RESUMO
Acanthamoeba keratitis is a sight-threatening infectious disease. Resistance of the cystic form of the protozoan to biocides and the potential toxicity of chemical compounds to corneal cells are the main concerns related to long-term treatment with the clinically available ophthalmic drugs. Currently, a limited number of recognized antimicrobial agents are available to treat ocular amoebic infections. Topical application of biguanide and diamidine antiseptic solutions is the first-line therapy. We consider the current challenges when treating Acanthamoeba keratitis and review the chemical properties, toxicities, and mechanisms of action of the available biocides. Antimicrobial therapy using anti-inflammatory drugs is controversial, and aspects related to this topic are discussed. Finally, we offer our perspective on potential improvement of the effectiveness and safety of therapeutic profiles, with the focus on the quality of life and the advancement of individualized medicine.
Assuntos
Ceratite por Acanthamoeba/tratamento farmacológico , Acanthamoeba , Amoeba/isolamento & purificação , Antiprotozoários/uso terapêutico , Desinfetantes/uso terapêutico , Infecções Oculares Parasitárias/tratamento farmacológico , Ceratite por Acanthamoeba/parasitologia , Animais , Infecções Oculares Parasitárias/parasitologia , HumanosRESUMO
BACKGROUND: Proteolytic enzymes secreted by trophozoites (amoebic secretome) are suggested as the main virulence factor involved in the severity of Acanthamoeba keratitis. The degradation profile of the main glycoprotein components of anterior and posterior portions of the cornea and the cytopathic effect of secretomes on endothelial cells by contact-independent mechanism were evaluated. METHODS: Trophozoites were isolated primarily from corneal tissue samples (n = 11) and extracellular proteins were collected from axenic cell culture supernatants. The molecular weights of proteolytic enzymes were estimated by zymography. Enzymatic cleavage of laminin and fibronectin substrates by amoebic secretome was investigated and cluster analysis was applied to the proteolysis profiles. Primary cultures of endothelial cells were used in both qualitative and quantitative assays of cytophatogenicity. RESULTS: Differential patterns of proteolysis were observed among the Acanthamoeba secretomes that were analysed. The uniformity of laminin degradation contrasted with the diversity of the proteolysis profiles observed in the fibronectin substrate. Acanthamoeba secretome extracted from four clinical isolates was shown to be toxic when in contact with the endothelial cell monolayer (p < 0.01). Induction of apoptosis and membrane permeability, at different percentual values, were suggested as the main mechanisms that could induce endothelial cell death when in contact with amoebic secretome. CONCLUSIONS: Our results provide evidence that virulence factors secreted by Acanthamoeba trophozoites can be related to an increased pathogenicity pattern by an independent contact-trophozoite mechanism, through induction of endothelial cell death by apoptosis at a higher percentage than providing the lack of cell viability by the membrane-associated pore-forming toxin activity.
Assuntos
Ceratite por Acanthamoeba/parasitologia , Acanthamoeba castellanii/enzimologia , Fibronectinas/metabolismo , Laminina/metabolismo , Proteínas de Protozoários/toxicidade , Serina Proteases/toxicidade , Tubulina (Proteína)/metabolismo , Acanthamoeba castellanii/isolamento & purificação , Acanthamoeba castellanii/patogenicidade , Apoptose/efeitos dos fármacos , Permeabilidade da Membrana Celular/efeitos dos fármacos , Células Cultivadas , Córnea/parasitologia , Eletroforese em Gel de Poliacrilamida , Células Endoteliais da Veia Umbilical Humana/efeitos dos fármacos , Células Endoteliais da Veia Umbilical Humana/metabolismo , Células Endoteliais da Veia Umbilical Humana/patologia , Humanos , Proteólise , Fatores de VirulênciaRESUMO
PURPOSE: To assess dose- and concentration-dependent rates of biguanides on the viability of Acanthamoeba cysts isolated from severe ulcerative keratitis, and to correlate cysticidal activites with cytotoxic profiles in corneal and endothelial cells. METHODS: Cysticidal activities of polyhexamethylene biguanide and chlorhexidine digluconate were evaluated in the Acanthamoeba castellanii strain and clinical isolates of Acanthamoeba spp obtained from two severe and recurrent cases of ulcerative keratitis. The molecular characterization of protozoa used in the experimental assays was performed by sequencing reactions of the 18S rDNA gene. Acanthamoeba cysts were exposed at different dosages and concentrations of both biguanides; the application of double-biguanides was also evaluated. Automated cell viability assessment of cysts was performed using the trypan blue dye exclusion method. Cytotoxicity assays of biguanides were conducted using primary cultures of endothelial cells alone or in coculture with Acanthamoeba cysts. Human corneal epithelial cells were used as a comparative pattern to assess the toxicity of biguanide compounds. Cell viability was measured using both quantitative and qualitative methods. Statistical analyses were applied to the data. RESULTS: The in vitro study showed that all dosages, concentrations, and combinations of biguanides tested had a cysticidal effect on Acanthamoeba spp strains tested compared with control cultures not exposed to any antimicrobials; the difference in response was statistically significant. The use of both biguanides in combination demonstrated the best cysticidal effect. The use of isolated biguanides was associated with greater cytotoxic effects than with biguanides used in combination. Chlorhexidine digluconate used alone tended to have greater cytotoxicity than polyhexamethylene biguanide. Furthermore, the double-biguanide application had a statistically significant decrease in the deleterious effect on endothelial cells at higher dosage and concentration. Quantitative and qualitative analyses demonstrated the toxic effect of biguanide compounds on the viability of corneal epithelial cells, under single or in combination usage. CONCLUSIONS: We demonstrated that the combined use of biguanides had greater cysticidal activity than individual drug application as well as a possible protective effect on endothelial cells. The biguanide compounds tested were able to induce corneal epithelial cell death in time and concentration-independent fashions. Findings support the hypothesis concerning the cysticidal effect and the differential patterns of toxicity expressed by polyhexamethylene biguanide and chlorhexidine digluconate on the endothelial and corneal cells.
Assuntos
Ceratite por Acanthamoeba/parasitologia , Acanthamoeba castellanii/isolamento & purificação , Biguanidas/administração & dosagem , Córnea/patologia , Cistos/parasitologia , Ceratite por Acanthamoeba/tratamento farmacológico , Ceratite por Acanthamoeba/patologia , Acanthamoeba castellanii/efeitos dos fármacos , Animais , Sobrevivência Celular/efeitos dos fármacos , Córnea/efeitos dos fármacos , Córnea/parasitologia , Cistos/tratamento farmacológico , Cistos/patologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Testes de Sensibilidade ParasitáriaRESUMO
Com a finalidade de estudar as condiçöes sanitárias de águas de piscinas de uso coletivo da cidade de Campo Grande (MS), foram realizadas análises físico-químicas e bacteriológicas e pesquisadas as leveduras, algas e amebas de vida livre. No período de 9 de agosto de 1981 a 27 de junho de 1982, foram coletadas 336 amostras constatando-se que as piscinas näo mantem níveis de cloro suficientes a desinfecçäo. A presença dos microorganismos antes mencionados, indica a necessidade de tratamento adequado da água: treinamento especializado de operadores e a prática de princípios básicos de saúde. Paralelamente e imperioso o estabelecimento de legislaçäo estadual fixando os limites dos paramêtros físico-químicos, como também microbiológicos a serem seguidos visando a manutençäo da qualidade estética e sanitária da água