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David Andes

Publications and source records attributed to David Andes.

At least 19 recordsLinked to original sources

Putative role of beta-1,3 glucans in Candida albicans biofilm resistance.

Biofilms are microbial communities, embedded in a polymeric matrix, growing attached to a surface. Nearly all device-associated infections involve growth in the biofilm life style. Biofilm communities have characteristic architecture and distinct phenotypic properties. The most clinically important phenotype involves extraordinary resistance to antimicrobial therapy, making biofilm infections very difficulty to cure without device removal. The current studies examine drug resistance in Candida albicans biofilms. Similar to previous reports, we observed marked fluconazole and amphotericin B resistance in a C. albicans biofilm both in vitro and in vivo. We identified biofilm-associated cell wall architectural changes and increased beta-1,3 glucan content in C. albicans cell walls from a biofilm compared to planktonic organisms. Elevated beta-1,3 glucan levels were also found in the surrounding biofilm milieu and as part of the matrix both from in vitro and in vivo biofilm models. We thus investigated the possible contribution of beta-glucans to antimicrobial resistance in Candida albicans biofilms. Initial studies examined the ability of cell wall and cell supernatant from biofilm and planktonic C. albicans to bind fluconazole. The cell walls from both environmental conditions bound fluconazole; however, four- to fivefold more compound was bound to the biofilm cell walls. Culture supernatant from the biofilm, but not planktonic cells, bound a measurable amount of this antifungal agent. We next investigated the effect of enzymatic modification of beta-1,3 glucans on biofilm cell viability and the susceptibility of biofilm cells to fluconazole and amphotericin B. We observed a dose-dependent killing of in vitro biofilm cells in the presence of three different beta-glucanase preparations. These same concentrations had no impact on planktonic cell viability. beta-1,3 Glucanase markedly enhanced the activity of both fluconazole and amphotericin B. These observations were corroborated with an in vivo biofilm model. Exogenous biofilm matrix and commercial beta-1,3 glucan reduced the activity of fluconazole against planktonic C. albicans in vitro. In sum, the current investigation identified glucan changes associated with C. albicans biofilm cells, demonstrated preferential binding of these biofilm cell components to antifungals, and showed a positive impact of the modification of biofilm beta-1,3 glucans on drug susceptibility. These results provide indirect evidence suggesting a role for glucans in biofilm resistance and present a strong rationale for further molecular dissection of this resistance mechanism to identify new drug targets to treat biofilm infections.

Amphotericin B↗

GliZ, a transcriptional regulator of gliotoxin biosynthesis, contributes to Aspergillus fumigatus virulence.

Gliotoxin is a nonribosomal peptide produced by Aspergillus fumigatus. This compound has been proposed as an A. fumigatus virulence factor due to its cytotoxic, genotoxic, and apoptotic properties. Recent identification of the gliotoxin gene cluster identified several genes (gli genes) likely involved in gliotoxin production, including gliZ, encoding a putative Zn(2)Cys(6) binuclear transcription factor. Replacement of gliZ with a marker gene (DeltagliZ) resulted in no detectable gliotoxin production and loss of gene expression of other gli cluster genes. Placement of multiple copies of gliZ in the genome increased gliotoxin production. Using endpoint survival data, the DeltagliZ and a multiple-copy gliZ strain were not statistically different from the wild type in a murine pulmonary model; however, both the wild-type and the multiple-copy gliZ strain were more virulent than DeltalaeA (a mutant reduced in production of gliotoxin and other toxins). A flow-cytometric analysis of polymorphonuclear leukocytes (PMNs) exposed to supernatants from wild-type, DeltagliZ, complemented DeltagliZ, and DeltalaeA strains supported a role for gliotoxin in apoptotic but not necrotic PMN cell death. This may indicate that several secondary metabolites are involved in A. fumigatus virulence.

Animals↗

Candida albicans biofilm development, modeling a host-pathogen interaction.

Medical device-associated infections involve the attachment of cells to a surface, production of an extracellular matrix and development of a mature biofilm. Many Candida albicans disease states involve biofilm growth. These infections have great impact on public health because organisms in biofilms exhibit dramatically reduced susceptibility to antifungal therapy. Progression to a mature biofilm is dependent on cell adhesion, extracellular matrix production and the yeast-to-hyphae transition. Numerous in vitro biofilm model systems have been successfully used to examine biofilm architecture, development, cell phenotypes and drug resistance. Although these studies have included a number of experimental variables to mimic infections in patients, it is difficult to accurately account for the multitude of host and infection-site variables that are probably important in humans. Recent studies have begun to explore C. albicans biofilms using animal biofilm infection models in order to more completely reflect the complexity of this host-fungal interaction.

