WO2011119119A2 - The combination of antifungal compound and modifier of proton homeostasis for destroying or growth inhibition and reproduction of fungi - Google Patents

The combination of antifungal compound and modifier of proton homeostasis for destroying or growth inhibition and reproduction of fungi Download PDF

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WO2011119119A2
WO2011119119A2 PCT/SI2010/000050 SI2010000050W WO2011119119A2 WO 2011119119 A2 WO2011119119 A2 WO 2011119119A2 SI 2010000050 W SI2010000050 W SI 2010000050W WO 2011119119 A2 WO2011119119 A2 WO 2011119119A2
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combination
fungi
modifier
antifungal
proton
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PCT/SI2010/000050
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French (fr)
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WO2011119119A3 (en
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Mojca Bencina
Tanja Bagar
Nataša MEDVED
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Kemijski inštitut
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/4164—1,3-Diazoles
    • A—HUMAN NECESSITIES
    • A01—AGRICULTURE; FORESTRY; ANIMAL HUSBANDRY; HUNTING; TRAPPING; FISHING
    • A01N—PRESERVATION OF BODIES OF HUMANS OR ANIMALS OR PLANTS OR PARTS THEREOF; BIOCIDES, e.g. AS DISINFECTANTS, AS PESTICIDES OR AS HERBICIDES; PEST REPELLANTS OR ATTRACTANTS; PLANT GROWTH REGULATORS
    • A01N37/00—Biocides, pest repellants or attractants, or plant growth regulators containing organic compounds containing a carbon atom having three bonds to hetero atoms with at the most two bonds to halogen, e.g. carboxylic acids
    • A01N37/06—Unsaturated carboxylic acids or thio analogues thereof; Derivatives thereof
    • A—HUMAN NECESSITIES
    • A01—AGRICULTURE; FORESTRY; ANIMAL HUSBANDRY; HUNTING; TRAPPING; FISHING
    • A01N—PRESERVATION OF BODIES OF HUMANS OR ANIMALS OR PLANTS OR PARTS THEREOF; BIOCIDES, e.g. AS DISINFECTANTS, AS PESTICIDES OR AS HERBICIDES; PEST REPELLANTS OR ATTRACTANTS; PLANT GROWTH REGULATORS
    • A01N43/00—Biocides, pest repellants or attractants, or plant growth regulators containing heterocyclic compounds
    • A01N43/02—Biocides, pest repellants or attractants, or plant growth regulators containing heterocyclic compounds having rings with one or more oxygen or sulfur atoms as the only ring hetero atoms
    • A01N43/04—Biocides, pest repellants or attractants, or plant growth regulators containing heterocyclic compounds having rings with one or more oxygen or sulfur atoms as the only ring hetero atoms with one hetero atom
    • A01N43/14—Biocides, pest repellants or attractants, or plant growth regulators containing heterocyclic compounds having rings with one or more oxygen or sulfur atoms as the only ring hetero atoms with one hetero atom six-membered rings
    • A01N43/16—Biocides, pest repellants or attractants, or plant growth regulators containing heterocyclic compounds having rings with one or more oxygen or sulfur atoms as the only ring hetero atoms with one hetero atom six-membered rings with oxygen as the ring hetero atom
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/4196—1,2,4-Triazoles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof

Definitions

  • the invention relates to a combination of antifungal compound for destroying fungi or growth inhibition and reproduction of fungi.
  • Invention refers to an antifungal compound, a pharmaceutical and a plant protection product for treatment and prevention of fungal infections in vivo in in vitro.
  • Fungi including pathogenic species can be found all over the world. They are important pests in agriculture and food production. They also represent a serious threat in medicine, due to the increasing number of severe and difficult to cure fungal infections that result from a lack of novel antifungal substances, increased resistance of fungi to existing antifungals and growing number of immunocompromised patients, who are susceptible to fungal infections. Fungi in humans cause three types of clinical situations: infections, allergic reactions and toxicosis. Immunosuppression after transplantation of organs and patients affected by AIDS, extensive burns, diabetic ketoacidosis and chemotherapy are the main predisposing factors for the development of infections. Clinical conditions resulting after fungal infections can occur in a local or systemic form.
  • Aspergillus is the second most common cause of opportunistic mycosis, the first being Candida.
  • Candida the most common cause of aspergillosis are A. fumigatus, followed by A. flavus.
  • antimycotics known to work against fungi. Their use is restricted mainly due to very common side effects, poor transition in various tissues, narrow range of antimycotic activity and insensitivity of some fungi to certain antifungals (Groll and Kolva River, 2004, 1998, Klich, 2007).
  • polyene antifungals In clinical use: polyene antifungals, derivatives of azoles, alilamines, tiokarbamats and fluoropyrimidine.
  • the target of the first three classes is ergosterol. Azoles inhibit lanosterol-demethylase, older azoles (imidazoles) inhibit a number of other enzymes, membrane bound enzymes and the biosynthesis of membrane lipids. (Sheehan et al., 1999).
  • Polyene antifungal group is composed of nearly 200 natural macrolide antibiotics, of which only amphotericin B and nystatin were developed for systemic treatment of fungal infections.
  • Polyens are amphipatic molecules that incorporate into the membrane of cells, thereby forming channels that change the permeability, cause the loss of vital cytoplasmic components and consequently lead to the death of the micro-organism (Georgopapadakou and Walsh, 1996).
  • naftifin and terbinafine and tolnaftat which is a tiokarbamat. All three are reversible, non-competitive inhibitors of squalane-2 ,3-epoksidase.
  • Synthetically prepared morpholines are agricultural fungicides, except for the amorpholine, which is used topically for treatment of nail infections.
  • Echinocandins are a new class of antifungal lipopeptides. They inhibit the synthesis of l ,3-P-D-glucan, a polysaccharide present in the cell wall of many pathogenic fungi and fungi, but absent in the cell wall of mammals (Groll et al., 2004).
  • the key drawback of antimycotics is the developing resistance of fungi to the antifungal substances.
  • the acquired resistance to fluconazole among strains of C. albicans has been reported particularly in patients infected with the HIV virus.
  • Acquired resistance to amphotericin has been reported in Cryptococcus neoformans and Candida spp., and also in C. lusitaniae, C. glabrata and C. krusei.
  • filamentous fungi Pieris, Fusarium
  • yeasts Trichosporon beigelii, C. Lusitania, C. guiliermondii
  • some species have inherited resistance to amphotericin B (Richter et al., 2005).
  • Ketoconazole accumulates in fatty tissues due to its high lipophilicity.
  • Clinical use of amphotericin B is associated with toxicity in the form of nephrotoxicity, azotemia, reduced glomerular filtration rate, decreased ability to concentrate urine, renal loss of sodium and potassium, renal tubular acidosis, hypocalaemy, hypomagnesaemia, low blood pressure, headache, bone marrow depression, leucopenia, hepatitis, hyperlipidemia and hyponatremia, fever, chills, muscle aches, anemia and thrombocytopenia.
  • the problem of acquired resistance to the antifungals can be resolved by using a combination of various antimycotics.
  • the resistance of fungi to certain antifungal drugs can also be addressed through combinations with other substances that by themselves have weak or no antifungal activity, such as curcumin or FK506.
  • Antifungal agents Chemoterapeutic targets and immunologic strategies. Antimicrobial agents and chemoterapy, 40, 279-291.
  • An invention is a combination containing an antifungal substance and a modifier of proton homeostasis where the combination according to the invention is used to destroy or inhibit growth and replication of fungi, preferably of pathogenic and opportunistic fungi.
  • the invention refers to the combination to be used for developing a drug for in vivo and in vitro prevention and treatment of fungal infections in animals and humans and the drug contains an effective therapeutic amount of the combination.
  • the combination is used for prevention and treatment of fungal infections of plants in vivo and in vitro, where the product of the combination contains fungicidic or fungistatic amount of the combination.
  • the discovery is based on the realization that the combination of the antifungal substance and the modifier of proton homeostasis increases the fungicidic or fungistatic effect against fungi compared to the antifungal substance itself.
  • the active ingredients act synergistically and reduce amount of the antifungal substance, increase the efficiency of therapeutic action of the antifungal substance, shorten the treatment time, lower the costs of treatment and in many cases achieve a fungicidic effect with the combination, which could not be achieved with individual components.
