45.76%, p < .05). Trichophyton, Alternaria and Malassezia could accurately differentiate psoriatic and nonpsoriatic patients with OM, with an area under the curve (AUC) of 0.86. The severity of OM was positively correlated with the relative abundance of Trichophyton rubrum. Further, Trichophyton was positively correlated with Staphylococcus and negatively correlated with Corynebacterium, Anaerococcus, Malassezia and Alternaria. CONCLUSIONS The nail microbiome in psoriatic patients with OM has distinct bacterial and fungal signatures, suggesting that different dysbiosis is associated with the pathogenesis of OM in psoriatic and nonpsoriatic patients.
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Affiliation(s)
- Shiqi Wang
- Department of Dermatology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Yinggai Song
- Department of Dermatology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Zhe Wan
- Department of Dermatology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Wei Chen
- Department of Dermatology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Ruojun Wang
- Department of Dermatology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Ruoyu Li
- Department of Dermatology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
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16
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Costa-Orlandi CB, Martinez LR, Bila NM, Friedman JM, Friedman AJ, Mendes-Giannini MJS, Nosanchuk JD. Nitric Oxide-Releasing Nanoparticles Are Similar to Efinaconazole in Their Capacity to Eradicate Trichophyton rubrum Biofilms. Front Cell Infect Microbiol 2021; 11:684150. [PMID: 34336712 PMCID: PMC8319823 DOI: 10.3389/fcimb.2021.684150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
Filamentous fungi such as Trichophyton rubrum and T. mentagrophytes, the main causative agents of onychomycosis, have been recognized as biofilm-forming microorganisms. Nitric oxide-releasing nanoparticles (NO-np) are currently in development for the management of superficial and deep bacterial and fungal infections, with documented activity against biofilms. In this context, this work aimed to evaluate, for the first time, the in vitro anti-T. rubrum biofilm potential of NO-np using standard ATCC MYA-4438 and clinical BR1A strains and compare it to commonly used antifungal drugs including fluconazole, terbinafine and efinaconazole. The biofilms formed by the standard strain produced more biomass than those from the clinical strain. NO-np, fluconazole, terbinafine, and efinaconazole inhibited the in vitro growth of planktonic T. rubrum cells. Similarly, NO-np reduced the metabolic activities of clinical strain BR1A preformed biofilms at the highest concentration tested (SMIC50 = 40 mg/mL). Scanning electron and confocal microscopy revealed that NO-np and efinaconazole severely damaged established biofilms for both strains, resulting in collapse of hyphal cell walls and reduced the density, extracellular matrix and thickness of the biofilms. These findings suggest that biofilms should be considered when developing and testing new drugs for the treatment of dermatophytosis. Development of a biofilm phenotype by these fungi may explain the resistance of dermatophytes to some antifungals and why prolonged treatment is usually required for onychomycosis.
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Affiliation(s)
- Caroline Barcelos Costa-Orlandi
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, United States.,Deparment of Clinical Analysis, School of Pharmaceutical Sciences, Sao Paulo State University (UNESP), Araraquara, Brazil
| | - Luis R Martinez
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Níura Madalena Bila
- Deparment of Clinical Analysis, School of Pharmaceutical Sciences, Sao Paulo State University (UNESP), Araraquara, Brazil.,Department of Para-Clinic, School of Veterinary, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Joel M Friedman
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Adam J Friedman
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC, United States.,Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Maria José S Mendes-Giannini
- Deparment of Clinical Analysis, School of Pharmaceutical Sciences, Sao Paulo State University (UNESP), Araraquara, Brazil
| | - Joshua D Nosanchuk
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, United States
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17
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The Success of Topical Treatment of Onychomycosis Seems to Be Influenced by Fungal Features. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5553634. [PMID: 34335823 PMCID: PMC8286179 DOI: 10.1155/2021/5553634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/20/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022]
Abstract
Aim To evaluate the topical treatment of onychomycosis using a 10% hydroalcoholic propolis extract (PE) in two aleatorily chosen patients and analyze possible risk factors from hosts including some particularities of the isolated fungi that may justify the outcomes achieved. Materials and Methods A topical treatment, with PE, was started in two cases of toe onychomycosis due to T. rubrum. The in vitro PE antifungal activity against these isolates was confirmed. Moreover, the ability of the fungi to infect the human nail was evaluated also in an ex vivo study, analyzed by histopathology. Results Within four months, both patients showed evident improvement, but with different outcomes. The possible host-related risk factors justifying the poorer outcome in patient 1 include a longer duration time of onychomycosis (50 years). Some particularities in the T. rubrum strain isolated from this patient in relation to that found in patient 2 were observed: (1) the hypha morphology suggesting a major adaptation of the fungus to the host; (2) a 16 times greater propolis concentration was required in vitro; and (3) a faster ability to start a growth using the nail as the only nutritional source. Additionally, this isolate was more efficient in producing a biofilm on the nail surface. Conclusions A partial clinical and complete mycological cure for the two patients was achieved after four months of PE daily use. Despite a complete recovery, a different outcome was observed between both cases. A more persistent onychomycosis, added to greater fungal potential to produce biofilm on the nail, seems to influence greatly the success of a topical treatment with PE.
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18
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Veiga FF, de Castro-Hoshino LV, Sato F, Baesso ML, Silva S, Negri M, Svidzinski TIE. Characterization of a biofilm formed by Fusarium oxysporum on the human nails. Int J Dermatol 2021; 61:191-198. [PMID: 34235733 DOI: 10.1111/ijd.15747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/06/2021] [Accepted: 06/10/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Fusarium spp. has been considered as an onychomycosis agent, but little is known about the etiopathogenesis of fusarial onychomycosis; thus, the objective of this study was to characterize the fungal-nail interaction and the consequences of the nail infection process by Fusarium oxysporum using the human nail, in an ex␣vivo model. METHODS The kinetic of biofilm production and infection by F. oxysporum using the nail as the only nutritional source were evaluated by scanning electron microscopy, number of culturable cells, metabolic activity, characterization of extracellular matrix, spectroscopy and histopathology analyses. RESULTS After evaluating the biofilm kinetic over 7 days using different parameters and techniques, it was possible to characterize the Fusarium-nail interaction. CONCLUSIONS This study is a part of a big project aiming to clarify the fusarial pathogenesis and contributes to proving F. oxysporum is able to adapt, grow, develop, and form a biofilm on healthy human nails, which are crucial steps for the invasion process.
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Affiliation(s)
- Flavia Franco Veiga
- Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá (UEM), Maringá, Brazil
| | | | - Francielle Sato
- Departamento de Física, Universidade Estadual de Maringá (UEM), Maringá, Brazil
| | | | - Sónia Silva
- CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Braga, Portugal
| | - Melyssa Negri
- Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá (UEM), Maringá, Brazil
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19
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Bila NM, Costa-Orlandi CB, Vaso CO, Bonatti JLC, de Assis LR, Regasini LO, Fontana CR, Fusco-Almeida AM, Mendes-Giannini MJS. 2-Hydroxychalcone as a Potent Compound and Photosensitizer Against Dermatophyte Biofilms. Front Cell Infect Microbiol 2021; 11:679470. [PMID: 34055673 PMCID: PMC8155603 DOI: 10.3389/fcimb.2021.679470] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022] Open
Abstract
Dermatophytes, fungi that cause dermatophytosis, can invade keratinized tissues in humans and animals. The biofilm-forming ability of these fungi was described recently, and it may be correlated with the long treatment period and common recurrences of this mycosis. In this study, we evaluated the anti-dermatophytic and anti-biofilm activity of 2-hydroxychalcone (2-chalcone) in the dark and photodynamic therapy (PDT)-mediated and to determine its mechanism of action. Trichophyton rubrum and Trichophyton mentagrophytes strains were used in the study. The antifungal susceptibility test of planktonic cells, early-stage biofilms, and mature biofilms were performed using colorimetric methods. Topographies were visualized by scanning electron microscopy (SEM). Human skin keratinocyte (HaCat) monolayers were also used in the cytotoxicity assays. The mechanisms of action of 2-chalcone in the dark and under photoexcitation were investigated using confocal microscopy and the quantification of ergosterol, reactive oxygen species (ROS), and death induction by apoptosis/necrosis. All strains, in the planktonic form, were inhibited after treatment with 2-chalcone (minimum inhibitory concentration (MIC) = 7.8-15.6 mg/L), terbinafine (TRB) (MIC = 0.008–0.03 mg/L), and fluconazole (FLZ) (1–512 mg/L). Early-stage biofilm and mature biofilms were inhibited by 2-chalcone at concentrations of 15.6 mg/L and 31.2 mg/L in all tested strains. However, mature biofilms were resistant to all the antifungal drugs tested. When planktonic cells and biofilms (early-stage and mature) were treated with 2-chalcone-mediated PDT, the inhibitory concentrations were reduced by four times (2–7.8 mg/L). SEM images of biofilms treated with 2-chalcone showed cell wall collapse, resulting from a probable extravasation of cytoplasmic content. The toxicity of 2-chalcone in HaCat cells showed higher IC50 values in the dark than under photoexcitation. Further, 2-chalcone targets ergosterol in the cell and promotes the generation of ROS, resulting in cell death by apoptosis and necrosis. Overall, 2-chalcone-mediated PDT is a promising and safe drug candidate against dermatophytes, particularly in anti-biofilm treatment.
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Affiliation(s)
- Níura Madalena Bila
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil.,Department of Para-Clinic, School of Veterinary, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Caroline Barcelos Costa-Orlandi
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil
| | - Carolina Orlando Vaso
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil
| | - Jean Lucas Carvalho Bonatti
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil
| | - Letícia Ribeiro de Assis
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, Universidade Estadual Paulista (UNESP), Sao Jose do Rio Preto, Brazil
| | - Luís Octavio Regasini
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, Universidade Estadual Paulista (UNESP), Sao Jose do Rio Preto, Brazil
| | - Carla Raquel Fontana
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil
| | - Ana Marisa Fusco-Almeida
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara, Brazil
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20
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Leung AKC, Lam JM, Leong KF, Hon KL, Barankin B, Leung AAM, Wong AHC. Onychomycosis: An Updated Review. ACTA ACUST UNITED AC 2020; 14:32-45. [PMID: 31738146 PMCID: PMC7509699 DOI: 10.2174/1872213x13666191026090713] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 12/19/2022]
Abstract
Background: Onychomycosis is a common fungal infection of the nail. Objective: The study aimed to provide an update on the evaluation, diagnosis, and treatment of onychomycosis. Methods: A PubMed search was completed in Clinical Queries using the key term “onychomycosis”. The search was conducted in May 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. The search was restricted to English literature. Patents were searched using the key term “onychomycosis” in www.freepatentsonline.com. Results: Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wet-mount preparation, histopathologic examination of the trimmed affected nail plate with a periodic-acid-Schiff stain, fungal culture, or polymerase chain reaction assays. Laboratory confirmation of onychomycosis before beginning a treatment regimen should be considered. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated. Recent patents related to the management of onychomycosis are also discussed. Conclusion: Oral antifungal therapies are effective, but significant adverse effects limit their use.Although topical antifungal therapies have minimal adverse events, they are less effective than oral antifungal therapies, due to poor nail penetration. Therefore, there is a need for exploring more effective and/or alternative treatment modalities for the treatment of onychomycosis which are safer and more effective.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Shatin, Hong Kong
| | | | - Amy A M Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
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21
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Garcia LM, Costa-Orlandi CB, Bila NM, Vaso CO, Gonçalves LNC, Fusco-Almeida AM, Mendes-Giannini MJS. A Two-Way Road: Antagonistic Interaction Between Dual-Species Biofilms Formed by Candida albicans/Candida parapsilosis and Trichophyton rubrum. Front Microbiol 2020; 11:1980. [PMID: 33013741 PMCID: PMC7499241 DOI: 10.3389/fmicb.2020.01980] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022] Open
Abstract
Dermatomycoses include superficial fungal infections of the skin and its appendages. Trichophyton rubrum, Candida albicans, and Candida parapsilosis are some of the most prevalent species that cause dermatomycoses. Several studies show a variable predominance of Candida spp. in relation to dermatophytes, especially in onychomycosis and the possibility of isolating both from the same site. The ability of dermatophytes to form biofilms recently been explored and there is currently no evidence on the involvement of these filamentous fungi in multi-species biofilms. Thus, this study aims to investigate the probable dual-species interaction between T. rubrum and C. albicans and T. rubrum and C. parapsilosis biofilms, considering variable formation conditions, as well as the susceptibility of these dual-species biofilms against terbinafine and efinaconazole. Three conditions of formation of dual-species biofilms were tested: (a) the suspensions of T. rubrum and Candida albicans or C. parapsilosis placed together; (b) suspensions of C. albicans and C. parapsilosis added the pre-adhesion of T. rubrum biofilms; (c) after the maturation of T. rubrum sessile cells. In the first and second conditions, the quantification of metabolic activities, biomass, and polysaccharide materials of mixed biofilms tended to resemble Candida monospecies biofilms. In the third condition, the profiles were modified after the addition of Candida, suggesting that T. rubrum biofilms served as substrate for the development of Candida biofilms. Scanning electron microscopy showed Candida predominance, however, numerous blastoconidia were noted, most evident in the conditions under which Candida was added after the pre-adhesion and maturation of T. rubrum biofilms. Despite the predominance of Candida, the presence of T. rubrum appears to inhibit C. albicans filamentation and C. parapsilosis development, confirming an antagonistic interaction. Fungal burden assays performed when the biofilms were formed together confirmed Candida predominance, as well as susceptibility to antifungals. Further studies will be needed to identify the components of the Candida and T. rubrum biofilm supernatants responsible for inhibiting dermatophyte growth and C. albicans filamentation.
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Affiliation(s)
- Letícia Morais Garcia
- Clinical Mycology Laboratory, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Caroline Barcelos Costa-Orlandi
- Clinical Mycology Laboratory, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Níura Madalena Bila
- Clinical Mycology Laboratory, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil.,School of Veterinary, Eduardo Mondlane University, Maputo, Mozambique
| | - Carolina Orlando Vaso
- Clinical Mycology Laboratory, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Larissa Naiara Carvalho Gonçalves
- Clinical Mycology Laboratory, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Ana Marisa Fusco-Almeida
- Clinical Mycology Laboratory, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Maria José Soares Mendes-Giannini
- Clinical Mycology Laboratory, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
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Gupta A, Stec N, Summerbell R, Shear N, Piguet V, Tosti A, Piraccini B. Onychomycosis: a review. J Eur Acad Dermatol Venereol 2020; 34:1972-1990. [DOI: 10.1111/jdv.16394] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/25/2020] [Indexed: 01/25/2023]
Affiliation(s)
- A.K. Gupta
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Mediprobe Research Inc. London ON Canada
| | - N. Stec
- Mediprobe Research Inc. London ON Canada
| | - R.C. Summerbell
- Sporometrics Toronto ON Canada
- Dalla Lana School of Public Health University of Toronto Toronto ON Canada
| | - N.H. Shear
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Division of Dermatology Sunnybrook Health Sciences Centre Toronto ON Canada
| | - V. Piguet
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Division of Dermatology Women's College Hospital Toronto ON Canada
| | - A. Tosti
- Department of Dermatology and Cutaneous Surgery Leonard Miller School of Medicine University of Miami Miami FL USA
| | - B.M. Piraccini
- Dermatology Unit Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
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Pereira LD, Vila T, Borba-Santos LP, de Souza W, Navarro M, Rozental S. Activity of Metal-Azole Complexes Against Biofilms of Candida albicans and Candida glabrata. Curr Pharm Des 2020; 26:1524-1531. [DOI: 10.2174/1381612826666200217120321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/21/2020] [Indexed: 02/06/2023]
Abstract
Background:
Onychomycosis is a chronic nail infection caused by fungi frequently resistant to antifungal
treatments. Recalcitrance in nail infections is a result of reduced antifungal penetration due to biofilm
formation, combined with poor patient compliance with the treatment, which can be as long as 18 months.