Animals↗

Pharmacokinetics and pharmacodynamics of antifungals.

Application of pharmacodynamic principles to antifungal drug therapy of Candida and Aspergillus infections has provided and understanding of the relationship between drug dosing and treatment efficacy. Observations of the pharmacodynamics of triazoles and AmB have correlated with the results of clinical trials and have proven useful for validation of in vitro susceptibility breakpoints. Although there remain many unanswered questions regarding antifungal pharmacodynamics, available data suggest usefulness in the application of pharmacodynamics to antifungal clinical development. Future application of these principles should aid in the design of optimal combination antifungal therapies.

Antifungal Agents↗

Alcohol dehydrogenase restricts the ability of the pathogen Candida albicans to form a biofilm on catheter surfaces through an ethanol-based mechanism.

Candida biofilms formed on indwelling medical devices are increasingly associated with severe infections. In this study, we used proteomics and Western and Northern blotting analyses to demonstrate that alcohol dehydrogenase (ADH) is downregulated in Candida biofilms. Disruption of ADH1 significantly (P = 0.0046) enhanced the ability of Candida albicans to form biofilm. Confocal scanning laser microscopy showed that the adh1 mutant formed thicker biofilm than the parent strain (210 microm and 140 microm, respectively). These observations were extended to an engineered human oral mucosa and an in vivo rat model of catheter-associated biofilm. Inhibition of Candida ADH enzyme using disulfiram and 4-methylpyrazole resulted in thicker biofilm (P < 0.05). Moreover, biofilms formed by the adh1 mutant strain produced significantly smaller amounts of ethanol, but larger amounts of acetaldehyde, than biofilms formed by the parent and revertant strains (P < 0.0001), demonstrating that the effect of Adh1p on biofilm formation is mediated by its enzymatic activity. Furthermore, we found that 10% ethanol significantly inhibited biofilm formation in vitro, with complete inhibition of biofilm formation at ethanol concentrations of >/=20%. Similarly, using a clinically relevant rabbit model of catheter-associated biofilm, we found that ethanol treatment inhibited biofilm formation by C. albicans in vivo (P < 0.05) but not by Staphylococcus spp. (P > 0.05), indicating that ethanol specifically inhibits Candida biofilm formation. Taken together, our studies revealed that Adh1p contributes to the ability of C. albicans to form biofilms in vitro and in vivo and that the protein restricts biofilm formation through an ethanol-dependent mechanism. These results are clinically relevant and may suggest novel antibiofilm treatment strategies.

Alcohol Dehydrogenase↗

LaeA, a regulator of morphogenetic fungal virulence factors.

Opportunistic animal and plant pathogens, well represented by the genus Aspergillus, have evolved unique mechanisms to adapt to and avoid host defenses. Aspergillus fumigatus, an increasingly serious pathogen owing to expanding numbers of immunocompromised patients, causes the majority of human infections; however, an inability to identify bona fide virulence factors has impeded therapeutic advances. We show that an A. fumigatus mutation in a developmentally expressed transcriptional regulator (deltalaeA) coordinating morphological and chemical differentiation reduces virulence in a murine model; impaired virulence is associated with decreased levels of pulmonary gliotoxin and multiple changes in conidial and hyphal susceptibility to host phagocytes ex vivo. LaeA, a conserved protein in filamentous fungi, is a developmental regulator of virulence genes and, possibly, the first antimicrobial target specific to filamentous fungi that are pathogenic to plants and animals.

Adult↗

Aspergillus cyclooxygenase-like enzymes are associated with prostaglandin production and virulence.

Oxylipins comprise a family of oxygenated fatty acid-derived signaling molecules that initiate critical biological activities in animals, plants, and fungi. Mammalian oxylipins, including the prostaglandins (PGs), mediate many immune and inflammation responses in animals. PG production by pathogenic microbes is theorized to play a role in pathogenesis. We have genetically characterized three Aspergillus genes, ppoA, ppoB, and ppoC, encoding fatty acid oxygenases similar in sequence to specific mammalian prostaglandin synthases, the cyclooxygenases. Enzyme-linked immunosorbent assay analysis showed that production of PG species is decreased in both Aspergillus nidulans and A. fumigatus ppo mutants, implicating Ppo activity in generating PGs. The A. fumigatus triple-ppo-silenced mutant was hypervirulent in the invasive pulmonary aspergillosis murine model system and showed increased tolerance to H(2)O(2) stress relative to that of the wild type. We propose that Ppo products, PG, and/or other oxylipins may serve as activators of mammalian immune responses contributing to enhanced resistance to opportunistic fungi and as factors that modulate fungal development contributing to resistance to host defenses.

Amino Acid Sequence↗

Use of an animal model of disseminated candidiasis in the evaluation of antifungal therapy.