  • the presented invention is based on the discovery that the synergistic effect of the modifier of proton homeostasis with the antifungal substance can be used to prepare products for the treatment of a subject that is infected with fungi and provides a novel way of treating such infections.
  • the advantage of this invention is the ability to treat fungal infections that are considered difficult to treat.
  • An additional advantage of the invention is the possibility to treat infections with fungi that have acquired resistance to known antifungal substance.
  • the advantage is also an improved quality of life, since the novel treatment considerably reduces the duration of therapy.
  • the invention also includes the preparation of (i) a drug or (ii) a plant protection product containing the combination for prevention and treatment of fungal infections in plants, animals and humans.
  • the combination may be used in the form of a drug to treat fungal infections or for decontamination of surfaces, sterilization of medical equipment and implants.
  • a drug according to the invention, which contains the combination is prepared in an appropriate pharmaceutical form containing all necessary pharmaceutical additives and, if necessary, also additional antifungal substances.
  • the combination, according to the invention is a medicament containing therapeutically effective amount of the combination for treatment or prevention of fungal infection.
  • the product that contains the combination in an appropriate pharmaceutical form suitable for topical, intravenous, oral, intramuscular, subcutaneous, intraperitoneal, intraocular, transpulmular, transdermal an aerosol use.
  • the active ingredients of the combination are presented in mixed form or used in a form containing active ingredients separate, but used in a manner that achieves desired synergistic effect.
  • Invention represents the combination in the form suitable as a plant protection product with suitable additives and which contained therapeutically efficient amount of the combination, which is used for treatment or prevention of fungal infection in plants.
  • the invention presents a method for destroying or inhibiting the growth of fungi, which includes direct contact of the medicine or the plant protection product containing the combination with the fungi.
  • the method can be used in vitro for decontamination of surfaces and sterilization of medical equipment and implants, for in situ sterilization of intravenous catheters and implants.
  • the invention refers to a method of sequential co-administration of active ingredients of the combination; however, the active ingredients are in individual forms.
  • the therapeutic effect of separate forms is equal to or better than the concurrent administration and the separate application is applied because of the improved properties of the individual components.
  • the invention presented here is a product with an effective therapeutic amount of a pharmaceutical combination for treatment of patients infected with fungi.
  • FIG. 1 Metabolic activity of the fungus A. niger in the presence of the combination; bafilomycin and antifungal amphotericine B, fluconazole, ketoconazole or clotrimazole.
  • Bafilomycina final concentrations of 0, 0.5, 2 in 10 nM
  • amphotericine final concentrations of 0, 0.25, 0.5 mg/1)
  • A fluconazole
  • B ketoconazole
  • C final concentrations of 0, 5, 10 mg/1)
  • clotrimazole final concentrations of 0, 0.4, 1 mg/1)
  • FIG. 1 Growth inhibition of yeast S. cerevisiae. Increase in biomass in the presence of sorbic acid (0, 2.5, 5 mM) and amphotericine B (0, 0.1, 0.2 mg/1) [A].
  • FIG. 4 Microscopic images of fungus A. niger in the presence of the antifungal substance and the modifier of proton homeostasis. Growth of fungi in the medium without the combination [A]; with 0.125 mg/1 amphotericine and 5 mM sorbic acid [E].
  • the presented invention refers to the discovery that a modifier of proton homeostasis improves function of an antifungal substance and could be used as a combination of an antifungal substance and a proton homeostasis modifier to prepare (i) a medicament or (ii) a plant protection product for treatment of subject: human, animal or plant; which is infected with fungi and provides means for treating such infection.
  • a synergistic combination of the antifungal substance and the modifier of proton homeostasis is useful for preparation of a medicament for (i) in vivo prevention and treatment of fungal infection, and fungi are selected preferentially among pathogenic and opportunistic pathogenic fungi and for (ii) in vitro decontamination of surfaces and sterilizing medical equipment and implants.
  • the combination of the antifungal substance and the modifier of proton homeostasis could be used for preparation of a plant protection product and for in vivo prevention and treatment of fungal infections in plant.
  • antifungal substance refers to "antifungal drug” or "fungicide” and represents the antifungal substance that is used to prevent and treat infection with fungi.
  • antifungal drug or antimycotic refers to a substance that inhibits the growth and replication of the fungus or destroy fungal cell and the substance is selected from a group (i) polyene antimycotics such as: natamicin, rimocidin, philipine, nystatin, amphotericin B, candicin (ii) azole antimycotics, such as: miconazole, ketoconazole, clotrimazole, ekonazol, bifonazol, butokonazol, fentikonazol, izokonazol, oksikonazol, sertaconazol, sulkonazol, tiokonazol, pramikonazol, (iii) triazole antimycotics, such as: fluconazole
  • antifungal substance also refers to proteins that inhibit the growth of fungi, such as PAF, AFP, and other plant defensins, antifungal proteins and peptides.
  • fungicide refers to a chemical agent used to control fungal infection and could function as contact, half-systemic or systemic drug.
  • modifier of proton homeostasis refers to (i) a compound inhibiting enzymes that maintain intracellular pH in the physiological range and (ii) a compound that directly affect intracellular pH.
  • homeostasis refers to physiological processes or physiological mechanisms that enable that physiological processes and body structures remain unchanged even if the external conditions vary.
  • a proton homeostasis modifier triggers a permanent or long-term transient drop of intracellular pH and intensity of drop depends on concentration of the modifier. Transient long-term drop of intracellular pH should be longer that 30 minutes to affect cellular processes in such extend to improve the mode of action of antifungal compound.
  • Enzymes of proton homeostasis which regulate intracellular pH are: ATPases, ion channels, ion exchangers, cellular buffers.
  • the modifier inhibits one or more enzymes of proton homeostasis and are: bafilomycine, concavaline, concanamycine, ouabin, oligomycine, FR177995, peptide-C5-amiylide, acil-guanidine with condensed triacyl ring CCCP, FCCP, DCCD, arhazolid and apikularen, azides, cianides, antimycine, rotenon and TTFA, ionophores, salts and derivates thereof, (ii)
  • a special class of proton homeostasis modifiers are weak carboxylic and hydroxy-carboxylic acids, such as: sorbic acid, benzoic, propionic, citric, ascorbic acid and others. Weak acid reduces intracellular pH when eners into the cell and
  • salt, derivative refers to salt or derivative of modifier.
  • the salt and derivative of compound does not substantially alter function of modifier, but improves solubility, availability in tissue, improves or alters metabolism, degradation or elimination from the body.
  • modifier according to the invention is an enhancement of therapeutic efficiency of the antifungal substance for treatment and prevention of fungal infections and the enhancement is expressed synergistically.
  • the invention refers to the discovery that the modifier of proton homeostasis, selected form a group of compounds that inhibits or activates proton ATPases, ion exchangers, oxidative phosphorylation; together with the antifungal compound, antimycotic or fungicide; expresses synergistic effect and improves therapeutic efficiency of the antifungal compound for prevention and treatment of fungal infection.
  • these compouds are selected from: are bafilomycine, concavaline, concanamycine, ouabin, oligomycine, FR177995, peptide-C5-amiylide, acil-guanidine with condensed triacyl ring CCCP, FCCP, DCCD, arhazolid and apikularen, azides, cianides, antimycine, rotenon and TTFA, ionophores, salt and derivative thereof;.
  • the invention refers to the discovery that the modifier of proton homeostasis, weak carboxylic and hydroxy-carboxylic acids; together with the antifungal compound, antimycotic or fungicide; expresses synergistic effect and improves therapeutic efficiency of the antifungal compound for prevention and treatment of fungal infection.
  • Therapeutically effective amount of the antifungal substance in the combination is decreased in the presence of proton homeostasis modifier compared with the therapeutically effective amount of antifungal substance, which is used without the modifier.
  • the term “synergistic” describes the improved fungicidic or fungistatic therapeutic efficacy of the antifungal substance in the presence of proton homeostasis modifier.
  • therapeutic efficacy refers to the successful clinical outcome, which not necessarily means that the pharmaceutical combination eliminates all fungi involved in infection. The success depends on intensity of fungal infection at the site of infection and refers to the improvement of the infection state. The therapeutic effectiveness depends also upon the condition of treated subject. A healthy subject requires less of the combination compared to the subject with a weakened immune response. According to the invention the therapeutically effective amount of the antifungal substance in the presence of proton homeostasis modifier in the combination according to the invention is reduced compared to the treatment with only the antifungal substance.
