New treatments for tinea capitis

Exploring treatment and antifungal resistance in an outbreak of tinea caused by Microsporum audouinii

BACKGROUND

Microsporum audouinii has resurged recently. Infections with the dermatophyte are difficult to treat, which raises the question if we treat M. audouinii infections with the most effective antifungal (AF) agent.

OBJECTIVES

The aims of this study was to investigate an outbreak of tinea capitis (TC) in Denmark, address the challenges in outbreak management and to conduct two reviews regarding previous outbreaks and minimal inhibitory concentration (MIC).

METHODS

We used Wood's light, culture, direct microscopy, and PCR for screening and antifungal susceptibility testing (AFST) for treatment optimization. We performed two reviews to explore M. audouinii outbreaks and MIC values using broth microdilution method.

RESULTS

Of 73 screened individuals, 10 had confirmed M. audouinii infections. Clinical resistance to griseofulvin was observed in 4 (66%) cases. While previous outbreaks showed high griseofulvin efficacy, our study favoured terbinafine, fluconazole and itraconazole in our hard-to-treat cases. AFST guided the choice of AF. Through the literature search, we identified five M. audouinii outbreaks, where differences in management included the use of Wood's light and prophylactic topical AF therapy. Terbinafine MIC values from the literature ranged from 0.002 to 0.125 mg/L.

CONCLUSION

Use of Wood's light and preventive measurements were important for limiting infection. The literature lacked MIC data for griseofulvin against M. audouinii, but indicated sensitivity for terbinafine. The clinical efficacy for M. audouinii treatment was contradictory favouring both terbinafine and griseofulvin. AFST could have a key role in the treatment of difficult cases, but lack of standardisation of AFST and MIC breakpoints limits its usefulness.

OSMAC Strategy Integrated with Molecular Networking for Accessing Griseofulvin Derivatives from Endophytic Fungi of Moquiniastrum polymorphum (Asteraceae)

Three endophytic fungi isolated from Moquiniastrum polymorphum (Less.) G. Sancho (Asteraceae) were cultivated using the one strain many compounds (OSMAC) strategy to evaluate the production of griseofulvin derivatives. Extracts obtained were analyzed by HPLC-MS/MS and the chromatographic and spectrometric data used to elaborate a feature-based molecular network (FBMN) through the GNPS platform. This approach allowed the observation of differences such as medium-specific and strain-specific production of griseofulvin derivatives and variations of cytotoxic activity in most extracts. To evaluate the efficiency of the OSMAC approach allied with FBMN analysis in the prospection of compounds of biotechnological interest, griseofulvin and 7-dechlorogriseofulvin were isolated, and the relative concentrations were estimated in all culture media using HPLC-UV, allowing for the inference of the best strain-medium combinations to maximize its production. Malt extract-peptone broth and Wickerham broth media produced the highest concentrations of both secondary metabolites.

Tinea blepharitis and follicular conjunctivitis in a child

Trichophyton tonsurans is a fungal species that frequently causes tinea capitis (ringworm), a skin infection found in children. We report a case of unilateral blepharoconjunctivitis due to tinea capitis in a previously healthy 8-year-old boy. Although no case of blepharitis or follicular conjunctivitis due to T. tonsurans has been previously reported, the findings are consistent with other rare causes of ringworm blepharitis. Emerging or chronic fungal blepharitis should be considered in the differential diagnosis of unilateral follicular conjunctivitis.

Anticancer fungal natural products: Mechanisms of action and biosynthesis

Many fungal metabolites show promising anticancer properties both in vitro and in animal models, and some synthetic analogs of those metabolites have progressed into clinical trials. However, currently, there are still no fungi-derived agents approved as anticancer drugs. Two potential reasons could be envisioned: 1) lacking a clear understanding of their anticancer mechanism of action, 2) unable to supply enough materials to support the preclinical and clinic developments. In this review, we will summarize recent efforts on elucidating the anticancer mechanisms and biosynthetic pathways of several promising anticancer fungal natural products.

