Antifungal activity of a trypsin inhibitor from Salvia hispanica L. (chia) seeds against fluconazole-resistant strains of Candida spp. and evaluation of its toxicity in vitro.

The incidence of Candida species resistant to traditional antifungal drugs is increasing globally. This issue significantly impacts patients' lives and increases healthcare expenses, confirming the need to develop novel therapeutic strategies. Recently, a thermostable trypsin inhibitor named ShTI (11.558 kDa), which has antibacterial effects on Staphylococcus aureus, was isolated from Salvia hispanica L. (chia) seeds. This study aimed to assess the antifungal effect of ShTI against Candida species and its synergism with fluconazole and to evaluate its mode of action. Preliminary toxicological studies on mouse fibroblasts were also performed. ShTI exhibited antifungal effects against C. parapsilosis (ATCC® 22,019), C. krusei (ATCC® 6258), and six clinical fluconazole-resistant strains of C. albicans (2), C. parapsilosis (2), and C. tropicalis (2). The minimum inhibitory concentration (MIC) values were 4.1 µM (inhibiting 50% of the isolates) and 8.2 µM (inhibiting 100% of the isolates). Additionally, when combined with fluconazole, ShTI had a synergistic effect on C. albicans, altering the morphological structure of the yeast. The mode of action of ShTI against C. krusei (ATCC® 6258) and C. albicans involves cell membrane permeabilization, the overproduction of reactive oxygen species, the formation of pseudohyphae, pore formation, and consequently, cell death. In addition, ShTI (8.65 and 17.3 µM) had noncytotoxic and nongenotoxic effects on L929 mouse fibroblasts. These findings suggest that ShTI could be a promising antimicrobial candidate, but further research is necessary to advance its application as a novel antifungal agent.

Moderate alcohol consumption during pregnancy increases potency of two different drugs (the antifungal fluconazole and the antiepileptic valproate) in inducing craniofacial defects: prediction by the in vitro rat whole embryo culture.

The prenatal exposure to ethanol (Eth), fluconazole (FLUCO) and sodium valproate (VPA) is related to effects on development, producing characteristic syndromic pictures. Among embryotoxic effects described for the three molecules, the alteration on craniofacial morphogenesis is a common feature in humans and animal models, including rodent embryos developed in vitro. The aim of the present work is to evaluate the developmental effects of low Eth serum concentration (17 mM, corresponding to the legal limit to drive in UK, USA, Canada, and many other countries) in mixture with increasing realistic concentrations of the antifungal drug FLUCO (62.5-500 µM) or with increasing realistic concentrations of the antiepileptic drug VPA (31.25-250 µM). Groups exposed to Eth alone (17-127.5 mM), FLUCO alone (62.5-500 µM) or VPA alone (31.25-750 µM) were also included. The chosen alternative animal model was the post-implantation rat whole embryo culture (WEC). E9.5 embryos were exposed in vitro to the test molecules during the whole test period (48 h, corresponding to the developmental stages characteristics of any vertebrate, for human embryos post-fertilization days 23-31). Data were statistically analyzed and processed for modelling applying the benchmark dose (BMD) and relative potency factor (RPF) approaches. Concentration-related effects on facial outcomes were observed in all experimental groups, with a significant enhancement in the groups co-exposed with Eth in comparison to the single exposures. Data obtained by the present work suggest an additional alert for the assumption of even low levels of alcohol in pregnant women during FLUCO or VPA therapy.

Enantioselective toxic effects of mefentrifluconazole in the liver of adult zebrafish (Danio rerio) based on transcription level and metabolomic profile.

Mefentrifluconazole, a new type of chiral triazole fungicide, is widely applied to control a variety of fungal diseases in crops. However, the toxicological effects of mefentrifluconazole on aquatic organisms are unknown, especially at the enantiomer level. In the present study, zebrafish were selected as a typical model for mefentrifluconazole enantiomer exposure. Metabolomic and transcription analyses were performed with 0.01 and 0.10 mg/L mefentrifluconazole and its enantiomers (i.e., rac-mfz/(-)-mfz/(+)-mfz) at 28 days. The 1H nuclear magnetic resonance (NMR)-based metabolomics analysis showed that 9, 10 and 4 metabolites were changed significantly in the rac-mfz, (+)-mfz and (-)-mfz treatment groups compared with the control group, respectively. The differential metabolites were related to energy metabolism, lipid metabolism and amino acid metabolism. The qRT-PCR analysis revealed that the expression of lipid metabolism-, apoptosis- and CYP-related genes in the livers of female zebrafish in rac-mfz and (+)-mfz was 1.61-108.92 times and 2.37-551.34 times higher than that in (-)-mfz, respectively. The results above indicate that exposure to mefentrifluconazole induced enantioselective liver toxicity in zebrafish. Our study underlined the importance of distinguishing different enantiomers, which will contribute to environmental protection.

Evaluation of in vitro activity of five antimicrobial agents on Acanthamoeba isolates and their toxicity on human corneal epithelium.

BACKGROUND: Acanthamoeba keratitis (AK) is an important cause of ocular morbidity in both contact lens wearers and non wearers. Medical management comprises prolonged empiric treatment with multiple drugs, leading to adverse effects and suboptimal cure. The present study evaluated the efficiency and safety of common antimicrobial agents used in treatment of AK. METHODS: Six Acanthamoeba isolates (four AK, two water samples) were axenized and subjected to in vitro susceptibility testing against chlorhexidine, pentamidine isethionate, polymyxin B, miltefosine, and fluconazole to check for trophocidal and cysticidal activity. The safety profile was analysed by observing the cytotoxicity of the highest cidal concentration toward human corneal epithelial cell (HCEC) line. RESULTS: Chlorhexidine had the lowest cidal concentration against both cysts and trophozoites (range 4.16-25 µg/ml) followed by pentamidine isethionate (range 25-166.7 µg/ml). Both agents were nontoxic to HCEC. Polymyxin B (range 25-200 µg/ml) and fluconazole (range 64-512 µg/ml) had relatively higher minimum inhibitory concentrations (MIC); fluconazole was nontoxic even at 1024 µg/ml, but cytotoxicity was observed at 400 µg/ml with polymyxin B. Miltefosine was not effective against cysts at tested concentrations. A. castellanii were more susceptible to all agents (except pentamidine isethionate) than A. lenticulata. Clinical isolates were less susceptible to polymyxin B and fluconazole than environmental isolates, reverse was true for miltefosine. CONCLUSION: Chlorhexidine and pentamidine isethionate were the most effective and safe agents against both trophozoites and cysts forms of our Acanthamoeba isolates. Fluconazole had higher MIC but was nontoxic. Polymyxin B was effective at high MIC but therapeutic dose was found toxic. Miltefosine, at tested concentrations, could not inhibit cysts of Acanthamoeba. Clinical isolates had higher MICs for polymyxin B and fluconazole.

Efeitos antibiofilme e citotóxico de um novo nanosistema carreador de clorexidina e fluconazol / Antibiofilm and cytotoxic effects of a new nanocarrier of chlorhexidine and fluconazole