  • the invention refers to the combination for preparation of a medicament or a plant protection product for prevention or treatment of infection caused by opportunistic pathogens and pathogenic yeasts and filamentous fungi.
  • fungal infection refers to infection of plant, animal and human as well as material, liquid and surface with filamentous fungi and yeasts.
  • fungus refers to micro-organism from the kingdom of fungi, preferentially yeasts and filamentous fungi, which are plant or animal pathogens or opportunistic pathogens.
  • the group of pathogenic and opportunistic pathogenic fungi are selected from: Candida, preferably C. albicans, C. glabrata, C. krusei, C. laurentii, C. parapsilosis, C. tropicalis, C. lusitaniae, C. kefyr, C. guilliermondii, C.
  • Cryptococcus preferably C. neoformans, C. albidus, C. gattii, Aspergillus, preferably A. flavus, A. fumigatus, A. clavatus, A. niger, A. nidulans, A. terreus, A. Sydow, A. glaucus, A. oryzae, A. ustus, A. versicolor, Histoplasma, Histoplasma capsulatum priority, Paracoccidioides, preferably P. brasiliensis, Sporothrix, schenckii Sporothrix priority, Blastomyces, preferably B. dermatitidis, Paecilomyces preferably P.
  • fungi refers to yeasts and filamentous fungi which in healthy subject do not cause a disease, but in immunocompromised patient the same fungi can cause a disease.
  • fungi refers also to fungi, which are plant pathogens such as: Fusarium spp., Thielaviopsis spp., Verticillium spp., Rhizoctonia spp. Pachyrhizi Sydow Phakospora, Puccinia spp. Magnaporthe spp. e.g. Magnaporthe grisea, Ustilago spp. e.g. Ustilago mydis, Uncinula necator, Plasmopara viticola, Pseudopezicula tracheiphila, Botrytis spp. e.g. Botrytis cinerea, Phomopsis viticola.
  • disease refers to a disease caused by infection with yeasts and filamentous fungi.
  • the term “disease” refers to a disease caused by (a) surface infection of fungi and is limited to infection of the skin, nails and hair, (b) disease caused by subcutaneous infection such as dermatitis and is infection of subcutaneous tissue and surrounding structures, (c) systemic disease is infections of internal organs: lungs, liver, heart of the central nervous system, gastrointestinal tract and opportunistic diseases, (d) infection of immune compromised patient with non-pathogenic fungi.
  • Disease is expressed in the form of mycosis, candidosis, systemic mycosis, histoplasmosis, blastomycosis, cocidiomycosis and paracocidiomycosis, inflammation, redness, dandruff, athletic feet, mouth and vaginal candidosis, dermatitis, eczema, onikomycosis, aspergillosis, histoplasmosis, pneumonia, respiratory damage and headaches, asthma.
  • the term "disease” refers to illness caused by fungi in animal or human, preferably in honeybees and vertebrates, particularly birds, poultry, mammals, especially ungulates, rabbits, carnivores, cats, primates, and man.
  • treatment refers to preventive and therapeutic treatment.
  • In vitro method of treatment refers to the killing and inhibiting of fungal growth and replication through the transfer of the combination according to the invention to the site of infection with fungi, which is a surface of material.
  • the invention refers to a medicament, which contains the combination according to the invention to treat fungal infection and the medicament contains the pharmaceutical combination in effective amount to inhibit or destroy fungal cells.
  • Techniques of assessment a therapeutically effective amount of the combination with the antifungal substance and the proton homeostasis modifier are well known to the experts in the field.
  • the therapeutically effective amount of the combination according to the invention includes quantitatively reduced amount of the antifungal substance due to the synergistic action of modifier of proton homeostasis which is administrated/incorporated into the combination as a mixture or separate component.
  • a synergistic effect of the proton homeostasis mofifier with the antifungal substance is expressed with a less of the antifungal substance needed for elimination or inhibition of replication and growth of fungi.
  • a medicament according to the invention ensures a faster or more efficient fungistatic or fungicidic effect compared to antifungal substance.
  • a drug that contains the combination according to the invention overcomes fungal resistance to the antifungal substance, or change the fungistatic mode of action of antifungal substance into fungicidic. In the combination a therapeutically effective amount of the antifungal substance is reduced due to the synergistic activity of components of the composition.
  • a medicament may contain both active ingredients of the combination: antifungal substance and proton homeostasis modifier in the form of a mixture or as a separate active ingredients provided that the individual active ingredients of the medicament are used in a manner which ensures that the effect of active ingredient in separate form at the site of fungal infections is as good as effect of their mixture.
  • Active components are in separate forms due to improved stability of the individual components and due to easier administration when using different administration routes.
  • Individual active ingredients of the combination of the invention: the antifungal substance and the proton homeostasis modifier can be in various pharmaceutical forms.
  • the combination that provides simultaneous administration of the antifungal substance and the modifier of proton homeostasis is expected to be as efficient as co-application, with fungistatic or fungicidal effects in vivo compared with the administration of individual components of the combination of the invention.
  • fungistatic effect describes inhibited growth and reproduction of fungi
  • fungicidic effect refers to the death of fungi.
  • the combination destroys or inhibits fungal growth in the way of direct contact of fungus with the combination.
  • This method can be used in vitro, as for plant protection products, for decontamination of fluids and surfaces or to sterilize surgical and other medical tools and implants, including prostheses, in situ sterilization of catheters, intravenous implants.
  • the invention refers to the preparation of a medicinal product that contains the combination for treatment of fungal infection.
  • the medicament is in any pharmaceutical form and contains the required pharmaceutical additives.
  • pharmaceutical form refers to a form in which the pharmaceutical combination in a form of powder, suspension, emulsion, solution, paste, cream, ointment, gel, lotion, liniment, dosage forms for injection, infusion formulation, tablet, capsules, suppositories, transdermal patch, a therapeutic system, tinctures, percolat extract.
  • pharmaceutical supplement refers to additives in pharmaceutical formulation. The function of pharmaceutical supplement is to facilitate and enhance the entry of the pharmaceutical combination of the invention to the infection site and is part of the pharmaceutical form.
  • the pharmaceutical supplement includes appropriate dilutants, adjuvants and carriers.
  • Administration of the pharmaceutical form containing the combination may be topic, intravenous, oral or intramuscular, via an aerosol, subcutaneous, intraperitoneal, intraocular, transpulmonary, transdermal.
  • the combination according to the invention may be administrated in conjunction with other drugs.
  • the combination may contain one or more antifungal substances in addition to modifier of proton homeostasis.
  • the invention also relates to a plant protection product in an appropriate form and with appropriate additives and is used to prevent or treat fungal infection in plant.
  • the invention relates to a method for use the combination in form of a medicament or a plant protection product for elimination or inhibition of fungal growth and reproduction and is used as plant protection product and for decontamination of fluids and surfaces or to sterilize surgical and other medical tools and implants, including prostheses, and in situ sterilization of catheters, intravenous implants.
  • Antifungal substance (amiodarone 2 mM DMSO, amphotericin 0.04 g/1 DMSO, clotrimazole 1 g/1 DMSO, fluconazole 40 g/1 DMSO, ketoconazole 5 g/1 methanol) and modifier of proton homeostasis (bafilomycin 0.16 ⁇ in DMSO, sorbic acid) were dissolved in an appropriate solvent in adequate concentration. 0.2 ml of spore solution with supplements was placed in the wells of microtitre plates (we used 96 well plates). The test was performed after 24-hour incubation at 37 °C.
  • the XTT method was used to determine the presence of living cells.
  • XTT reagent is internalised in the cell and is converted to a coloured compound in active mitochondria.
  • Solution of XTT and menadione was freshly prepared.
  • XTT was dissolved in hot water at a final concentration of 1 g/1.
  • Menadione was dissolved in acetone at a concentration of 10 mM, and then it was further diluted with saline in the ratio 1 :10.
  • Final XTT reagent contains the XTT reagent (concentration 0.6 g/1 final concentration in the well is 0.2 g/1) and menadione (concentration 75 ⁇ , the final concentration in the well 25 ⁇ ).
