1. Synergistic potential of lopinavir and azole combinational therapy against clinically important Aspergillus species.
- Author
-
Burns N, Salama EA, and Seleem MN
- Subjects
- Itraconazole pharmacology, Humans, Azoles pharmacology, Drug Resistance, Fungal drug effects, Triazoles pharmacology, Drug Therapy, Combination, Aspergillus fumigatus drug effects, Aspergillosis drug therapy, Aspergillosis microbiology, Drug Synergism, Lopinavir pharmacology, Lopinavir therapeutic use, Antifungal Agents pharmacology, Microbial Sensitivity Tests, Aspergillus drug effects
- Abstract
Aspergillus fumigatus is a widely distributed pathogen responsible for severe infections, particularly in immunocompromised individuals. Triazoles are the primary treatments options for Aspergillus infections; however, the emergence of acquired resistance to this antifungal class is becoming a growing concern. In this study, we investigated the potential of the antiviral drug, lopinavir (LPV) to restore the susceptibility of A. fumigatus strains to a set of azoles, while also reducing the required azole dosage for treatment of susceptible isolates. The combination of LPV with either itraconazole (ITC) or posaconazole (POS) demonstrated potent synergistic interactions against 16 out of 23 (~70%) and 21 out of 23 (~91%) A. fumigatus isolates, respectively. Moreover, the combination showed synergistic activity against other clinically important Aspergillus species, including A. niger, A. flavus, and A. brasiliensis. The fractional inhibitory concentration index (FICI) for the combinations ranged from 0.18 to 0.313 for ITC and 0.091 to 0.313 for POS, indicating strong synergistic effects. Further investigation revealed that efflux pump inhibition contributed to the synergy observed between azole and LPV. Morphological examination of the fungal cells subjected to this combinational therapy at sub-inhibitory doses showed the presence of carbohydrate granules/patches. The identification of LPV as a promising adjunct therapy holds promise for addressing the emerging challenge of azole resistance in Aspergillus species and improving treatment outcomes for patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Burns et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
- Published
- 2024
- Full Text
- View/download PDF