Challenges in the Therapy of Chromoblastomycosis

Chromoblastomycosis (CBM) is an implantation mycosis mainly occurring in tropical and subtropical zones worldwide. If not diagnosed at early stages, patients with CBM require long-term therapy with systemic antifungals flanked by various physical treatment regimens. As in other neglected endemic mycoses, comparative clinical trials have not been performed for this disease; nowadays, therapy is mainly based on a few open trials and on expert opinions. Itraconazole, either as monotherapy or associated with other drugs, or with physical methods, is widely used. Recently, photodynamic therapy has been employed successfully in combination with antifungals in patients presenting with CBM. In the present paper, the most used therapeutic options against CBM are reviewed as well as the several factors that may have impact on the patient’s outcome.     

胆管癌的光动力疗法

胆管癌(Cholangiocarcinoma CC)是一种罕见的胆道原发性恶性肿瘤,预后较差。根治性手术只适用于一小部分早期诊断的患者。姑息性的经皮或内镜下支架置入胆管引流术能通过减轻瘙痒,疼痛,和胆管炎的程度从而提高生活质量,但对于延长生存时间作用甚微。光动力疗法(PDT)是对于不能手术切除的CC的一种较新颖的局部微创性的姑息疗法。其原理是PDT中使用的光敏性分子能特异性的聚集在增生组织如肿瘤,在特定波长的光照下光敏剂激活生成活性氧类物质,从而选择性的导致肿瘤细胞的死亡。经过初步的可行性性研究和充满前景的前瞻性II期临床研究后,关于研究比较胆管支架置入联合光动力治疗与单纯胆管内支架置入的两组前瞻性随机对照试验已经发表。其中一组试验结果显示PDT组(493天)与非PDT组(98天)相比在中位生存期方面的显著优势(P0.0001),且PDT组患者的体力状态也明显改善。另一组试验也进一步明确了PDT治疗对于提高生存率方面的优势(PDT组630天而单纯支架置入组210天,P0.01)。整个治疗过程耐受性良好。有报道称PDT作为CC的辅助或新辅助疗法已取得了令人满意的结果,因此PDT可以被看作是治疗不能手术切除的胆管癌的一种标准性姑息治疗方法。     

Antifungal Therapy in Pediatric Patients

Invasive fungal infections still play a major role in morbidity and mortality in pediatric patients, especially in children undergoing therapy for an underlying malignancy and in preterm infants. Relative to the adult population, pediatric age groups display important differences not only in host biology, predisposing conditions, epidemiology, and presentation of fungal infections, but also in the disposition and clearance of antifungal compounds. During the past decade, several new antifungal agents have been developed. Although not all of these agents are yet approved for children, the pediatric development of antifungal agents has moved forward in an exemplary manner, which is essential for the successful management of the individual patient. This article reviews the current data on pharmacokinetics, safety, and dosing of antifungal agents in pediatric patients.     

A Case of Relapsed Chromoblastomycosis Due to Fonsecaea monophora: Antifungal Susceptibility and Phylogenetic Analysis

Chromoblastomycosis is a chronic cutaneous and subcutaneous mycosis. The management of this infection continues to be challenging because there is no consensus on the therapeutic regimen. We report here a case of a 69-year-old male patient with cauliflower-like lesions on his left leg and foot. He had already been treated with itraconazole at a dose of 200 mg/day for 5 months, with mycological cure for all the affected areas. However, the lesions relapsed at both sites, and treatment with itraconazole was resumed at the dose previously used. Initially, direct mycological examination, cultural, and microculture slide observation were performed. Afterward, sequencing of the ITS1-5.8S rDNA-ITS2 region of the fungal DNA and evaluation of its susceptibility to antifungal agents alone and in combination were performed. In direct mycological examination, the presence of sclerotic cells was verified, and the fungus was identified as Fonsecaea based on cultural and microscopic examinations. Identification as Fonsecaea monophora was confirmed after sequencing of the ITS region and phylogenetic analysis. The isolate was susceptible to itraconazole and terbinafine. The combinations of amphotericin B and terbinafine and terbinafine and voriconazole were synergistic. The use of drugs for which the causative agent is susceptible to singly or in combination may be an alternative for the treatment of mycosis. Furthermore, the identification of the agent by molecular techniques is important for epidemiological purposes. To the best of our knowledge, this is the first case of relapsed chromoblastomycosis caused by F. monophora in Brazil.     