  • bafilomycine was used in concentrations up to 10 nM. It is obvious from results that combination of bafilomycine and antimycotics is synergistic and improves fungal growth inhibition. When 10 nM bafilomycine was added to fluconazole fungicidic growth inhibition was achieved. A combination of bafilomycine and ketoconazole is also successful in combination of 2 nM bafilomycine and ketoconazole 15 ⁇ g/ml since 99 % growth inhibition is achieved. Similar outcome was detected with combination of 10 nM bafilomycine and clotrimazole.
  • Figure 2 presents combination of sorbic acid and amphotericine having 85 % of fungal growth inhibition in combination of 3 raM sorbic acid and 0.5 mg/1 amphotericine. A 100% inhibition was determined with the combination of sorbic acid 3 mM and fluconazole in concentration 1.5 g/1. Combination of 3 mM of sorbic acid and 10 mg/1 ketoconazol gives 99 % growth inhibition. Similar results were obtained with combination of chlotrimazole and sorbic acid.
  • Leica TCS SP5. This is a laser microscope mounted on a Leica DMI 6000 CS inverted microscope (Leica Microsystems, Germany). Immersion lens with HCX Plan Apo 63x oil (NA 1.4) was used.
  • the SynaptoRed 2 Biotium is excited with the argon laser at 514 nm and the emission is collected between 650 and 700 nm, and SYTOX Green is excited at 488 nm and emits light at 520 to 540 nm.
  • a spore suspension with the concentration of 10 5 spores/ml Vogel's medium was prepared. The media was supplemented with the active ingredients of the combination. 0.2 ml of the spore suspension was inoculated on cover slip and incubated for 14 hours at 30 °C in a humid chamber. Preparations were stained with Synapto Red (dyes the cell membrane) and 10 ⁇ of 0.5 mM Sytox Green dye for 15 minutes at 30 °C.
  • Example 3 Identification of suitable modifiers of proton homeostasis with measurment of intracellular pH.
  • the method of genetically encoded biosensor RaVC was used for measurements of intracellular pH.
  • the method is used to identify substances, compounds that could be classified as suitable for proton homeostasis modifier.
  • the measurements were performed according to Bagar et al. 2009.
  • results of intracellular pH measurements in fungal cells are presented. Fungi were treated with bafilomycin or sorbic acid and intracellular pH was recorded. Both modifiers of proton homeostasis bafilomycine and sorbic acid exerted concentration dependent intracellular pH drop.
  • yeast Saccharomyces cerevisiae The effect of the pharmaceutical combinations was tested on the yeast Saccharomyces cerevisiae in liquid media.
  • Yeast culture was grown overnight (16 to 24 h) in a synthetic liquid medium at 28 oC.
  • the medium contained different pharmaceutical combinations.
  • yeast cells were grown in medium free of any active ingredient of the pharmaceutical combinations. Initially yeast cells were diluted to optical density 0.04 at 600 nm. Growth speed was monitored spectrophotometrically in 8 h incubation at 28 oC. Results are presented in Figure 3.

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Abstract

The presented invention refers to the combination of an antifungal substance and a proton homeostasis modifier for enhancing the fungicidic or fungistatic action of the antifungal substance for treating or preventing fungal infections. The invention refers to a medicament or a plant protection product, which contains the combination. The invention refers to a method for preventing and treating fungal infection and in vitro for the disinfection of surfaces and implants.

Description

The combination of antifungal compound and modifier of proton homeostasis for destroying or growth inhibition and reproduction of fungi
Field of invention
The invention relates to a combination of antifungal compound for destroying fungi or growth inhibition and reproduction of fungi. Invention refers to an antifungal compound, a pharmaceutical and a plant protection product for treatment and prevention of fungal infections in vivo in in vitro.
State of the art
Fungi, including pathogenic species can be found all over the world. They are important pests in agriculture and food production. They also represent a serious threat in medicine, due to the increasing number of severe and difficult to cure fungal infections that result from a lack of novel antifungal substances, increased resistance of fungi to existing antifungals and growing number of immunocompromised patients, who are susceptible to fungal infections. Fungi in humans cause three types of clinical situations: infections, allergic reactions and toxicosis. Immunosuppression after transplantation of organs and patients affected by AIDS, extensive burns, diabetic ketoacidosis and chemotherapy are the main predisposing factors for the development of infections. Clinical conditions resulting after fungal infections can occur in a local or systemic form. Of all the filamentous fungi, Aspergillus is the second most common cause of opportunistic mycosis, the first being Candida. In Europe, the most common cause of aspergillosis are A. fumigatus, followed by A. flavus. There are only a few antimycotics known to work against fungi. Their use is restricted mainly due to very common side effects, poor transition in various tissues, narrow range of antimycotic activity and insensitivity of some fungi to certain antifungals (Groll and Kolva River, 2004, 1998, Klich, 2007).
Currently there are four classes of antifungal substances in clinical use: polyene antifungals, derivatives of azoles, alilamines, tiokarbamats and fluoropyrimidine. The target of the first three classes is ergosterol. Azoles inhibit lanosterol-demethylase, older azoles (imidazoles) inhibit a number of other enzymes, membrane bound enzymes and the biosynthesis of membrane lipids. (Sheehan et al., 1999). Polyene antifungal group is composed of nearly 200 natural macrolide antibiotics, of which only amphotericin B and nystatin were developed for systemic treatment of fungal infections. Polyens are amphipatic molecules that incorporate into the membrane of cells, thereby forming channels that change the permeability, cause the loss of vital cytoplasmic components and consequently lead to the death of the micro-organism (Georgopapadakou and Walsh, 1996). Currently there are two alilamin antifungal substances in clinical use, naftifin and terbinafine and tolnaftat, which is a tiokarbamat. All three are reversible, non-competitive inhibitors of squalane-2 ,3-epoksidase. Synthetically prepared morpholines are agricultural fungicides, except for the amorpholine, which is used topically for treatment of nail infections. Echinocandins are a new class of antifungal lipopeptides. They inhibit the synthesis of l ,3-P-D-glucan, a polysaccharide present in the cell wall of many pathogenic fungi and fungi, but absent in the cell wall of mammals (Groll et al., 2004).
The key drawback of antimycotics is the developing resistance of fungi to the antifungal substances. The acquired resistance to fluconazole among strains of C. albicans has been reported particularly in patients infected with the HIV virus. Acquired resistance to amphotericin has been reported in Cryptococcus neoformans and Candida spp., and also in C. lusitaniae, C. glabrata and C. krusei. Among filamentous fungi (Peudalesheria boydii, Scopulariopsis, Fusarium), as well as some yeasts (Trichosporon beigelii, C. Lusitania, C. guiliermondii), some species have inherited resistance to amphotericin B (Richter et al., 2005).
Treatment with antifungals is often accompanied by adverse side effects. Ketoconazole accumulates in fatty tissues due to its high lipophilicity. Clinical use of amphotericin B is associated with toxicity in the form of nephrotoxicity, azotemia, reduced glomerular filtration rate, decreased ability to concentrate urine, renal loss of sodium and potassium, renal tubular acidosis, hypocalaemy, hypomagnesaemia, low blood pressure, headache, bone marrow depression, leucopenia, hepatitis, hyperlipidemia and hyponatremia, fever, chills, muscle aches, anemia and thrombocytopenia.
It is evident from the above-mentioned that there is a dire need for new products, with antifungal activity or products, which would improve function of the antifungal substances and thus lower required therapeutically effective amount of antifungal substance. Ideally, the antifungal activity of the new product would affect a broad spectrum of fungi. Products would be useful in combination with other antifungal substances especially if the activity of the antifungal substance is improved, since this improves the effectiveness of therapy and reduces the potential toxicity of the antifungal substance.
The problem of acquired resistance to the antifungals can be resolved by using a combination of various antimycotics. The resistance of fungi to certain antifungal drugs can also be addressed through combinations with other substances that by themselves have weak or no antifungal activity, such as curcumin or FK506.
Maintenance of pH in physiological range is essential for proteins stability, enzymes and ion channels activity and for growth, development and survival of cells. The inventors have come to the discovery that modifiers of proton homeostasis efficiently improve the performance of antifungal substance with lowering intracellular pH for longer time and with this enabling better efficiency of antifungal substance.