Os objetivos do presente estudo foram montar e caracterizar um novo nanocarreador dual de clorexidina (CLX) e fluconazol (FLZ), bem como avaliar seu efeito sobre biofilmes microcosmos e sua citotoxicidade sobre queratinócitos orais. Para montar o nanocarreador dual, CLX e FLZ foram adicionados a nanopartículas de óxido de ferro (NPsOF) previamente revestidas por quitosana (QTS), seguido de um processo de solubilização sob agitação magnética. O nanocarreador foi, então, caracterizado por microscopia eletrônica de transmissão, difração de raios X, espectroscopia no infravermelho por transformada de Fourier e análise termogravimétrica. A suscetibilidade de Candida albicans e Candida glabrata no estado planctônico ao nanocarreador dual foi determinada pelos valores de concentração inibitória mínima, utilizando o método da microdiluição em caldo. Um pool de saliva de 2 doadores saudáveis suplementado com espécies de Candida foi usado como inóculo para a formação de biofilmes microcosmos. Os biofilmes foram cultivados (72 h) sobre discos de vidro posicionados no Amsterdam Active Attachment model e tratados (24 h) com NPsOF-QTS carreando 39 µg/mL de CLX + 156 µg/mL de FLZ (NPsOF-QTS-CLX39-FLZ156), 78 µg/mL de CLX + 312 µg/mL de FLZ (NPsOF-QTS-CLX78-FLZ312) e 156 µg/mL de CLX + 624 µg/mL de FLZ (NPsOF-QTS-CLX156-FLZ624). NPsOF (218,5 µg/mL), QTS (218,5 µg/mL) e 156 µg/mL de CLX + 624 µg/mL de FLZ (CLX156-FLZ624) foram testados como controles. Posteriormente, foram realizadas as análises de quantificação das unidades formadoras de colônias (UFCs), produção de ácido lático (LA), composição da matriz extracelular (ME) e viabilidade celular por microscopia confocal de varredura a laser (MCVL). Para o ensaio de citotoxicidade, queratinócitos orais humanos (linhagem NOKsi) foram expostos a diferentes concentrações do nanocarreador dual, por 24 ou 48 h, e a viabilidade celular foi determinada pelo ensaio de redução de MTT. Os dados foram analisados por ANOVA ou teste de Kruskal-Wallis, seguidos dos testes de Fisher LSD ou Tukey (α = 0,05). Os testes de caracterização físico-química mostraram que um nanocarreador dual com dimensões em torno de 6 nm foi obtido, sem comprometer a propriedade cristalina e a estabilidade de NPsOF. Os compostos que formam o nanocarreador estabeleceram uma interação sinérgica em relação ao efeito sobre células planctônicas de Candida. Para os ensaios de biofilme, NPsOF-QTS-CLX156-FLZ624 foi o composto mais eficaz na redução de UFCs de Streptococcus mutans, Lactobacillus spp., C. albicans e C. glabrata, diferindo significativamente dos outros grupos, e esses achados foram confirmados por MCVL. NPsOF-QTS-CLX39-FLZ156, NPsOF-QTS-CLX78-FLZ312 e CLX156- FLZ624 mostraram efeitos antibiofilme similares. O nanocarreador dual também reduziu significativamente a produção de AL e a quantidade de carboidratos e ácidos nucleicos da ME. Um efeito citotóxico dose-dependente sobre queratinócitos orais foi observado para o nanocarreador dual, independentemente do período de exposição testado (24 ou 48 h). NPsOF-QTS-CLX-FLZ e CLX-FLZ reduziram significativamente a viabilidade dos queratinócitos em concentrações de CLX e FLZ iguais ou superiores a 7,8 e 31,25 µg/mL, respectivamente. Por fim, a nanoterapia testada no presente estudo é promissora e constitui um grande avanço dentro dos métodos alternativos aos antimicrobianos tradicionais para o controle da candidíase oral(AU)

The objectives of the present study were to assemble and characterize a new dual nanocarrier of chlorhexidine (CHX) and fluconazole (FLZ), and evaluate its effect on microcosm biofilms and its cytotoxicity against oral keratinocytes. To assemble the dual nanocarrier, CHX and FLZ were added to iron oxide nanoparticles (IONPs) previously coated by chitosan (CS), followed by a solubilization process under magnetic stirring. The nanocarrier was then characterized by transmission electron microscopy, X-ray diffraction, Fourier transform infrared spectroscopy, and thermogravimetric analysis. The susceptibility of Candida albicans and Candida glabrata in the planktonic state to the dual nanocarrier was determined by the minimum inhibitory concentration values, using the broth microdilution method. A saliva pool from 2 healthy donors supplemented with Candida species was used as an inoculum for microcosm biofilm formation. Biofilms were grown (72 h) on glass discs positioned in the Amsterdam Active Attachment model and treated (24 h) with IONPs-CS carrying 39 µg/mL CHX + 156 µg/mL FLZ (IONPsCS-CHX39-FLZ156), 78 µg/mL CHX + 312 µg/mL FLZ (IONPs-CS-CHX78-FLZ312), and 156 µg/mL CHX + 624 µg/mL FLZ (IONPs-CS-CHX156-FLZ624). IONPs at 218.5 µg/mL, 218.5 µg/mL CS, and 156 µg/mL CHX + 624 µg/mL FLZ (CHX156-FLZ624) were tested as controls. Next, analyses of the quantification of colony-forming units (CFUs), lactic acid production (LA), composition of the extracellular matrix (EM), and viability by confocal laser scanning microscopy (CLSM) were performed. For the cytotoxicity assay, human oral keratinocytes (NOKsi lineage) were exposed to different concentrations of the dual nanocarrier, for 24 or 48 h, and cell viability was determined by the MTT reduction assay. Data were analyzed by ANOVA or Kruskal-Wallis test, followed by Fisher LSD or Tukey tests (α = 0.05). The physico-chemical characterization tests showed that a dual nanocarrier with dimensions around 6 nm was assembled, without compromising the crystalline property and stability of IONPs. The compounds that form the nanocarrier established a synergistic interaction in relation to the effect on Candida planktonic cells. Regarding biofilm assays, IONPs-CS-CHX156-FLZ624 was the most effective compound in reducing CFUs from Streptococcus mutans, Lactobacillus spp., C. albicans, and C. glabrata, differing significantly from the other groups, and these findings were confirmed by CLSM. IONPs-CS-CHX39-FLZ156, IONPs-CS-CHX78-FLZ312, and CHX156-FLZ624 showed similar antibiofilm effects. The dual nanocarrier also significantly reduced LA production and the amount of carbohydrates and nucleic acids from the EM. A dose-dependent cytotoxic effect against oral keratinocytes was observed for the dual nanocarrier, regardless of the exposure period tested (24 or 48 h). IONPs-CSCHX-FLZ and CHX-FLZ significantly reduced keratinocyte viability at CHX and FLZ concentrations equal to or greater than 7.8 and 31.25 µg/mL, respectively. In conclusion, the nanotherapy tested in the current study is promising and constitutes a major advance in alternative methods to traditional antimicrobials for oral candidiasis control(AU)

