Efeito da combinação de amiodarona com fluconazol, in vitro, frente a isolados de C. tropicalis resistentes ao fluconazol : novos olhares para antigos fármacos

Abstract

Candida tropicalis is a diploid yeast causing superficial infections and / or systemic, which can be acquired endogenously or exogenously and can affect several organs. In Brazil, among the species of Candida spp. The C.tropicalis is the second most common species isolated in Ceará and is rarely studied. Nowadays, we have experienced a significant increase in invasive fungal infections. But antifungal drugs on the market are restricted to a small number when compared to the antibacterial. Therefore, this fact coupled with the increased frequency of cross-resistance is necessary to search for new therapeutic strategies. Amiodarone (AMD) is traditionally used to treat patients with arrhythmia. Recent studies have shown a broad antifungal activity of this drug when combined with fluconazole (FLC). In the present study we induced resistance in seven strains of Candida tropicalis and evaluate a possible synergism between FLC and AMD. The evaluation of the interaction of the drugs was determined by calculating the Fractionary Inhibitory Concentration (FICI) and by flow cytometry, where we also evaluated the likely mechanism of action of this synergism. The isolates used in this study belong to the Laboratory of Experimental Bioprospecting in yeast (LABEL) the UFC. For the fulfillment of the methodology, the strains were recovered from stock and identified by molecular biology. The induction was carried out adapting the protocol of Pinto and Silva (2009). Sensitivity tests were performed using the broth microdilution test standardized by the CLSI, the document M27-A3. To evaluate the synergism used the technique of checkboard. Finally, to determine the possible mechanism of action of synergism, we determine the membrane integrity, mitochondrial transmembrane potential, formation of reactive oxygen species (ROS), comet assay, analysis of the oxidation of purine bases and caspases. Strains C.tropicalis after ~ 100 days reached an MIC> 64μg/mL. The sensitivity tests were MIC> 64μg/mL both the FLC as AMD. Of the strains tested, six showed synergism. The treatment changed the FLC + AMD plasma membrane integrity and mitochondrial increased levels of intracellular ROS, cause DNA damage and therefore led cell death by apoptosis.