[Augmentation of anti-Candida activity of neutrophils by macrophages treated with itraconazole]

Itraconazole IV nanosuspension enhances efficacy through altered pharmacokinetics in the rat

The goal of this research was to evaluate an intravenous itraconazole nanosuspension dosage form, relative to a solution formulation, in the rat. Itraconazole was formulated as a nanosuspension by a tandem process of microcrystallization followed by homogenization. Acute toxicity, pharmacokinetics, and distribution were studied in the rat, and compared with a solution formulation of itraconazole. Efficacy was studied in an immunocompromised rat model, challenged with a lethal dose of either itraconazole-sensitive or itraconazole-resistant C. albicans. Itraconazole nanosuspension was tolerated at significantly higher doses compared with a solution formulation. Pharmacokinetics of the nanosuspension were altered relative to the solution formulation. C(max) was reduced and t(1/2) was much prolonged. This occurred due to distribution of the nanosuspension to organs of the monocyte phagocytic system (MPS), followed by sustained release from this IV depot. The higher dosing of the drug, enabled in the case of the nanosuspension, led to higher kidney drug levels and reduced colony counts. Survival was also shown to be superior relative to the solution formulation. Thus, formulation of itraconazole as a nanosuspension enhances efficacy of this antifungal agent relative to a solution formulation, because of altered pharmacokinetics, leading to increased tolerability, permitting higher dosing and resultant tissue drug levels.

Characteristic biological effects of itraconazole on L929 fibroblasts and their cell membrane

Itraconazole (ITCZ), a triazole antifungal agent, was studied for its effects on the morphology and function of L929 fibroblasts. L929 fibroblasts were cultured for 20 h with ITCZ or one of several other triazoles (fluconazole, ketoconazole, and hydroxy-itraconazole [ITCZ-OH]) at the concentration of 0.5 microg/ml. Among these agents, only ITCZ and its metabolite ITCZ-OH markedly elongated the cells bidirectionally. Scanning electron microscopy studies showed that the surface of the elongated cells was smoother than that of the untreated cells. The viability of L929 cells cultured with 0.5 microg/ml of ITCZ for 20 h was not lowered. However, after treatment with 0.0375% sodium deoxycholate (DOC) solution, the viability of the cells treated with ITCZ, as evaluated by the 3-(4,5-dimethyl-2thiazoyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) proliferation assay or the release of lactic dehydrogenase from cytoplasm, was decreased. When L929 cells were cultured in the presence of a combination of ITCZ and vincristine, their growth was synergistically inhibited. This synergism was also observed when ITCZ was replaced by ITCZ-OH, but not by the other azoles. These findings suggest that the exposure of L929 fibroblasts to low ITCZ concentrations affects the physiological nature of their cell membrane.

Morphological effects of itraconazole on murine macrophage

Morphological effects of itraconazole (ITCZ) on murine macrophages were examined by light microscopy (LM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM), and compared with the effects of other antifungal agents. Thioglycolate-induced peritoneal macrophages were prepared from C3H/He J mice and cultured for 20 h in the presence of the antifungal azoles econazole, fluconazole, miconazole, ketoconazole, ITCZ, hydroxy-itraconazole (ITCZ-OH), and a polyene antibiotic amphotericin B (AMPH). Among these reagents, only ITCZ and its derivative ITCZ-OH were effective in causing morphological changes of murine macrophage as determined by LM and SEM. Macrophages treated with 2 microg/ml ITCZ or ITCZ-OH were stretched out bidirectionally, their surface was smooth and their 'ruffles' decreased. TEM observation showed that the bundles of the filamentous structure existed along the cell shape in the cytoplasm. These findings suggest that ITCZ and ITCZ-OH affect the morphology of macrophages.