Reference:
Bagar T., Altenbach K., Read N.D., Bencina M. 2009. Live-cell imaging and measurement of intracellular pH in filamentous fungi using a genetically encoded ratiometric probe. Eukaryotic cell, 8, 703-712.
Georgopapadakou N.H., Walsh T.J. 1996. Minireview, Antifungal agents: Chemoterapeutic targets and immunologic strategies. Antimicrobial agents and chemoterapy, 40, 279-291.
Groll A.H., Kolve H. 2004. Antifungal agents: In vitro susceptibility testing, pharmacodynamics, and prospects for combination therapy. European journal of clinical microbiology & infectious diseases, 23, 256-270.
Klich M.A. 2007. Aspergillus flavus: the major producer of aflatoxin. Molecular Plant Pathology, 8(6), 713-722.
Richter S.S., Galask R.P., Messer S.A., Hollis R.J., Diekema D.J., Pfaller M.A. 2005 Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol 43, 2155-2162.
Sheehan D.J., Hitchcock C.A., Sibley CM. 1999. Current and emerging azole antifungal agents. Clinical Microbiology Reviews, 12, 40-79. Summary of invention
An invention is a combination containing an antifungal substance and a modifier of proton homeostasis where the combination according to the invention is used to destroy or inhibit growth and replication of fungi, preferably of pathogenic and opportunistic fungi. The invention refers to the combination to be used for developing a drug for in vivo and in vitro prevention and treatment of fungal infections in animals and humans and the drug contains an effective therapeutic amount of the combination. According to the invention, the combination is used for prevention and treatment of fungal infections of plants in vivo and in vitro, where the product of the combination contains fungicidic or fungistatic amount of the combination.
The discovery is based on the realization that the combination of the antifungal substance and the modifier of proton homeostasis increases the fungicidic or fungistatic effect against fungi compared to the antifungal substance itself. Within the combination, according to the invention, the active ingredients act synergistically and reduce amount of the antifungal substance, increase the efficiency of therapeutic action of the antifungal substance, shorten the treatment time, lower the costs of treatment and in many cases achieve a fungicidic effect with the combination, which could not be achieved with individual components.
The presented invention is based on the discovery that the synergistic effect of the modifier of proton homeostasis with the antifungal substance can be used to prepare products for the treatment of a subject that is infected with fungi and provides a novel way of treating such infections. The advantage of this invention is the ability to treat fungal infections that are considered difficult to treat. An additional advantage of the invention is the possibility to treat infections with fungi that have acquired resistance to known antifungal substance. We present the advantage of therapy with the combination with marked reduction of the amount of antifungal substance, thereby also a reduction of undesirable side effects. The advantage is also an improved quality of life, since the novel treatment considerably reduces the duration of therapy.
The invention also includes the preparation of (i) a drug or (ii) a plant protection product containing the combination for prevention and treatment of fungal infections in plants, animals and humans. The combination, according to the invention, may be used in the form of a drug to treat fungal infections or for decontamination of surfaces, sterilization of medical equipment and implants. A drug according to the invention, which contains the combination, is prepared in an appropriate pharmaceutical form containing all necessary pharmaceutical additives and, if necessary, also additional antifungal substances. The combination, according to the invention, is a medicament containing therapeutically effective amount of the combination for treatment or prevention of fungal infection. According to the invention, the product that contains the combination in an appropriate pharmaceutical form suitable for topical, intravenous, oral, intramuscular, subcutaneous, intraperitoneal, intraocular, transpulmular, transdermal an aerosol use. The active ingredients of the combination are presented in mixed form or used in a form containing active ingredients separate, but used in a manner that achieves desired synergistic effect.
Invention represents the combination in the form suitable as a plant protection product with suitable additives and which contained therapeutically efficient amount of the combination, which is used for treatment or prevention of fungal infection in plants.
Additionally, the invention presents a method for destroying or inhibiting the growth of fungi, which includes direct contact of the medicine or the plant protection product containing the combination with the fungi. The method can be used in vitro for decontamination of surfaces and sterilization of medical equipment and implants, for in situ sterilization of intravenous catheters and implants.
The invention refers to a method of sequential co-administration of active ingredients of the combination; however, the active ingredients are in individual forms. The therapeutic effect of separate forms is equal to or better than the concurrent administration and the separate application is applied because of the improved properties of the individual components.
The invention presented here is a product with an effective therapeutic amount of a pharmaceutical combination for treatment of patients infected with fungi.
Figure legend
Figure 1 Metabolic activity of the fungus A. niger in the presence of the combination; bafilomycin and antifungal amphotericine B, fluconazole, ketoconazole or clotrimazole. Bafilomycina (final concentrations of 0, 0.5, 2 in 10 nM) and amphotericine (final concentrations of 0, 0.25, 0.5 mg/1) (A), fluconazole (final concentration 0, 0.5, 1.5 g/1) (B), ketoconazole (final concentrations of 0, 5, 10 mg/1) (C) and clotrimazole (final concentrations of 0, 0.4, 1 mg/1) (D) were used.
Figure 2. Metabolic activity of A. niger in the presence of the combination; sorbic acid and antifungal amphotericine B, fluconazole, ketoconazole or clotrimazole. Sorbic acid (final concentrations of 0, 3 in 10 nM) and amphotericine (final concentrations of 0, 0.25, 0.5 mg/1) (A), fluconazole (final concentration 0, 0.5, 1.5 g/1) (B), ketoconazole (final concentrations of 0, 5, 10 mg/1) (C) and clotrimazole (final concentrations of 0, 0.4, 1 mg/1) (D) were used.
Figure 3. Growth inhibition of yeast S. cerevisiae. Increase in biomass in the presence of sorbic acid (0, 2.5, 5 mM) and amphotericine B (0, 0.1, 0.2 mg/1) [A].
Figure 4. Microscopic images of fungus A. niger in the presence of the antifungal substance and the modifier of proton homeostasis. Growth of fungi in the medium without the combination [A]; with 0.125 mg/1 amphotericine and 5 mM sorbic acid [E].
A detailed description of the invention
Unless otherwise defined, technical and scientific terms have the same meaning as it is - generally accepted among experts. The terminology in the description of the invention is intended to describe a certain part of the invention and not to limit the invention. The description of the invention and claims are in the singular form, but the invention also includes the plural, which is not highlighted for ease of understanding.
The presented invention refers to the discovery that a modifier of proton homeostasis improves function of an antifungal substance and could be used as a combination of an antifungal substance and a proton homeostasis modifier to prepare (i) a medicament or (ii) a plant protection product for treatment of subject: human, animal or plant; which is infected with fungi and provides means for treating such infection. According to the invention, a synergistic combination of the antifungal substance and the modifier of proton homeostasis is useful for preparation of a medicament for (i) in vivo prevention and treatment of fungal infection, and fungi are selected preferentially among pathogenic and opportunistic pathogenic fungi and for (ii) in vitro decontamination of surfaces and sterilizing medical equipment and implants. According to the invention, the combination of the antifungal substance and the modifier of proton homeostasis could be used for preparation of a plant protection product and for in vivo prevention and treatment of fungal infections in plant.
The term "antifungal substance" refers to "antifungal drug" or "fungicide" and represents the antifungal substance that is used to prevent and treat infection with fungi. The term "antifungal drug or antimycotic" refers to a substance that inhibits the growth and replication of the fungus or destroy fungal cell and the substance is selected from a group (i) polyene antimycotics such as: natamicin, rimocidin, philipine, nystatin, amphotericin B, candicin (ii) azole antimycotics, such as: miconazole, ketoconazole, clotrimazole, ekonazol, bifonazol, butokonazol, fentikonazol, izokonazol, oksikonazol, sertaconazol, sulkonazol, tiokonazol, pramikonazol, (iii) triazole antimycotics, such as: fluconazole, itraconazole, izavukonazol, ravukonazol, posakonazol, voriconazole, terkonazol, (iv) alilamine antimycotics, such as: terbinafine, amorolfin, naftidin, butenafin, or (v) echinocandins, such as: anidulafungin, kaspofungin, mikafungin, and others, such as: amiodarone, terbinafine, ciklopiroks, pimaricin, flucitosin, allylamin-tiokarbamati, grizeofulvin, haloprogin. The term "antifungal substance" also refers to proteins that inhibit the growth of fungi, such as PAF, AFP, and other plant defensins, antifungal proteins and peptides. The term "fungicide" refers to a chemical agent used to control fungal infection and could function as contact, half-systemic or systemic drug.
