Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Pharmidex, London, United Kingdom.
PLoS Negl Trop Dis. 2021 Mar 2;15(3):e0009013. doi: 10.1371/journal.pntd.0009013. eCollection 2021 Mar.
BACKGROUND: There is a continued need to develop effective and safe treatments for visceral leishmaniasis (VL). Preclinical studies on pharmacokinetics and pharmacodynamics of anti-infective agents, such as anti-bacterials and anti-fungals, have provided valuable information in the development and dosing of these agents. The aim of this study was to characterise the pharmacokinetic and pharmacodynamic properties of the anti-leishmanial drugs AmBisome and miltefosine in a preclinical disease model of VL. METHODOLOGY / PRINCIPAL FINDINGS: BALB/c mice were infected with L. donovani (MHOM/ET/67/HU3) amastigotes. Groups of mice were treated with miltefosine (orally, multi-dose regimen) or AmBisome (intravenously, single dose regimen) or left untreated as control groups. At set time points groups of mice were killed and plasma, livers and spleens harvested. For pharmacodynamics the hepatic parasite burden was determined microscopically from tissue impression smears. For pharmacokinetics drug concentrations were measured in plasma and whole tissue homogenates by LC-MS. Unbound drug concentrations were determined by rapid equilibrium dialysis. Doses exerting maximum anti-leishmanial effects were 40 mg/kg for AmBisome and 150 mg/kg (cumulatively) for miltefosine. AmBisome displayed a wider therapeutic range than miltefosine. Dose fractionation at a total dose of 2.5 mg/kg pointed towards concentration-dependent anti-leishmanial activity of AmBisome, favouring the administration of large doses infrequently. Protein binding was >99% for miltefosine and amphotericin B in plasma and tissue homogenates. CONCLUSION / SIGNIFICANCE: Using a PK/PD approach we propose optimal dosing strategies for AmBisome. Additionally, we describe pharmacokinetic and pharmacodynamic properties of miltefosine and compare our findings in a preclinical disease model to available knowledge from studies in humans. This approach also presents a strategy for improved use of animal models in the drug development process for VL.
背景:开发针对内脏利什曼病(VL)的有效且安全的治疗方法仍然是当务之急。针对抗感染药物(如抗细菌和抗真菌药物)的药代动力学和药效学的临床前研究为这些药物的开发和给药提供了有价值的信息。本研究旨在通过 VL 的临床前疾病模型来描述抗利什曼原虫药物两性霉素 B 脂质体和米替福新的药代动力学和药效学特性。
方法/主要发现:BALB/c 小鼠感染 L. donovani(MHOM/ET/67/HU3)无鞭毛体。将小鼠分为米替福新(口服,多剂量方案)或两性霉素 B 脂质体(静脉内,单剂量方案)治疗组或未治疗对照组。在设定的时间点,处死各组小鼠并采集血浆、肝脏和脾脏。为了进行药效学研究,从组织印片上用显微镜确定肝内寄生虫负担。为了进行药代动力学研究,通过 LC-MS 测量血浆和整个组织匀浆中的药物浓度。通过快速平衡透析法测定游离药物浓度。发挥最大抗利什曼原虫作用的剂量分别为 40mg/kg 的两性霉素 B 脂质体和 150mg/kg(累积)的米替福新。两性霉素 B 脂质体的治疗范围比米替福新更广。在总剂量为 2.5mg/kg 时,剂量分割表明两性霉素 B 的抗利什曼原虫活性呈浓度依赖性,有利于大剂量但不频繁给药。米替福新和两性霉素 B 在血浆和组织匀浆中的蛋白结合率均>99%。
结论/意义:我们使用 PK/PD 方法为两性霉素 B 脂质体提出了最佳的给药策略。此外,我们描述了米替福新的药代动力学和药效学特性,并将我们在临床前疾病模型中的发现与来自人类研究的现有知识进行了比较。这种方法还为 VL 药物开发过程中更好地利用动物模型提供了一种策略。
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