Experimental murine mycotic mastitis: a sensitive and lenient model for studies of antifungal chemotherapy

The murine model of mycotic mastitis was used to study the efficacy of amphotericin B (AmB). Twenty-four BALB/cJ mice at the fifth day of lactation were anesthetized and inoculated through the teat canal (two glands) with 50 microl suspension containing 5.0 x 10(7) cfu ml(-1) Candida albicans blastospores. Mice were randomly divided into two groups: untreated controls and AmB treated. Animals were euthanized 3 and 6 days after infection and treatment (4 mg kg(-1) per day intraperitoneally). The fungal burden of the mammary gland was determined by quantitative cultures. The number of C. albicans cells recovered from mammary gland homogenates were significantly lower in the AmB treated animals (both 3 and 6 days post-infection) than in the untreated controls (P<0.007 and P<0.003, respectively). The mammary glands of all untreated control animals showed marked neutrophilic infiltration, severe necrosis, and presence of blastospores, hyphae and pseudohyphae. In contrast, 10 of 12 animals treated with AmB showed only a mild neutrophilic infiltration which was restricted to alveoli and excretory ducts. All extra-mammary organs were free of infection in both groups. The results demonstrate that the murine mycotic mastitis model is suitable for investigations of new antifungal compounds. In addition, this model is more lenient than the systemic candidiasis models.     

真菌耐药的分子机制及新型抗真菌药物

真菌耐药性的发生率日益增多,严重影响了抗真菌药物的治疗效果。在分子水平上了解真菌耐药性的发生机制对控制其耐药性的发展和新型抗真菌药物的研究和开发十分重要。本文介绍了近年来真菌耐药性研究的新进展,以及目前正处于研究阶段的新型抗真菌药物。     

解淀粉芽孢杆菌抗菌活性物质的分离纯化及抑菌活性研究

植物真菌病害给农业生产带来了巨大损失,因此对生物农药的开发迫在眉睫。从堆肥中分离得到一株解淀粉芽孢杆菌,它具有强烈的抗真菌活性。其发酵液经硫酸胺沉淀得到粗提液,粗提液经Hiprep 26/10 Desalting,HiLoad 26/10 Q Sepharose和HPLC多步柱层析,分离纯化得到一种抗真菌活性物质。ESI-MS质谱法测得其分子量为1498 Da。经活性检测发现,该纯物质对尖孢镰刀菌、草莓蛇病菌等植物病原真菌具有很强的抑制作用,对毛霉、黑曲霉等食品腐败菌也有抑制作用。经过显微镜观测,该物质可造成草莓蛇病菌菌丝生长异常,表现在菌丝弯曲,顶端膨大,分生孢子数量减少。     

6种抗真菌药物对皮肤癣菌体外抗真菌活性评价

目的评价6种抗真菌药物对皮肤癣菌体外抗真菌活性。方法采用CLSI推荐的M-38P方案对分离自足癣和体、股癣的皮肤癣菌进行联苯苄唑、硝酸舍他康唑、硝酸异康唑、盐酸布替萘芬、阿莫洛芬、利拉萘酯6种抗真菌药物敏感性测定。结果联苯苄唑MIC范围为0．03—4mg／L,MIC50为1mg／L,MIC90为2mg／L。硝酸舍他康唑分别为0．06—16mg／L、0．5mg／L和2mg／L。硝酸异康唑分别为0．03～2mg／L、0．25mg／L和0．5mg／L。盐酸布替萘芬分别为0．0025～0．04mg／L、0．01mg／L和0．02mg／L。阿莫罗芬分别为0．01～〉0．08mg／L、0．02mg／L和0．04mg／L。利拉萘酯分别为0．004—0．625mg／L、0．039mg／L和0．312mg／L。结论6种抗真菌药物对皮肤癣菌均有强的抗菌活性,由强到弱依次为布替萘芬、阿莫罗芬、利拉萘酯和咪唑类药物。     

