两性霉素B及其脂质体的抗真菌机制

自20世纪60年代发现两性霉素B以来,至今仍是最有效的抗真菌药物;但由于其对人体的毒副作用大而在临床上的应用受限。近年来,随着化疗、AIDS及器官移植患者的增多,临床真菌感染的病例呈上升趋势。相应的两性霉素B脂质体的出现也给临床提供了新的治疗手段。所以对两性霉素B及其脂质体作用机制的研究、探讨有着重要的临床意义。     

病原性曲霉三唑类药物耐药机制的研究进展

近年来随着免疫抑制人群的不断增加,侵袭性曲霉病的发病率不断增高。然而随着三唑类药物在临床上的广泛使用,病原性曲霉对三唑类药物的耐药率逐渐增加,是临床治疗重大挑战。文中综述了病原性曲霉对三唑类药物耐药机制的研究进展。曲霉对三唑类药物的耐药机制主要包括cyp51的突变与过表达、药物外排泵的过表达、应激适应通路的激活、生物膜的形成,以及脂质合成相关基因参与而导致的耐药。     

两性霉素B抗真菌治疗进展CSCD

真菌病危害全世界超过10亿人,每年死于真菌病的人超过150万,但自从多烯类抗真菌药被发现以来,真菌病得到很好的治疗。两性霉素B(amphotericin B,AmB)是1953年1月由科学家从链霉菌培养物M4575中分离出的具有抗真菌活性的化合物,经过半个多世纪的临床应用,被证实抗真菌谱广、耐药率低,在抗侵袭性真菌感染中具有重要作用[1]。     

两性霉素B脂质体抗烟曲霉的研究

目的 通过对两性霉素B脂质体（L-AmB）的烟曲霉抵抗实验的研究,初步探讨其抗真菌的机制,为临床的合理使用两性霉素B脂质体提供实验指导。方法 将烟曲霉菌株复苏后,接种于沙保弱平板,恢复正常毒力。用洗液洗脱烟曲霉的孢子,进行两性霉素B脂质体及两性霉素B体外抗真菌的研究;用注射器吸取一定量的含烟曲霉孢子的溶液,注入小鼠的肺部,当确证其肺部感染了烟曲霉后,用L-AmB进行治疗,后期通过观察小鼠肺部的病理结果判断疗效并检测鼠肺部细胞在药物治疗后的细胞自噬相关基因LC3B,Beclin-1的水平。结果 L-AmB组的体内外抑菌作用强于AmB组且L-AmB可显著增加鼠肺部细胞的自噬水平。结论 两性霉素B脂质体可通过显著的增加细胞的自噬水平,来有效的抵抗烟曲霉的感染。     

两性霉素B治疗侵袭性肺部真菌感染的临床分析

目的 分析两性霉素B治疗ICU内侵袭性真菌感染的疗效与不良反应.方法 回顾性分析98例合并侵袭性肺部真菌感染的重症患者接受两性霉素B微泵静脉给药的临床资料.结果 两性霉素B的临床有效率77.55％,真菌清除率75.51％.不良反应包括寒战发热（9.18％）、皮疹（4.08％）、静脉炎（1.02％）、恶心呕吐（6.12％）、低钾血症（16.32％）、肝损害（1.02％）和肾损害（4.08％）.结论 国产两性霉素B对于重症患者侵袭性真菌感染疗效确定,采用持续微泵静脉给药不良反应发生率低.     

两性霉素B对小儿白血病化疗后肺部侵袭性真菌感染的疗效研究

目的探讨两性霉素B对小儿白血病化疗后肺部侵袭性真菌感染（PIFI）的疗效。方法选取沈阳军区总医院于2012年4月至2014年8月收治的54例白血病化疗后PIFI患儿为研究对象,随机分成A、B两组,每组27例。B组采用米卡芬净,A组采用两性霉素B。对比两组临床疗效、G试验结果、肺部CT改变情况及不良反应发生率。结果 （1）A组治疗有效率为66.67%,明显优于B组的44.44%,且治疗后A组死亡6例（22.22%）,低于B组的13例（48.15%）,组间对比差异有统计学意义（P〈0.05）;（2）所有受试患儿均行动态G试验检测,发现阳性者43例（79.63%）,A组22例、B组21例（P〉0.05）。其中37例（86.05%）治疗后转阴,A组20例,B组17例（P〉0.05）;治疗前,54例患儿高分辨CT影像显示其肺部出现片状或结节状高密度影,呈现明显新月形或空洞改变;（3）治疗后,两组患者均无严重腹泻、头晕、头痛等不良反应发生（P〉0.05）;A组3例因耐受不足停药,B组4例因肾功能改变而停止治疗,不良反应发生对比差异无统计学意义（P〉0.05）。结论对白血病化疗后出现PIFI症状的患者给予两性霉素B进行治疗,疗效显著,安全可靠,值得临床推广。     