光动力疗法过程中的光漂白特性

基于光动力过程中的光分布规律,研究了半无限大组织中组织光学特性和光分布对光漂白作用效果的影响.研究发现光漂白效果与组织的散射系数和吸收系数成反比;光漂白的有效作用深度是4.5 mm,最大作用深度是33 mm.研究所得结果不仅表明通过光分布研究光漂白的特性是一种有效的方法,而且对临床上设计合理的治疗法案具有重要的参考作用...     

抗氧化剂辅助疗法对光动力疗法疗效的影响

研究食物中含有的天然抗氧化剂对光动力疗法治疗效果的影响。通过在常规培养的K562细胞悬浮液中分别加入染料木素、鞣花酸、山竹黄酮这几种天然抗氧剂,用戊氨基乙酰丙酸-光动力疗法（ALA—PDT）作用后,检测各组细胞的存活率。研究发现染料木素、鞣花酸、山竹黄酮均可以提高光动力疗法的疗效。研究结果表明,抗氧化剂疗法和光动力疗法相互结合能够起到良好的治疗效果。     

在光动力疗法中应用的量子点

概述了现存的主要量子点的构成及其特点,阐述了量子点的性质主要由量子点的成分、结构、包覆和尺寸所决定。并重点讨论量子点在光动力疗法中,量子点直接代替传统光敏剂、量子点的荧光共振能量转移、量子点作为宽禁带半导体材料TiO2的敏化剂等三种不同应用中,对量子点的要求,通过讨论指出由于其特性,量子点将在光动力疗法中得到更广泛的应用,也对在光动力疗法中应用的量子点的毒性及其他可能产生的问题提出了展望。     

Glycan-Targeted Virus-like Nanoparticles for Photodynamic Therapy

Virus-like particles (VLPs) have proven to be versatile platforms for chemical and genetic functionalization for a variety of purposes in biomedicine, catalysis, and materials science. We describe here the simultaneous modification of the bacteriophage Qβ VLP with a metalloporphyrin derivative for photodynamic therapy and a glycan ligand for specific targeting of cells bearing the CD22 receptor. This application benefits from the presence of the targeting function and the delivery of a high local concentration of singlet oxygen-generating payload.     

Antifungal Therapy in Pregnancy and Breastfeeding

Antifungal therapy during pregnancy and lactation is challenging because of a lack of data on efficacy and safety, coupled with reports of teratogenicity. Although the Food and Drug Administration pregnancy category provides guidance regarding a drug’s potential fetal risks, limitations such as lack of a specific toxic dose or predisposing pregnancy trimester thwart its application. Central to the selection of optimal antifungal therapy are exploration of the literature and assessment of patient-specific factors, including awareness of effects on the pharmacokinetics of antifungal agents that result from physiologic changes during pregnancy. Topical azoles are favored for superficial fungal infections during pregnancy and lactation, whereas amphotericin B is preferred for invasive fungal infections. Data regarding the use of antifungal agents by breastfeeding women are lacking. More studies are needed, particularly with newer antifungals, to better guide clinicians in selecting optimal antifungal therapy that will provide benefit to the mother without harm to the fetus.     

杜仲抗真菌肽对黄曲霉的抑制作用(英文)

用纸片琼脂扩散法,研究了杜仲抗真菌肽EAFP3对黄曲霉(Aspergillus flavus)的抗真菌活性.研究结果表明,EAFP3对黄曲霉有明显抑制作用,最小抑菌浓度为125 μg/mL.     

Update in Antifungal Therapy of Dermatophytosis

Treatment of dermatophyte infection involves primarily oral and/or topical formulations of azoles or allylamines, particularly itraconazole and terbinafine. Topical medications applied once or twice daily are the primary treatment indicated for tinea corporis/cruris, and tinea pedis/manuum. Use of oral antifungals may be practical where the tinea involvement is extensive or chronic, or where application of a topical is not feasible. For tinea unguium (onychomycosis) and tinea capitis, oral therapies are the primary treatments provided. Recently, topical amorolfine and ciclopirox formulations have been approved for use in milder onychomycosis cases, and their role in the treatment of the different clinical forms of onychomycosis is currently being defined. Relapse of infection remains a problem, particularly with tinea pedis/unguium. Appropriate follow-up duration and education of patients on proper foot hygiene are also important components in providing effective therapy.     