Commercialization of antifungal peptides

There remains an urgent and very much unmet medical need for new antifungal therapies. Ideally, the next generation of treatments for nosocomial and community-acquired infections, including those caused by Candida spp, Aspergillus spp, Cryptococcus spp and Fusarium spp, will be more efficacious, with higher therapeutic indices and broader activity spectra than existing antifungal drug classes. Moreover, future antifungal therapeutics should have novel modes of action/drug targets that at least minimise, if not negate, the risk of acquired resistance developing in their target fungal pathogen populations. In short, developing the next generation of antifungals is a tall order and whoever is successful in doing so must address the various and well-described shortcomings of what remains at present, a very limited choice of largely small molecule-based therapeutics against the fungal infection spectrum. Novel peptide antifungals engineered from a template of mammalian, amphibian and even insect endogenous antimicrobial peptides (AMPs) have clear potential to meet these requirements and consequent clinical success in a range of fungal diseases. This potential will hopefully be realised in the future as any number of the promising preclinical candidate antifungal peptides identified to date are developed further towards the clinic. The size of the ever-increasing market potential as well as unmet clinical need for new antifungal treatments is such that succeeding in delivering novel peptide antifungals as safe and potently efficacious therapies for the future will have a significant health-economic impact.     

Commercialization of antifungal peptides

There remains an urgent and very much unmet medical need for new antifungal therapies. Ideally, the next generation of treatments for nosocomial and community-acquired infections, including those caused by Candida spp, Aspergillus spp, Cryptococcus spp and Fusarium spp, will be more efficacious, with higher therapeutic indices and broader activity spectra than existing antifungal drug classes. Moreover, future antifungal therapeutics should have novel modes of action/drug targets that at least minimise, if not negate, the risk of acquired resistance developing in their target fungal pathogen populations. In short, developing the next generation of antifungals is a tall order and whoever is successful in doing so must address the various and well-described shortcomings of what remains at present, a very limited choice of largely small molecule-based therapeutics against the fungal infection spectrum. Novel peptide antifungals engineered from a template of mammalian, amphibian and even insect endogenous antimicrobial peptides (AMPs) have clear potential to meet these requirements and consequent clinical success in a range of fungal diseases. This potential will hopefully be realised in the future as any number of the promising preclinical candidate antifungal peptides identified to date are developed further towards the clinic. The size of the ever-increasing market potential as well as unmet clinical need for new antifungal treatments is such that succeeding in delivering novel peptide antifungals as safe and potently efficacious therapies for the future will have a significant health-economic impact.     

Mechanisms of antifungal resistance

The many drugs that are available at present to treat fungal infections can be divided into four broad groups on the basis of their mechanism of action. These antifungal agents either inhibit macromolecule synthesis (flucytosine), impair membrane barrier function (polyenes), inhibit ergosterol synthesis (allylamines, thiocarbamates, azole derivatives, morpholines), or interact with microtubules (griseofulvin). Drug resistance has been identified as the major cause of treatment failure among patients treated with flucytosine. A lesion in the UMP-pyrophosphorylase is the most frequent clinical determinant of resistance to 5FC in Candida albicans. Despite extensive use of polyene antibiotics for more than 30 years, emergence of acquired resistance seems not be a significant clinical problem. Polyene-resistant Candida isolates have a marked decrease in their ergosterol content. Acquired resistance to allylamines has not been reported from human pathogens, but, resistant phenotypes have been reported for variants of Saccharomyces cerevisiae and of Ustilago maydis. Tolerance to morpholines is seldom found. Intrinsic resistance to griseofulvin is due to the absence of a prolonged energy-dependent transport system for this antibiotic. Resistance to azole antifungal agents is known to be exceptional, although it does now appear to be increasing in importance in some groups of patients infected with e.g. Candida spp., Histoplasma capsulatum or Cryptococcus neoformans. For example, resistance to fluconazole is emerging in C. albicans, the major agent of oro-pharyngeal candidosis in AIDS patients, after long-term suppressive therapy. In the majority of cases, primary and secondary resistance to fluconazole and cross-resistance to other azole antifungal agents seems to originate from decreased intracellular accumulation of the azoles, which may result from reduced uptake or increased efflux of the molecules. In most C. albicans isolates the decreased intracellular levels can be correlated with enhanced azole efflux, a phenomenon linked to an increase in the amounts of mRNA of a C. albicans ABC transporter gene CDR1 and of a gene (BEN(r) or CaMDR) coding for a transporter belonging to the class of major facilitator multidrug efflux transporters. Not only fluconazole, ketoconazole and itraconazole are substrates for CDR1, terbinafine and amorolfine have also been established as substrates, BEN(r) overexpression only accounts for fluconazole resistance. Other sources of resistance: changes in membrane sterols and phospholipids, altered or overproduced target enzyme(s) and compensatory mutations in the Delta5,6-desaturase.     