致病性曲霉的耐药性研究进展

随着抗真菌药物在临床上的广泛使用,致病性真菌的耐药率越来越高,耐药曲霉对侵袭性曲霉病的诊治产生了重要影响。目前,致病性曲霉耐药性的确定主要依靠抗真菌药敏试验和分子诊断。在有关曲霉耐药机制的研究中,报道最多的是曲霉对唑类药物的耐药,其机制主要包括外排泵表达增加、靶酶Cyp51突变和表达水平增高、形成生物膜,以及热休克蛋白90（Hsp90）介导的信号通路参与而导致的耐药。本文就上述领域近年来的主要进展进行综述。     

两性霉素B和伏立康唑对临床真菌的体外抗菌活性分析

目的比较两性霉素B和伏立康唑对临床真菌的体外抗菌活性。方法用两性霉素B和伏立康唑的E-test条对分离自临床标本的116株真菌进行体外药敏试验,其中热带念珠菌15株,光滑念珠菌14株,近平滑念珠菌11株,克柔念珠菌6株,新生隐球菌8株,阿萨希毛孢子菌9株,烟曲霉29株,黄曲霉15株,黑曲霉1株,镰刀菌属7株,根霉属1株,以ATCC22019光滑念珠菌为质控菌株。结果两性霉素B对阿萨希毛孢子菌、镰刀菌、黄曲霉的MIC90均为64μg/ml,对其余受试菌株的MIC90均≤1μg/ml,伏立康唑对镰刀菌的MIC90为64μg/ml,对大部分受试菌株的MIC90均≤2μg/ml。结论除对某些真菌可能无效外,两性霉素B和伏立康唑可能适用于治疗大多数的真菌感染。     

低氧对曲霉和假丝酵母体外两性霉素B、伊曲康唑和棘白素药敏试验的影响[英]／Warn PA…／／J Antimicrobial Chemother．

抗真菌药在体外和体内的效果有很大差异,可靠的体外药敏试验在对真菌病的用药是有帮助的。已知许多因素可影响真菌的最低抑菌浓度(MIC)测定,如培养基、菌悬液的浓度、试验方法的选择(多量稀释法或微量稀释法)和培养温度。作者研究了不同氧浓度对真菌体外药敏试验的影响。     

国产两性霉素B抢先治疗血液病患者肺部侵袭性真菌感染的疗效与安全性分析

目的观察国产两性霉素B抢先治疗血液病患者侵袭性肺部真菌感染(以下简称IFI)的疗效与不良反应。方法回顾性分析我院2004年12月～2008年12月间,45例免疫功能低下IFI患者接受国产两性霉素B治疗的临床资料。结果 45例患者均应用两性霉素B治疗两周以上,最长应用时间为14周,中位数6周。总有效率为86.7%,不良反应主要有低钾血症、发热、转氨酶升高、肾功损害、胃肠道反应,根据WHO药物毒性分级标准均为I～II级毒性。结论国产两性霉素B对于血液病患者IFI临床诊断的抢先治疗疗效肯定,不良反应可耐受。     

Transformation of Aspergillus terreus with the hygromycin B resistance marker from Escherichia coli

Aspergillus terreus was transformed to hygromycin B resistance using a bacterial resistance gene under the control of Aspergillus nidulans regulatory sequences. Southern hybridization of transformants indicated that in most of the cases the vector DNA was integrated into the recipient chromosome in the form of tandem arrays. Transformants were mitotically stable in both selective and non-selective medium and retained their capacity to produce xylanase or glucoamylase activities.     