Dermatophytes and dermatophytosis in the eastern and southern parts of Africa

Dermatophytosis is currently a disease of global importance and a public health burden. It is caused by dermatophytes, which attack and grow on dead animal keratin. Dermatophytes belong to three genera, namely, Epidermophyton, Microsporum, and Trichophyton. The predominant clinical forms and causative agents vary from one region of the world to another. Poor socioeconomic status, high population densities, and poor sanitary conditions are some of the factors responsible for the high prevalence of dermatophytosis in many developing countries, which include countries in southern and eastern Africa, the focus of this review. To the best of our knowledge, there is currently no review article on published findings on dermatophytosis in the eastern and southern parts of Africa. This information will be of interest to the medical and research community since the world has become a global village. This review covers published research findings in eastern and southern regions of Africa until this date. The countries covered in the current review include Kenya, Ethiopia, Tanzania, South Africa, Mozambique, Madagascar, Malawi, Rwanda, Burundi, Uganda, Zambia, Zimbabwe, and Botswana. T. violaceum is the most common human etiological agent in all the countries under review with prevalence ranging from 56.7% to 95%, except for Madagascar (M. langeronii, reclassified as M. audouinii), Uganda (M. gypseum) and Malawi (M. audouinii). Tinea capitis was the most clinical type, followed by tinea corporis. Etiological agents of animal dermatophytoses were variable in the countries where they were reported. Major risk factors for dermatophytoses are age, climatic, and socioeconomic factors.

Eyelid tinea with blepharitis due to Microsporum canis

CASE REPORT

The case is presented of a 3-year-old girl with an erythematous oedematous plaque associated with blepharitis, and chalazion in the right upper eyelid. She received empirical treatment with topical corticosteroids, as well as an antifungal and antibiotic, without observing any improvement. The culture of the eyelid scrape showed Microsporum canis. Therefore, she was prescribed oral terbinafine and topical miconazole-betamethasone, achieving a clinical and microbiological recovery.

DISCUSSION

Eyelid infection due to dermatophytes is uncommon, but it should be considered among the diagnostic suspicions of palpebral skin lesions. The microbiological study is a key factor for its diagnosis and appropriate treatment.

Exploring the binding sites and binding mechanism for hydrotrope encapsulated griseofulvin drug on γ-tubulin protein

The protein γ-tubulin plays an important role in centrosomal clustering and this makes it an attractive therapeutic target for treating cancers. Griseofulvin, an antifungal drug, has recently been used to inhibit proliferation of various types of cancer cells. It can also affect the microtubule dynamics by targeting the γ-tubulin protein. So far, the binding pockets of γ-tubulin protein are not properly identified and the exact mechanism by which the drug binds to it is an area of intense speculation and research. The aim of the present study is to investigate the binding mechanism and binding affinity of griseofulvin on γ-tubulin protein using classical molecular dynamics simulations. Since the drug griseofulvin is sparingly soluble in water, here we also present a promising approach for formulating and achieving delivery of hydrophobic griseofulvin drug via hydrotrope sodium cumene sulfonate (SCS) cluster. We observe that the binding pockets of γ-tubulin protein are mainly formed by the H8, H9 helices and S7, S8, S14 strands and the hydrophobic interactions between the drug and γ-tubulin protein drive the binding process. The release of the drug griseofulvin from the SCS cluster is confirmed by the coordination number analysis. We also find hydrotrope-induced alteration of the binding sites of γ-tubulin protein and the weakening of the drug-protein interactions.

