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Zhou Y, Li Y, Xie X, Song L, Lan G, Sun B, Tang T, Yan H, Zhang B, Xu P. Higher Incidence of Neurotoxicity and Skin Hyperpigmentation in Renal Transplant Patients Treated With Polymyxin B. Br J Clin Pharmacol 2022; 88:4742-4750. [PMID: 35508710 DOI: 10.1111/bcp.15384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Toxicity is a major concern related to the clinical use of polymyxin B, and available safety data for renal transplant patients are limited. AIMS We investigated the safety of polymyxin B and toxicity risk factors in renal transplant patients. METHODS A prospective study was performed on a group of renal transplant patients who received intravenous polymyxin B between January 2018 and August 2021. Polymyxin B treatment was monitored to evaluate toxicity and risk factors. RESULTS A total of 235 courses of polymyxin B were administered to 213 patients. Of these, 121 (51.5%) developed SH, 149 (63.4%) developed neurotoxicity, and 10 (5.5%) developed acute kidney injury of which 80% was reversible. Risk factors for developing SH included a high total dose by weight (OR=1.31, 95%CI: 1.08-1.60, p=0.008) and the presence of neurotoxicity (OR=2.86, 95%CI: 1.56-5.26, p=0.001). Neurotoxicity manifested during the first two days of treatment. Neurotoxicity occurred most commonly in women (OR=3.84, 95%CI: 1.82-8.10, p<0.0001), and the presence of SH (OR=1.98, 95%CI: 1.13-3.46, p=0.016) was also an independent risk factor. CONCLUSIONS Neurotoxicity and SH are the two major adverse effects of polymyxin B in renal transplant patients, which may limit its clinical use.
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Affiliation(s)
- Yangang Zhou
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ying Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Xubiao Xie
- Department of Kidney Transplantation, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lei Song
- Department of Kidney Transplantation, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Gongbin Lan
- Department of Kidney Transplantation, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bao Sun
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Tiantian Tang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Han Yan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Bikui Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ping Xu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
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Zhang C, Liu X, Wu H, Wang Y, Fan Y, Guo B, Bian X, Li X, Zhang J. Proteomic Response Revealed Signaling Pathways Involving in the Mechanism of Polymyxin B-Induced Melanogenesis. Microbiol Spectr 2022; 10:e0273021. [PMID: 35377227 PMCID: PMC9045165 DOI: 10.1128/spectrum.02730-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/05/2022] [Indexed: 12/03/2022] Open
Abstract
Polymyxin B is a last-line antibiotic for extensively resistant Gram-negative bacterial infection. Skin hyperpigmentation is a serious side effect induced by polymyxin B that severely compromises the psychological health and compliance of patients. The literature lacks mechanistic studies that explain how hyperpigmentation occurs, and this substantially hinders the development of intervention strategies and improved compliance. SK-MEL-2 cells were used for the polymyxin B-induced hyperpigmentation mechanism study. Melanin content and tyrosinase activity were measured after polymyxin B treatment. Tandem mass tag (TMT)-labeling quantitative proteomics was employed to investigate the response of SK-MEL-2 cells to polymyxin B treatment. Real-time quantitative PCR and Western blot were applied to validate the mRNA and protein levels of related genes and proteins. The melanin content and tyrosinase activity were significantly upregulated after polymyxin B treatment in SK-MEL-2 cells at 48 h and 72 h. Quantitative proteomics showed that 237 proteins were upregulated and 153 proteins were downregulated in the 48 h group, and 49 proteins were upregulated and 49 proteins were downregulated in the 72 h group. The differentially expressed proteins were involved in pathways such as lysosome, PI3K/Akt signaling pathway, and calcium signaling pathway. The upregulation of melanogenic enzymes and microphthalmia-associated transcription factor (MITF) was validated by qPCR and Western blot. Meanwhile, phosphorylation of PI3K, β-catenin, and cyclic-AMP response binding protein (CREB) in response to polymyxin B treatment was observed. The present study reveals the proteomic response of polymyxin B-induced melanogenesis in SK-MEL-2 cells for the first time. Signaling pathways, including melanin biosynthesis, PI3K/Akt, and calcium signaling pathways may be involved in the mechanism of melanogenesis. IMPORTANCE Polymyxin B-induced skin hyperpigmentation seriously affects the psychological health and compliance of patients. This study provides a proteomic clue to the mechanism at the cellular level for understanding polymyxin B-induced hyperpigmentation, contributing to a follow-up investigation of the corresponding PI3K/Akt signaling transduction pathway and calcium signaling pathway. The elucidation of its underlying mechanism is of great significance for patients' compliance improvement, intervention strategy, and new drug development.