抗真菌药物的联合应用

目前真菌感染,特别是免疫缺陷患者中侵入性真菌感染的发病率和死亡率在不断增加,但现有抗真菌药物可选择范围小、毒副作用大而且耐药情况日渐严重。联合用药这一概念的提出,给耐药株及严重性真菌感染提供了新的治疗途径,并且已在临床中广泛运用。该文对不同种类抗真菌药物联用的研究成果及作用机制做一综述。     

Sordaricin antifungal agents

Compounds based on sordaricin were prepared via organometallic addition onto a fully protected sordaricin aldehyde. The fungal growth inhibition profiles for these compounds were established and the results are presented here. The synthesis of homologated sordaricin as well as ether and ester derivatives is presented, and structural rearrangement products upon oxidation. These compounds were evaluated as agents to inhibit fungal growth.     

昆虫抗真菌肽

随着对昆虫抗菌肽理论和应用研究的不断深入,已陆续发现了10多种昆虫抗真菌肽。文章就昆虫抗真菌肽的类型、结构和功能的关系、作用机理、应用等方面的新进展进行简要介绍和分析,为昆虫抗真菌肽的理论研究和发展新型抗生素等提供了必要的信息。     

Insight into the antifungal mechanism of Neosartorya fischeri antifungal protein

Small, cysteine-rich, highly stable antifungal proteins secreted by filamentous Ascomycetes have great potential for the development of novel antifungal strategies. However, their practical application is still limited due to their not fully clarified mode of action. The aim of this work was to provide a deep insight into the antifungal mechanism of Neosartorya fischeri antifungal protein (NFAP), a novel representative of this protein group. Within a short exposure time to NFAP, reduced cellular metabolism, apoptosis induction, changes in the actin distribution and chitin deposition at the hyphal tip were observed in NFAP-sensitive Aspergillus nidulans. NFAP did show neither a direct membrane disruptingeffect nor uptake by endocytosis. Investigation of A. nidulans signalling mutants revealed that NFAP activates the cAMP/protein kinase A pathway via G-protein signalling which leads to apoptosis and inhibition of polar growth. In contrast, NFAP does not have any influence on the cell wall integrity pathway, but an unknown cell wall integrity pathway-independent mitogen activated protein kinase A-activated target is assumed to be involved in the cell death induction. Taken together, it was concluded that NFAP shows similarities, but also differences in its mode of antifungal action compared to two most investigated NFAP-related proteins from Aspergillus giganteus and Penicillium chrysogenum.     

覆盆子提取物联合唑类药物抗真菌活性研究

目的 探讨中药覆盆子提取物联合唑类药物的体外抗真菌作用.方法 采用CLSI公布的M27-A方案微量液基稀释法和棋盘式微量稀释法,测定覆盆子提取物单用及联合唑类药物对不同念珠菌的MIC值和FICI指数.结果 覆盆子不同溶液提取物与氟康唑均表现出协同关系,以覆盆子醇提物为例,单用对念珠菌的MIC80测定值范围主要集中在0.16～1.25 mg/mL,与氟康唑合用后表现出协同关系(FICI≤0.5),且MIC80测定值范围降至0.01 ～0.04 mg/mL;合用后的氟康唑抗真菌活性也明显增强.另外,覆盆子醇提物与不同唑类药物合用后均有协同关系,其MIC80测定值由单用时大于10 mg/mL降至0.04 mg/mL.结论 覆盆子醇提物和唑类药物单用时对耐药念珠菌的抑菌作用较弱,但二者合用后表现出明显的协同关系,对耐药念珠菌的抑菌作用明显增强.     