Kerion Type of Tinea Capitis Treated with Double Pulse Dose Terbinafine

Objective: Tinea capitis is a common dermatophyte infection affecting hair and skin which always requires systemic treatment to get a clinical and mycologic cure, preventing relapse, and infection spread. Griseofulvin has been the antifungal therapy of choice for tinea capitis, but it often requires higher doses and a longer duration than recommended. Thus, effective alternative antifungal with good oral tolerability and shorter course of treatment are therefore required. The objective of this report is to evaluate the effectiveness of double pulse dose terbinafine for tinea capitis alternative therapy.Method: A case of kerion type of tinea capitis in a two-year-old girl was reported. Diagnosis was established based on clinical manifestations of alopecia, presented as erythematous macule with pustules, hemorrhagic crusts, and scales on the scalp, accompanied with occipital lymphadenopathy. Fungal culture showed growth of Microsporum canis (M. canis) colonies. Patient was treated with doubled pulse dose terbinafine 125 mg/day and 2% ketoconazole shampoo for two months.Result: Clinical improvements were found on 35th day of follow up, while mycologic cure was achieved on 60th day of follow up. Tolerability was excellent and no side effects observed.Conclusion: Double pulse dose terbinafine is effective for kerion type of tinea capitis. Key words: double pulse dose, kerion, M. canis, terbinafine, tinea capitis

Tinea capitis: a retrospective epidemiological comparative study

BACKGROUND

Currently, a wide spectrum of retrospective studies regarding the incidence of TC among children and adults are available in the world literature, but none of them are comparative, aiming to distinguish etiological diversity depending on the different geographic areas.

OBJECTIVE

This study aimed to investigate the epidemiology of TC in Plovdiv, Bulgaria and Thessaloniki, and Greece, and to compare the results and predominant etiological agents using retrospective comparative analysis for an 11-year time period.

MATERIALS AND METHODS

The subjects included were selected from archives of the Mycological Laboratory of the University Dermatologic Clinic, University Hospital "St. George" Plovdiv, Bulgaria, and the Mycological Laboratory of the First Dermatology Department of Aristotle University Thessaloniki, Greece, by retrospective analysis of data from an 11-year time period (2004-2014). A total count of 374 children aged 0-18, with confirmed diagnosis of TC via direct mycological examination and culture were included (128 children from Plovdiv, Bulgaria, and 246 children from Thessaloniki, Greece). Samples were plated on Sabouraud agar, followed by species identification of the isolated colonies.

RESULTS

Our results demonstrate that the incidence of TC in the region of Bulgaria and Thessaloniki for the investigated period was lower than for the previously reported period. In Plovdiv, Bulgaria, it was 1.20 ± 0.09 % (n = 172 from a total count of 14,278 cases of mycoses), as the disease accounts for 23.10 ± 1.79 % of all mycological infections among the pediatric population and 0.36 ± 0.05 % (n = 49 from a total count of 13,724) among the adults patients in Plovdiv, Bulgaria. The incidence of the disease during the period 2004-2014 in Thessaloniki was 2.49 ± 0.15 % (n = 253 cases of TC from a total count of 10,168 mycoses), as it accounts for approximately 27.06 ± 1.47 % of mycological infections among the pediatric population in Thessaloniki, Greece, and 0.08 ± 0.03 % (n = 7 from a total count of 9259) of the population of adult patients with mycoses. Our study confirmed the presumption that M. canis is the leader among the causative agents in TC in children in both of the included countries, but its presence in the etiology of disease in adult patients was very low and nonsignificant. We categorically identified dominance of the female gender among the children with TC in Plovdiv, Bulgaria; while in Thessaloniki, Greece, the gender distribution had an almost equal ratio of males to females.

CONCLUSION

Our results suggest that the gender predisposition depends also on the investigated geographic region and the time of the study, rather than only on the causative pathogen and age.

Effects of griseofulvin on apoptosis through caspase-3- and caspase-9-dependent pathways in K562 leukemia cells: An in vitro study

BACKGROUND

Griseofulvin, an oral nontoxic antifungal drug, has been reported to possess anticancer effect in human cancer cells, while the mechanisms are not completely understood.

OBJECTIVE

The aim of this study was to investigate the cytotoxic effect of griseofulvin on K562 cells and to understand its underlying molecular pathways.

