1
|
Hargrove T, Lamb DC, Wawrzak Z, Hull M, Kelly SL, Guengerich FP, Lepesheva GI. Identification of Potent and Selective Inhibitors of Acanthamoeba: Structural Insights into Sterol 14α-Demethylase as a Key Drug Target. J Med Chem 2024; 67:7443-7457. [PMID: 38683753 PMCID: PMC11089504 DOI: 10.1021/acs.jmedchem.4c00303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/27/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
Acanthamoeba are free-living pathogenic protozoa that cause blinding keratitis, disseminated infection, and granulomatous amebic encephalitis, which is generally fatal. The development of efficient and safe drugs is a critical unmet need. Acanthamoeba sterol 14α-demethylase (CYP51) is an essential enzyme of the sterol biosynthetic pathway. Repurposing antifungal azoles for amoebic infections has been reported, but their inhibitory effects on Acanthamoeba CYP51 enzymatic activity have not been studied. Here, we report catalytic properties, inhibition, and structural characterization of CYP51 from Acanthamoeba castellanii. The enzyme displays a 100-fold substrate preference for obtusifoliol over lanosterol, supporting the plant-like cycloartenol-based pathway in the pathogen. The strongest inhibition was observed with voriconazole (1 h IC50 0.45 μM), VT1598 (0.25 μM), and VT1161 (0.20 μM). The crystal structures of A. castellanii CYP51 with bound VT1161 (2.24 Å) and without an inhibitor (1.95 Å), presented here, can be used in the development of azole-based scaffolds to achieve optimal amoebicidal effectiveness.
Collapse
Affiliation(s)
- Tatiana
Y. Hargrove
- Department
of Biochemistry, Vanderbilt University School
of Medicine, Nashville, Tennessee 37232, United States
| | - David C. Lamb
- Faculty
of Medicine, Health and Life Science, Swansea
University, Swansea SA2 8PP, U.K.
| | - Zdzislaw Wawrzak
- Synchrotron
Research Center, Life Science Collaborative Access Team, Northwestern University, Argonne, Illinois 60439, United States
| | - Marcus Hull
- Faculty
of Medicine, Health and Life Science, Swansea
University, Swansea SA2 8PP, U.K.
| | - Steven L. Kelly
- Faculty
of Medicine, Health and Life Science, Swansea
University, Swansea SA2 8PP, U.K.
| | - F. Peter Guengerich
- Department
of Biochemistry, Vanderbilt University School
of Medicine, Nashville, Tennessee 37232, United States
| | - Galina I. Lepesheva
- Department
of Biochemistry, Vanderbilt University School
of Medicine, Nashville, Tennessee 37232, United States
- Vanderbilt
Institute of Chemical Biology, Nashville, Tennessee 37232, United States
- Center
for Structural Biology, Vanderbilt University, Nashville, Tennessee 37232, United States
| |
Collapse
|
2
|
Vilares-Morgado R, Ferreira AM, Marques-Couto P, Madeira C, Moreira R, Torrão L, Neves-Cardoso P, Cunha AM, Rebelo S, Pinheiro-Costa J. Clinical outcomes and prognostic factors in Acanthamoeba keratitis. Cont Lens Anterior Eye 2024; 47:102119. [PMID: 38220498 DOI: 10.1016/j.clae.2023.102119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/23/2023] [Accepted: 12/31/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To report clinical findings and prognostic factors for visual and morphological outcomes in patients with Acanthamoeba keratitis (AK). METHODS Single-center, retrospective, longitudinal study of 51 cases of AK diagnosed by real-time polymerase chain reaction (RT-PCR) between March 2010 and October 2022. The primary outcome was the final best corrected visual acuity (BCVA). Poor visual outcome was defined as a final BCVA ≥ 1 logMAR unit, while good visual outcome was defined as a final BCVA < 1 logMAR unit. Eyes from these two groups were compared, regarding demographic and initial clinical variables, anti-Acanthamoeba treatment used, and complications of the disease. Early diagnosis was defined as ≤ 14 days from symptom onset to diagnostic confirmation and initiation of Acanthamoeba medical treatment. Multivariable logistic regression was used to determine predictors of poor visual outcome. RESULTS A total of 51 eyes from 46 patients diagnosed with AK, all contact lens (CL) wearers, were included in this study. Average follow-up was 39.0 ± 30.2 [total range 14-120] months. Thirty-one eyes (60.8 %) presented good visual outcome, with a lower baseline age (30.5 ± 9.0 vs. 42.3 ± 15.8; p = 0.020), better initial BCVA (0.8 ± 0.7 logMAR units vs. 1.3 ± 0.9 logMAR units; p = 0.047), higher rate of early diagnosis (45.2 % vs. 5.6 %; p = 0.004), and higher rate of therapeutic epithelial debridement (64.5 % vs. 10 %; p < 0.001). 20 eyes (39.2 %) presented poor visual outcome, with 12 eyes undergoing evisceration/enucleation (23.5 %). These 20 eyes presented a higher rate of complications (90 % vs. 61.3 %; p = 0.031). In multivariable analysis, early diagnosis of AK (OR 19.78; 95 % CI 2.07-189.11; p = 0.010) and therapeutic epithelial debridement (OR 19.02; 95 % CI 3.27-110.57; p = 0.001) were associated with a good visual outcome. CONCLUSIONS In the present study, poor visual outcome was present in 39 % of affected eyes. Early AK diagnosis (≤14 days from symptom onset) and therapeutic epithelial debridement were associated with good final visual outcome.
Collapse
Affiliation(s)
- Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Ana Margarida Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal
| | - Pedro Marques-Couto
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Neves-Cardoso
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Rebelo
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Molecular Biology Laboratory, Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitáro de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
3
|
Huang L, Suhler EB, Rosenberg C, Ta Kim D, Winthrop KL, Doan T, Lin P. Acanthamoeba-associated retinitis successfully treated with intravitreal and systemic antimicrobials. Am J Ophthalmol Case Rep 2023; 32:101902. [PMID: 37663996 PMCID: PMC10474359 DOI: 10.1016/j.ajoc.2023.101902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose To describe a case of unilateral Acanthamoeba-associated retinitis in the absence of concomitant corneal infection in an immunocompetent host without risk factors. Observations A 37-year-old woman presented with unilateral multifocal retinitis with minimal vitritis. Anterior segment was normal. Conventional diagnostics of bacterial, fungal, viral, Toxoplasma and Toxocara etiologies all returned negative. Empiric treatments were unsuccessful, including oral valacyclovir, oral fluconazole, as well as intravitreal injection of vancomycin and ceftazidime. Metagenomic deep sequencing (MDS) identified Acanthamoeba genomic fragments in the vitreous sample. Multiple intravitreal voriconazole injections were performed and achieved partial suppression of lesion growth. Subsequent dual therapy of oral voriconazole and trimethoprim-sulfamethoxazole led to resolution of the lesions and vision improvement without further injections. Conclusions and importance This is an unusual case of unilateral Acanthamoeba-associated retinitis without concomitant corneal infection, diagnosed via unbiased DNA and RNA deep sequencing, with other etiologies ruled out by conventional approaches. Treatment with systemic and intravitreal therapy led to a successful resolution of retinitis and vision improvement. Our case demonstrates the potential of MDS as an unbiased diagnostic tool for rare ocular pathogens and the therapeutic effect of oral voriconazole with trimethoprim-sulfamethoxazole for Acanthamoeba intraocular infection.
