Antifungal efficacy of atorvastatin-containing emulgel in the treatment of oral and vulvovaginal candidiasis

Med Mycol. 2021 May 4;59(5):476-485. doi: 10.1093/mmy/myaa071.

Abstract

Drug repositioning has been an important ally in the search for new antifungal drugs. Statins are drugs that act to prevent sterol synthesis in both humans and fungi and for this reason they are promissory candidates to be repositioned to treat mycoses. In this study we evaluated the antifungal activity of atorvastatin by in vitro tests to determine the minimum inhibitory concentration against azole resistant Candida albicans and its mechanisms of action. Moreover, the efficacy of both atorvastatin-loaded oral and vaginal emulgels (0.75%, 1.5% and 3% w/w) was evaluated by means of in vivo experimental models of oral and vulvovaginal candidiasis, respectively. The results showed that atorvastatin minimal inhibitory concentration against C. albicans was 31.25 μg/ml. In oral candidiasis experiments, the group treated with oral emulgel containing 3.0% atorvastatin showcased total reduction in fungal load after nine days of treatment. Intravaginal delivery atorvastatin emulgel showed considerable effectiveness at the concentration of 3% (65% of fungal burden reduction) after nine days of treatment. From these findings, it is possible to assert that atorvastatin may be promising for drug repositioning towards the treatment of these opportunistic mycoses.

Keywords: Candida albicans; Atorvastatin; oral candidiasis; vulvovaginal candidiasis.

Plain language summary

Atorvastatin is a statin drug that presents antifungal activity. This study showed that atorvastatin-containing oral and vaginal emulgels were able to treat vulvovaginal and oral candidiasis of infected animal model. Therefore, we showcased that atorvastatin may be a possible therapeutic agent in order to be a used to control opportunistic mucosal fungal infections caused by Candida albicans.

MeSH terms

  • Animals
  • Antifungal Agents / pharmacology
  • Antifungal Agents / therapeutic use
  • Atorvastatin / pharmacology*
  • Atorvastatin / therapeutic use*
  • Azoles / pharmacology
  • Candida albicans / drug effects*
  • Candidiasis, Oral / drug therapy*
  • Candidiasis, Oral / microbiology
  • Candidiasis, Vulvovaginal / drug therapy*
  • Candidiasis, Vulvovaginal / microbiology
  • Disease Models, Animal
  • Drug Repositioning
  • Drug Resistance, Fungal
  • Female
  • Humans
  • Mice
  • Microbial Sensitivity Tests
  • Rats
  • Treatment Outcome

Substances

  • Antifungal Agents
  • Azoles
  • Atorvastatin