METHODS

K562 cells were treated with griseofulvin at different concentrations for 24 hours, and the inhibition effect of griseofulvin on K562 cell proliferation was assessed by tetrazolium salt colorimetric assay. Apoptosis was assessed by examining nuclear morphology and quantifying phosphatidylserine externalization, and alterations in cellular morphology were analyzed by laser scanning confocal microscopy for fluorescent analysis. Flow cytometry was used in the analysis of cell cycle, mitochondrial membrane potential, and caspase pathways.

RESULTS

Griseofulvin could inhibit the growth of K562 cells in a dose-dependent manner with a mean (SD) inhibitory concentration of 50% value of 15.38 (1.35) μg/mL compared with untreated controls. Apoptosis was induced in K562 cells (38.35% [2.73%]; P < 0.01) by griseofulvin with the observation of both an increase in phosphatidylserine level and accumulation of chromatin nucleation in griseofulvintreated cells. In addition, cell-cycle analysis using propidium iodide staining suggested a significant G2/M accumulation (increase from mean 17.64% [4.49%] to 48.29 [1.89%]; P < 0.01) as a result of griseofulvin treatment. Flow cytometry analysis found that griseofulvin treatment was associated with the depolarization of the mitochondrial membrane in K562 cells. Furthermore, increased activities of caspase-3 by 22.15-fold (P < 0.01) and caspase-9 by 16.73-fold (P < 0.01) were observed in K562 cells after griseofulvin treatment compared with the untreated control; a decrease of caspase-8 activity was also observed, but the change was not statistically significant.

CONCLUSIONS

These findings suggest that griseofulvin inhibited growth of K562 cells and induced cell apoptosis through cell-cycle arrest and mitochondrial membrane potential decrease as well as caspase-3 and -9 activation. Further testing is needed to evaluate the potential of griseofulvin as a candidate in the chemotherapy of hematologic malignancies.

Solvates of the antifungal drug griseofulvin: structural, thermochemical and conformational analysis

Four solvates of an antifungal drug, griseofulvin (GF), were discovered. All the solvates were characterized by differential scanning calorimetry, thermogravimetric analysis, and their crystal structures were determined by single-crystal X-ray diffraction. The solvents that form the solvates are acetonitrile, nitromethane and nitroethane (2:1 and 1:1). It was found that all the solvates lose the solvent molecules from the crystal lattice between 343 and 383 K, and that the melting point of the desolvated materials matched the melting point of the solvent-free GF (493 K). The conformation of the GF molecule in solvent-free form was found to be significantly different from the conformations found in the solvates. Solution stability studies revealed that the GF–acetonitrile solvate transforms to GF and that GF–nitroethane (1:1) solvate transforms to GF–nitroethane (2:1) solvate. On the other hand, GF–nitromethane and GF–nitroethane (2:1) solvates were found to be stable in solution. Our results highlight the importance of the co-crystallization technique in the pharmaceutical drug development; it not only expands the solid form diversity but also creates new avenues for unraveling novel solvates.

Microsporum canis infection in three familial cases with tinea capitis and tinea corporis

We report a familial infection caused by Microsporum canis. The first two patients were a 30-year-old female and her son, a 5-year-old boy, who came in contact with a pet dog at a farm house. The boy then suffered from hair loss for 3 months. There were circular and patchy alopecia with diffuse scaling on his scalp. Meanwhile, his mother also developed patchy erythema and scaling on her face. Several weeks later, the boy's sister, a 4-year-old girl, was noted to have inconspicuous scaly plaques in the center of her scalp. The development of tinea capitis in the two children and tinea corporis in their mother were diagnosed based on the positive KOH examination. Morphologic characteristics and sequencing of the internal transcribed spacers 1 and 2, amplified from primary culture isolates, confirmed that their infections were caused by the zoophilic M. canis. Repetitive sequence-based molecular typing using the DiversiLab system secreted enzymatic activity analysis, and antifungal susceptibility indicated that these isolates might share the same source. The boy and girl were cured by the treatment with oral itraconazole and topical naftifine-ketoconazole cream after washing the hair with 2 % ketoconazole shampoo, and their mother was successfully treated by terbinafine orally in combination with topical application of naftifine-ketoconazole cream.