Collapse
Affiliation(s)
- Lingling Huang
- Casey Eye Institute, Oregon Health & Science University, 515 SW Campus Drive, Portland, OR, USA
| | - Eric B. Suhler
- Casey Eye Institute, Oregon Health & Science University, 515 SW Campus Drive, Portland, OR, USA
- Veterans Affairs Portland Health Care System, 3710 Southwest US Veterans Hospital Road, Portland, OR, USA
| | - Christopher Rosenberg
- Casey Eye Institute, Oregon Health & Science University, 515 SW Campus Drive, Portland, OR, USA
| | - David Ta Kim
- University of British Columbia, 2550 Willow Street, Vancouver, British Columbia, Canada
| | - Kevin L. Winthrop
- Division of Infectious Diseases, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California San Francisco, 490 Illinois Street, San Francisco, CA, USA
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University, 515 SW Campus Drive, Portland, OR, USA
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA
| |
Collapse
|
4
|
McCoy C, Patel S, Thulasi P. Update on the Management of Acanthamoeba Keratitis. Curr Ophthalmol Rep 2022. [DOI: 10.1007/s40135-022-00296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
5
|
Kaufman AR, Tu EY. Advances in the management of Acanthamoeba keratitis: A review of the literature and synthesized algorithmic approach. Ocul Surf 2022; 25:26-36. [DOI: 10.1016/j.jtos.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 01/01/2023]
|
6
|
Wang X, Jacobs DS. An Update on the Initial Treatment of Acanthamoeba Keratitis. Int Ophthalmol Clin 2022; 62:101-110. [PMID: 35325913 DOI: 10.1097/iio.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Iovieno A, Yeung SN. Comment on: 'A randomized masked pilot clinical trial to compare the efficacy of topical 1% voriconazole ophthalmic solution as monotherapy with combination therapy of topical 0.02% polyhexamethylene biguanide and 0.02% chlorhexidine in the treatment of Acanthamoeba keratitis'. Eye (Lond) 2022; 36:475-476. [PMID: 33514894 PMCID: PMC8807596 DOI: 10.1038/s41433-021-01400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/24/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- Alfonso Iovieno
- grid.17091.3e0000 0001 2288 9830Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC Canada
| | - Sonia N. Yeung
- grid.17091.3e0000 0001 2288 9830Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC Canada
| |
Collapse
|
8
|
Smith C, Ashraf N, Haghnegahdar M, Goins K, Newman JR. Acanthamoeba Keratitis: A Single-Institution Series of Four Cases With Literature Review. Cureus 2022; 14:e21112. [PMID: 35165570 PMCID: PMC8830394 DOI: 10.7759/cureus.21112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/05/2022] Open
|
9
|
Büchele MLC, Filippin-Monteiro FB, de Lima B, Camargo CDJ, Restrepo JAS, Souza LC, Creczynski-Pasa TB, Caumo KS. Super aggregated amphotericin B with a thermoreversible in situ gelling ophthalmic system for amoebic keratitis treatment. Acta Trop 2021; 224:106144. [PMID: 34562424 DOI: 10.1016/j.actatropica.2021.106144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/31/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
Acanthamoeba spp. are the causative agents of a sight-threatening infection of the cornea known as Acanthamoeba keratitis (AK). Amphotericin B - deoxycholate (AB) is used in the treatment of infectious keratitis, however, its topical administration has side effects as blepharitis, iritis, and painful instillation. In this context, the preheating of AB can decrease its toxicity by the formation of super aggregates (hAB). hAB associated with a thermoreversible in situ gelling ophthalmic system is a promising option due to the latter biocompatibility, low toxicity, and high residence time on the ocular surface. Our objective was to develop a topical ocular formulation of hAB for the treatment of AK. After heating at 70°C for 20 min, hAB was incorporated into a thermoreversible gelling system. The amebicidal activity of AB and hAB was evaluated against trophozoites and cysts of A. castellanii (ATCC 50492) and a regional clinical isolate (IC01). The results showed that the preheating of AB did not change the pharmacological action of the drug, with the amebicidal effect of AB and hAB under trophozoites and cysts of Acanthamoeba spp. The thermoreversible system remained stable, allowing the increase of drug retention time. For assessment of cytotoxicity, HUVEC (ATCC® CRL-1730) cells were challenged with AB and hAB for 48h. Cell viability was assessed, and hAB did not show cytotoxicity for HUVEC cells. As far as we know this was the first study that showed the preheated AB associated with a thermoreversible in situ gelling ophthalmic system as a promising system for topical ocular topical administration of hAB for AK therapy.
Collapse
Affiliation(s)
- Maria Luiza Carneiro Büchele
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Estudos de Protozoários Emergentes e Oportunistas. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Fabíola Branco Filippin-Monteiro
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Imunobiologia do Tecido Adiposo. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Barbara de Lima
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Imunobiologia do Tecido Adiposo. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Carolina de Jesus Camargo
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Estudos de Protozoários Emergentes e Oportunistas. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Jelver Alexander Sierra Restrepo
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Grupo de Estudos de Interações entre Micro e Macromoléculas, CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Liliete Canes Souza
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Imunobiologia do Tecido Adiposo. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Tania Beatriz Creczynski-Pasa
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Grupo de Estudos de Interações entre Micro e Macromoléculas, CEP: 88040-970, Florianópolis, Santa Catarina, Brazil
| | - Karin Silva Caumo
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Análises Clínicas, Laboratório de Estudos de Protozoários Emergentes e Oportunistas. CEP: 88040-970, Florianópolis, Santa Catarina, Brazil..
| |
Collapse
|
10
|
Shing B, Balen M, McKerrow JH, Debnath A. Acanthamoeba Keratitis: an update on amebicidal and cysticidal drug screening methodologies and potential treatment with azole drugs. Expert Rev Anti Infect Ther 2021; 19:1427-1441. [PMID: 33929276 PMCID: PMC8551003 DOI: 10.1080/14787210.2021.1924673] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/28/2021] [Indexed: 01/10/2023]
Abstract
Introduction: Acanthamoeba encompasses several species of free-living ameba encountered commonly throughout the environment. Unfortunately, these species of ameba can cause opportunistic infections that result in Acanthamoeba keratitis, granulomatous amebic encephalitis, and occasionally systemic infection.Areas covered: This review discusses relevant literature found through PubMed and Google scholar published as of January 2021. The review summarizes current common Acanthamoeba keratitis treatments, drug discovery methodologies available for screening potential anti-Acanthamoeba compounds, and the anti-Acanthamoeba activity of various azole antifungal agents.Expert opinion: While several biguanide and diamidine antimicrobial agents are available to clinicians to effectively treat Acanthamoeba keratitis, no singular treatment can effectively treat every Acanthamoeba keratitis case.Efforts to identify new anti-Acanthamoeba agents include trophozoite cell viability assays, which are amenable to high-throughput screening. Cysticidal assays remain largely manual and would benefit from further automation development. Additionally, the existing literature on the effectiveness of various azole antifungal agents for treating Acanthamoeba keratitis is incomplete or contradictory, suggesting the need for a systematic review of all azoles against different pathogenic Acanthamoeba strains.
Collapse
Affiliation(s)
- Brian Shing
- Biomedical Sciences Graduate Division, University of California San Diego, 9500 Gilman Drive, MC 0685, La Jolla, CA 92093-0756, USA
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, MC 0756, La Jolla, CA 92093-0756, USA
| | - Mina Balen
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, MC 0756, La Jolla, CA 92093-0756, USA
- Division of Biological Sciences, University of California San Diego, San Diego, 9500 Gilman Drive, MC 0346, La Jolla, CA 92093-0756, USA
| | - James H. McKerrow
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, MC 0756, La Jolla, CA 92093-0756, USA
| | - Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, MC 0756, La Jolla, CA 92093-0756, USA
| |
Collapse
|
11
|
Musayeva A, Riedl JC, Schuster AK, Wasielica-Poslednik J, Pfeiffer N, Gericke A. Topical Voriconazole as Supplemental Treatment for Acanthamoeba Keratitis. Cornea 2020; 39:986-90. [PMID: 32243421 DOI: 10.1097/ICO.0000000000002315] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Voriconazole was shown to inhibit ergosterol synthesis in various acanthamoeba species. The purpose of this study was to evaluate the clinical outcome of treatment with supplemental topical voriconazole in patients with acanthamoeba keratitis (AK). METHODS All patients who had been treated for AK with voriconazole 1% drops in conjunction with topical first-line antiacanthamoeba therapy composed of polyhexamethylene biguanide (PHMB) 0.02% and propamidine isethionate 0.1% (Brolene) between November 2014 and August 2017 at the Department of Ophthalmology, University Medical Center Mainz, were included. The main outcomes were treatment failure and recurrence rate. Secondary outcomes were visual acuity, need for keratoplasty, and presence of adverse reactions. RESULTS Twenty-eight eyes of 28 patients with AK, whose treatment had included topical voriconazole, were identified (12 men, 16 women, mean age: 41.7 ± 16.3 years), and 26 of them could be tracked for at least 3 months after cessation of therapy. Resolution of infection under therapy was seen in all eyes, and only one of 26 (3.85%) had a relapse after the therapy had been stopped. Best-corrected visual acuity improved during therapy. Keratoplasty because of central corneal scarring was scheduled in 5 of 26 patients (19.2%) after the pharmacological therapy had been stopped. Five of 26 patients (19.2%) reported on stinging or burning sensation after application of voriconazole 1% drops. CONCLUSIONS Topical voriconazole 1% combined with first-line therapy composed of polyhexamethylene biguanide 0.02% and propamidine isethionate 0.1% appears to be an effective option with minor side effects for the treatment of AK.