In vitro and in vivo antifungal activities of liposomal amphotericin B,and amphotericin B lipid complex

The in vitro and in vivo antifungal activities of liposomal amphotericin B (L-AMPH) and amphotericin B lipid complex (ABLC), which is composed of amphotericin B and the phospholipids dimyristoyl phosphatidylcholine and dimyristoyl phosphatidylglycerol, were compared with those of conventional amphotericin B (Fungizone®, AMPH). The acute intravenous toxicity was markedly lower in BALB/c mice; 50% lethal doses (LD_50s) were 2.75 mg/kg in AMPH, 32.9 mg/kg in L-AMPH and >75 mg/kg in ABLC. In vitro antifungal activities againstCandida albicans, C. parapsilosis, C. tropicalis, C. glabrata, andC. krusei were evaluated by the agar plate dilution method. The activities were unchanged againstC. albicans, but MICs increased more than four fold in 18 of the 20 strains other thanC. albicans in L-AMPH and in 9 of the 20 in ABLC. L-AMPH and ABLC were as efficacious as AMPH in the treatment of mice infected withC. albicans, and at a dose of 0.5 and 1.0 mg/kg of body weight, ABLC was more efficacious on survival. A ten-times larger dose (10 mg/kg) of L-AMPH and ABLC was administered to mice with 100% survival, suggesting improved tolerability as compared to amphotericin B.     

土曲霉致双外耳道曲霉病

目的报道1例发生在双外耳道的曲霉病。方法取双耳耵聍行真菌直接镜检,将耵聍接种到沙堡培养基培养,并对培养出的病原菌进行形态学鉴定和rDNA序列分析。结果耵聍真菌直接镜检阳性,耵聍在沙堡培养基25℃培养长出沙褐色菌落,28℃小培养后光镜及扫描电镜下见分生孢子头呈柱状,顶囊半球形,直径约10μm,小梗双层,两层小梗的长度无明显差别,平行紧密生长在顶囊的上2/3处。分生孢子呈球形,小而光滑。分生孢子梗壁光滑、透明。提取真菌总DNA用PCR方法扩增rDNA序列,测序后登录Gene Bank进行比对,该菌与土曲霉菌株ATCC1012 rDNA序列一致性达100%,鉴定为土曲霉。患者外用4%氟康唑注射液直接滴耳,2次/d,治疗1个月后痊愈。结论确诊1例双外耳道土曲霉病,局部应用氟康唑注射液治疗外耳道曲霉病有效。     

Determination of amphotericin B, liposomal amphotericin B, and amphotericin B colloidal dispersion in plasma by high-performance liquid chromatography

Amphotericin B is a potent polyene antifungal drug for intravenous treatment of severe infections. It is used as amphotericin B-deoxycholate and in order to reduce amphotericin B toxicity as lipid-formulated complex (liposomal or colloidal dispersion). A sensitive and specific analytical method is presented for the separation of lipid-complexed and plasma protein-bound amphotericin B in human heparinized plasma. This separation, which is required for pharmacokinetic studies, is achieved by solid-phase extraction (SPE) via Bond Elut C₁₈. The protein-bound amphotericin B has a higher affinity to the SPE material and is therefore retained, whereas the lipid-complexed amphotericin B is eluted in the first step. The recovery of the SPE was >75% for high concentrations and >95% for low concentrations. Quantification was performed by reversed-phase HPLC using a LiChrosorb-RP-8 column, UV detection (λ=405 nm) and a mixture of acetonitrile–methanol–0.010 M NaH₂PO₄ buffer (41:10:49, v/v) as mobile phase. The retention time for amphotericin B under the given conditions was 6.7 min. The calibration curves were found to be linear (r≥0.999) in two different ranges (5.0–0.50 μg/ml and 0.50–0.005 μg/ml). Intra- and inter-day precision and accuracy fulfilled the international requirements. No interference from other drugs (typical broad medication for intensive-care patients) or common plasma components was detected in >400 samples analyzed.     

A macrokinetic modelling of the biosynthesis of lovastatin by Aspergillus terreus

In this work a simple kinetic model to describe the biosynthesis of lovastatin by Aspergillus terreus ATCC 20542 was proposed. Several series of experiments were conducted at different media compositions. The concentrations of C- and N-sources were changed over a wide range and so were the initial biomass concentrations. From these runs the relationships ruling the substrates uptake, biomass and product formation were learnt. Lovastatin biosynthesis appeared to be partly growth associated. The inhibitive effect of organic nitrogen on lovastatin biosynthesis was found and lactose appeared to be an important limiting substrate in the formation of lovastatin. The parameters of the model were evaluated on the basis of the kinetic data obtained in the separate experiments made in triplicate at two chosen media compositions. Other results obtained at different media compositions were independent of the ones mentioned above and used for the verification of the model. The validity of the model was also examined for the lactose-fed fed-batch run. Finally, a sensitivity analysis of the model parameters was performed. The formulated model, although relatively simplified, described the experimental data quite well and could be regarded as the background for further attempts to mathematically describe the process of lovastatin biosynthesis.     

Determination of the minimal inhibitory concentration of Amphotericin B and Miconazole for 21 strains of Aspergillus

The susceptibility of 21 strains ofAspergillus (11 ofA. fumigatus, 8 ofA. niger, and 2 ofA. flavus) isolated from human pathologic specimens to Amphotericin B and Miconazole has been comparatively studied. Determination of the minimal inhibitory concentration of both drugs in a liquid medium showed a noticeably variability for the different strains. The values obtained for Amphotericin B varied between 0.25g/ml (2 strains) and 1.25g/ml (5 strains) after 48 hours, and between 1.25g/ml (1 strain) and 50g/ml (1 strain) after 10 days. For Miconazole the results varied between 0.1g/ml (1 strain) and 25g/ml (1 strain) after 48 hours of incubation, and between 0.5g/ml (5 strains) and > 100g/ml after 10 days. The variability of these results indicates the usefulness of carrying ourin vitro sensitivity studies whenever it is possible.     

Purification and biochemical characterization of feruloyl esterases from Aspergillus terreus MTCC 11096

Aspergillus terreus MTCC 11096 isolated from the soils of agricultural fields cultivating sweet sorghum was previously identified to produce feruloyl esterases (FAEs). The enzymes responsible for feruloyl esterase activity were purified to homogeneity and named as AtFAE‐1, AtFAE‐2, and AtFAE‐3. The enzymes were monomeric having molecular masses of 74, 23 and 36 kDa, respectively. Active protein bands were identified by a developed pH‐dependent zymogram on native PAGE. The three enzymes exhibited variation in pH tolerance ranging between pH 5–8 and thermostability of up to 55°C. Inhibition studies revealed that the serine residue was essential for feruloyl esterase activity; moreover aspartyl and glutamyl residues are not totally involved at the active site. Metal ions such as Ca²⁺, K⁺, and Mg²⁺ stabilized the enzyme activity for all three FAEs. Kinetic data indicated that all three enzymes showed catalytic efficiencies (k_cat/K_m) against different synthesized alkyl and aryl esters indicating their broad substrate specificity. The peptide mass fingerprinting by MALDI/TOF‐MS analysis and enzyme affinity toward methoxy and hydroxy substituents on the benzene ring revealed that the AtFAE‐1 belonged to type A while AtFAE‐2 and AtFAE‐3 were type C FAE. The FAEs could release 65 to 90% of ferulic acid from agrowaste substrates in the presence of xylanase. © 2013 American Institute of Chemical Engineers Biotechnol. Prog., 29:924–932, 2013     

稻瘟净（Blasticidin S）脱氨酶基因的克隆

从一株抗稻瘟净（ＢＳ）的Ａｓｐｅｒｇｉｌｌｕｓ ｔｅｒｒｅｕｓ菌中克隆到一个ｂｌａｓｔｉｅｉｄｉｎＳ脱氨酶基因,命名为ｂｓｒＡＳ。ＤＮＡ序列分析表明ｂｓｒＡＳ不含内含子。编码区长３９０ｂｐ,编码１３０个氨基酸。将ｂｓｒＡＳ转化到稻瘟菌中,能使受体菌表达出ＢＳ脱氨酶的活性,从而产生抗药性。该基因可作为抗药标记基因使用,建立稻瘟菌的基因转化系统。