Prophylactic ketoconazole shampoo for tinea capitis in a high-risk pediatric population

OBJECTIVES

Although topical agents for the treatment of tinea capitis decrease viable fungal elements and reduce shedding, their use as a prophylactic agent has not been investigated. This study evaluated the effectiveness of a prophylactic ketoconazole shampoo (Nizoral 2%) protocol to reduce the number of clinically evident tinea capitis infections in a high-risk African American, urban population.

METHODS

We conducted a retrospective analysis of a ketoconazole prophylaxis protocol that was implemented at an urban pediatric clinic for medically fragile children. Patients at high risk for tinea capitis received twice-weekly ketoconazole shampoo. The primary outcome of the study was a reduction in the number of documented tinea capitis infections between the 12-month preprotocol and 12-month postprotocol periods. A secondary outcome included the evaluation of predisposing risk factors for acquiring tinea infections.

RESULTS

Ninety-seven patients, with a mean age of 8.06 years, were included. Most patients (78%) were African American. There were a total of 13 tinea capitis infections during the 12-month preprotocol period. During the 12-month postprotocol period, 41 infections were documented: 37 (90.2%) in the prophylaxis group and 4 (9.8%) in the nonprophylaxis group. The average numbers of per-patient infections in the postprotocol period were 0.79 and 0.08 in the prophylaxis and nonprophylaxis groups, respectively. Initiation of prophylaxis did not reduce tinea capitis infections (p=NS). Previous history of infection and a high level of care were significant predictors of infections (p<0.05).

CONCLUSIONS

Improved hygiene, adherence to prescribed treatment regimens, and prevention of recurrent environmental exposure to surviving fomites should be stressed in high-risk patients and supersede the need for an antifungal (ketoconazole shampoo) prophylaxis protocol.

Naturally occurring and synthetic polyyne glycosides

Polyyne glycosides are a class of natural products that have been found in terrestrial plants, fungi, and marine algae. Many display interesting and potentially useful biological activities, which in some cases has initiated synthetic efforts toward their formation. This review provides a comprehensive report of polyyne glycosides isolated from natural sources, as well as the synthesis of these molecules and their analogues.

Identification of griseofulvin as an inhibitor of centrosomal clustering in a phenotype-based screen

A major drawback of cancer chemotherapy is the lack of tumor-specific targets which would allow for the selective eradication of malignant cells without affecting healthy tissues. In contrast with normal cells, most tumor cells contain multiple centrosomes, associated with the formation of multipolar mitotic spindles and chromosome segregation defects. Many tumor cells regain mitotic stability after clonal selection by the coalescence of multiple centrosomes into two functional spindle poles. To overcome the limitations of current cancer treatments, we have developed a cell-based screening strategy to identify small molecules that inhibit centrosomal clustering and thus force tumor cells with supernumerary centrosomes to undergo multipolar mitoses, and subsequently, apoptosis. Using a chemotaxonomic selection of fungi from a large culture collection, a relatively small but diverse natural product extract library was generated. Screening of this compound library led to the identification of griseofulvin, which induced multipolar spindles by inhibition of centrosome coalescence, mitotic arrest, and subsequent cell death in tumor cell lines but not in diploid fibroblasts and keratinocytes with a normal centrosome content. The inhibition of centrosome clustering by griseofulvin was not restricted to mitotic cells but did occur during interphase as well. Whereas the formation of multipolar spindles was dynein-independent, depolymerization of interphase microtubules seemed to be mechanistically involved in centrosomal declustering. In summary, by taking advantage of the tumor-specific phenotype of centrosomal clustering, we have developed a screening strategy that might lead to the identification of drugs which selectively target tumor cells and spare healthy tissues.