Collapse
|
12
|
Raghavan A, Nair AV, N K, Venkatapathy N, Rammohan R. Voriconazole in the successful management of a case of Acanthamoeba-Cladosporium keratitis. Am J Ophthalmol Case Rep 2021; 22:101107. [PMID: 33981917 PMCID: PMC8085662 DOI: 10.1016/j.ajoc.2021.101107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/02/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Acanthamoeba and fungal infections can be recalcitrant to therapy - more so when the deeper layers of the corneas are involved. We describe the diagnosis and successful management strategies employed in a case of deep keratitis due to co-infection with Acanthamoeba and Cladosporium sp. Observations Once the diagnosis of co-infection with both Acanthamoeba and Cladosporium was made, treatment was initiated with a combination of PHMB, chlorhexidine, natamycin, and voriconazole; to which the response was favorable. Signs of relapse with spread of the infection to the deeper plane and the presence of endothelial exudates were noted at 5 weeks. This was attributed to poor compliance. Though the response to re-initiation of therapy under direct supervision was once again favorable; it was only after the introduction of intrastromal voriconazole repeated at timely intervals that rapid and complete resolution was obtained. Conclusions Severe keratitis due to fungi or Acanthamoeba very often requires surgical intervention. Complete resolution with medical therapy was obtained only after the introduction of intrastromal voriconazole; thereby avoiding a therapeutic keratoplasty. The addition of voriconzole both topically and particularly intrastromally facilitated faster resolution as well as restricted the duration of therapy with more toxic drugs such as phmb and chlorhexidine.
Collapse
Affiliation(s)
- Anita Raghavan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Arjun Velayudhan Nair
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Kavitha N
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Narendran Venkatapathy
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| | - Ram Rammohan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, 641 014, India
| |
Collapse
|
13
|
Thulasi P, Saeed HN, Rapuano CJ, Hou JH, Appenheimer AB, Chodosh J, Kang JJ, Morrill AM, Vyas N, Zegans ME, Zuckerman R, Tu EY. Oral Miltefosine as Salvage Therapy for Refractory Acanthamoeba Keratitis. Am J Ophthalmol 2021; 223:75-82. [PMID: 33045218 DOI: 10.1016/j.ajo.2020.09.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To report a case series of patients with treatment-resistant Acanthamoeba keratitis (AK) using oral miltefosine, often as salvage therapy. DESIGN Descriptive, retrospective multicenter case series. METHODS We reviewed 15 patients with AK unresponsive to therapy who were subsequently given adjuvant systemic miltefosine between 2011 and 2017. The main outcome measures were resolution of infection, final visual acuity, tolerance of miltefosine, and clinical course of disease. RESULTS All patients were treated with biguanides and/or diamidines or azoles without resolution of disease before starting miltefosine. Eleven of 15 patients retained count fingers or better vision, and all were considered disease free at last follow-up. Eleven of 15 patients had worsening inflammation with miltefosine, with 10 of them improving with steroids. Six patients received multiple courses of miltefosine. Most tolerated oral miltefosine well, with mild gastrointestinal symptoms as the most common systemic side effect. CONCLUSIONS Oral miltefosine is a generally well-tolerated treatment adjuvant in patients with refractory AK. The clinician should be prepared for a steroid-responsive inflammatory response frequently encountered during the treatment course.
Collapse
|
14
|
List W, Glatz W, Riedl R, Mossboeck G, Steinwender G, Wedrich A. Evaluation of Acanthamoeba keratitis cases in a tertiary medical care centre over 21 years. Sci Rep 2021; 11:1036. [PMID: 33441799 DOI: 10.1038/s41598-020-80222-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/17/2020] [Indexed: 01/29/2023] Open
Abstract
To report on Acanthamoeba keratitis cases in a tertiary university eye-hospital in Graz, Austria, over a 21-year period. Retrospective study. Parameters included demographics, diagnostics, clinical courses, medical therapies, surgical interventions, secondary complications, and best spectacle-corrected visual acuity (BSCVA). Patient records for 44 eyes of 42 patients were analysed; 2 bilateral infections. Mean age at presentation was 31 ± 13 (16-65) years; contact lenses were used in 41 of 44 eyes (93.2%). Symptoms at initial presentation were mainly pain (41/43, 95.3%) and photophobia (16/43, 37.2%). Most frequent morphological findings were stromal infiltrates (30/44, 68.2%). Diagnosis was mainly confirmed by smears (40/42, 95.2%) and polymerase chain reaction (8/42, 19%). Antiamoebic treatment comprised biguanides and diamidines. Penetrating keratoplasty was performed in 10/44 (22.7%) eyes. Median time from symptom onset to initial visit was 2 (0-26) weeks; median follow-up was 30 (2-1008) weeks. BSCVA improved in 23/36 (63.9%) eyes, remained unchanged in 6/36 (16.7%) eyes and deteriorated in 7/36 (19.4%) eyes. Acanthamoeba keratitis predominantly occurs in young contact lens wearers. Diagnosis should be considered in patients with pain and stromal infiltrates. In the majority of cases, BSCVA can be improved. Early diagnosis and adequate treatment should be implemented to prevent complications.
Collapse
|
15
|
Walvekar S, Anwar A, Anwar A, Sridewi N, Khalid M, Yow YY, Khan NA. Anti-amoebic potential of azole scaffolds and nanoparticles against pathogenic Acanthamoeba. Acta Trop 2020; 211:105618. [PMID: 32628912 DOI: 10.1016/j.actatropica.2020.105618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022]
Abstract
Acanthamoeba spp. are free living amoeba (FLA) which are widely distributed in nature. They are opportunistic parasites and can cause severe infections to the eye, skin and central nervous system. The advances in drug discovery and modifications in the chemotherapeutic agents have shown little improvement in morbidity and mortality rates associated with Acanthamoeba infections. The mechanism-based process of drug discovery depends on the molecular drug targets present in the signaling pathways in the genome. Synthetic libraries provide a platform for broad spectrum of activities due to their desired structural modifications. Azoles, originally a class of synthetic anti-fungal drugs, disrupt the fungal cell membrane by inhibiting the biosynthesis of ergosterol through the inhibition of cytochrome P450 dependent 14α-lanosterol, a key step of the sterol pathway. Acanthamoeba and fungi share the presence of similar sterol intermediate, as ergosterol is also the major end-product in the sterol biosynthesis in Acanthamoeba. Sterols present in the eukaryotic cell membrane are one of the most essential lipids and exhibit important structural and signaling functions. Therefore, in this review we highlight the importance of specific targeting of ergosterol present in Acanthamoebic membrane by azole compounds for amoebicidal activity. Previously, azoles have also been repurposed to report antimicrobial, antiparasitic and antibacterial properties. Moreover, by loading the azoles into nanoparticles through advanced techniques in nanotechnology, such as physical encapsulation, adsorption, or chemical conjugation, the pharmacokinetics and therapeutic index of the drugs can be significantly improved. The current review proposes an important strategy to target Acanthamoeba using synthetic libraries of azoles and their conjugated nanoparticles for the first time.
Collapse
|
16
|
Bagga B, Sharma S, Gour RPS, Mohamed A, Joseph J, M Rathi V, Garg P. A randomized masked pilot clinical trial to compare the efficacy of topical 1% voriconazole ophthalmic solution as monotherapy with combination therapy of topical 0.02% polyhexamethylene biguanide and 0.02% chlorhexidine in the treatment of Acanthamoeba keratitis. Eye (Lond) 2020; 35:1326-1333. [PMID: 32719525 DOI: 10.1038/s41433-020-1109-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the efficacy of topical voriconazole 1% and the combination therapy of 0.02% polyhexamethylene biguanide (PHMB) and 0.02% chlorhexidine for the treatment of Acanthamoeba keratitis (AK). METHODS This is a prospective, pilot, double-masked randomized comparative study. Twenty-three eyes of 23 patients with microbiologically (smear and/or growth on culture) confirmed AK were randomized to group BG (PHMB 0.02% and chlorhexidine 0.02%) or group VZ (voriconazole 1%). Primary outcome measure was change in geometric mean (GM) of the corneal ulcer size at final visit. Secondary outcome measures were change in visual acuity. RESULTS Out of 71 patients with confirmed AK seen during study period, 23 patients were recruited and 18 patients completed minimum 2 weeks of treatment and further analyzed. Ten patients received BG, whereas eight received VZ. Median ulcer size measured as GM of infiltrate decreased from 5.7 mm (IQR, 5.3-6.5 mm) (p = 0.02) to 1 mm (IQR, 0-4.3 mm) in group BG and from 4.5 mm (IQR, 1.8-5.1 mm) (p < 0.05) to 0.7 mm (IQR, 0-1.6 mm) in VZ group. Median visual acuity improved from 1.79 (IQR, 1.48-2.78) to 1.10 (IQR, 0.48-1.79) in BG group (p = 0.02) and from 1.60 (IQR, 1.00-2.78) to 0.80 (IQR, 0.48-1.30) in VZ group (p = 0.18). CONCLUSION These outcomes suggest that topical VZ as a monotherapy in AK treatment is effective and comparable to BG combination therapy but needs trials with larger sample size and longer follow-up to provide conclusive evidence.
Collapse
Affiliation(s)
- Bhupesh Bagga
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India.
