Relationship between acute toxicity in mice and polymorphic forms of polyene antibiotics

Efficacy of Liposomal Nystatin in a Rabbit Model of Cryptococcal Meningitis

Cryptococcal meningitis (CM) causes significant global morbidity and mortality. Current therapeutic strategies rely on deoxycholated or liposomal forms of the polyene amphotericin B. Nystatin is also a polyene with broad-spectrum antimicrobial activity. Treatment with systemic nystatin has been limited by toxicity, which is a consistent challenge with polyene therapeutics. One mechanism to improve the toxicity is usage of a liposomal form of the active agent. Previous data from a murine candidemia model indicated that liposomal nystatin may be an effective antifungal drug formulation. Since the rabbit model of CM is a highly predictive preclinical system for evaluating antifungal therapeutics, we tested the effectiveness of two doses of daily liposomal nystatin, 3 and 8 mg/kg in the rabbit model of CM. Treatment with liposomal nystatin in this model did not reduce the fungal burden in the cerebrospinal fluid. A subsequent clinical trial also did not find activity in a human population. These data indicate that liposomal nystatin in the current form and at the tested dosages is not an effective therapy for CM. The data provide further evidence for the predictive power of the rabbit model of CM as a vital preclinical system for testing novel antifungal therapeutics for CM.

New nystatin polymeric complexes and their in vitro antifungal evaluation in a model study with Fusarium oxysporum

Six water-soluble nystatin-polyvilnylpyrrolidone complexes with respective MW of 10 kDa (NC1), 25 kDa (NC2), 30 kDa (NC3), 40 kda (NC4), 90 kDa (NC5), 360 kDa (NC6) were synthesized. The activity of the complexes was compared with that of nystatin against growth and spore germination of Fusarium oxysporum f.sp. radiciscucumerinum. The ED50 value (effective dose) of free nystatin in aqueous solution on growth inhibition on solid medium was determined at 35.7 ppm. The ED50 of the complexes NC3, NC4, NC5, and NC6 ranged from 2.2 to 4 times lower than that of nystatin. The NC6 complex exhibited the highest activity, followed by NC5, NC4, and NC3. The activities of NC1 and NC2 were about 3 and 1.7 times higher than nystatin respectively in the same in vitro model. The complexes NC6. NC1 and NC4 were 25.4, 13.6 and 6.9 times more active respectively than nystatin against spore germination of E oxysporum. The activity of the nystatin complexes was dependent on the molecular weight of the polymeric carrier.

Protection by tetracyclines against ion transport disruption caused by nystatin in human airway epithelial cells

Polyene antifungal antibiotics like nystatin form monovalent cation pores on the plasma membrane that perturb the intracellular electrolyte milieu, resulting in cell damage. In the present study, we investigated the effects of tetracyclines (minocycline and tetracycline) on ion transporters disrupted by nystatin in cultured human airway Calu-3 cells. Apical application of nystatin (50 microM) on a monolayer of the cells stimulated Na(+)-K(+) pump activity as estimated by ouabain (1 mM)-sensitive short-circuit current (I(sc)). The nystatin-potentiated I(sc) was inhibited by minocycline (IC(50) = 25 microM) or tetracycline (IC(50) = 150 microM) applied only from the apical (nystatin-treated) side. Nystatin increased monolayer conductance that was reversed by the application of tetracyclines. In contrast, ouabain potentiated the nystatin-induced change in the conductance. Further, Na(+)-glucose transport affected by nystatin was also normalized by tetracyclines from the nystatin-treated side of the membrane. These data suggest that tetracyclines may lower the cell permeability potentiated by nystatin, protecting cells against damage.

Methods for the recovery and purification of polyene antifungals

Despite the development of newer antifungal drugs, the polyene antifungals continue to be the most potent broad-spectrum fungicides available for clinical use. The incidence and severity of fungal infections are on the rise, underscoring the need for new and more effective antifungal drugs. Thus, the search for new polyene antifungals is ongoing. The limited solubility, polymorphic character, and inherent chemical instability of these compounds make their economical recovery and purification from mass culture challenging problems in biotechnology. This article provides a comprehensive review of the methods that have been developed for the recovery and purification of amphotericin B and nystatin, the two most important polyenes currently in clinical use.

