期刊
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS
卷 62, 期 1, 页码 -出版社
ELSEVIER
DOI: 10.1016/j.ijantimicag.2023.106807
关键词
Cryptococcosis; drug repurposing; antimalarials; synergism
Cryptococcus gattii and Cryptococcus neoformans are the main causes of cryptococcosis, and the current treatments for this invasive fungal infection, such as amphotericin B, 5-fluorocytosine, and fluconazole, have limitations including toxicity and antifungal resistance. This study investigated the repurposing of antimalarial drugs (ATMs) for cryptococcosis treatment and found that ATMs not only inhibited fungal growth but also induced oxidative and nitrosative stresses, and altered fungal physiology. ATMs showed synergistic effects when combined with amphotericin B, reducing its fungicidal concentrations and toxicity to macrophages. Furthermore, the combination of halofantrine or amodiaquine with amphotericin B effectively reduced the lethality and fungal burden in murine cryptococcosis. These findings provide new perspectives for the use of ATMs against cryptococcosis and other fungal infections.
Cryptococcus gattii and Cryptococcus neoformans are the main etiological agents of cryptococcosis, an invasive mycosis treated with amphotericin B, 5-fluorocytosine, and fluconazole. This limited arsenal is toxic and is associated with antifungal resistance. Cryptococcosis and malaria pathogens are eukaryotic organisms that have a high incidence in Sub-Saharan Africa. The antimalarials (ATMs) halofantrine (HAL) and amodiaquine (AQ) block Plasmodium heme polymerase, and artesunate (ART) induces oxidative stress. Considering that Cryptococcus spp. is susceptible to reactive oxygen species and that iron is essential for metabolism, the repurposing of ATMs for treating cryptococcosis was tested. ATMs reduced fungal growth, induced oxidative and nitrosative stresses, and altered ergosterol content, melanin production, and polysaccharide capsule size in C. neoformans and C. gattii , revealing a dynamic effect on fungal physiology. A comprehensive chemical-genetic analysis using two mutant libraries demonstrated that the deletion of genes involved in synthesizing components of the plasma membrane and cell wall, and oxidative stress responses are essential for fungal susceptibility to ATMs. Interestingly, the amphotericin B (AMB) fungicidal concentrations were similar to 10 times lower when combined with ATMs, demonstrating a synergistic interaction. Further, the combinations showed reduced toxicity to murine macrophages. Finally, HAL + AMB and AQ + AMB efficiently reduced lethality and fungal burden in the lungs and brain in murine cryptococcosis. These findings provide perspectives for further studies with ATMs against cryptococcosis and other fungal infections. (c) 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.
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