The term "modifier of proton homeostasis" refers to (i) a compound inhibiting enzymes that maintain intracellular pH in the physiological range and (ii) a compound that directly affect intracellular pH. The term "homeostasis" refers to physiological processes or physiological mechanisms that enable that physiological processes and body structures remain unchanged even if the external conditions vary. A proton homeostasis modifier triggers a permanent or long-term transient drop of intracellular pH and intensity of drop depends on concentration of the modifier. Transient long-term drop of intracellular pH should be longer that 30 minutes to affect cellular processes in such extend to improve the mode of action of antifungal compound. Enzymes of proton homeostasis which regulate intracellular pH are: ATPases, ion channels, ion exchangers, cellular buffers. The modifier inhibits one or more enzymes of proton homeostasis and are: bafilomycine, concavaline, concanamycine, ouabin, oligomycine, FR177995, peptide-C5-amiylide, acil-guanidine with condensed triacyl ring CCCP, FCCP, DCCD, arhazolid and apikularen, azides, cianides, antimycine, rotenon and TTFA, ionophores, salts and derivates thereof, (ii) A special class of proton homeostasis modifiers are weak carboxylic and hydroxy-carboxylic acids, such as: sorbic acid, benzoic, propionic, citric, ascorbic acid and others. Weak acid reduces intracellular pH when eners into the cell and dissociates to anion and proton.
The term "appropriate salt, derivative" refers to salt or derivative of modifier. The salt and derivative of compound does not substantially alter function of modifier, but improves solubility, availability in tissue, improves or alters metabolism, degradation or elimination from the body.
The function of modifier according to the invention is an enhancement of therapeutic efficiency of the antifungal substance for treatment and prevention of fungal infections and the enhancement is expressed synergistically.
The invention refers to the discovery that the modifier of proton homeostasis, selected form a group of compounds that inhibits or activates proton ATPases, ion exchangers, oxidative phosphorylation; together with the antifungal compound, antimycotic or fungicide; expresses synergistic effect and improves therapeutic efficiency of the antifungal compound for prevention and treatment of fungal infection.
Preferentially these compouds are selected from: are bafilomycine, concavaline, concanamycine, ouabin, oligomycine, FR177995, peptide-C5-amiylide, acil-guanidine with condensed triacyl ring CCCP, FCCP, DCCD, arhazolid and apikularen, azides, cianides, antimycine, rotenon and TTFA, ionophores, salt and derivative thereof;.
The invention refers to the discovery that the modifier of proton homeostasis, weak carboxylic and hydroxy-carboxylic acids; together with the antifungal compound, antimycotic or fungicide; expresses synergistic effect and improves therapeutic efficiency of the antifungal compound for prevention and treatment of fungal infection.
Therapeutically effective amount of the antifungal substance in the combination is decreased in the presence of proton homeostasis modifier compared with the therapeutically effective amount of antifungal substance, which is used without the modifier.
The term "synergistic" describes the improved fungicidic or fungistatic therapeutic efficacy of the antifungal substance in the presence of proton homeostasis modifier. The term "therapeutic efficacy" refers to the successful clinical outcome, which not necessarily means that the pharmaceutical combination eliminates all fungi involved in infection. The success depends on intensity of fungal infection at the site of infection and refers to the improvement of the infection state. The therapeutic effectiveness depends also upon the condition of treated subject. A healthy subject requires less of the combination compared to the subject with a weakened immune response. According to the invention the therapeutically effective amount of the antifungal substance in the presence of proton homeostasis modifier in the combination according to the invention is reduced compared to the treatment with only the antifungal substance.
The invention refers to the combination for preparation of a medicament or a plant protection product for prevention or treatment of infection caused by opportunistic pathogens and pathogenic yeasts and filamentous fungi.
The term "fungal infection" refers to infection of plant, animal and human as well as material, liquid and surface with filamentous fungi and yeasts. The term "fungus" refers to micro-organism from the kingdom of fungi, preferentially yeasts and filamentous fungi, which are plant or animal pathogens or opportunistic pathogens. The group of pathogenic and opportunistic pathogenic fungi are selected from: Candida, preferably C. albicans, C. glabrata, C. krusei, C. laurentii, C. parapsilosis, C. tropicalis, C. lusitaniae, C. kefyr, C. guilliermondii, C. dubliniensis, Cryptococcus, preferably C. neoformans, C. albidus, C. gattii, Aspergillus, preferably A. flavus, A. fumigatus, A. clavatus, A. niger, A. nidulans, A. terreus, A. Sydow, A. glaucus, A. oryzae, A. ustus, A. versicolor, Histoplasma, Histoplasma capsulatum priority, Paracoccidioides, preferably P. brasiliensis, Sporothrix, schenckii Sporothrix priority, Blastomyces, preferably B. dermatitidis, Paecilomyces preferably P. lilacinus, P. variotii, pneumonia, preferably P. jirovecii, Stachybotrys, preferably S. chartarum, Malassezia, preferably M. furfuryl, Pityrisporum, preferably P. ovalae, Coccidioides, Fonsecaea, Cladosporium, Basidiobolus, Conidiobolus, Rhizopus, Rhizomucor, Mucor, Absidia, Mortierella, Cunninghamella, Saksenaea, Trychophyton, preferably T. rubrum, T. tonsurans, T. mentagrophytes, T. soudanense, T. verrucosum, T. ajelloi, T. concentricum, T. equinum, T. erinacei, T. flavescens, T. gloriae, T. inter digitale, T. megnini, T. phaseoliforme, T. schoenleini, T. simia, T. terrestre, T. tonsurans, T. vanbreuseghemii, T. violaceum, T. Yaounde, Microsporum, preferably M. canis, M. gypseum, M. audouini, M. gallinae, M. ferrugineum, M. distortum, M. nanum, M. cookie, M. vanbreuseghemii, Epidermophyton, preferentially E. floccosum, E. stockdaleae, Trichosporon, Fusarium, preferably F. oxysporum, F. solani, F. semitectum, Scytalidium, preferably S. dimidiatum, S. hyalinum, S. infestans, S. japonicum, S. lignicola, Penicillium, Actinomyceees, Cochliobolus, Scopulariopsis, preferably S. brevicaulis, S. Candida, S. koningii, S. acremonium, S. flava, S. cinerea, S. trigonospora, S. brumptii, S. chartarum, S. fusca, S. asperula, Alternaria, preferably A. alternate, A. chartarum, A. dianthicola, A. geophilia, A. infectoria, A. stemphyloides, A. teunissima, Curvularia, preferably C. brachyspora, C. clavata, C. geniculata, C. lunata, C. pallescens, C. senegalensis, C. verruculosa, C. Chaetomium priority atrobrunneum, C. funicola, C. globosum, C. strumarium. The term "fungi" refers to yeasts and filamentous fungi which in healthy subject do not cause a disease, but in immunocompromised patient the same fungi can cause a disease. The term "fungi" refers also to fungi, which are plant pathogens such as: Fusarium spp., Thielaviopsis spp., Verticillium spp., Rhizoctonia spp. Pachyrhizi Sydow Phakospora, Puccinia spp. Magnaporthe spp. e.g. Magnaporthe grisea, Ustilago spp. e.g. Ustilago mydis, Uncinula necator, Plasmopara viticola, Pseudopezicula tracheiphila, Botrytis spp. e.g. Botrytis cinerea, Phomopsis viticola.
The term "disease" refers to a disease caused by infection with yeasts and filamentous fungi. The term "disease" refers to a disease caused by (a) surface infection of fungi and is limited to infection of the skin, nails and hair, (b) disease caused by subcutaneous infection such as dermatitis and is infection of subcutaneous tissue and surrounding structures, (c) systemic disease is infections of internal organs: lungs, liver, heart of the central nervous system, gastrointestinal tract and opportunistic diseases, (d) infection of immune compromised patient with non-pathogenic fungi. Disease is expressed in the form of mycosis, candidosis, systemic mycosis, histoplasmosis, blastomycosis, cocidiomycosis and paracocidiomycosis, inflammation, redness, dandruff, athletic feet, mouth and vaginal candidosis, dermatitis, eczema, onikomycosis, aspergillosis, histoplasmosis, pneumonia, respiratory damage and headaches, asthma. The term "disease" refers to illness caused by fungi in animal or human, preferably in honeybees and vertebrates, particularly birds, poultry, mammals, especially ungulates, rabbits, carnivores, cats, primates, and man.