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Affiliation(s)
- Chuhan Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaofen Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hailan Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yaxin Fan
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Beining Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xingchen Bian
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Phase I Clinical Trial Center, Huashan Hospital, Fudan University, Shanghai, China
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Zou D, Yu H, Li F. The Difference Between Polymyxin B and Polymyxin E in Causing Skin Hyerpigmentation. Front Pharmacol 2021; 12:647564. [PMID: 33935746 PMCID: PMC8087172 DOI: 10.3389/fphar.2021.647564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Dongna Zou
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haitao Yu
- Department of Pharmacy, Zao Zhuang Municipal Hospital, Zao Zhuang, China
| | - Feifei Li
- Department of Infection, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Xing H, Cheng C, Zhang Y, Cai Y, Wang X, Deng D, Xu L, Xu M, Chen J. Successful Treatment With Intrathecal and Intravenous Polymyxin B-Based Combination Against MDR Acinetobacter baumannii Meningitis in Pediatric Patient: A Case Report. Front Pediatr 2021; 9:564991. [PMID: 34386463 PMCID: PMC8353103 DOI: 10.3389/fped.2021.564991] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nosocomial meningitis with multidrug-resistant (MDR) or extensively drug-resistant (XDR) Acinetobacter baumannii is a life-threatening complication in neurosurgery. Treatment of these infections is challenging because of poor penetration of the available antibiotics into the cerebrospinal fluid (CSF). Intrathecal (ITH) or intraventricular (IVT) administration of antibiotics is increasingly used as the last treatment option against MDR/XDR Gram-negative bacteria meningitis not responding to intravenous (IV) regimens. However, pertinent data in pediatric patients is scarce. Case Presentation: A 14-year-old male patient developed meningitis from an MDR strain of A. baumannii following endoscopic endonasal resection of craniopharyngioma. Despite a combination therapy involving IV tigecycline, we observed clinical and bacteriologic failure. The patient was then successfully treated with an ITH and IV polymyxin B-based combination. Quantification of tigecycline and polymyxin B in CSF was performed with two-dimensional high-performance liquid chromatography (2D-HPLC) and HDLC coupled with tandem mass spectrometry (HPLC-MS/MS), respectively. Adverse drug reactions (neurotoxicity and skin hyperpigmentation), probably induced by polymyxin B, were acceptable and reversible. Conclusions: The case illustrates ITH and IV Polymyxin B-based combination is an optimal therapeutic option against MDR A. baumannii meningitis in this pediatric patient. In the future, real-time PK/PD data obtained from patients during ITH/IVT polymyxin B therapy should be required to optimize polymyxin use with maximal efficacy and minimal adverse effects.
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Affiliation(s)
- Haiyan Xing
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Caiyi Cheng
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yihua Zhang
- Department of Neurosurgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yongqing Cai
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Xianfeng Wang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Dongmei Deng
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Lunshan Xu
- Department of Neurosurgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Minhui Xu
- Department of Neurosurgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Jianhong Chen
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
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Lu C, Hou N. Skin Hyperpigmentation in Coronavirus Disease 2019 Patients: Is Polymyxin B the Culprit? Front Pharmacol 2020; 11:01304. [PMID: 33013367 PMCID: PMC7494845 DOI: 10.3389/fphar.2020.01304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/06/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Cuicui Lu
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ning Hou
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Zheng G, Cao L, Che Z, Mao E, Chen E, He J. Polymyxin B-induced skin hyperpigmentation: a rare case report and literature review. BMC Pharmacol Toxicol 2018; 19:41. [PMID: 29973293 PMCID: PMC6032769 DOI: 10.1186/s40360-018-0226-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/20/2018] [Indexed: 01/10/2023] Open
Abstract
Background Polymyxin B (PMB), which is regarded as the ultimate antibacterial treatment against some intractable gram-negative bacteria with its outstanding anti-bacterial activities, inflicts several adverse effects on patients. However, skin hyperpigmentaion (SH) induced by PMB is very rare. Here, we report a case of polymyxin B-induced skin hyperpigmentation (PMB-iSH) in a 21-year-old female. To the best of our knowledge, this is the first case of PMB-iSH in China. Case presentation A 21-year-old female patient with sepsis received the administration of PMB by intravenous injection for the treatment of multi-drug resistant Klebsiella pneumoniae (MDR-KP) infection. She later suffered from a rare adverse drug reaction (ADR), namely PMB-iSH, after 5-day PMB administration during her treatment. There were multiple red rashes spread on the whole body skin at first. With the rashes fading away, SH with dark round spots appeared, associated with no pain or pruritus. The skin of the head and neck was darkened evidently, and dark brown spots were spread on the skin of trunk and limbs. About a month after her admission, urged by the relatives, the patient was transferred back to the local hospital for further treatment in the end, and her skin color didn’t recover to the previous state at that time. Conclusion Both our case and the literature review highlight that PMB can give rise to SH indeed. Clinicians and pharmacists should attach great importance to this rare pigmentary disorder and further investigation is warranted.
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Affiliation(s)
- Guanhao Zheng
- Department of Pharmacy, Xiaolan Hospital Affiliated to Southern Medical University, Zhongshan, China
| | - Li Cao
- Department of Pharmacy, Zhongshan People's Hospital, Zhongshan, China
| | - Zaiqian Che
- Department of Emergency Intensive Care Unit, Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Enqiang Mao
- Department of Emergency Intensive Care Unit, Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Erzhen Chen
- Department of Emergency Intensive Care Unit, Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine, EICU 3 Floor, 5 Building, 197 Ruijin No. 2 Road, Huangpu District, Shanghai, China.
| | - Juan He
- Department of Pharmacy, Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine, 202 Room, 12 Building, 197 Ruijin No. 2 Road, Huangpu District, Shanghai, China.
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