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, India
| | | | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Varsha M Rathi
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Prashant Garg
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
17
|
Anwar A, Yi YP, Fatima I, Khan KM, Siddiqui R, Khan NA, Anwar A. Antiamoebic activity of synthetic tetrazoles against Acanthamoeba castellanii belonging to T4 genotype and effects of conjugation with silver nanoparticles. Parasitol Res 2020; 119:1943-1954. [PMID: 32385711 DOI: 10.1007/s00436-020-06694-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/15/2020] [Indexed: 01/16/2023]
Abstract
Acanthamoeba causes diseases such as Acanthamoeba keratitis (AK) which leads to permanent blindness and granulomatous Acanthamoeba encephalitis (GAE) where there is formation of granulomas in the brain. Current treatments such as chlorhexidine, diamidines, and azoles either exhibit undesirable side effects or require immediate and prolonged treatment for the drug to be effective or prevent relapse. Previously, antifungal drugs amphotericin B, nystatin, and fluconazole-conjugated silver with nanoparticles have shown significantly increased activity against Acanthamoeba castellanii. In this study, two functionally diverse tetrazoles were synthesized, namely 5-(3-4-dimethoxyphenyl)-1H-tetrazole and 1-(3-methoxyphenyl)-5-phenoxy-1H-tetrazole, denoted by T1 and T2 respectively. These compounds were evaluated for anti-Acanthamoeba effects at different concentrations ranging from 5 to 50 μM. Furthermore, these compounds were conjugated with silver nanoparticles (AgNPs) to enhance their efficacy. Particle size analysis showed that T1-AgNPs and T2-AgNPs had an average size of 52 and 70 nm respectively. After the successful synthesis and characterization of tetrazoles and tetrazole-conjugated AgNPs, they were subjected to anti-Acanthamoeba studies. Amoebicidal assay showed that at concentration 10 μM and above, T2 showed promising antiamoebic activities between the two compounds while encystation and excystation assays reveal that both T1 and T2 have inhibited differentiation activity against Acanthamoeba castellanii. Conjugation of T1 and T2 to AgNP also increased efficacy of tetrazoles as anti-Acanthamoeba agents. This may be due to the increased bioavailability as AgNP allows better delivery of treatment compounds to A. castellanii. Human cell cytotoxicity assay revealed that tetrazoles and AgNPs are significantly less toxic towards human cells compared with chlorhexidine which is known to cause undesirable side effects. Cytopathogenicity assay also revealed that T2 conjugated with AgNPs significantly reduced cytopathogenicity of A. castellanii compared with T2 alone, suggesting that T2-conjugated AgNP is an effective and safe anti-Acanthamoeba agent. The use of a synthetic azole compound conjugated with AgNPs can be an alternative strategy for drug development against A. castellanii. However, mechanistic and in vivo studies are needed to explore further translational values.
Collapse
Affiliation(s)
- Areeba Anwar
- Department of Biological Sciences, School of Science and Technology, Sunway University, 47500, Subang Jaya, Selangor, Malaysia
| | - Yim Pei Yi
- Department of Biological Sciences, School of Science and Technology, Sunway University, 47500, Subang Jaya, Selangor, Malaysia
| | - Itrat Fatima
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Khalid Mohammed Khan
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan.,Department of Clinical Pharmacy, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Ruqaiyyah Siddiqui
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, Sharjah, 26666, United Arab Emirates
| | - Naveed Ahmed Khan
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, Sharjah, 26666, United Arab Emirates
| | - Ayaz Anwar
- Department of Biological Sciences, School of Science and Technology, Sunway University, 47500, Subang Jaya, Selangor, Malaysia.
| |
Collapse
|
18
|
Brunet K, Eestermans R, Rodier MH, Cateau E. In vitro activity of isavuconazole against three species of Acanthamoeba. J Fr Ophtalmol 2020; 43:330-333. [DOI: 10.1016/j.jfo.2019.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/25/2019] [Indexed: 10/24/2022]
|
19
|
Morgan SR, Pilia N, Hewitt M, Moses RL, Moseley R, Lewis PN, Morrison PW, Kelly SL, Parker JE, Whitaker D, Quantock AJ, Heard CM. Controlled in vitro delivery of voriconazole and diclofenac to the cornea using contact lenses for the treatment of Acanthamoeba keratitis. Int J Pharm 2020; 579:119102. [DOI: 10.1016/j.ijpharm.2020.119102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 11/28/2022]
|
20
|
Avdagic E, Chew HF, Veldman P, Tu EY, Jafri M, Doshi R, Boggild AK, Reidy JJ, Farooq AV. Resolution of Acanthamoeba Keratitis with Adjunctive Use of Oral Miltefosine. Ocul Immunol Inflamm 2019; 29:278-281. [PMID: 31829774 DOI: 10.1080/09273948.2019.1695853] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To report a series of cases demonstrating the resolution of Acanthamoeba keratitis (AK) with adjunctive use of oral miltefosine.Methods: Retrospective case series.Results: The first case was a 27-year-old female who presented with severe pain and photophobia. The diagnosis of AK was made with confocal microscopy, which revealed a significant burden of stromal cysts. After approximately 2 weeks of adjunctive oral miltefosine therapy, there was a severe inflammatory response within the cornea followed by quick resolution of the AK. The second case was a 31-year-old male in whom the diagnosis of AK was confirmed by culture and polymerase chain reaction. Adjunctive oral miltefosine was started 3 months after presentation, leading to a quick resolution.Conclusions: Oral miltefosine may have cysticidal properties and should be considered as adjunctive therapy for the treatment of AK, particularly in cases with a significant burden of cysts or in cases recalcitrant to other treatments.
Collapse
Affiliation(s)
- Ema Avdagic
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Hall F Chew
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Canada
| | - Peter Veldman
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Elmer Y Tu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mansab Jafri
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Rutvi Doshi
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Andrea K Boggild
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Tropical Disease Unit, Toronto General Hospital, Toronto, Canada.,Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada
| | - James J Reidy
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Asim V Farooq
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
21
|
Pascha J, Frings A, Walochnik J, Wissiak E, Dirisamer M, Daas L, Ardjomand N. Akanthamöbenendophthalmitis – Ein Fallbericht. Ophthalmologe 2020; 117:926-9. [DOI: 10.1007/s00347-019-01013-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Khan NA, Anwar A, Siddiqui R. Acanthamoeba Keratitis: Current Status and Urgent Research Priorities. Curr Med Chem 2019; 26:5711-5726. [DOI: 10.2174/0929867325666180510125633] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/10/2018] [Accepted: 05/01/2018] [Indexed: 12/13/2022]
Abstract
Background:First discovered in the early 1970s, Acanthamoeba keratitis has remained a major eye infection and presents a significant threat to the public health, especially in developing countries. The aim is to present a timely review of our current understanding of the advances made in this field in a comprehensible manner and includes novel concepts and provides clear directions for immediate research priorities.Methods:We undertook a search of bibliographic databases for peer-reviewed research literature and also summarized our published results in this field.Results:The present review focuses on novel diagnostic and therapeutic strategies in details which can provide access to management and treatment of Acanthamoeba keratitis. This coupled with the recently available genome sequence information together with high throughput genomics technology and innovative approaches should stimulate interest in the rational design of preventative and therapeutic measures. Current treatment of Acanthamoeba keratitis is problematic and often leads to infection recurrence. Better understanding of diagnosis, pathogenesis, pathophysiology and therapeutic regimens, would lead to novel strategies in treatment and prophylaxis.
Collapse
Affiliation(s)
- Naveed Ahmed Khan
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Ayaz Anwar
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Ruqaiyyah Siddiqui
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| |
Collapse
|
23
|
Vasantha Ruban V, Anbukkarasi M, Anand T, Thomas PA, Geraldine P. Oxidative stress in corneal tissue in experimental keratitis due to Aspergillus flavus: Effect of topical voriconazole therapy. Biocatalysis and Agricultural Biotechnology 2019. [DOI: 10.1016/j.bcab.2019.101323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
24
|
Talbott M, Cevallos V, Chen MC, Chin SA, Lalitha P, Seitzman GD, Lietman TM, Keenan JD. Synergy Testing of Antiamoebic Agents for Acanthamoeba: Antagonistic Effect of Voriconazole. Cornea 2019; 38:1309-1313. [DOI: 10.1097/ico.0000000000002055] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
|
26
|
Abstract
The efficiency of treatment of human infections with the unicellular eukaryotic pathogens such as fungi and protozoa remains deeply unsatisfactory. For example, the mortality rates from nosocomial fungemia in critically ill, immunosuppressed or post-cancer patients often exceed 50%. A set of six systemic clinical azoles [sterol 14α-demethylase (CYP51) inhibitors] represents the first-line antifungal treatment. All these drugs were discovered empirically, by monitoring their effects on fungal cell growth, though it had been proven that they kill fungal cells by blocking the biosynthesis of ergosterol in fungi at the stage of 14α-demethylation of the sterol nucleus. This review briefs the history of antifungal azoles, outlines the situation with the current clinical azole-based drugs, describes the attempts of their repurposing for treatment of human infections with the protozoan parasites that, similar to fungi, also produce endogenous sterols, and discusses the most recently acquired knowledge on the CYP51 structure/function and inhibition. It is our belief that this information should be helpful in shifting from the traditional phenotypic screening to the actual target-driven drug discovery paradigm, which will rationalize and substantially accelerate the development of new, more efficient and pathogen-oriented CYP51 inhibitors.