Antifungal Treatment Aggravates Sepsis through the Elimination of Intestinal Fungi.

Prophylactic antifungal therapy is widely adopted clinically for critical patients and effective in reducing the morbidity of invasive fungal infection and improves outcomes of those diagnosed patients; however, it is not associated with higher overall survival. As intestinal commensal fungi play a fundamental role in the host immune response in health and disease, we propose that antifungal therapy may eliminate intestinal fungi and aggravate another critical syndrome, sepsis. Here, with murine sepsis model, we found that antifungal therapy with fluconazole dismissed intestinal fungal burden and aggravated endotoxin-induced but no gram-positive bacteria-induced sepsis. Nevertheless, antifungal therapy did not exert its detrimental effect on germ-free mice. Moreover, colonizing more commensal fungi in the mouse intestine or administration of fungal cell wall component mannan protected the mice from endotoxin-induced sepsis. On the molecular level, we demonstrated that antifungal therapy aggravated endotoxin sepsis through promoting Gasdermin D cleavage in the distal small intestine. Intestinal colonization with commensal fungi inhibited Gasdermin D cleavage in response to lipopolysaccharide challenge. These findings show that intestinal fungi inhibit Gasdermin D-mediated pyroptosis and protect the mice from endotoxin-induced sepsis. This study demonstrates the protective role of intestinal fungi in the pathogenesis of endotoxin-induced sepsis in the laboratory. It will undoubtedly prompt us to study the relationship between antifungal therapy and sepsis in critical patients who are susceptible to endotoxin-induced sepsis in the future.

Effects of nanoplastic on toxicity of azole fungicides (ketoconazole and fluconazole) in zebrafish embryos.

The ubiquity of nanoplastics (NPs) raises concerns about their interactions and combined toxicity with other common contaminants. Although azoles are present throughout the natural environment, their interactions with NP are not well known. We investigated the effects of polystyrene (PS) NP on the toxicity of ketoconazole (KCZ) and fluconazole (FCZ) in zebrafish embryos using the developmental toxicity, oxidative-stress-related biochemical parameters, and expression of genes related to neurotoxicity (ache), cardiotoxicity (gata4, bmp4), inflammation (il1b), oxidative stress (sod1, sod2, cyp1a), and apoptosis (bax, bcl2). Co-exposure to NP (1 mg/L) and KCZ/FCZ (1 mg/L) for 96 h reduced the hatching rate, survival rate, and heart rate and increased the malformation rate and catalase activity. The bax/bcl2 ratio, an apoptosis indicator, was higher after NP, KCZ, or FCZ treatment. However, the bax/bcl2 ratio after exposure to NP + KCZ or NP + FCZ was much higher than that after single exposure. Overall, the results indicated that NP aggravated the toxicity of azole by significantly increasing the reactive oxygen species, lipid peroxidation and altering the expression of oxidative-stress- and apoptosis-related genes. The interactive toxicity of PS NP with KCZ/FCZ reported in this study emphasises the need for caution in the release of azole fungicides in the environment.

Ocular toxicity assessment of nanoemulsion in-situ gel formulation of fluconazole.

PURPOSE: Fluconazole is an effective anti-fungal drug. Due to the limitations of fluconazole, such as poor water solubility and consequently low ocular bioavailability, an optimized fluconazole nanoemulsion in-situ gel formulation (temperature-sensitive) was developed. METHODS AND MATERIALS: To verify formulation's safety for ophthalmic use, preparation was tested for potential ocular toxicity using a cell viability assay on retinal cells. The hen's egg test-chorioallantoic membrane (HET-CAM), as a borderline test between in vivo and in vitro techniques, was chosen for investigating the irritation potential of the formulation. HET-CAM test was done by adding the formulation directly to the CAM surface and monitoring the vessels visually in terms of irritation reactions. Eye tolerance was determined using the modified Draize test. RESULTS: Viability assay on retinal cells displayed that fluconazole nanoemulsion in-situ gel formulation was non-toxic and can be safely used in the eye at concentrations of 0.1% and 0.5%. HET-CAM and Draize tests revealed that optimized formulation of fluconazole did not result in any irritation and was considered non-irritant and well-tolerated for ocular use. CONCLUSION: Regarding to the findings of the three mentioned methods, fluconazole nanoemulsion in-situ gel formulation is harmless and as a proper and safe alternative, can be considered for ocular delivery of fluconazole in the future.

Antibiotic-Based Conjugates Containing Antimicrobial HLopt2 Peptide: Design, Synthesis, Antimicrobial and Cytotoxic Activities.

Recent studies have shown that modified human lactoferrin 20-31 fragment, named HLopt2, possesses antibacterial and antifungal activity. Thus, we decided to synthesize and evaluate the biological activity of a series of conjugates based on this peptide and one of the antimicrobials with proven antibacterial (ciprofloxacin, CIP, and levofloxacin, LVX) or antifungal (fluconazole, FLC) activity. The drugs were covalently connected to the peptide via amide, methylenecarbonyl moieties, or a disulfide bridge. The antibacterial and antifungal activities were evaluated under Clinical and Laboratory Standard Institute (CLSI) recommended conditions or in a low-salt brain-heart infusion diluted medium (BHI1/100). Results showed that conjugation of the peptide with the drug increased its antimicrobial activity up to 4-fold. Under CLSI-recommended conditions, all the compounds revealed rather low efficiency. Among conjugates, the highest antibacterial activity was recorded for the CIP-Cys-S-S-HLopt2-NH2 (III). In BHI1/100, which had lower differentiating properties, all of the conjugates revealed low MIC and MMC (minimum inhibitory and microbicidal concentrations) values. The disulfide bridge used as a linker in the most active conjugate (III) upon incubation with S. aureus cells is reduced, releasing constituent peptide and CIP-Cys. In addition, we showed that its fluorescently labeled analogue and constituent peptide are able to be internalized into both C. albicans and S. aureus cells. Moreover, the invaluable advantage of the presented conjugates was their low toxicity to mammalian cells and very low hemolytic activity. The current research can form a solid basis for further in vivo studies and drug development.

The classic azole antifungal drugs are highly potent endocrine disruptors in vitro inhibiting steroidogenic CYP enzymes at concentrations lower than therapeutic Cmax.

Azole antifungal drugs are used worldwide to treat a variety of fungal infections such as vulvovaginal candidiasis, particularly in pregnant women who are at increased risk. The aim of this study was to mechanistically investigate the endocrine disrupting potential of four commonly used azole antifungal drugs; clotrimazole, miconazole, ketoconazole and fluconazole in vitro using the H295R cell assay and two recombinant, CYP17A1 and CYP19A1 (aromatase), assays. Steroids were quantified using LC-MS/MS. In both recombinant assays, all four azoles inhibited the CYP enzymes investigated, at therapeutically relevant concentrations. However, responses were much more complex in the H295R cell line. Clotrimazole inhibited steroid production in a dose-dependent manner with IC50 values for CYP17A1 and CYP19A1 in the range 0.017-0.184 µM. Miconazole and ketoconazole increased all steroids on the hydroxylase axis (IC50 MIC: 0.042-0.082 µM, KET: 0.041-1.2 µM), leading to accumulation of progestagens and corticosteroids and suppression of androgens and estrogens, indicating inhibition of CYP17A1, in particular lyase activity. However, ketoconazole suppressed all steroids at higher concentrations, resulting in bell-shaped curves for all steroids on the hydroxylase axis. Fluconazole was found to inhibit CYP17A1-lyase activity, causing suppression of androgens (IC50 = 114-209 µM) and estrogens (IC50 = 28 µM). The results indicate that these four azole drugs are highly potent in vitro and, based on plasma Cmax values, may exert endocrine disrupting effects at therapeutically relevant concentrations. This raises concern for endocrine related effects in patients using azole antifungal drugs, particularly when taken during sensitive periods like pregnancy.