Objective:
Metal-drug complexation is a widely used strategy to increase drug efficacy. Therefore, the aim of this
work was to evaluate the antifungal and anti-biofilm activity of several metal-azole complexes against Candida
albicans and Candida glabrata.
Methods:
Susceptibility assays and scanning electron microscopy were performed to determine the anti-biofilm
activity of eight metal-azole complexes in vitro and ex-vivo, using human nail fragments.
Results:
In vitro susceptibility assays showed that complexation of both Au(I) and Zn(II) to clotrimazole and
ketoconazole improved the anti-biofilm activity compared to the azole alone. Using an ex-vivo model of biofilm
formation on fragments of human nails, we also demonstrate the improved efficacy of metal-azole complexes
against biofilms of C. albicans and C. glabrata that resembles the onychomycosis structure. Noteworthy, biofilms
of C. glabrata were more susceptible to the optimized complexes than those of C. albicans.
Conclusion:
In conclusion, metal-azole complexes used in this work show promising anti-biofilm activity and
further clinical studies should confirm its potential for the treatment of Candida-associated onychomycosis.
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Affiliation(s)
- Livia D. Pereira
- Laboratório de Biologia Celular de Fungos; Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Taissa Vila
- Department of Oncology and Diagnostic Sciences, Dental School, University of Maryland, Baltimore, United States
| | - Luana P. Borba-Santos
- Laboratório de Biologia Celular de Fungos; Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wanderley de Souza
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maribel Navarro
- Laboratório de Química Bioinorgânica e Catalise, Departamento de Química, Instituto de Ciências Exatas, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Sonia Rozental
- Laboratório de Biologia Celular de Fungos; Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Sprenger AB, Purim KSM, Sprenger F, Queiroz-Telles F. A Week of Oral Terbinafine Pulse Regimen Every Three Months to Treat all Dermatophyte Onychomycosis. J Fungi (Basel) 2019; 5:E82. [PMID: 31487828 PMCID: PMC6787629 DOI: 10.3390/jof5030082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 12/30/2022] Open
Abstract
Terbinafine has proved to treat numerous fungal infections, including onychomycosis, successfully. Due to its liver metabolization and dependency on the cytochrome P450 enzyme complex, undesirable drug interaction are highly probable. Additionally to drug interactions, the treatment is long, rising the chances of the appearance of side effects and abandonment. Pharmacokinetic data suggest that terbinafine maintains a fungicidal effect within the nail up to 30 weeks after its last administration, which has aroused the possibility of a pulse therapy to reduce the side effects while treating onychomycosis. This study's goal was to evaluate the effectiveness of three different oral terbinafine regimens in treating onychomycosis due to dermatophytes. Sixty-three patients with onychomycosis were sorted by convenience in three different groups. Patients from group 1 received the conventional terbinafine dose (250 mg per day for 3 months). Group 2 received a monthly week-long pulse-therapy dose (500 mg per day for 7 days a month, for 4 months) and group 3 received a 500 mg/day dose for 7 days every 3 months, totaling four treatments. There were no statistical differences regarding the effectiveness or side effects between the groups. Conclusion: A quarterly terbinafine pulse regimen can be a possible alternative for treating onychomycosis caused by dermatophytes.
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Affiliation(s)
- Anarosa B Sprenger
- Santa Casa de Curitiba Hospital, Clinic of Diseases and Surgery of the Nail Apparatus, Department of Dermatology, Praça Rui Barbosa, 694, 80.010-030 Curitiba, Brazil.
| | - Katia Sheylla Malta Purim
- Hospital de Clínicas de Curitiba-Universidade Federal do Paraná (UFPR), Clinic of Dermatology, Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil
| | - Flávia Sprenger
- Univerdidade Federal do Paraná (UFPR), Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil
| | - Flávio Queiroz-Telles
- Hospital de Clínicas de Curitiba-Paraná Federal University (UFPR), Department of Public Health, Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil
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