Animal models have been helpful in assessing a drug's potential application to treatment of humans. These controlled experiments allow description of the impact of a wide range of important treatment variables, including drug dose or concentration, dosing interval, pathogen, and host immune state. Animal models of mycoses are designed to address particular therapeutic questions. Some models are designed to screen multiple compounds in a rapid manner. Other models are selected to more closely mimic clinical infections. The following chapter will be limited to the description of a murine model of disseminated candidiasis in which in vitro results, pharmacokinetic properties, and a microbiological in vivo end point is used in the assessment of a wide variety of antifungal compounds.

Animals↗

Exophiala jeanselmei infection in a heart transplant recipient successfully treated with oral terbinafine.

An immunosuppressed heart transplant recipient developed Exophiala jeanselmei infection on the second toe. After unsuccessful treatment with different antifungal drugs, the infection responded to a high-dose regimen of oral terbinafine (an antifungal agent not yet approved in the United States for use against the dematiaceous fungi) and warm packs. This is, to our knowledge, the only known case of successful terbinafine treatment of E. jeanselmei infection.

Administration, Topical↗

Application of pharmacokinetics and pharmacodynamics to antimicrobial therapy of respiratory tract infections.

The pharmacologic field that studies antimicrobial pharmacokinetics and pharmacodynamics (PK/PD) has had a major impact on the choice and dosing regimens used for many antibiotics especially those used in the treatment of respiratory tract infections. PK/PD parameters are particularly important in light of increasing antimicrobial resistance. Drug pharmacokinetic features, such as serum concentrations over time and area under the concentration-time curve, when integrated with minimum inhibitory concentration (MIC) values of antibiotics against pathogens, can predict the probability of bacterial eradication and clinical success. These pharmacokinetic and pharmacodynamic relationships also are important in preventing the selection and spread of resistant strains and have led to the description of the mutation prevention concentration, which is the lowest concentration of antimicrobial that prevents selection of resistant bacteria from high bacterial inocula. b-lactams are time-dependent agents without significant post-antibiotic effects, resulting in bacterial eradication when unbound serum concentrations exceed MICs of these agents against infecting pathogens for >40% to 50% of the dosing interval. Macrolides, azaolides, and lincosamides are time-dependent agents with prolonged post-antibiotic effects, and fluoroquinolones are concentration-dependent agents, resulting in both cases in bacterial eradication when unbound serum area-under-the-curve to MIC ratios exceed 25 to 30. These observations have led to changes in recommended antimicrobial dosing against respiratory pathogens and are used to assess the role of current agents, develop new formulations, and assess potency of new antimicrobials.

Anti-Bacterial Agents↗

Antifungal pharmacokinetics and pharmacodynamics: understanding the implications for antifungal drug resistance.

Pharmacodynamics (PDs) describe the relationship between drug exposure and outcome. The drug exposures in these analyses are most commonly expressed in a variety of pharmacokinetic terms. The outcome of interest with anti-infective therapy is either microbiologic resolution or a clinical surrogate of treatment efficacy. An in vitro measure of drug potency, such as the minimum inhibitory concentration (MIC) is also frequently considered in this relationship. Examination of the relationships among drug pharmacokinetics, MIC, and efficacy has provided a framework for choice of antifungal drug and dose. These analyses provide a PD target for drug class/organism combinations. The PD target can be useful for defining the upper MIC limit for a drug-dosing regimen that would be expected to result in treatment efficacy. The PD target can be used to optimize dosing regimens and to aid in defining susceptibility breakpoints.

Antifungal Agents↗

Clinical utility of antifungal pharmacokinetics and pharmacodynamics.

PURPOSE OF REVIEW: Historically the anti-infective dose and dosing interval chosen in clinical trials have been based on an arbitrary goal of maintaining drug levels in serum above the minimum inhibitory concentration of infecting pathogens for most if not all of the dosing interval. Subsequent United States Food and Drug Administration approval of a dosing regimen is then based on clinical success in treatment trials. Over the past decade, the emergence of drug resistance has limited the clinical utility of an increasing number of antimicrobial agents. However, early in drug development clinical trials do not often define the impact of infection with these less susceptible pathogens. The field of pharmacodynamics provides analysis tools that can help predict the likelihood of treatment success with various antimicrobial treatment regimens against susceptible and resistant pathogens. RECENT FINDINGS: In-vitro and animal model studies have begun to define the pharmacodynamic characteristics of a variety of antifungal compounds. In-vivo studies have demonstrated that the pharmacodynamic target associated with efficacy is similar among antifungal drugs within the same class and have shown the importance of considering protein. Analysis of clinical trial data suggests that the pharmacodynamic target identified in animal model studies is predictive of outcomes in humans. SUMMARY: Antifungal pharmacodynamics can be used to understand the relationship between drug dosing, in-vitro susceptibility and treatment efficacy. Consideration of these relationships can be used to optimize dosing regimens with current antifungal agents, to develop susceptibility breakpoint guidelines, and in the design of dosing regimens for drugs in early development.