The term "treatment" refers to preventive and therapeutic treatment. In vitro method of treatment refers to the killing and inhibiting of fungal growth and replication through the transfer of the combination according to the invention to the site of infection with fungi, which is a surface of material.
The invention refers to a medicament, which contains the combination according to the invention to treat fungal infection and the medicament contains the pharmaceutical combination in effective amount to inhibit or destroy fungal cells. Techniques of assessment a therapeutically effective amount of the combination with the antifungal substance and the proton homeostasis modifier are well known to the experts in the field.
The therapeutically effective amount of the combination according to the invention includes quantitatively reduced amount of the antifungal substance due to the synergistic action of modifier of proton homeostasis which is administrated/incorporated into the combination as a mixture or separate component. A synergistic effect of the proton homeostasis mofifier with the antifungal substance is expressed with a less of the antifungal substance needed for elimination or inhibition of replication and growth of fungi.
These is important since application of some antifungal substances is limited by their systemic toxicity or costs related with treatment with antifungal substance. Reducing the concentration of antifungal substance with the addition of modifier will decrease side effects of treatment and its cost, which enables wider use of the combination. A medicament according to the invention ensures a faster or more efficient fungistatic or fungicidic effect compared to antifungal substance. A drug that contains the combination according to the invention overcomes fungal resistance to the antifungal substance, or change the fungistatic mode of action of antifungal substance into fungicidic. In the combination a therapeutically effective amount of the antifungal substance is reduced due to the synergistic activity of components of the composition.
According to the invention a medicament may contain both active ingredients of the combination: antifungal substance and proton homeostasis modifier in the form of a mixture or as a separate active ingredients provided that the individual active ingredients of the medicament are used in a manner which ensures that the effect of active ingredient in separate form at the site of fungal infections is as good as effect of their mixture. Active components are in separate forms due to improved stability of the individual components and due to easier administration when using different administration routes. Individual active ingredients of the combination of the invention: the antifungal substance and the proton homeostasis modifier can be in various pharmaceutical forms. The combination that provides simultaneous administration of the antifungal substance and the modifier of proton homeostasis is expected to be as efficient as co-application, with fungistatic or fungicidal effects in vivo compared with the administration of individual components of the combination of the invention. The term "fungistatic effect" describes inhibited growth and reproduction of fungi, the term "fungicidic effect" refers to the death of fungi.
According to the invention, the combination destroys or inhibits fungal growth in the way of direct contact of fungus with the combination. This method can be used in vitro, as for plant protection products, for decontamination of fluids and surfaces or to sterilize surgical and other medical tools and implants, including prostheses, in situ sterilization of catheters, intravenous implants.
The invention refers to the preparation of a medicinal product that contains the combination for treatment of fungal infection. The medicament is in any pharmaceutical form and contains the required pharmaceutical additives.
The term "pharmaceutical form" refers to a form in which the pharmaceutical combination in a form of powder, suspension, emulsion, solution, paste, cream, ointment, gel, lotion, liniment, dosage forms for injection, infusion formulation, tablet, capsules, suppositories, transdermal patch, a therapeutic system, tinctures, percolat extract. The term "pharmaceutical supplement" refers to additives in pharmaceutical formulation. The function of pharmaceutical supplement is to facilitate and enhance the entry of the pharmaceutical combination of the invention to the infection site and is part of the pharmaceutical form. The pharmaceutical supplement includes appropriate dilutants, adjuvants and carriers. Administration of the pharmaceutical form containing the combination may be topic, intravenous, oral or intramuscular, via an aerosol, subcutaneous, intraperitoneal, intraocular, transpulmonary, transdermal.
The combination according to the invention may be administrated in conjunction with other drugs. The combination may contain one or more antifungal substances in addition to modifier of proton homeostasis.
The invention also relates to a plant protection product in an appropriate form and with appropriate additives and is used to prevent or treat fungal infection in plant. The invention relates to a method for use the combination in form of a medicament or a plant protection product for elimination or inhibition of fungal growth and reproduction and is used as plant protection product and for decontamination of fluids and surfaces or to sterilize surgical and other medical tools and implants, including prostheses, and in situ sterilization of catheters, intravenous implants. Below are examples to illustrate the innovation. Descriptions of cases are not intended to limit innovation and to be understood in terms of innovation demonstrations.
Examples
Example 1. Growth inhibition test
Effect of the combination was tested on the fungi Aspergillus spp. in liquid media. Spores were grown overnight (16 to 24 h) in a synthetic liquid Vogel's medium at 30 oC. The Vogel's medium was supplemented with the combination of the antifungal compound and the modifier of proton homeostasis. For positive control the medium without the active ingredients of the combination was used. The XTT method was used for measuring the metabolic activity of fungi.
Preparation of spore suspension and media. Spore suspension was prepared in 0.1% (w / v) Tween 80. Spore suspension in the final concentration of 105 spores/ml was used to inoculate the liquid Vogel's medium. Vogel's medium contains: 8.5 mM sodium citrate dihydrate of (Na3(C6H507)), 36.8 mM KH2P04, 25 mM NH4N03, 0.7 mM CaC12.2H20, 0.8 mM MgS04.7H20, pH 6.0, 0.2 ml of trace elements (34.3 mM EDTA, 15.3 mM ZnS04.7H20, 8 MnC12.4H20 mM, 1.6 mM CoC12.6H20, 1.3 mM CuS04.5H20, 0.2 mM (NH4)6Mo7O24.4H20, CaC12.2H20 10 mM, 3.6 mM FeS04.7H20, pH 6.5) and 2% (w/v) glucose. Antifungal substance (amiodarone 2 mM DMSO, amphotericin 0.04 g/1 DMSO, clotrimazole 1 g/1 DMSO, fluconazole 40 g/1 DMSO, ketoconazole 5 g/1 methanol) and modifier of proton homeostasis (bafilomycin 0.16 μΜ in DMSO, sorbic acid) were dissolved in an appropriate solvent in adequate concentration. 0.2 ml of spore solution with supplements was placed in the wells of microtitre plates (we used 96 well plates). The test was performed after 24-hour incubation at 37 °C.
The XTT method was used to determine the presence of living cells. XTT reagent is internalised in the cell and is converted to a coloured compound in active mitochondria. Solution of XTT and menadione was freshly prepared. XTT was dissolved in hot water at a final concentration of 1 g/1. Menadione was dissolved in acetone at a concentration of 10 mM, and then it was further diluted with saline in the ratio 1 :10. Final XTT reagent contains the XTT reagent (concentration 0.6 g/1 final concentration in the well is 0.2 g/1) and menadione (concentration 75 μΜ, the final concentration in the well 25 μΜ). After adding 0.1 ml of XTT reagent in each well, the plate was incubated at 30 °C for 4 hours. After incubation we transferred 0.1 ml from each well to a new transparent microti ter plate, where the absorbance of the solutions was measured at a wavelength of 450 nm on a Bio-Tek ® XS PowerWave reader.
In all experiments presented on Figure 1, bafilomycine was used in concentrations up to 10 nM. It is obvious from results that combination of bafilomycine and antimycotics is synergistic and improves fungal growth inhibition. When 10 nM bafilomycine was added to fluconazole fungicidic growth inhibition was achieved. A combination of bafilomycine and ketoconazole is also successful in combination of 2 nM bafilomycine and ketoconazole 15 μg/ml since 99 % growth inhibition is achieved. Similar outcome was detected with combination of 10 nM bafilomycine and clotrimazole.
In all experiments presented in Figure 2, sorbic acid was used in combination with antimycotics. Figure 2 presents combination of sorbic acid and amphotericine having 85 % of fungal growth inhibition in combination of 3 raM sorbic acid and 0.5 mg/1 amphotericine. A 100% inhibition was determined with the combination of sorbic acid 3 mM and fluconazole in concentration 1.5 g/1. Combination of 3 mM of sorbic acid and 10 mg/1 ketoconazol gives 99 % growth inhibition. Similar results were obtained with combination of chlotrimazole and sorbic acid.