Collapse
Affiliation(s)
- Galina I. Lepesheva
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
| | - Laura Friggeri
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
| | - Michael R. Waterman
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
| |
Collapse
|
27
|
Abstract
Purpose The aim of this study was to evaluate the long-term outcomes of ethanol pretreatment in Acanthamoeba keratitis (AK). Patients and methods This single-center, retrospective, interventional study included 22 patients (24 eyes) who developed AK and underwent ethanol pretreatment between 2009 and 2015. Samples for smears, polymerase chain reaction, and culture for evidence of Acanthamoeba were collected. After ethanol pretreatment, the patients were treated with corneal epithelial debridement, topical 0.02% polyhexamethylene biguanide, and 0.1% propamidine isethionate. The primary outcomes were a clinically stable ocular surface, complete recovery from corneal infection, and acceptable corneal haze. The secondary outcome measure was improvement in best-corrected visual acuity. Complications and predictors of the visual outcome were also recorded. Results Ethanol pretreatment was successful in 20 (83.3%) of the 24 eyes, and no further optical keratoplasty was required. Four eyes required rescue therapeutic keratoplasty because of rapid progression of AK. Patients in whom ethanol pretreatment was successful achieved good final visual outcomes regardless of sex, age, or causative Acanthamoeba species. Patients with worse initial best-corrected visual acuity and rigid gas permeable lens-related AK had better improvement in vision. Conclusion Ethanol as a pretreatment for AK is safe and effective. Combined with corneal epithelial debridement, ethanol pretreatment may preclude the need for optical and therapeutic keratoplasty. This technique is suitable for all stages of AK presenting within 3 weeks of symptom onset and achieves favorable results especially in early AK.
Collapse
Affiliation(s)
- I-Huang Lin
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China,
| | - Sung-Huei Tseng
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China,
| | - Fu-Chin Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China,
| | - Yi-Hsun Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China, .,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China,
| |
Collapse
|
28
|
Gueudry J, Le Goff L, Compagnon P, Lefevre S, Colasse E, Aknine C, Duval F, François A, Razakandrainibe R, Ballet JJ, Muraine M, Favennec L. Evaluation of voriconazole anti-Acanthamoeba polyphaga in vitro activity, rat cornea penetration and efficacy against experimental rat Acanthamoeba keratitis. J Antimicrob Chemother 2018; 73:1895-1898. [DOI: 10.1093/jac/dky094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/26/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Julie Gueudry
- EA3800 ‘Protozooses Transmises par l'Alimentation’ – University of Rouen Normandy, Rouen, France
- Department of Ophthalmology – Charles Nicolle University Hospital, Rouen, France
| | - Laetitia Le Goff
- EA3800 ‘Protozooses Transmises par l'Alimentation’ – University of Rouen Normandy, Rouen, France
| | - Patricia Compagnon
- Department of Clinical Pharmacology – Charles Nicolle University Hospital, Rouen, France
| | - Sabine Lefevre
- Department of Ophthalmology – Charles Nicolle University Hospital, Rouen, France
| | - Elodie Colasse
- Department of Pathological Anatomy and Cytology – Charles Nicolle University Hospital, Rouen, France
| | - Camille Aknine
- EA3800 ‘Protozooses Transmises par l'Alimentation’ – University of Rouen Normandy, Rouen, France
| | - François Duval
- EA3800 ‘Protozooses Transmises par l'Alimentation’ – University of Rouen Normandy, Rouen, France
| | - Arnaud François
- EA3800 ‘Protozooses Transmises par l'Alimentation’ – University of Rouen Normandy, Rouen, France
- Department of Pathological Anatomy and Cytology – Charles Nicolle University Hospital, Rouen, France
| | - Romy Razakandrainibe
- EA3800 ‘Protozooses Transmises par l'Alimentation’ – University of Rouen Normandy, Rouen, France
| | - Jean Jacques Ballet
- EA3800 ‘Protozooses Transmises par l'Alimentation’ – University of Rouen Normandy, Rouen, France
| | - Marc Muraine
- Department of Ophthalmology – Charles Nicolle University Hospital, Rouen, France
| | - Loïc Favennec
- EA3800 ‘Protozooses Transmises par l'Alimentation’ – University of Rouen Normandy, Rouen, France
| |
Collapse
|
29
|
Juárez MM, Tártara LI, Cid AG, Real JP, Bermúdez JM, Rajal VB, Palma SD. Acanthamoeba in the eye, can the parasite hide even more? Latest developments on the disease. Cont Lens Anterior Eye 2017; 41:245-251. [PMID: 29273391 DOI: 10.1016/j.clae.2017.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 12/01/2022]
Abstract
Acanthamoeba spp. is a free living protozoan in the environment, but can cause serious diseases. Acanthamoeba keratitis (AK), a severe and painful eye infection, must be treated as soon as possible to prevent ulceration of the cornea, loss of visual acuity, and eventually blindness or enucleation. Although the disease affects principally contact lens (CLs) wearers, it is recognized nowadays as a cause of keratitis also in non-CLs wearers. Although the number of infections caused by these amoebae is low, AK is an emerging disease presenting an extended number of cases each year worldwide mostly due to the increasing use of CLs, but also to better diagnostic methods and awareness. There are two principal causes that lead to severe outcomes: misdiagnosis or late diagnosis of the causal agent, and lack of a fully effective therapy due to the existence of a highly resistant cyst stage of Acanthamoeba. Recent studies have reported different genotypes that have not been previously associated with this disease. In addition, Acanthamoeba can act as a reservoir for phylogenetically diverse microorganisms. In this regard, recently giant viruses called Pandoravirus have been found within genotypes producing keratitis. What potential risk this poses is not yet known. This review focuses on an overview of the present status and future prospects of this re-emerging pathology, including features of the parasite, epidemiology, clinical aspects, diagnosis, and treatment.
Collapse
Affiliation(s)
- M M Juárez
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina
| | - L I Tártara
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA, CONICET - Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba), Ciudad Universitaria, 5000, Córdoba, Argentina
| | - A G Cid
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina
| | - J P Real
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA, CONICET - Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba), Ciudad Universitaria, 5000, Córdoba, Argentina
| | - J M Bermúdez
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina
| | - V B Rajal
- Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina; Singapore Centre on Environmental Life Sciences Engineering (SCELSE), School of Biological Sciences, Nanyang Technological University, Singapore
| | - S D Palma
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA, CONICET - Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba), Ciudad Universitaria, 5000, Córdoba, Argentina.
| |
Collapse
|
30
|
Abstract
The purpose of the study is to describe epidemiology, clinical features, diagnosis, and treatment of Acanthamoeba keratitis (AK) with special focus on the disease in nonusers of contact lenses (CLs). This study was a perspective based on authors' experience and review of published literature. AK accounts for 2% of microbiology-proven cases of keratitis. Trauma and exposure to contaminated water are the main predisposing factors for the disease. Association with CLs is seen only in small fraction of cases. Contrary to classical description experience in India suggests that out of proportion pain, ring infiltrate, and radial keratoneuritis are seen in less than a third of cases. Majority of cases present with diffuse infiltrate, mimicking herpes simplex or fungal keratitis. The diagnosis can be confirmed by microscopic examination of corneal scraping material and culture on nonnutrient agar with an overlay of Escherichia coli. Confocal microscopy can help diagnosis in patients with deep infiltrate; however, experience with technique and interpretation of images influences its true value. Primary treatment of the infection is biguanides with or without diamidines. Most patients respond to medical treatment. Corticosteroids play an important role in the management and can be used when indicated after due consideration to established protocols. Surgery is rarely needed in patients where definitive management is initiated within 3 weeks of onset of symptoms. Lamellar keratoplasty has been shown to have good outcome in cases needing surgery. Since the clinical features of AK in nonusers of CL are different, it will be important for ophthalmologists to be aware of the scenario wherein to suspect this infection. Medical treatment is successful if the disease is diagnosed early and management is initiated soon.
