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Efficacy of APX2039 in a Rabbit Model of Cryptococcal Meningitis.
Giamberardino, Charles D; Schell, Wiley A; Tenor, Jennifer L; Toffaletti, Dena L; Palmucci, Julia R; Marius, Choiselle; Boua, Jane-Valeriane K; Soltow, Quinlyn; Mansbach, Robert; Moseley, M Arthur; Thompson, J Will; Dubois, Laura G; Hope, William; Perfect, John R; Shaw, Karen Joy.
Afiliación
  • Giamberardino CD; Duke University School of Medicinegrid.471396.e, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina, USA.
  • Schell WA; Duke University School of Medicinegrid.471396.e, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina, USA.
  • Tenor JL; Duke University School of Medicinegrid.471396.e, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina, USA.
  • Toffaletti DL; Duke University School of Medicinegrid.471396.e, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina, USA.
  • Palmucci JR; Duke University School of Medicinegrid.471396.e, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina, USA.
  • Marius C; Duke University School of Medicinegrid.471396.e, Department of Surgery, Durham, North Carolina, USA.
  • Boua JK; Duke University School of Medicinegrid.471396.e, Department of Neurosurgery, Durham, North Carolina, USA.
  • Soltow Q; Pfizer, Inc., La Jolla, California, USA.
  • Mansbach R; Mansbach Consulting, LLC, San Diego, California, USA.
  • Moseley MA; Duke University School of Medicinegrid.471396.e, Duke Proteomics and Metabolomics Core Facility, Center for Genomic and Computational Biology, Durham, North Carolina, USA.
  • Thompson JW; Duke University School of Medicinegrid.471396.e, Duke Proteomics and Metabolomics Core Facility, Center for Genomic and Computational Biology, Durham, North Carolina, USA.
  • Dubois LG; Duke University School of Medicinegrid.471396.e, Duke Proteomics and Metabolomics Core Facility, Center for Genomic and Computational Biology, Durham, North Carolina, USA.
  • Hope W; Antimicrobial Pharmacodynamics and Therapeutics, University of Liverpoolgrid.10025.36, Liverpool Health Partners, Liverpool, United Kingdom.
  • Perfect JR; Duke University School of Medicinegrid.471396.e, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina, USA.
  • Shaw KJ; Hearts Consulting Group, LLC, Poway, California, USA.
mBio ; 13(6): e0234722, 2022 12 20.
Article en En | MEDLINE | ID: mdl-36222509
Cryptococcal Meningitis (CM) is uniformly fatal if not treated, and treatment options are limited. We previously reported on the activity of APX2096, the prodrug of the novel Gwt1 inhibitor APX2039, in a mouse model of CM. Here, we investigated the efficacy of APX2039 in mouse and rabbit models of CM. In the mouse model, the controls had a mean lung fungal burden of 5.95 log10 CFU/g, whereas those in the fluconazole-, amphotericin B-, and APX2039-treated mice were 3.56, 4.59, and 1.50 log10 CFU/g, respectively. In the brain, the control mean fungal burden was 7.97 log10 CFU/g, while the burdens were 4.64, 7.16, and 1.44 log10 CFU/g for treatment with fluconazole, amphotericin B, and APX2039, respectively. In the rabbit model of CM, the oral administration of APX2039 at 50 mg/kg of body weight twice a day (BID) resulted in a rapid decrease in the cerebrospinal fluid (CSF) fungal burden, and the burden was below the limit of detection by day 10 postinfection. The effective fungicidal activity (EFA) was -0.66 log10 CFU/mL/day, decreasing from an average of 4.75 log10 CFU/mL to 0 CFU/mL, over 8 days of therapy, comparing favorably with good clinical outcomes in humans associated with reductions of the CSF fungal burden of -0.4 log10 CFU/mL/day, and, remarkably, 2-fold the EFA of amphotericin B deoxycholate in this model (-0.33 log10 CFU/mL/day). A total drug exposure of the area under the concentration-time curve from 0 to 24 h (AUC0-24) of 25 to 50 mg · h/L of APX2039 resulted in near-maximal antifungal activity. These data support the further preclinical and clinical evaluation of APX2039 as a new oral fungicidal monotherapy for the treatment of CM. IMPORTANCE Cryptococcal meningitis (CM) is a fungal disease with significant global morbidity and mortality. The gepix Gwt1 inhibitors are a new class of antifungal drugs. Here, we demonstrated the efficacy of APX2039, the second member of the gepix class, in rabbit and mouse models of cryptococcal meningitis. We also analyzed the drug levels in the blood and cerebrospinal fluid in the highly predictive rabbit model and built a mathematical model to describe the behavior of the drug with respect to the elimination of the fungal pathogen. We demonstrated that the oral administration of APX2039 resulted in a rapid decrease in the CSF fungal burden, with an effective fungicidal activity of -0.66 log10 CFU/mL/day, comparing favorably with good clinical outcomes in humans associated with reductions of -0.4 log10 CFU/mL/day. The drug APX2039 had good penetration of the central nervous system and is an excellent candidate for future clinical testing in humans for the treatment of CM.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Anfotericina B / Meningitis Criptocócica Tipo de estudio: Prognostic_studies Límite: Animals / Humans Idioma: En Revista: MBio Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Anfotericina B / Meningitis Criptocócica Tipo de estudio: Prognostic_studies Límite: Animals / Humans Idioma: En Revista: MBio Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos