title: Pharmacodynamics and dose-response relationships of liposomal amphotericin B against different azole-resistant Aspergillus fumigatus isolates in a murine model of disseminated aspergillosis.
abstract: The management of invasive aspergillosis (IA) has become more complicated due to the emergence of acquired azole resistance in Aspergillus fumigatus, which is associated with treatment failure and a mortality rate of 88%. Treatment with liposomal amphotericin B (L-AmB) may be a useful alternative to improve therapeutic outcome in azole-resistant IA. Four clinical A. fumigatus isolates obtained from patients with proven IA were studied in a nonneutropenic murine model of infection: a wild-type isolate without mutations in the cyp51A gene and three azole-resistant isolates harboring a single mutation at codon 220 (M220I) and tandem repeat mutations (a 34-bp tandem repeat mutation in the promoter region of the cyp51A gene in combination with substitutions at codon L98 [TR(34)/L98H] and a 46-bp tandem repeat mutation in the promoter region of the cyp51A gene in combination with mutation at codons Y121 and T289 [TR(46)/Y121F/T289A]), respectively. Female CD-1 mice were infected intravenously 24 h prior to the start of therapy. Groups of 11 mice were treated at days 1, 2, and 5 postchallenge with increasing 4-fold doses of L-AmB ranging from 0.004 to 16 mg/kg/day and observed for 14 days. Survival for all 4 isolates at day 14 was significantly better than that of controls. A dose-response relationship was observed independent of the azole resistance mechanism. The Hill-type model with a variable slope fitted the relationship between the dose and 14-day survival well for all isolates, with R(2) values of 0.95 (wild-type), 0.97 (M220I), 0.85 (TR(34)/L98H), and 0.94 (TR(46)/Y121F/T289A), respectively. Multiple logistic regression analysis confirmed that there was no significant difference between groups. The results of these experiments indicate that L-AmB was able to prolong survival in vivo in disseminated IA independent of the presence of an azole resistance mechanism in a dose-dependent manner, and therefore, they support a role for L-AmB in the treatment of azole-resistant IA.
authors: Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors: Seyedmojtaba
authors: S
authors: Seyedmousavi
authors: Willem J G
authors: WJ
authors: Melchers
authors: Johan W
authors: JW
authors: Mouton
authors: Paul E
authors: PE
authors: Verweij
mesh_terms: D000666:Amphotericin B / Q000493:pharmacokinetics* / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D000935:Antifungal Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000378:metabolism; D001232:Aspergillus fumigatus / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity*; D001393:Azoles / Q000627:therapeutic use*; D025141:Drug Resistance, Fungal / Q000235:genetics; D005260:Female; D005656:Fungal Proteins / Q000235:genetics / Q000378:metabolism; D051379:Mice; D008826:Microbial Sensitivity Tests
chemical_list: D000935:Antifungal Agents; D001393:Azoles; D005656:Fungal Proteins; C068538:liposomal amphotericin B; D000666:Amphotericin B
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