Collapse
Affiliation(s)
- Prashant Garg
- Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Paavan Kalra
- Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
31
|
Ruban VV, Archana PT, Sundararajan M, Geraldine P, Thomas PA. Inflammation and oxidative stress in corneal tissue in experimental keratitis due to Fusarium solani: Amelioration following topical therapy with voriconazole and epigallocatechin gallate. Mycoses 2017; 61:159-171. [PMID: 29064157 DOI: 10.1111/myc.12718] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/15/2017] [Accepted: 10/17/2017] [Indexed: 01/14/2023]
Abstract
Combined antifungal and antioxidant therapy may help to reduce oxidative stress in fungal keratitis. Experimental Fusarium solani keratitis was induced by application of F. solani conidia to scarified cornea (right eye) of 16 rabbits (another four rabbits were negative controls [Group I]). Five days later, F. solani-infected animals began receiving hourly topical saline alone (Group II), voriconazole (10 mg/mL) alone (Group III), epigallocatechin gallate (EGCG, 10 mg/mL) alone (Group IV) or voriconazole and EGCG (Group V). Twenty days post-inoculation, corneal lesions were graded. After animal sacrifice, excised corneas underwent histopathological and microbiological investigations. Corneal tissue levels/activities of interleukin 1 beta (IL-1β) and tumour necrosis factor alpha (TNF-α) gene mRNA transcripts, matrix metalloproteinase (MMP) 2 and 9 proteins, malondialdehyde (MDA) and reduced glutathione (GSH), and superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx), were also measured. Clinical and histopathological scores (severity of corneal lesions; [P < .05]) and mean levels (P < .05) of IL-1β and TNF-α mRNA transcripts, MMP 2, MMP 9 and MDA were Group II > Groups IV and III > Groups V and I. Mean SOD, CAT, GPx and GSH levels (P < .05) were Group II < Groups IV and III < Groups V and I. Topical voriconazole with EGCG apparently reduces inflammation in experimental F. solani keratitis, as manifested by improved clinical, histological, microbiological and molecular parameters.
Collapse
Affiliation(s)
- Vasanthakumar V Ruban
- Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - Philip T Archana
- Thomas Diagnostic and Research Centre, Tiruchirapalli, Tamil Nadu, India
| | - Mahalingam Sundararajan
- Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - Pitchairaj Geraldine
- Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - Philip A Thomas
- Thomas Diagnostic and Research Centre, Tiruchirapalli, Tamil Nadu, India
| |
Collapse
|
32
|
Kidane ME, Vanderloop BH, Zhou W, Thomas CD, Ramos E, Singha U, Chaudhuri M, Nes WD. Sterol methyltransferase a target for anti-amoeba therapy: towards transition state analog and suicide substrate drug design. J Lipid Res 2017; 58:2310-2323. [PMID: 29042405 PMCID: PMC5711494 DOI: 10.1194/jlr.m079418] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/17/2017] [Indexed: 01/18/2023] Open
Abstract
Ergosterol biosynthesis pathways essential to pathogenic protozoa growth and absent from the human host offer new chokepoint targets. Here, we present characterization and cell-based interference of Acanthamoeba spp sterol 24-/28-methylases (SMTs) that catalyze the committed step in C28- and C29-sterol synthesis. Intriguingly, our kinetic analyses suggest that 24-SMT prefers plant cycloartenol whereas 28-SMT prefers 24(28)-methylene lophenol in similar fashion to the substrate preferences of land plant SMT1 and SMT2. Transition state analog-24(R,S),25-epiminolanosterol (EL) and suicide substrate 26,27-dehydrolanosterol (DHL) differentially inhibited trophozoite growth with IC50 values of 7 nM and 6 µM, respectively, and EL yielded 20-fold higher activity than reference drug voriconazole. Against either SMT assayed with native substrate, EL exhibited tight binding ∼Ki 9 nM. Alternatively, DHL is methylated at C26 by 24-SMT that thereby, generates intermediates that complex and inactivate the enzyme, whereas DHL is not productively bound to 28-SMT. Steroidal inhibitors had no effect on human epithelial kidney cell growth or cholesterol biosynthesis at minimum amoebicidal concentrations. We hypothesize the selective inhibition of Acanthamoeba by steroidal inhibitors representing distinct chemotypes may be an efficient strategy for the development of promising compounds to combat amoeba diseases.
Collapse
Affiliation(s)
- Medhanie E Kidane
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409
| | - Boden H Vanderloop
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409
| | - Wenxu Zhou
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409
| | - Crista D Thomas
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409
| | - Emilio Ramos
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409
| | - Ujjal Singha
- Department of Microbiology and Immunology, Meharry Medical College, Nashville, TN 37208
| | - Minu Chaudhuri
- Department of Microbiology and Immunology, Meharry Medical College, Nashville, TN 37208
| | - W David Nes
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79409
| |
Collapse
|
33
|
Boukari M, Erraïs K, Ammous I, El Amri-Mezghanni K, Zhioua-Braham I, Bouchekoua M, Trabelsi S, Aloui D, Khaled S, Saidani M, Mabrouk S, Mili-Boussen I, Zhioua R. Risk factors and clinical features of Acanthamoeba keratitis in a Tunisian tertiary eye care center. Exp Parasitol 2017; 183:254-257. [PMID: 28964757 DOI: 10.1016/j.exppara.2017.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/26/2017] [Accepted: 09/26/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Mejdi Boukari
- Department of Ophthalmology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia.
| | - Khalil Erraïs
- Department of Ophthalmology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| | - Imen Ammous
- Department of Ophthalmology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| | - Khaoula El Amri-Mezghanni
- Department of Ophthalmology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| | - Imen Zhioua-Braham
- Department of Ophthalmology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| | - Meriam Bouchekoua
- Laboratory of Parasitology-Mycology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| | - Sonia Trabelsi
- Laboratory of Parasitology-Mycology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| | - Dorsaf Aloui
- Laboratory of Parasitology-Mycology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| | - Samira Khaled
- Laboratory of Parasitology-Mycology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| | - Mabrouka Saidani
- Laboratory of Bacteriology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| | - Sonia Mabrouk
- Department of Ophthalmology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| | - Ilhem Mili-Boussen
- Department of Ophthalmology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| | - Raja Zhioua
- Department of Ophthalmology, Charles Nicolle University Hospital, Boulevard du 9 Avril 1938, Tunis 1006, Tunisia
| |
Collapse
|
34
|
Thomson S, Rice CA, Zhang T, Edrada-Ebel R, Henriquez FL, Roberts CW. Characterisation of sterol biosynthesis and validation of 14α-demethylase as a drug target in Acanthamoeba. Sci Rep 2017; 7:8247. [PMID: 28811501 DOI: 10.1038/s41598-017-07495-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/29/2017] [Indexed: 11/16/2022] Open
Abstract
The soil amoebae Acanthamoeba causes Acanthamoeba keratitis, a severe sight-threatening infection of the eye and the almost universally fatal granulomatous amoebic encephalitis. More effective treatments are required. Sterol biosynthesis has been effectively targeted in numerous fungi using azole compounds that inhibit the cytochrome P450 enzyme sterol 14α-demethylase. Herein, using Gas Chromatography Mass Spectrometry (GCMS), we demonstrate that the major sterol of Acanthamoeba castellanii is ergosterol and identify novel putative precursors and intermediate sterols in its production. Unlike previously reported, we find no evidence of 7-dehydrostigmasterol or any other phytosterol in Acanthamoeba. Of five azoles tested, we demonstrate that tioconazole and voriconazole have the greatest overall inhibition for all isolates of Acanthamoeba castellanii and Acanthamoeba polyphaga tested. While miconazole and sulconazole have intermediate activity econazole is least effective. Through GCMS, we demonstrate that voriconazole inhibits 14α-demethylase as treatment inhibits the production of ergosterol, but results in the accumulation of the lanosterol substrate. These data provide the most complete description of sterol metabolism in Acanthamoeba, provide a putative framework for their further study and validate 14α-demethylase as the target for azoles in Acanthamoeba.
Collapse
|
35
|
Nakaminami H, Tanuma K, Enomoto K, Yoshimura Y, Onuki T, Nihonyanagi S, Hamada Y, Noguchi N. Evaluation of In Vitro Antiamoebic Activity of Antimicrobial Agents Against Clinical Acanthamoeba Isolates. J Ocul Pharmacol Ther 2017; 33:629-634. [PMID: 28704121 DOI: 10.1089/jop.2017.0033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to elucidate in vitro antiamoebic activity of antimicrobial agents at short exposure times similar to those used for actual treatment against Acanthamoeba strains isolated from patients with keratitis. METHODS The 5 clinical Acanthamoeba isolated in Japan were used in this study. Identification of genotypes for the Acanthamoeba isolates was performed using partial 18S ribosomal DNA (rDNA), including the ASA.S1 region sequences. Fluconazole, miconazole, itraconazole, voriconazole, amphotericin B, natamycin (pimaricin), and micafungin (antifungal agents), and chlorhexidine (a biguanide disinfectant), and sulfamethoxazole and paromomycin (antibacterial agents) were used to determine the antiamoebic activity against Acanthamoeba, which were determined by 50% and 90% growth inhibitory concentrations (IC50 and IC90) following exposing to each drug at 25°C for 7 days and 12 h. RESULTS Among the tested antimicrobial agents, natamycin strongly inhibited the growth of all Acanthamoeba isolates at low concentration in both the 7-day (IC90 = 4.1 μg/mL) and 12-h (IC90 = 11.6 μg/mL) assays. Additionally, sulfamethoxazole exhibited strong antiamoebic activity (IC90 = 9.8 μg/mL) at low concentration in the 7-day assay. CONCLUSIONS Our findings showed that natamycin ophthalmic solution might be an effective agent against Acanthamoeba keratitis. Additionally, frequent administration of sulfamethoxazole ophthalmic solution or systemic sulfamethoxazole-trimethoprim is also considered as an effective treatment for Acanthamoeba keratitis.
