Efficacy of a poly-aggregated formulation of amphotericin B in treating systemic sporotrichosis caused by Sporothrix brasiliensis

Med Mycol. 2018 Apr 1;56(3):288-296. doi: 10.1093/mmy/myx040.

Abstract

In severe cases of sporotrichosis, it is recommended to use amphotericin B deoxycholate (D-AMB) or its lipid formulations and/or in association with itraconazole (ITC). Our aim was to evaluate the antifungal efficacy of a poly-aggregated amphotericin B (P-AMB), a nonlipid formulation, compared with D-AMB on systemic sporotrichosis caused by Sporothrix brasiliensis. In vitro assays showed that Sporothrix schenckii sensu stricto and S. brasiliensis yeast clinical isolates were susceptible to low concentrations of P-AMB and D-AMB. Although P-AMB presented a higher minimal inhibitory concentration (MIC) compared to D-AMB, its cytotoxic effect on renal cells and erythrocytes was lower. For the in vivo assays, male BALB/c mice were intravenously infected with S. brasiliensis yeasts, and P-AMB or D-AMB was administered 3 days post-infection. The efficacy of five therapeutic regimens was tested: intravenous monotherapy with P-AMB or D-AMB, intravenous pulsed-therapy with P-AMB or D-AMB, and intravenous therapy with P-AMB, followed by oral ITC. These treatments increased murine survival and controlled the fungal burden in the liver, spleen, lungs, and kidneys. However, only D-AMB monotherapy or the pulsed-therapies with D-AMB or P-AMB led to 100% survival of the mice 45 days post-infection; only pulsed administration of D-AMB was able to control the fungal load in all organs 45 days post-infection. Accordingly, the histopathological findings showed reductions in the fungal burden and inflammatory reactions in these treatment regimens. Together, our results suggest that the P-AMB formulation could be considered as an alternative drug to D-AMB for treating disseminated sporotrichosis.

Publication types

  • Comparative Study

MeSH terms

  • Amphotericin B / administration & dosage
  • Amphotericin B / chemistry
  • Amphotericin B / pharmacology
  • Amphotericin B / therapeutic use*
  • Animals
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / chemistry
  • Antifungal Agents / pharmacology
  • Antifungal Agents / therapeutic use*
  • Cell Survival / drug effects
  • Colony Count, Microbial
  • Deoxycholic Acid / administration & dosage
  • Deoxycholic Acid / chemistry
  • Deoxycholic Acid / pharmacology
  • Deoxycholic Acid / therapeutic use
  • Disease Models, Animal
  • Drug Combinations
  • Male
  • Mice
  • Mice, Inbred BALB C
  • Microbial Sensitivity Tests
  • Sporothrix / drug effects
  • Sporothrix / growth & development
  • Sporotrichosis / drug therapy*
  • Sporotrichosis / mortality
  • Survival Rate

Substances

  • Antifungal Agents
  • Drug Combinations
  • Deoxycholic Acid
  • Amphotericin B
  • amphotericin B, deoxycholate drug combination