Clinical application of antifungal pharmacodynamics

Studies of pharmacodynamics are used to develop dosing regimens that maximize safety and efficacy in clinical practice. Antifungal pharmacodynamics is a growing field, and studies are increasingly moving from the in vitro phase to animal models to clinical evaluations. Preclinical studies that determine pharmacodynamic predictors of efficacy and safety provide valuable data in the determination of a dosage regimen, but evaluations of antifungal pharmacodynamic parameters in vivo are less common. This article reviews areas where antifungal pharmacodynamics has been evaluated in clinical trials to develop principles that may be used in the pharmacotherapy of invasive mycoses.     

Immunomodulating effects of antifungal therapy

The action of modern antifungal drugs may not be restricted to their direct fungicidal or fungistatic activity. Recent evidence suggests that antifungals may stimulate or alter the host immune response by mechanisms that may result in enhanced fungal clearance, but with possible increased collateral damage to the host. Dissecting the net impact of antifungal therapy-mediated immunomodulation is difficult because the type and magnitude of these immunostimulatory properties are influenced by the class and type of the drug, the immunologic status of the host, and the specific fungal pathogen. Ultimately, immunopharmacologic considerations may become important in selecting and dosing antifungal therapy for opportunistic mycoses.     

Action of imidazole-containing antifungal drugs

During the past few years several promising new antifungal drugs (e.g. miconazole and ketoconazole) have emerged from a large and diverse group of synthetic imidazole-containing compounds. Potentially, these agents could provide the first major break-through in the management of systematic mycoses in over 20 years. Although this review briefly traces the historical development of antifungal imidazoles and summarizes pertinent information regarding chemical characteristics, biological properties, and growth inhibitory activities, it is primarily concerned with experimental findings and current ideas with respect to mode of action. Physiological, biochemical, and cytological studies have established that the primary adverse effect of imidazoles on fungal cells is disorganization of the plasma membrane. Normal structural and permeability characteristics of the membrane are altered to the extent that the fungal cell cannot adequately govern cytoplasmic levels of essential ions and low molecular weight metabolites. This much seems clear, but the biochemical mechanisms involved in membrane disorganization have not been resolved. There are currently two major hypotheses, each of which is based on substantial experimental evidence. The first suggests that imidazoles interfere with one or more enzymatic steps in the biosynthesis of ergosterol, an integral sterol component of fungal cell membranes. In the second hypothesis, membrane disorganization is explained in purely physicochemical terms. It is postulated that imidazoles and unsaturated fatty acid components of the membrane undergo hydrophobic interactions that are the direct cause of structural alterations and loss of normal permeability controls.     

Pharmacogenomics of systemic antifungal agents

The genomic era offers a multitude of new technologies that may make the promise of personalized medicine a reality for patients in this century. Numerous new antifungal agents have been developed over the past two decades, but use of these agents requires optimization of pharmacokinetics and dosing to achieve efficacy and minimize toxicity. This article reviews the potential application of pharmacogenomics to the use of antifungal agents, highlighting genetic variation that may affect absorption, distribution, metabolism, and elimination of these compounds.     

Pediatric pharmacology of antifungal agents

Pediatric age groups display important differences in host biology, predisposing conditions, epidemiology, and presentation of fungal infections relative to the adult population. Over the past decade, major advances have been made in the field of medical mycology. Most importantly, an array of new antifungal agents has entered the clinical arena. Although pediatric approval of several of these agents remains to be established, the pediatric development of antifungal agents is moving forward. Invasive fungal infections will remain important causes for morbidity and mortality in immunocompromised pediatric patients. Although the availability of new therapeutic options is an important advance, antifungal therapy has become increasingly complex, and a thorough understanding of the available antifungal armamentarium is essential for the successful management of individual patients.     

抗真菌药物敏感性试验方法的新进展

真菌感染,尤其是免疫低下患者机会性真菌感染发病率的不断上升使真菌病的治疗面临着严峻的挑战,各种新的抗真菌药物纷纷涌现。临床实践中,人们需要规范快速、易于应用的药敏试验来指导用药和判断预后,抗真菌药物敏感性试验在真菌感染的治疗中起着重要作用。