Mihara Tomo, Kakeya Hiroshi, Izumikawa Koichi, Obata Yoko, Nishino Tomoya, Takazono Takahiro, Kosai Kosuke, Morinaga Yoshitomo, Kurihara Shintaro, Nakamura Shigeki, Imamura Yoshifumi, Miyazaki Taiga, Tsukamoto Misuzu, Yamamoto Yoshihiro, Yanagihara Katsunori, Tashiro Takayoshi, Kohno Shigeru
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
J Infect Chemother. 2014 Feb;20(2):104-8. doi: 10.1016/j.jiac.2013.09.002. Epub 2013 Dec 11.
Invasive pulmonary mucormycosis is a life-threatening fungal infection encountered in immunocompromised patients. An intravenous high-dose lipid formulation of amphotericin B, such as liposomal amphotericin B (L-AMB), is the recommended treatment. The efficacy of inhaled L-AMB against mucormycosis has not been evaluated. We evaluated the efficacy of inhaled aerosolized L-AMB in murine invasive pulmonary mucormycosis. ICR female mice were immunosuppressed with cortisone acetate and cyclophosphamide and challenged on day 0 with 1 × 10⁶ conidia of Rhizopus oryzae (TIMM 1327) intratracheally. Infected mice were assigned to one of the following 3 treatment groups: (i) control, (ii) treatment only (aerosolized L-AMB from day 1-5 after challenge), and (iii) prophylaxis followed by treatment (aerosolized L-AMB from day -2 to 5 before and after challenge). Survival was monitored until 12 days after challenge. For fungal-burden and histopathological examination, mice were sacrificed 4 h after treatment on day 3. Numbers of colony-forming units per lung were calculated. To study the distribution of AMB after inhalation of L-AMB, immunohistochemical studies using AMB antibody were performed. Aerosolized L-AMB significantly improved survival rate and decreased fungal burden compared with control group, and histopathology findings were superior to those of control group. However, no significant differences were detected between the treatment-only and prophylaxis followed by treatment groups. Immunohistochemical analysis showed that L-AMB was promptly distributed in lung tissue after inhalation therapy. Aerosolized L-AMB showed modest efficacy against R. oryzae infection in mice treated after fungal challenge. Prophylaxis with aerosolized L-AMB was not effective in this animal model.
侵袭性肺毛霉病是免疫功能低下患者中一种危及生命的真菌感染。推荐的治疗方法是静脉注射高剂量两性霉素B脂质制剂,如脂质体两性霉素B(L-AMB)。吸入L-AMB治疗毛霉病的疗效尚未得到评估。我们评估了吸入雾化L-AMB对小鼠侵袭性肺毛霉病的疗效。用醋酸可的松和环磷酰胺对ICR雌性小鼠进行免疫抑制,并在第0天经气管内接种1×10⁶个米根霉(TIMM 1327)分生孢子进行攻击。将感染的小鼠分为以下3个治疗组之一:(i)对照组,(ii)仅治疗组(攻击后第1 - 5天雾化L-AMB),以及(iii)预防后治疗组(攻击前后第 - 2至5天雾化L-AMB)。监测生存情况直至攻击后12天。为进行真菌负荷和组织病理学检查,在第3天治疗后4小时处死小鼠。计算每只肺的菌落形成单位数量。为研究吸入L-AMB后两性霉素B的分布情况,进行了使用两性霉素B抗体的免疫组织化学研究。与对照组相比,雾化L-AMB显著提高了生存率并降低了真菌负荷,组织病理学结果也优于对照组。然而,仅治疗组和预防后治疗组之间未检测到显著差异。免疫组织化学分析表明,吸入治疗后L-AMB迅速分布于肺组织中。雾化L-AMB对真菌攻击后治疗的小鼠中的米根霉感染显示出适度疗效。在该动物模型中,雾化L-AMB预防无效。