Table 1. Growth inhibition of A. terreus with the combination; sorbic acid and fluconazole. For comparison, growth inhibition in media without and with single active ingredient was determine.
Sorbic acid - 10 mM - 10 mM
Fluconazole - -' 0.5 g/1 0.5 g/1
Growth of A. terreus (%) 100 ±7 6 ±1 92 ±1 1 ±1
Example 2. Confocal microscopy
With microscopy we evaluated an impact of the combination on the growth of the tested fungi. Cells were stained with the SynaptoRed and SYTOX dye. SynaptoRed dye stains the cell membrane, while SYTOX cell membrane impermeable and emits fluorescence only after binding to DNA. Visualization of the SYTOX dye within the cell is an indication of damaged cell membrane. We tested the combination of fluconazole and ascorbic acid and amphotericin and sorbic acid. As a control, the fungus A. niger was inoculated in media without supplements. Results are shown in Figure 4. Magnification is similar for all images. Comparison of growth and staining with SYTOX clearly shows impaired growth of fungi in presence of the combinations. It is obvious that growth of A. niger in media without active ingredients is more intensive and the intracellular content is not stained with SYTOX dye. The combination strongly inhibited the growth. Detailed description of the performed experiment is presented below.
We used confocal microscope Leica TCS SP5. This is a laser microscope mounted on a Leica DMI 6000 CS inverted microscope (Leica Microsystems, Germany). Immersion lens with HCX Plan Apo 63x oil (NA 1.4) was used. The SynaptoRed 2 (Biotium) is excited with the argon laser at 514 nm and the emission is collected between 650 and 700 nm, and SYTOX Green is excited at 488 nm and emits light at 520 to 540 nm.
A spore suspension with the concentration of 105 spores/ml Vogel's medium was prepared. The media was supplemented with the active ingredients of the combination. 0.2 ml of the spore suspension was inoculated on cover slip and incubated for 14 hours at 30 °C in a humid chamber. Preparations were stained with Synapto Red (dyes the cell membrane) and 10 μΐ of 0.5 mM Sytox Green dye for 15 minutes at 30 °C.
Example 3. Identification of suitable modifiers of proton homeostasis with measurment of intracellular pH.
The method of genetically encoded biosensor RaVC was used for measurements of intracellular pH. The method is used to identify substances, compounds that could be classified as suitable for proton homeostasis modifier. The measurements were performed according to Bagar et al. 2009. In table 2 results of intracellular pH measurements in fungal cells are presented. Fungi were treated with bafilomycin or sorbic acid and intracellular pH was recorded. Both modifiers of proton homeostasis bafilomycine and sorbic acid exerted concentration dependent intracellular pH drop.
Table 2: Intracellular pH after the addition of proton homeostasis modifier; bafilomycine and sorbic acid. Time (min) 0 3 5 10 15
Bafilomycine
50 nM 7.5 7.7 7.7 7.5 7.0
100 nM 7.5 7.0 6.7 6.5 6.0
Sorbic acid
5 mM 7.5 7.0 6.9 6.9 6.9
10 mM 7.5 5.9 6.1 5.9 5.9
Example 4 Inhibition of yeast growth
The effect of the pharmaceutical combinations was tested on the yeast Saccharomyces cerevisiae in liquid media. Yeast culture was grown overnight (16 to 24 h) in a synthetic liquid medium at 28 oC. The medium contained different pharmaceutical combinations. For a control, yeast cells were grown in medium free of any active ingredient of the pharmaceutical combinations. Initially yeast cells were diluted to optical density 0.04 at 600 nm. Growth speed was monitored spectrophotometrically in 8 h incubation at 28 oC. Results are presented in Figure 3.
The fastest growth was observed for yeast cultivated in medium without supplements, positive control. Results are calculated as a percentage of growth relative to positive control. The results show (Figure 3) that the pharmaceutical combination of acetylsalicylic acid and amphotericin inhibits the growth of S. cerevisiae and that the inhibition of growth is much better than inhibition of growth in the presence of individual components.

Claims

Claims
1. A combination of an antifungal substance and a modifier of proton homeostasis to destroy or inhibit the growth and replication of fungi.
2. The combination according to claim 1 characterised by that the modifier of proton homeostasis is selected from group of compounds that inhibit ATP-ases, proton exchangers or oxidative phosphorylation, preferentially these compounds are: bafilomycine, concavaline, concanamycine, ouabin, oligomicin, FR177995, peptide-C5- amiloid, acil-guanidine with condensed triacyl rings, CCCP, FCCP, DCCD, arhazolide and apikularen, azides, cianides, antimycine, rotenon and TTFA, ionophores and derivatives of these compounds.
3. The combination according to claim 1 characterised by that the modifier of proton homeostasis is selected from group of weak carboxylic and hydroxy-carboxylic acids.
4. The combination according to any claim from 1 to 3 characterised by that the antifungal substance is selected from the group antimycotics or fungicides.
5. The combination according to any claim 1 or 4 characterised by that a fungicidic or a fungistatic therapeutic efficient amount of the antifungal substance in combination with modifier of proton homeostasis is improved compared to the therapeutically efficient amount of the individual antifungal substance.
6. The combination according to any claim from 1 to 5 for preparation of a drug or a plant protection product for in vivo and in vitro prevention or treatment infections caused by fungi, preferentially pathogenic and opportunistic pathogenic yeasts and filamentous fungi.
7. A medicament that contains the combination according to any claim from 1,2 and from 4 to 6 and the medicament prevents or treat fungal infection that initiates a disease in animal or human and this infection in animal or human is either (a) superficial, limited to the skin, nails and hair; (b) subcutaneous infections of tissues and surrounding structures or (c) systemic infections of internal organs.
8. The medicament according to claim 7 characterised by that it contains a therapeutically effective amount of the combination according to any claim from 1 , 2, from 4 to 6 in a suitable pharmaceutical form with appropriate pharmaceutical additives.
9. The medicament according to any claim from 7 to 8 characterised by that the medicament is in pharmaceutical form suitable for topical, intravenous, oral, intramusculature, subcutaneous, intraperitoneal, intraocular, transpulmonary, transdermal, aerosol use.
10. The medicament according to any claim from 7 to 9 characterised by that it contains the combination in a form, which contains the antifungal substance seperated from the modifier of proton homeostasis, and both forms are used in a manner to achieve a synergistic effect characteristic for the combination and are in separate forms to improve stability of individual components of the combination or to be administrated differently.
11. A plant protection product containing the combination according to any claim from 1 to 6 in a suitable form with an appropriate additives and is intended to prevent or treat fungal infections in plants.
12. The method of destroying fungi or inhibiting growth and replication of fungi, preferentially pathogenic and opportunistic pathogenic fungi through the transfer of the combination according to any claim from 1 to 6 in the form of the medicament according to any claim from 7 to 10 or the plant protection product of claim 11 to the region infected with the fungus and is used for plant protection, for decontamination of fluids and surfaces or to sterilize surgical and other medical tools and implants, including prostheses, in situ sterilization of catheters, intravenous implants.
13. The method according to claim 12 characterised by that the active ingredients of combination according to any claim from 1 to 6 are used sequentially, but still in a way to attain a significant synergistic effect of simultaneous use.
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BAGAR T.; ALTENBACH K.; READ N.D.; BENCINA M.: "Live-cell imaging and measurement of intracellular pH in filamentous fungi using a genetically encoded ratiometric probe", EUKARYOTIC CELL, vol. 8, 2009, pages 703 - 712
GEORGOPAPADAKOU N.H.; WALSH T.J.: "Minireview, Antifungal agents: Chemoterapeutic targets and immunologic strategies", ANTIMICROBIAL AGENTS AND CHEMOTERAPY, vol. 40, 1996, pages 279 - 291
GROLL A.H.; KOLVE H.: "Antifungal agents: In vitro susceptibility testing, pharmacodynamics, and prospects for combination therapy", EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, vol. 23, 2004, pages 256 - 270
KLICH M.A.: "Aspergillus flavus: the major producer of aflatoxin", MOLECULAR PLANT PATHOLOGY, vol. 8, no. 6, 2007, pages 713 - 722
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