A randomized controlled trial assessing the efficacy of fluconazole in the treatment of pediatric tinea capitis

BACKGROUND

Griseofulvin is considered first-line therapy for tinea capitis, and the Physician's Desk Reference currently recommends 11 mg/kg per day microsize formulation for use in children. Diverse selective pressures have resulted in waning clinical efficacy of griseofulvin, such that higher doses and longer courses of treatment are required. These events have prompted the search for therapeutic alternatives. Fluconazole is one such treatment option, and a variety of studies using this drug have shown promise in the treatment of pediatric tinea capitis.

OBJECTIVE

We sought to assess the efficacy, safety, and optimal dose and duration of fluconazole therapy compared with standard-dose griseofulvin (11 mg/kg per day microsize formulation) in the treatment of pediatric tinea capitis.

METHODS

This randomized, multicenter, third-party-blind, 3-arm trial was designed as a superiority study to identify a therapeutically superior agent/regimen from the 3 treatment arms: (1) fluconazole 6 mg/kg per day for 3 weeks followed by 3 weeks of placebo, (2) fluconazole 6 mg/kg per day for 6 weeks, and (3) griseofulvin 11 mg/kg per day for 6 weeks. Efficacy variables included mycological, clinical, and combined outcomes. The primary efficacy variable was the combined outcome of the modified intent-to-treat population at week 6. Patient safety was assessed throughout the study. Statistical analysis of the efficacy variables was conducted by means of the Cochran-Mantel-Haenszel test.

RESULTS

At the end of treatment, mycological cures were present in 44.5%, 49.6%, and 52.2% of the fluconazole 3-week, fluconazole 6-week, and griseofulvin groups, respectively. Analysis of the primary efficacy variable failed to identify any superior agent, and differences between the combined outcomes of the fluconazole 6-week and griseofulvin groups at week 6 were not significant (P = .32). Regarding mycological, clinical, and combined outcomes, no significant differences between the fluconazole 6-week and griseofulvin groups were detected at any time point in the study. No new safety concerns were raised by this trial, and the incidence of treatment-related adverse events noted in this study is concordant with previous reports. Patients in the fluconazole arms of the study fared similarly. At the end of the trial, the difference in mycological cures between the fluconazole arms was only 7.5%, and increases in the incidence of certain treatment-related adverse events were observed in the fluconazole 6-week group.

LIMITATIONS

Adjunctive topical therapies and the impact of infected contacts were not assessed in this trial.

CONCLUSION

Systemic therapy with fluconazole 6 mg/kg per day and standard-dose griseofulvin produces comparable but low mycological and clinical cure rates. The limited efficacy of standard-dose griseofulvin and the lack of consensus regarding dose and duration of griseofulvin therapy in tinea capitis emphasize the need for controlled trials to identify optimal treatment parameters. Although the efficacy of fluconazole is no better than that of standard-dose griseofulvin, it may still be useful in select patients with a contraindication or intolerance to high-dose griseofulvin. The outcomes observed in this trial highlight the need to more clearly define the relative importance of adjunctive topical therapies and the evaluation and treatment of infected contacts as factors affecting cure rates.

In vitro Activities of Antifungal Drugs against Clinical Isolates of Trichophyton tonsurans

To determine drug susceptibility of Trichophyton tonsurans endemic in Japan, in vitro MICs of antifungal drugs against a total of 10 clinical isolates of T. tonsurans collected from dermatophytosis patients were measured by the agar dilution method and the broth microdilution method. The agar dilution method was not appropriate as the growth of T. tonsurans on the agar medium was too slow to determine drug activity, while the broth microdilution method was thought to be an appropriate method for this study. The MIC90 values determined by the broth microdilution method for terbinafine, itraconazole, miconazole and ketoconazole were 0.013, 0.1, 0.8 and 0.4 microg/ml, respectively. Meanwhile, the MIC90 values of lanoconazole and luliconazole, known to be antifungal drugs potent against dermatomycosis, were 0.00078 and 0.00039 microg/ ml, respectively. The drug susceptibility of these T. tonsurans isolates to the aforementioned antifungal drugs was found to be on a similar level with that of T. mentagrophytes and T. rubrum, major causative agents of dermatomycosis. The results also demonstrated the strong antifungal activity of lanoconazole and luliconazole against T. tonsurans.

