Addition of 17-(allylamino)-17-demethoxygeldanamycin to a suboptimal caspofungin treatment regimen in neutropenic rats with invasive pulmonary aspergillosis delays the time to death but does not enhance the overall therapeutic efficacy

PLoS One. 2017 Jul 24;12(7):e0180961. doi: 10.1371/journal.pone.0180961. eCollection 2017.

Abstract

Caspofungin (CAS) which is used as salvage therapy in patients with invasive pulmonary aspergillosis (IPA) inhibits the 1,3-β-D-glucan synthesis in Aspergillus fumigatus. Inhibiting 1,3-β-D-glucan synthesis induces a stress response and in an invertebrate model it was demonstrated that inhibiting this response with geldamycin enhanced the therapeutic efficacy of CAS. Since geldamycin itself is toxic to mammalians, the therapeutic efficacy of combining geldamycin with CAS was not studied in rodent models. Therefore in this study we investigated if the geldamycin derivate 17-(allylamino)-17-demethoxygeldanamycin (17-AAG) was able to enhance the therapeutic efficacy of CAS in vitro and in our IPA model in transiently neutropenic rats. In vitro we confirmed the earlier demonstrated synergy between 17-AAG and CAS in ten A. fumigatus isolates. In vivo we treated A. fumigatus infected neutropenic rats with a sub-optimal dose of 0.75 mg/kg/day CAS and 1 mg/kg/day 17-AAG for ten days. Survival was monitored for 21 days after fungal inoculation. It appeared that the addition 17-AAG delayed death but did not improve overall survival of rats with IPA. Increasing the doses of 17-AAG was not possible due to hepatic toxicity. This study underlines the need to develop less toxic and more fungal specific geldamycin derivatives and the need to test such drugs not only in invertebrate models but also in mammalian models.

MeSH terms

  • Animals
  • Antifungal Agents / administration & dosage
  • Aspergillus fumigatus / drug effects
  • Benzoquinones / administration & dosage*
  • Benzoquinones / toxicity
  • Caspofungin
  • Disease Models, Animal
  • Drug Synergism
  • Drug Therapy, Combination
  • Echinocandins / administration & dosage*
  • Female
  • Humans
  • Invasive Pulmonary Aspergillosis / complications
  • Invasive Pulmonary Aspergillosis / drug therapy*
  • Invasive Pulmonary Aspergillosis / microbiology
  • Lactams, Macrocyclic / administration & dosage*
  • Lactams, Macrocyclic / toxicity
  • Lipopeptides / administration & dosage*
  • Microbial Sensitivity Tests
  • Neutropenia / complications
  • Rats

Substances

  • Antifungal Agents
  • Benzoquinones
  • Echinocandins
  • Lactams, Macrocyclic
  • Lipopeptides
  • tanespimycin
  • Caspofungin

Grants and funding

This study was supported by an ErasmusMC grant from the ErasmusMC University. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.