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Contains fulltext : 220654.pdf (Publisher’s version ) (Open Access) In this prospective study, we examined the pharmacokinetics of 1 and 2 mg/kg liposomal amphotericin B in 16 morbidly obese individuals (104-177 kg). Body size had no effect on clearance. We recommend a fixed dose in patients ≥100 kg (ie, 300 or 500 mg rather than the current dose of 3 and 5 mg/kg, respectively). Clinical Trials Registration NCT02320604.

Candida species are the 4th leading cause of nosocomial infections in the US affecting both men and women. Since males of many species can be more susceptible to infections than females, we investigated whether male mice were more susceptible to systemic Candida albicans (C. albicans) infection and if sex hormones were responsible for sex-dependent susceptibility to this infection. Non-gonadectomized or gonadectomized mice were supplemented with sustained release 5α-dihydrotestosterone (5αDHT) or 17-β-estradiol (E2) using subcutaneous pellet implantation. Mice were challenged intravenously with 5 × 105C. albicans/mouse seven days after pellet implantation and monitored for survival and weight change. We observed that male mice were more susceptible to systemic C. albicans infection than female mice while gonadectomized male mice were as resistant to the C. albicans infection as female mice. 5αDHT supplementation of gonadectomized female or male mice increased their susceptibility to the yeast infection while E2 supplementation of gonadectomized male mice did not increase their resistance to the infection. Overall, our results strongly suggest that testosterone plays an important role in decreasing resistance to systemic C. albicans infection., Immunology; Microbiology; Pharmaceutical science; Molecular biology; Pathophysiology; Candida albicans; Sex hormones; Gonadectomized mice.

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Background Due to ethical and budgetary concerns associated with the use of vertebrate animals in research, interest in alternative models has increased over the past several decades. In the present study, we developed a Candida albicans quantitative infection model in Caenorhabditis elegans, a nonparasitic invertebrate nematode, to test the antifungal effects of liposomal amphotericin B (L-AmB). Methods To establish a lethal C. albicans infection, larval Stage 4 worms [n = 30/group (gp)] were fed various doses of yeast (2.5 × 102–2.5 × 105 cells/gp) for 4 hours at 20°C or 30°C. The infection was evaluated by monitoring worms for mortality and determining fungal burden in worm homogenates by plating for colony forming units every 24 hours for 4 days post-challenge. To examine the worm’s ability to ingest L-AmB and to determine drug toxicity, uninfected worms were fed L-AmB (6.3–25 μg/gp) for 4 hours at 30°C, and drug toxicity evaluated by survival with drug concentrations determined by bioassay of worm homogenates. The lack of toxicity allowed us to evaluate L-AmB activity in worms challenged for 4 hours at 30°C with 2.5 × 105 yeast cells/gp and then treated with L-AmB (0.5–25 ug/gp) for 4 hours at 30°C, with survival rate and fungal burden to assess L-AmB treatment. Results Calbicans infection was established in worms challenged with all yeast doses, with optimum infection observed with 2.5 × 105 yeast cells/gp at 30°C (13% survival in-infected worms vs. 87% in uninfected worms). We observed that uninfected worms could take up L-AmB at doses of 6.3–25 μg/gp and yet was not toxic for the worms (93–95% survival). In worms exposed to yeast and treated with L-AmB, complete clearance of infection was achieved with the higher doses (6.3–25 μg/gp), while lower doses (1.6–3.1 μg/gp) significantly reduced the fungal burden (P ≤ 0.05). Infected worms, not treated with L-AmB had only 10% survival, while L-AmB improved survival in a dose-dependent manner giving 40% survival for 0.5 μg L-AmBi/gp and 100% survival for doses of 6.3 μg/gp and higher. Conclusion By using fungal burden as a readout of efficacy, along with survival, we have established a quantitative, reproducible, flexible method for examining the activity of L-AmB in C. elegans which could be expanded for use in evaluating other antifungal drugs and different pathogenic fungi. Disclosures All authors: No reported disclosures.

