Locke Jeffrey B, Almaguer Amanda L, Zuill Douglas E, Bartizal Ken
Cidara Therapeutics, Inc., San Diego, California, USA
Cidara Therapeutics, Inc., San Diego, California, USA.
Antimicrob Agents Chemother. 2016 Sep 23;60(10):6100-7. doi: 10.1128/AAC.00620-16. Print 2016 Oct.
CD101 is a novel echinocandin with a long half-life undergoing clinical development for treatment of candidemia/invasive candidiasis and vulvovaginal candidiasis. The potential for and mechanisms underlying the development of resistance to CD101 in Candida species were investigated by using spontaneous resistance and serial passage selection methodologies. Four Candida spp. (C. albicans, C. glabrata, C. parapsilosis, and C. krusei) were chosen for resistance characterization with CD101, anidulafungin, and caspofungin. The frequency of spontaneous, single-step mutations conferring reduced susceptibility to CD101 at 1× the agar growth inhibition concentration was low across all species, with median frequencies ranging from 1.35 × 10(-8) to 3.86 × 10(-9), similar to ranges generated for anidulafungin and caspofungin. Serial passage of Candida spp. on agar plates containing drug gradients demonstrated a low potential for resistance development, with passage 20 CD101-selected strains possessing increases in MICs equivalent to or lower than those for the majority of strains generated under selection with anidulafungin and caspofungin. A total of 12 fks "hot spot" mutations were identified, typically in strains with the highest MIC shifts. Cross-resistance was broadly observed among the 3 echinocandins evaluated, with no CD101-selected mutants (with or without fks hot spot mutations) exhibiting reduced susceptibility to CD101 but not also to anidulafungin and/or caspofungin. Consistent with currently approved echinocandins, CD101 demonstrates a low potential for resistance development, which could be further enhanced in vivo by the high maximum concentration of drug in serum (Cmax)/area under the concentration-time curve (AUC) plasma drug exposure achieved with once-weekly dosing of CD101.
CD101是一种新型棘白菌素,半衰期长,正在进行临床开发,用于治疗念珠菌血症/侵袭性念珠菌病和外阴阴道念珠菌病。通过自发耐药和连续传代选择方法,研究了念珠菌属对CD101耐药的可能性及其潜在机制。选择了4种念珠菌(白色念珠菌、光滑念珠菌、近平滑念珠菌和克柔念珠菌),用CD101、阿尼芬净和卡泊芬净进行耐药性特征分析。在所有物种中,在1倍琼脂生长抑制浓度下,赋予对CD101敏感性降低的自发单步突变频率都很低,中位数频率范围为1.35×10⁻⁸至3.86×10⁻⁹,与阿尼芬净和卡泊芬净产生的范围相似。念珠菌属在含有药物梯度的琼脂平板上连续传代显示耐药发展的可能性较低,第20代CD101选择的菌株的最低抑菌浓度(MIC)增加量等于或低于在阿尼芬净和卡泊芬净选择下产生的大多数菌株。总共鉴定出12个fks“热点”突变,通常出现在MIC变化最大的菌株中。在所评估的3种棘白菌素中广泛观察到交叉耐药性,没有CD101选择的突变体(有或没有fks热点突变)对CD101敏感性降低,但对阿尼芬净和/或卡泊芬净不降低。与目前批准的棘白菌素一致,CD101显示出耐药发展的可能性较低,通过每周一次给药CD101在血清中达到的高最大药物浓度(Cmax)/浓度-时间曲线下面积(AUC)血浆药物暴露,在体内这种可能性可能会进一步增强。