Complexes of Amphotericin B and Cholesteryl Sulfate

Abstract

To improve the clinical utility of amphotericin B, we have developed a novel formulation of amphotericin B, Amphocil® (also known as Amphotericin B Colloidal Dispersion, or ABCD). Amphocil is a uniform disc-shaped complex of amphotericin B and sodium cholesteryl sulfate in a molar ratio of 1:1. The complex has a mean hydrodynamic diameter of approximately 115 nm and is thermodynamically stable. In an extensive series of pharmacodynamic, pharmacokinetic and toxicology studies, Amphocil was found to be less toxic than conventional amphotericin B (Fungizone®), providing a four- to five-fold improvement in safety, while remaining effective in treating a variety of fungal infections. Plasma pharmacokinetics and tissue disposition of amphotericin B differ in several respects after administration of Amphocil and conventional amphotericin B, due to a rapid uptake of Amphocil by liver. Animals receiving Amphocil demonstrated reduced peak levels in plasma, prolonged residence time and lowered levels of amphotericin B in most tissues including the kidney, the major target organ for toxicity, compared with animals receiving conventional amphotericin B.

In healthy male subjects receiving a single dose of Amphocil, ranging from 0.25-1.5 mg/kg, mild to moderate dose-dependent acute side effects typically seen with conventional amphotericin B were observed but there was no sign of renal or hepatic toxicities. In two dose-escalating studies, multiple daily doses of Amphocil up to 4.5 mg/kg were well tolerated in patients who had previously failed to tolerate or respond to conventional amphotericin B. In addition, complete clearance of fungal infection was observed with the Amphocil therapy. Thus, Amphocil is a safe and effective agent for treating systemic mycoses. Toleration and efficacy of higher doses of Amphocil in patients with life-threatening mycoses is currently being evaluated.