Tinea capitis: epidemiologia e ecologia dos casos observados entre 1983 e 2003 na Faculdade de Medicina de Botucatu, Estado de São Paulo, Brasil

FUNDAMENTOS: Tinea capitis é importante infecção fúngica de interesse dermatológico e pediátrico. No Brasil sua prevalência é desconhecida, e os agentes causais principais são o Trichophyton tonsurans nas regiões Norte-Nordeste e o Microsporum canis no Sul-Sudeste do país. Conhecimento sobre gênero e espécies mais prevalentes tem importância sanitária e terapêutica. OBJETIVOS: Identificar espécies de dermatófitos, causa de Tinea capitis, em serviço universitário que atende clientela do Sistema Único de Saúde, de procedência urbana e rural, no interior do Estado de São Paulo. MÉTODOS: Amostras de casos clínicos suspeitos de Tinea capitis, procedentes da área de abrangência da Faculdade de Medicina de Botucatu-Unesp, foram investigadas por exame direto e cultivo visando ao diagnóstico e isolamento do agente causal. RESULTADOS: De 1.055 suspeitas, 594 foram confirmadas por exame direto, em 364 (61,1%) isolou-se o agente: M. canis em 88,2%, seguindo-se T. tonsurans (4,7%), T. rubrum (3,3%), M. gypseum (1,9%), T. mentagrophytes (1,6%). O sexo masculino correspondeu a 55,7% dos casos, e a faixa etária entre 0-5 anos predominou com 62,6% (p < 0,05). CONCLUSÕES: A prevalência detectada do M. canis superou o esperado para a Região Sudeste do Brasil. A freqüência de 88,2% pode estar influenciada por pacientes procedentes da zona rural. Esse dado deve ser considerado quando de decisão terapêutica.

Kinetic suppression of microtubule dynamic instability by griseofulvin: implications for its possible use in the treatment of cancer

The antifungal drug griseofulvin inhibits mitosis strongly in fungal cells and weakly in mammalian cells by affecting mitotic spindle microtubule (MT) function. Griseofulvin also blocks cell-cycle progression at G(2)/M and induces apoptosis in human tumor cell lines. Despite extensive study, the mechanism by which the drug inhibits mitosis in human cells remains unclear. Here, we analyzed the ability of griseofulvin to inhibit cell proliferation and mitosis and to affect MT polymerization and organization in HeLa cells together with its ability to affect MT polymerization and dynamic instability in vitro. Griseofulvin inhibited cell-cycle progression at prometaphase/anaphase of mitosis in parallel with its ability to inhibit cell proliferation. At its mitotic IC(50) of 20 muM, spindles in blocked cells displayed nearly normal quantities of MTs and MT organization similar to spindles blocked by more powerful MT-targeted drugs. Similar to previously published data, we found that very high concentrations of griseofulvin (>100 microM) were required to inhibit MT polymerization in vitro. However, much lower drug concentrations (1-20 microM) strongly suppressed the dynamic instability behavior of the MTs. We suggest that the primary mechanism by which griseofulvin inhibits mitosis in human cells is by suppressing spindle MT dynamics in a manner qualitatively similar to that of much more powerful antimitotic drugs, including the vinca alkaloids and the taxanes. In view of griseofulvin's lack of significant toxicity in humans, we further suggest that it could be useful as an adjuvant in combination with more powerful drugs for the treatment of cancer.