福司莫杰克斯(APX001)治疗非中性粒细胞减少性兔眼内炎和血源性脑膜脑炎的疗效和药代动力学。
Efficacy and Pharmacokinetics of Fosmanogepix (APX001) in the Treatment of Endophthalmitis and Hematogenous Meningoencephalitis in Nonneutropenic Rabbits.
机构信息
Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York, USA
Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York, USA.
出版信息
Antimicrob Agents Chemother. 2021 Feb 17;65(3). doi: 10.1128/AAC.01795-20.
endophthalmitis is a serious sight-threatening complication of candidemia that may occur before or during antifungal therapy. Hematogenous meningoencephalitis (HCME) is also a serious manifestation of disseminated candidiasis in premature infants, immunosuppressed children, and immunocompromised adults. We evaluated the antifungal efficacy and pharmacokinetics of the prodrug fosmanogepix (APX001) in a rabbit model of endophthalmitis/HCME. Manogepix (APX001A), the active moiety of prodrug fosmanogepix, inhibits the fungal enzyme Gwt1 and is highly active and against spp., spp., and other fungal pathogens. Plasma pharmacokinetics of manogepix after oral administration of fosmanogepix on day 6 at 25, 50, and 100 mg/kg resulted in maximum concentration of drug in plasma () of 3.96 ± 0.41, 4.14 ± 1.1, and 11.5 ± 1.1 μg/ml, respectively, and area under the concentration-time curve from 0 to 12 h (AUC) of 15.8 ± 3.1, 30.8 ± 5.0, 95.9 ± 14 μgh/ml, respectively. Manogepix penetrated the aqueous humor, vitreous, and choroid with liquid-to-plasma ratios ranging from 0.19 to 0.52, 0.09 to 0.12, and 0.02 to 0.04, respectively. These concentrations correlated with a significant decrease in burden in vitreous (>10 to 10 log CFU/g) and choroid (>10 to 10 log CFU/g) (0.05 and 0.001, respectively). The aqueous humor had no detectable in treatment and control groups. The tissue/plasma concentration ratios of manogepix in meninges, cerebrum, cerebellum, and spinal cord were approximately 1:1, which correlated with a >10 to 10 decline of in tissue versus control (0.05). Serum and cerebrospinal fluid (CSF) (1→3)-β-d-glucan levels demonstrated significant declines in response to fosmanogepix treatment. These findings provide an experimental foundation for fosmanogepix in treatment of endophthalmitis and HCME and derisk the clinical trials of candidemia and invasive candidiasis.
眼内炎是念珠菌血症的一种严重威胁视力的并发症,可能在抗真菌治疗之前或期间发生。血行性脑膜脑炎(HCME)也是早产儿、免疫抑制儿童和免疫功能低下成人中播散性念珠菌病的一种严重表现。我们在兔眼内炎/HCME 模型中评估了前药福曼戈皮克斯(APX001)的抗真菌疗效和药代动力学。前药福曼戈皮克斯中的活性成分马尼戈皮克斯(APX001A)抑制真菌酶 Gwt1,对 spp.、 spp. 和其他真菌病原体具有高度活性和选择性。第 6 天,以 25、50 和 100mg/kg 的剂量口服福曼戈皮克斯后,马尼戈皮克斯在血浆中的最大浓度(Cmax)分别为 3.96±0.41、4.14±1.1 和 11.5±1.1μg/ml,0 至 12 小时的浓度-时间曲线下面积(AUC)分别为 15.8±3.1、30.8±5.0 和 95.9±14μgh/ml。马尼戈皮克斯穿透房水、玻璃体液和脉络膜,液-血浆比为 0.19 至 0.52、0.09 至 0.12 和 0.02 至 0.04。这些浓度与玻璃体液(>10 至 10logCFU/g)和脉络膜(>10 至 10logCFU/g)中负荷的显著降低相关(0.05 和 0.001)。在治疗和对照组中,眼水中均未检测到 。马尼戈皮克斯在脑膜、大脑、小脑和脊髓中的组织/血浆浓度比约为 1:1,这与组织与对照组相比(0.05)10 至 10log 减少相关。血清和脑脊液(CSF)(1→3)-β-d-葡聚糖水平显示出对福曼戈皮克斯治疗的显著下降。这些发现为福曼戈皮克斯治疗眼内炎和 HCME 提供了实验基础,并降低了念珠菌血症和侵袭性念珠菌病临床试验的风险。