Polyene antibiotics: relative degrees of in vitro cytotoxicity and potential effects on tubule phospholipid and ceramide content

Polyene antibiotic administration is limited by dose-dependent nephrotoxicity. The latter is believed to be mediated by polyene anchoring to plasma membrane cholesterol, resulting in pore formation, abnormal ion/solute flux, adenosine triphosphate (ATP) declines, and, ultimately, a loss of tubule viability. The relative nephrotoxicity of these agents and their liposomal preparations has remained poorly defined. Thus, freshly isolated mouse proximal tubules or cultured human proximal tubule (HK-2) cells were exposed to either nystatin, amphotericin B, or three different polyene liposomal preparations (Nyotran, AmBisome, or Abelcet; 4 to 64 microg/mL). The impact of these agents on (1) plasma membrane injury (sodium-driven ATP consumption, assessed by ATP-adenosine diphosphate [ADP] ratios); (2) cellular susceptibility to superimposed injury (chemical hypoxia or ferrous ammonium sulfate-mediated oxidative stress; assessed by lactate dehydrogenase release); and (3) membrane cholesterol, phospholipid, and ceramide expression was assessed. Amphotericin B was more cytotoxic than nystatin (approximately 25% to 50% greater ATP-ADP ratio declines). Most of this toxicity could be eliminated by polyene liposomal formulation. Nevertheless, the liposomal polyenes still fully sensitized tubule cells to superimposed chemical hypoxic (antimycin/deoxyglucose), but not oxidant, attack. Nystatin and amphotericin B caused acute increments in tubule sphingomyelin-phosphatidylcholine ratios and ceramide content (indicating an impact on the plasma membrane extending beyond the classic view of pore formation with ion flux). In conclusion, (1) nystatin is seemingly less cytotoxic than amphotericin B (in contrast to the prevailing clinical view); (2) liposomal formulation markedly decreases this cytotoxicity; (3) despite this reduced toxicity, liposomal polyenes are still able to render tubule cells more vulnerable to selected forms of superimposed injury; and (4) acute alterations in plasma membrane phospholipid and ceramide expression are previously unrecognized consequences and potential mediators of polyene-mediated tubular cell attack.

Effect of aggregation on the kinetics of autoxidation of the polyene antibiotic amphotericin B

We have previously studied the autoxidation of the polyene antibiotic amphotericin B (AB). In this paper we describe the dependence of the kinetics of autoxidation on the aggregation state of the antibiotic. Autoxidation, which is involved in drug inactivation and has been suggested to play a role in the mechanism of drug action, was assessed through the reaction of formed radicals with the spin label Tempol (2,2,6,6-tetramethyl-4-hydroxy-N-oxylpiperidine) by following the loss of the electron spin resonance signal, as previously described, and by oxygen consumption. Two types of AB (I and II) were used, the former being obtained by further purification of the latter. The kinetics of autoxidation were compared for aggregates formed by the antibiotic. Differences in aggregation state for both type I and type II AB were observed between monomeric, borax-complexed, and preparations in water containing variable proportions of dimethyl sulfoxide (DMSO) by optical absorption and circular dichroism (CD) spectra. On the other hand, although the suspensions of type I and type II AB in water-10% DMSO did not differ in their optical properties, they could be distinguished by quasielastic light scattering experiments, type II yielding smaller aggregates. It is proposed that the lack of difference in optical and CD spectra are due to the similarity of the microenvironments in both aggregates. In contrast, the borax complex of both type I and type II AB yielded similar optical and CD spectra and quasielastic light scattering behavior, indicating that complexation led to similar aggregates.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization and time dependence of amphotericin B: deoxycholate aggregation by quasielastic light scattering

Quasielastic light scattering measurements of amphotericin B (AB):deoxycholate (DOC) preparations provided information about particle size and aggregation as a function of concentration. The data allowed the time dependence of the aggregation to be followed and indicated that the initial rates of the change in average equivalent hydrodynamic diameter increased with decreasing concentration. The results extend the model proposed by Lamy-Freund and co-workers, which describes AB:DOC systems as consisting of AB:DOC mixed aggregates co-existing with pure DOC micelles. Although the AB:DOC aggregates are unstable at all concentrations studied, the rate of aggregation increases by three orders of magnitude as the concentration is reduced from 20 mM (DOC concentration) to the concentration region of DOC micellization. These results are in agreement with the different distribution of AB and DOC in the body of experimental animals, and may be of relevance for the understanding of the serious toxic effects of AB.