Delta-9-tetrahydrocannabinol (Δ9-THC), the psychoactive component of marijuana, is known to suppress the immune responses to bacterial, viral and protozoan infections, but its effects on fungal infections have not been studied. Therefore, we investigated the effects of chronic Δ9-THC treatment on mouse resistance to systemic Candida albicans (C. albicans) infection. To determine the outcome of chronic Δ9-THC treatment on primary, acute systemic candidiasis, c57BL/6 mice were given vehicle or Δ9-THC (16 mg/kg) in vehicle on days 1-4, 8-11 and 15-18. On day 19, mice were infected with 5×10(5) C. albicans. We also determined the effect of chronic Δ9-THC (4-64 mg/kg) treatment on mice infected with a non-lethal dose of 7.5×10(4) C. albicans on day 2, followed by a higher challenge with 5×10(5) C. albicans on day 19. Mouse resistance to the infection was assessed by survival and tissue fungal load. Serum cytokine levels were determine to evaluate the immune responses. In the acute infection, chronic Δ9-THC treatment had no effect on mouse survival or tissue fungal load when compared to vehicle treated mice. However, Δ9-THC significantly suppressed IL-12p70 and IL-12p40 as well as marginally suppressed IL-17 versus vehicle treated mice. In comparison, when mice were given a secondary yeast infection, Δ9-THC significantly decreased survival, increased tissue fungal burden and suppressed serum IFN-γ and IL-12p40 levels compared to vehicle treated mice. The data showed that chronic Δ9-THC treatment decreased the efficacy of the memory immune response to candida infection, which correlated with a decrease in IFN-γ that was only observed after the secondary candida challenge.

Monotherapy and combination therapy were compared using optimal doses of liposomal amphotericin B, micafungin, or caspofungin in Aspergillus fumigatus pulmonary and disseminated infections. Mice were challenged intravenously (2.8 × 10 4 to 5.7 × 10 4 conidia) or intranasally (5.8 × 10 7 conidia) with A. fumigatus . Drugs (5, 10, or 15 mg/kg of body weight) were given for 3 or 6 days as single, concomitant, or sequential therapy (i.e., days 1 to 3 and then days 4 to 6). Mice were monitored for survival, and tissues were assayed for fungal burden and drug concentrations. Treatments starting 24 h postchallenge significantly prolonged survival in disseminated aspergillosis ( P < 0.002), but only liposomal amphotericin B treatments or treatments beginning with liposomal amphotericin B increased survival to 100% in the pulmonary aspergillosis model. Fungi in kidneys and spleens (disseminated) and lungs (pulmonary) were significantly decreased ( P ≤ 0.04) by liposomal amphotericin B, liposomal amphotericin B plus echinocandin, or liposomal amphotericin B prior to echinocandin. In the disseminated infection, liposomal amphotericin B and micafungin (10 or 15 mg/kg) had similar kidney drug levels, while in the spleen, 5 and 15 mg/kg liposomal amphotericin B gave higher drug levels than micafungin ( P < 0.02). In the pulmonary infection, drug levels in lungs and spleen with 5-mg/kg dosing were significantly higher with liposomal amphotericin B than with caspofungin ( P ≤ 0.002). In summary, treatment of A. fumigatus infections with liposomal amphotericin B plus echinocandin or liposomal amphotericin B prior to echinocandin was as effective as liposomal amphotericin B alone, and a greater decrease in the fungal burden with liposomal amphotericin B supports using liposomal amphotericin B prior to echinocandin.

AmBisome is a liposomal formulation of amphotericin B that has broad-spectrum antifungal activity and greatly reduced toxicity compared to the parent drug. In this study, amphotericin B deoxycholate (Fungizone) (1 mg/kg) and AmBisome (1 to 20 mg/kg) were tested as single-dose prophylactic agents in both immunocompetent and immunosuppressed C57BL/6 mice challenged with either Candida albicans or Histoplasma capsulatum . Prophylactic efficacy was based on survival and fungal burden in the target organ (kidneys or spleen). At 9 to 10 days after histoplasma challenge, 80 to 90% of both immunocompetent and immunosuppressed mice in the control and Fungizone groups had died. All AmBisome-treated mice survived, although in the AmBisome groups given 1 mg/kg, the mice became moribund by day 10 to 12. No spleen CFU were detected in the histoplasma-challenged mice given 10 or 20 mg of AmBisome per kg. By 23 to 24 days after histoplasma challenge, fungal growth and/or death had occurred in all immunosuppressed mice except for four mice receiving 20 mg of AmBisome per kg. There were still no detectable fungi in the spleens of immunocompetent mice given 10 or 20 mg of AmBisome per kg. In the C. albicans experiment at 7 days postchallenge, all animals in both untreated and treated groups were alive with culture-positive kidneys. The kidney fungal burdens in AmBisome groups given 5 to 20 mg/kg were at least 1 log unit lower than those in the Fungizone group and significantly lower than those in the untreated control group ( P < 0.05). There was a trend toward decreasing fungal growth in the kidneys as the dose of AmBisome was increased. In conclusion, these results show that a single high dose of AmBisome (5 to 20 mg/kg) had prophylactic efficacy in immunocompetent and immunosuppressed murine H. capsulatum and C. albicans models.