Collapse
Affiliation(s)
- Hidemasa Nakaminami
- 1 Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Tokyo, Japan
| | - Kentaro Tanuma
- 1 Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Tokyo, Japan
| | - Kiichi Enomoto
- 1 Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Tokyo, Japan
| | - Yukihiko Yoshimura
- 1 Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Tokyo, Japan
| | - Tomoyo Onuki
- 2 Department of Medical Laboratory, Kitasato University Hospital , Kanagawa, Japan
| | - Shin Nihonyanagi
- 2 Department of Medical Laboratory, Kitasato University Hospital , Kanagawa, Japan .,3 Department of Infection Control and Prevention, Kitasato University Hospital , Kanagawa, Japan
| | - Yukihiro Hamada
- 4 Department of Pharmacy, Kitasato University East Hospital , Kanagawa, Japan
| | - Norihisa Noguchi
- 1 Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Tokyo, Japan
| |
Collapse
|
36
|
Abstract
Acanthamoeba keratitis (AK) is an unusual infectious disease of the cornea which sometimes leads to blindness. We report the experience of adding oral voriconazole in conjunction with topical antiacanthamoebic drops to treat refractory AK. A 20-year-old girl experienced a deep stromal keratitis with large epithelial defect in the left eye, suspected as AK. The initial best-corrected visual acuity (BCVA) of the eye was counting finger. She received topical chlorhexidine 0.02% and voriconazole 1% during the first 14 days but in vain. Oral voriconazole was administered and resulted in a rapid regression of the lesion. A total resolution was achieved after 2 weeks of triple combination therapy. The BCVA of the left eye finally achieved 20/20 at 6-month follow-up. Although oral voriconazole was seldom used in treating acute AK, the additional use of oral voriconazole combined with topical antiacanthamoebic drugs may help to achieve a successful treatment effect in refractory stromal AK.
Collapse
Affiliation(s)
- Tzu-Yu Hou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Chen Chen
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
37
|
Carrijo-Carvalho LC, Sant'ana VP, Foronda AS, de Freitas D, de Souza Carvalho FR. Therapeutic agents and biocides for ocular infections by free-living amoebae of Acanthamoeba genus. Surv Ophthalmol 2016; 62:203-218. [PMID: 27836717 DOI: 10.1016/j.survophthal.2016.10.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Abstract
Acanthamoeba keratitis is a sight-threatening infectious disease. Resistance of the cystic form of the protozoan to biocides and the potential toxicity of chemical compounds to corneal cells are the main concerns related to long-term treatment with the clinically available ophthalmic drugs. Currently, a limited number of recognized antimicrobial agents are available to treat ocular amoebic infections. Topical application of biguanide and diamidine antiseptic solutions is the first-line therapy. We consider the current challenges when treating Acanthamoeba keratitis and review the chemical properties, toxicities, and mechanisms of action of the available biocides. Antimicrobial therapy using anti-inflammatory drugs is controversial, and aspects related to this topic are discussed. Finally, we offer our perspective on potential improvement of the effectiveness and safety of therapeutic profiles, with the focus on the quality of life and the advancement of individualized medicine.
Collapse
Affiliation(s)
- Linda Christian Carrijo-Carvalho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Viviane Peracini Sant'ana
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Annette Silva Foronda
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Denise de Freitas
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Fabio Ramos de Souza Carvalho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
| |
Collapse
|
38
|
Padhi TR, Das S, Sharma S, Rath S, Rath S, Tripathy D, Panda KG, Basu S, Besirli CG. Ocular parasitoses: A comprehensive review. Surv Ophthalmol 2017; 62:161-89. [PMID: 27720858 DOI: 10.1016/j.survophthal.2016.09.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 12/14/2022]
Abstract
Parasitic infections of the eyes are a major cause of ocular diseases across the globe. The causative agents range from simple organisms such as unicellular protozoans to complex metazoan helminths. The disease spectrum varies depending on the geographic location, prevailing hygiene, living and eating habits of the inhabitants, and the type of animals that surround them. They cause enormous ocular morbidity and mortality not because they are untreatable, but largely due to late or misdiagnosis, often from unfamiliarity with the diseases produced. We provide an up-to-date comprehensive overview of the ophthalmic parasitoses. Each section describes the causative agent, mode of transmission, geographic distribution, ocular pathologies, and their management for common parasites with brief mention of the ones that are rare.
Collapse
|
39
|
Abstract
Microbial keratitis (MK) is a corneal condition that encompasses several different pathogens and etiologies. While contact lens associated MK is most often associated with bacterial infections, other pathogens (fungi, Acanthamoeba species, etc) may be responsible. This review summarizes the risk factors, microbiology, diagnostic characteristics, and treatment options for all forms of contact lens-related MK.
Collapse
Affiliation(s)
| | - Alex D Nixon
- College of Optometry, The Ohio State University, Columbus, OH, USA,
| | - Erin M Rueff
- College of Optometry, The Ohio State University, Columbus, OH, USA,
| |
Collapse
|
40
|
Carnt N, Stapleton F. Strategies for the prevention of contact lens-relatedAcanthamoebakeratitis: a review. Ophthalmic Physiol Opt 2015; 36:77-92. [DOI: 10.1111/opo.12271] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Nicole Carnt
- Save Sight Institute; University of Sydney; Sydney Australia
- School of Optometry and Vision Science; University of New South Wales; Sydney Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science; University of New South Wales; Sydney Australia
| |
Collapse
|
41
|
Lamb DC, Warrilow AG, Rolley NJ, Parker JE, Nes WD, Smith SN, Kelly DE, Kelly SL. Azole Antifungal Agents To Treat the Human Pathogens Acanthamoeba castellanii and Acanthamoeba polyphaga through Inhibition of Sterol 14α-Demethylase (CYP51). Antimicrob Agents Chemother 2015; 59:4707-13. [PMID: 26014948 DOI: 10.1128/AAC.00476-15] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/20/2015] [Indexed: 01/24/2023] Open
Abstract
In this study, we investigate the amebicidal activities of the pharmaceutical triazole CYP51 inhibitors fluconazole, itraconazole, and voriconazole against Acanthamoeba castellanii and Acanthamoeba polyphaga and assess their potential as therapeutic agents against Acanthamoeba infections in humans. Amebicidal activities of the triazoles were assessed by in vitro minimum inhibition concentration (MIC) determinations using trophozoites of A. castellanii and A. polyphaga. In addition, triazole effectiveness was assessed by ligand binding studies and inhibition of CYP51 activity of purified A. castellanii CYP51 (AcCYP51) that was heterologously expressed in Escherichia coli. Itraconazole and voriconazole bound tightly to AcCYP51 (dissociation constant [Kd] of 10 and 13 nM), whereas fluconazole bound weakly (Kd of 2,137 nM). Both itraconazole and voriconazole were confirmed to be strong inhibitors of AcCYP51 activity (50% inhibitory concentrations [IC50] of 0.23 and 0.39 μM), whereas inhibition by fluconazole was weak (IC50, 30 μM). However, itraconazole was 8- to 16-fold less effective (MIC, 16 mg/liter) at inhibiting A. polyphaga and A. castellanii cell proliferation than voriconazole (MIC, 1 to 2 mg/liter), while fluconazole did not inhibit Acanthamoeba cell division (MIC, >64 mg/liter) in vitro. Voriconazole was an effective inhibitor of trophozoite proliferation for A. castellanii and A. polyphaga; therefore, it should be evaluated in trials versus itraconazole for controlling Acanthamoeba infections.