Polydispersity of aggregates formed by the polyene antibiotic amphotericin B and deoxycholate. A spin label study

The amphotericin B-deoxycholate (AB-DOC) system (1:2, mole basis) was studied with regard to its organizational properties making use of spin label ESR spectra. The spectra of a fatty acid spin label intercalated in AB-DOC preparations revealed two components, one strongly (S) and one weakly (W) immobilized. Spectral subtractions indicated that S corresponds to label in mixed AB-DOC aggregates while W is due to label in deoxycholate micelles. This situation, coexistence of different aggregates, is similar to that found in systems consisting of bile salts and phospholipids. The DOC/AB mole ratio in the mixed aggregate is highest when pure DOC micelles are present. Dilution leads to disappearance of the latter and to continuous loss of DOC from AB-DOC accompanied by an increase in size and decrease in solubility of the aggregates, as verified by filtration and centrifugation experiments. The results indicate that AB-DOC systems are polydisperse. Since amphotericin B preparations having different organizational properties display different toxic and therapeutic effect, the study of amphotericin B aggregates should help in understanding these phenomena at a molecular level.

Is Fleming's lysozyme an analgesic agent? Experiments on mice

1. Antinociceptive activity of hen egg white lysozyme (Fleming's lysozyme) was determined against abdominal contractions provoked by irritants injected intraperitoneally into mice. Carrageenan (2 mg) (CA) injected with arachidonic acid (15 micrograms) (AA) or prostaglandins PGE1 or PGF2 alpha (0.04 ng), brewer's yeast (10 mg), caolin (10 mg), mepartricin (80 U) and phenylquinone (50 micrograms) were used as irritants. 2. Lysozyme was active at 400-800 mg/kg i.v. against CA + AA, CA + PG, brewer's yeast and caolin nociceptive stimulation. The compound was more effective against CA + AA than against CA + PG. Acetylsalicylic acid at 50-100-200 mg/kg p.o. was equally active against CA + AA and CA + PG. 3. Lysozyme was inactive in the tail pinch and hot plate tests that mainly detect central analgesics. 4. The results are discussed in relation to the claim advanced years ago that lysozyme is an effective analgesic agent in humans. The compound was found active against herpes zoster or cancer pain but did not find use despite the favourable reports presented. 5. The experimental results obtained on laboratory animals do not contradict the conclusions drawn after the clinical use of the compound.

Is Fleming's lysozyme an analgesic agent? An experimental reappraisal of clinical data

Hen egg white lysozyme (Fleming's lysozyme) was tested for antinociceptive activity in rats against foot hyperalgesia provoked by a subplantar injection of a number of irritants: arachidonic acid, brewer's yeast, carrageenan, kaolin, mepartricin and rabbit anti-rat serum (Randall-Selitto method). The compound was active when given p.o., i.m. or i.v. (100-200-400 mg/kg) as well as when injected locally in the foot pad concurrently with the irritant (1-2-4 mg/rat). Lysozyme decreased the sensitivity of the inflamed paw to the nociceptive stimulation, left unmodified the sensitivity of the normal paw and did not reduce the oedema of the inflamed paw. It differed in its activity from steroidal and non-steroidal anti-inflammatory drugs and from central analgesics that were used as standard reference drugs. Its activity was not shared by hen egg white and ovalbumin. Contrary to dextran, lysozyme i.p. did not induce anaphylactoid reactions. Lysozyme did not provoke tolerance and did not interfere with the antinociceptive activity of morphine. The results are in agreement with clinical data published years ago. Lysozyme was claimed to be an active agent against herpes zoster and cancer pain.