山苍子油对白假丝酵母抗菌活性研究

研究山苍子油对白假丝酵母菌的抗菌活性,并阐明其可能的抗菌机制。通过水蒸馏法提取山苍子油,并利用气相色谱-质谱联用仪(GC/MS)分析其成分。通过琼脂平板稀释法测定山苍子油对白假丝酵母的最低抑菌浓度(MIC)和最低杀菌浓度(MFC),并研究山苍子油对白假丝酵母的抗菌动力学;同时利用扫描电子显微镜(SEM)和透射电子显微镜(TEM)观察山苍子油对白假丝酵母细胞超微结构的影响。结果表明,自提山苍子油主成分为柠檬烯(26.51%),柠檬醛(11.94%)和马鞭烯醇(11.84%)。山苍子油对白假丝酵母菌的MIC和MFC均为1.25μL/m L;其抗菌动力学研究表明浓度低于其MIC时,山苍子油仅延长白假丝酵母的生长适应期,并不能彻底杀死细胞;SEM结果表示,山苍子易破坏正在出芽的细胞;TEM显示出山苍子破坏细胞壁,细胞膜,使细胞裂解。山苍子油具有优良的抗白假丝酵母活性,且白假丝酵母在芽痕处对山苍子油比较敏感,高浓度的精油(5.0μL/m L)对细胞产生不可逆破坏;山苍子油杀菌的靶标可能是细胞壁和细胞外膜,使细胞内大分子外泄,细胞器变形,最终导致细胞死亡。     

New Antifungal Agents and New Formulations Against Dermatophytes

A variety of oral and topical antifungal agents are available for the treatment of superficial fungal infections caused by dermatophytes. This review builds on the antifungal therapy update published in this journal for the first special issue on Dermatophytosis (Gupta and Cooper 2008;166:353–67). Since 2008, there have not been additions to the oral antifungal armamentarium, with terbinafine, itraconazole, and fluconazole still in widespread use, albeit for generally more severe or recalcitrant infections. Griseofulvin is used in the treatment of tinea capitis. Oral ketoconazole has fallen out of favor in many jurisdictions due to risks of hepatotoxicity. Topical antifungals, applied once or twice daily, are the primary treatment for tinea pedis, tinea corporis/tinea cruris, and mild cases of tinea unguium. Newer topical antifungal agents introduced include the azoles, efinaconazole, luliconazole, and sertaconazole, and the oxaborole, tavaborole. Research is focused on developing formulations of existing topical antifungals that utilize novel delivery systems in order to enhance treatment efficacy and compliance.     

Somatostatin Analogues for Receptor Targeted Photodynamic Therapy

Photodynamic therapy (PDT) is an established treatment modality, used mainly for anticancer therapy that relies on the interaction of photosensitizer, light and oxygen. For the treatment of pathologies in certain anatomical sites, improved targeting of the photosensitizer is necessary to prevent damage to healthy tissue. We report on a novel dual approach of targeted PDT (vascular and cellular targeting) utilizing the expression of neuropeptide somatostatin receptor (sst₂) on tumor and neovascular-endothelial cells. We synthesized two conjugates containing the somatostatin analogue [Tyr3]-octreotate and Chlorin e6 (Ce6): Ce6-K₃-[Tyr3]-octreotate (1) and Ce6-[Tyr3]-octreotate-K₃-[Tyr3]-octreotate (2). Investigation of the uptake and photodynamic activity of conjugates in-vitro in human erythroleukemic K562 cells showed that conjugation of [Tyr3]-octreotate with Ce6 in conjugate 1 enhances uptake (by a factor 2) in cells over-expressing sst₂ compared to wild-type cells. Co-treatment with excess free Octreotide abrogated the phototoxicity of conjugate 1 indicative of a specific sst₂-mediated effect. In contrast conjugate 2 showed no receptor-mediated effect due to its high hydrophobicity. When compared with un-conjugated Ce6, the PDT activity of conjugate 1 was lower. However, it showed higher photostability which may compensate for its lower phototoxicity. Intra-vital fluorescence pharmacokinetic studies of conjugate 1 in rat skin-fold observation chambers transplanted with sst₂ ⁺ AR42J acinar pancreas tumors showed significantly different uptake profiles compared to free Ce6. Co-treatment with free Octreotide significantly reduced conjugate uptake in tumor tissue (by a factor 4) as well as in the chamber neo-vasculature. These results show that conjugate 1 might have potential as an in-vivo sst₂ targeting photosensitizer conjugate.