title: In vitro synergism of a water insoluble fraction of Uncaria tomentosa combined with fluconazole and terbinafine against resistant non-Candida albicans isolates.
abstract: BACKGROUND
  Uncaria tomentosa D.C. (Rubiaceae) has several biological activities, including activity against resistant Candida strains. The synergistic interaction with terbinafine or fluconazole can be an important alternative to overcome this resistance.
  
  
  OBJECTIVE
  The potential synergy between a water insoluble fraction (WIF) from Uncaria tomentosa bark and the antifungals terbinafine (TRB) and fluconazole (FLZ) against non-Candida albicans resistant strains was investigated.
  
  
  METHODS
  TRB and FLZ, alone and combined with WIF, were tested by the checkerboard procedure using the micro-dilution technique against seven isolates of Candida glabrata and C. krusei. The molecular interactions occurring outside the cell wall were evaluated by scanning electron microscopy, Fourier transform infrared (FT-IR) and differential scanning calorimetry (DSC) analysis.
  
  
  RESULTS
  The checkerboard inhibitory assay demonstrated synergy for WIF:TRB and WIF:FLZ combinations, respectively. The best synergistic cell damage was demonstrated unequivocally for the associations of WIF and TRB (1.95:4.0 μg/mL) and WIF and FLZ (1.95:8.0 μg/mL). The comparison of the FT-IR spectra of the antifungal alone, and in combination with WIF, allows recognizing clear differences in 3000, 1600, 1400, and 700-800 cm-1bands. Additionally, modifications on TRB and FLZ thermograms were clearly noticed after their combination with WIF.
  
  
  CONCLUSIONS
  DSC and infrared analysis demonstrated intermolecular interactions between WIF and either TRB or FLZ. Hence, quite likely the synergistic effect is related to interaction events occurring outside the cell wall between antifungal and cat's claw proanthocyanidins. A direct action on the cell wall is suggested, without connection with the ABC efflux pump mechanism.
authors.affiliation: a Post-Graduate Program in Pharmaceutical Sciences (PPGCF), Faculty of Pharmacy , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil.
authors.forename: Renata Cougo
authors.initials: RC
authors.lastname: Moraes
authors.affiliation: a Post-Graduate Program in Pharmaceutical Sciences (PPGCF), Faculty of Pharmacy , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil.
authors.forename: Anderson Ramos
authors.initials: AR
authors.lastname: Carvalho
authors.affiliation: a Post-Graduate Program in Pharmaceutical Sciences (PPGCF), Faculty of Pharmacy , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil.
authors.forename: Aline Jacobi Dalla
authors.initials: AJ
authors.lastname: Lana
authors.affiliation: a Post-Graduate Program in Pharmaceutical Sciences (PPGCF), Faculty of Pharmacy , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kaiser
authors.affiliation: b Post-Graduate Program in Agricultural and Environmental Microbiology (PPGMAA) , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil.
authors.forename: Bruna
authors.initials: B
authors.lastname: Pippi
authors.affiliation: a Post-Graduate Program in Pharmaceutical Sciences (PPGCF), Faculty of Pharmacy , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil.|b Post-Graduate Program in Agricultural and Environmental Microbiology (PPGMAA) , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil.
authors.forename: Alexandre Meneghello
authors.initials: AM
authors.lastname: Fuentefria
authors.affiliation: a Post-Graduate Program in Pharmaceutical Sciences (PPGCF), Faculty of Pharmacy , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil.
authors.forename: George González
authors.initials: GG
authors.lastname: Ortega
mesh_terms: D000935:Antifungal Agents / Q000302:isolation & purification / Q000494:pharmacology*; D002152:Calorimetry, Differential Scanning; D002175:Candida / Q000187:drug effects* / Q000254:growth & development / Q000648:ultrastructure; D020948:Cat's Claw / Q000737:chemistry*; D002473:Cell Wall / Q000187:drug effects / Q000648:ultrastructure; D025141:Drug Resistance, Fungal / Q000187:drug effects*; D004357:Drug Synergism; D015725:Fluconazole / Q000494:pharmacology*; D008855:Microscopy, Electron, Scanning; D009281:Naphthalenes / Q000494:pharmacology*; D008517:Phytotherapy; D024301:Plant Bark; D010936:Plant Extracts / Q000302:isolation & purification / Q000494:pharmacology*; D010946:Plants, Medicinal; D012995:Solubility; D017550:Spectroscopy, Fourier Transform Infrared; D000077291:Terbinafine; D014867:Water / Q000737:chemistry
chemical_list: D000935:Antifungal Agents; D009281:Naphthalenes; D010936:Plant Extracts; D014867:Water; D015725:Fluconazole; D000077291:Terbinafine
keywords: Natural products; antifungal resistance; candida; checkerboard; polyphenols