Collapse
|
42
|
Sacher BA, Wagoner MD, Goins KM, Sutphin JE, Greiner MA, Kitzmann AS. Treatment of Acanthamoeba Keratitis With Intravenous Pentamidine Before Therapeutic Keratoplasty. Cornea 2015; 34:49-53. [DOI: 10.1097/ico.0000000000000263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Iovieno A, Gore DM, Carnt N, Dart JK. Acanthamoeba Sclerokeratitis. Ophthalmology 2014; 121:2340-7. [DOI: 10.1016/j.ophtha.2014.06.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/12/2014] [Accepted: 06/23/2014] [Indexed: 10/24/2022] Open
|
44
|
Bouheraoua N, Labbé A, Chaumeil C, Liang Q, Laroche L, Borderie V. [Acanthamoeba keratitis]. J Fr Ophtalmol 2014; 37:640-52. [PMID: 25169145 DOI: 10.1016/j.jfo.2014.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/25/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022]
Abstract
Early diagnosis and appropriate therapy are key elements for a good prognosis in Acanthamoeba keratitis (AK). AK should be considered in any case of corneal trauma complicated by exposure to soil or contaminated water, and in all contact lens (CL) wearers. A presumptive diagnosis of AK can be made clinically and with in vivo confocal microscopy, although a definitive diagnosis requires identification of Acanthamoeba on direct scraping, histology, or identification of Acanthamoeba DNA by polymerase chain reaction (PCR). We use cysticidal drugs for treating AK because encysted forms are more resistant than trophozoites to treatment. The treatment protocol used a biguanide (PHMB 0.02% or chlorhexidine 0.02%) and a diamidine (propamidine 0.1% or hexamidine 0.1%). New diagnostic modalities and more specific topical anti-amoebic treatments would substantially benefit patients with AK.
Collapse
Affiliation(s)
- N Bouheraoua
- Service d'ophtalmologie 5, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France.
| | - A Labbé
- Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France; Service d'ophtalmologie 3, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, DHU View maintain, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - C Chaumeil
- Service de biologie médicale, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - Q Liang
- Beijing Institute of Ophthalmology, Beijing TongRen Eye Center, Beijing TongRen Hospital, Capital Medical University, Beijing, Chine
| | - L Laroche
- Service d'ophtalmologie 5, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France
| | - V Borderie
- Service d'ophtalmologie 5, Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, UPMC Paris VI, UMR S 968, CNRS, UMR 7210, institut de la vision, 17, rue Moreau, 75012 Paris, France
| |
Collapse
|
45
|
Iovieno A, Miller D, Ledee DR, Alfonso EC. Cysticidal activity of antifungals against different genotypes of Acanthamoeba. Antimicrob Agents Chemother 2014; 58:5626-8. [PMID: 25001304 DOI: 10.1128/AAC.02635-14] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antifungal drugs have been proposed as a novel treatment for Acanthamoeba keratitis. The cysticidal activity of several antifungal compounds was tested against different genotypes of culture collection and clinical isolates of Acanthamoeba. Only voriconazole and posaconazole were found to be cysticidal, with no differences in activity observed between clinical and culture collection isolates.
Collapse
|
46
|
Kowalski RP, Abdel Aziz S, Romanowski EG, Shanks RMQ, Nau AC, Raju LV. Development of a practical complete-kill assay to evaluate anti-Acanthamoeba drugs. JAMA Ophthalmol 2014; 131:1459-62. [PMID: 24077460 DOI: 10.1001/jamaophthalmol.2013.5062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Acanthamoeba keratitis is a debilitating eye disease that requires effective topical drug therapy. Currently, there is no standard in vitro test to evaluate anti-Acanthamoeba drugs. OBJECTIVE To develop a practical in vitro complete-kill assay to assess anti-Acanthamoeba drugs. DESIGN AND SETTING Isolates of Acanthamoeba strains (n = 15) evaluated in a clinical laboratory. An in vitro laboratory assay was created to determine whether polyhexamethylene biguanide, 0.02%, chlorhexidine digluconate, 0.02%, hexamidine diisethioonate, 0.1%, and voriconazole, 1.0%, were effective in completely killing 15 different isolates of Acanthamoeba at time points of 24, 48, and 72 hours in comparison with a saline control. Each 0.5-mL volume of drug was inoculated with 0.1 mL of Acanthamoeba cysts (range, 1-3 × 10(6)/mL) (determined with a hemacytometer) and allowed to incubate at 30°C. At the time points listed, 0.05 mL from each treatment group was inoculated onto nonnutrient agar overlaid with Enterobacter aerogenes. The plates were microscopically examined for growth 1 and 2 weeks after inoculation. At 2 weeks, all plates were subcultured onto a fresh medium. At another 7 days, the growth in subculture at each time point was graded "1" for growth and "0" for no growth. MAIN OUTCOMES AND MEASURES The cumulative grades of 3 time points (range, 0-3) for each drug and isolate were nonparametrically compared to determine differences in growth between the drugs. The "kill" incidence rates over the 3 time points were also compared. RESULTS In vitro testing determined that antiacanthamoebal efficacy (determined by the median growth grade and the kill incidence rate) was more prominent for hexamidine diisethioonate (median growth grade, 0.0; kill incidence rate, 93% [14 of 15 isolates]) and polyhexamethylene biguanide (median growth grade, 0.0; kill incidence rate, 80% [12 of 15 isolates]) than for chlorhexidine digluconate (median growth grade, 1.0; kill incidence rate, 40% [6 of 15 isolates]), voriconazole (median growth grade, 2.0; kill incidence rate, 13% [2 of 15 isolates]), and saline (median growth grade, 3.0; kill incidence rate, 0% [0 of 15 isolates]). CONCLUSIONS AND RELEVANCE The complete-kill assay appears to provide separation in the effectiveness of different antiamoebic drug solutions. This assay may be helpful for guiding topical Acanthamoeba therapy and providing a practical method to evaluate and screen new anti-infectives in the treatment of Acanthamoeba keratitis.
Collapse
Affiliation(s)
- Regis P Kowalski
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, UPMC Eye Center, Ophthalmology and Visual Sciences Research Center, the Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | | | | | |
Collapse
|
47
|
Martín-navarro CM, López-arencibia A, Arnalich-montiel F, Valladares B, Piñero JE, Lorenzo-morales J. Evaluation of the in vitro activity of commercially available moxifloxacin and voriconazole eye-drops against clinical strains of Acanthamoeba. Graefes Arch Clin Exp Ophthalmol 2013; 251:2111-7. [DOI: 10.1007/s00417-013-2371-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/08/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022] Open
|
48
|
Clarke B, Sinha A, Parmar DN, Sykakis E. Advances in the diagnosis and treatment of acanthamoeba keratitis. J Ophthalmol 2012; 2012:484892. [PMID: 23304449 DOI: 10.1155/2012/484892] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/17/2012] [Indexed: 11/17/2022] Open
Abstract
This paper aims to review the recent literature describing Acanthamoeba keratitis and outline current thoughts on pathogenesis, diagnosis, and treatment as well as currently emerging diagnostic and treatment modalities.
Collapse
|
49
|
Troke P, Obenga G, Gaujoux T, Goldschmidt P, Bienvenu AL, Cornet M, Grenouillet F, Pons D, Ranque S, Sitbon K, Chaumeil C, Borderie V, Lortholary O. The efficacy of voriconazole in 24 ocular Fusarium infections. Infection 2013; 41:15-20. [PMID: 22718362 DOI: 10.1007/s15010-012-0273-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We examined, retrospectively, the efficacy of voriconazole in Fusarium eye infections. METHODS Voriconazole-treated patients with proven or probable keratitis or endophthalmitis from the voriconazole database (9 patients) and six French ophthalmology departments (15 patients) were included. Sociodemographic features, predisposing factors, history of corneal trauma, associated ocular conditions, other diseases and prior therapies were analysed. Investigator-determined success was defined as infection resolution with medical treatment. Failure was no response or persistent infection and required surgery. RESULTS Most patients were Caucasian (83 %) and male (71 %). The infection was keratitis (63 %) or endophthalmitis (37 %) and proven in 23 (96 %). Prior therapy included topical and/or systemic amphotericin (46 %), fluconazole (17 %) or others (33 %), often in combination. Causative fungi were Fusarium solani (14, 58 %), Fusarium moniliforme (1), Fusarium oxysporum (1) and Fusarium spp. (8). Voriconazole was administered systemically, topically and/or by intraocular injection, and 16 patients (67 %) received salvage and eight primary therapy. The overall response was 67 % (73 % keratitis and 56 % endophthalmitis) but seven patients required adjunctive surgery. However, response was 63 % for eight primary therapy patients and 69 % for 16 salvage therapy patients. Response by species was Fusarium solani 64 % (9/14) and all others 80 % (8/10). In 13 patients (77 %), voriconazole was used in combination (response 69 vs. 64 % alone) with topical [amphotericin B 10/24 (42 %), caspofungin 5 (21 %), natamycin 1 (4 %)] and systemic agents [caspofungin 3 (13 %), amphotericin 2 (8 %)]. CONCLUSIONS Topical and systemic voriconazole appears to be effective alone or in combination with other agents for treating severe Fusarium keratitis or endophthalmitis.
Collapse
|