Animals↗

In vivo pharmacodynamic activity of daptomycin.

Daptomycin is a lipopeptide antibiotic with activity against a wide range of gram-positive bacteria. We used the neutropenic murine thigh model to characterize the pharmacodynamics of daptomycin. ICR/Swiss mice were rendered neutropenic with cyclophosphamide; and the thigh muscles of the mice were infected with strains of Staphylococcus aureus, Streptococcus pneumoniae, and Enterococcus faecium. Animals were treated by subcutaneous injection of daptomycin at doses of 0.20 to 400 mg/kg of body weight/day divided into one, two, four, or eight doses over 24 h. Daptomycin exhibited linear pharmacokinetics, with an area under the concentration-time curve (AUC) from time zero to infinity/dose of 9.4 and a half-life of 0.9 to 1.4 h. The level of protein binding was 90%. Free daptomycin exhibited concentration-dependent killing and produced in vivo postantibiotic effects (PAEs) of 4.8 to 10.8 h. Nonlinear regression analysis was used to determine which pharmacokinetic (PK) or pharmacodynamic (PD) parameter was important for efficacy by using free drug concentrations. The peak concentration/MIC (peak/MIC) ratio and 24-h AUC/MIC ratio were the PK and PD parameters that best correlated with in vivo efficacy (R(2) = 83 to 87% for peak/MIC and R(2) = 86% for the AUC/MIC ratio, whereas R(2) = 47 to 50% for the time that the concentration was greater than the MIC) against standard strains of S. aureus and S. pneumoniae. The peak/MIC ratios required for a bacteriostatic effect ranged from 12 to 36 for S. pneumoniae, 59 to 94 for S. aureus, and 0.14 to 0.25 for E. faecium. The AUC/MIC ratios needed for a bacteriostatic effect ranged from 75 to 237 for S. pneumoniae, 388 to 537 for S. aureus, and 0.94 to 1.67 for E. faecium. The free daptomycin concentrations needed to average from one to two times the MIC over 24 h to produce a bacteriostatic effect and two to four times the MIC over 24 h to produce greater than 99% killing. The long PAE and potent bactericidal activity make daptomycin an attractive option for the treatment of infections caused by gram-positive bacteria.

Algorithms↗

Autochthonous furuncular myiasis in the United States: case report and literature review.

Most cases of furuncular myiasis in the United States are acquired during travel to other countries. Autochthonous cases are infrequently reported and are most often due to accidental infestation of humans by larvae of flies belonging to the genus Cuterebra, commonly known as "rabbit bot flies" or "rodent bot flies." We describe a case of furuncular myiasis due to Cuterebra larvae in the hand of a patient residing in Wisconsin. The infestation was acquired while the patient gardened near a seepage lake during August. The patient developed papular lesions on the hand and received therapy for presumed bacterial furunculosis, which did not lead to improvement. Retrieval of one of the larvae from the patient permitted identification of the causative agent, and application of an occlusive ointment resulted in complete cure. North American cuterebrid myiasis is rare, and the diagnosis is frequently delayed. Myiasis should be considered when treating patients with refractory furunculosis.

Adolescent↗

Hot tub-associated necrotizing pneumonia due to Pseudomonas aeruginosa.

We describe a case of severe necrotizing pneumonia due to community-acquired Pseudomonas aeruginosa. Cultures of fluid obtained from the filter of the patient's hot tub grew the same P. aeruginosa strain as that grown from culture of the patient's sputum. Centers for Disease Control and Prevention guidelines should be strictly followed for hot tub maintenance to prevent P. aeruginosa overgrowth: the range of free chlorine levels in the water should be kept at 1-3 mg/L, and the pH should be kept at 7.2-7.8.

Adult↗

Clinical pharmacodynamics of antifungals.

Application of pharmacodynamic principles to antifungal drugs has provided an understanding of the relationship between drug dosing and treatment outcomes similar to that observed in antibacterial pharmacodynamics. Initial observations with triazole pharmacodynamics have correlated with clinical trial results and proved useful for validation of in vitro susceptibility breakpoints. Pharmacodynamic studies have been invaluable for clinical trial dosing design for numerous antibacterial drugs in the development stage. More recently, pharmacodynamics has been used for the development of treatment guidelines. Although there remain many unanswered questions regarding antifungal pharmacodynamics, available data suggest usefulness in the application of pharmacodynamics to antifungal clinical development.

Animals↗