In Vitro Activity of the Echinocandin Antifungal Agent LY303,366 in Comparison with Itraconazole and Amphotericin B against Aspergillus spp.

LY303,366 (LY) is a novel derivative of the echinocandin class of antifungal agents. The in vitro activities of LY, itraconazole (ITZ), and amphotericin B (AMB) were assessed against 60 Aspergillus isolates, including 35 isolates of A. fumigatus, eight isolates of A. terreus, eight isolates of A. flavus, eight isolates of A. niger and one isolate of A. nidulans. Four A. fumigatus isolates were resistant to ITZ. Susceptibility testing for all drugs was performed with a broth microdilution procedure. LY was tested in two media: antibiotic medium 3 (AM3) and Casitone with 2% glucose (CAS) with an inoculum of 2 × 10³ spores/ml. ITZ and AMB were tested in RPMI 1640 with 2% glucose with an inoculum of 1 × 10⁶ spores/ml. All tests were incubated at 37°C for 48 h. A novel end point was used to determine a minimal effective concentration (MEC) for LY, i.e., almost complete inhibition of growth save a few tiny spherical colonies attached to the microplate. MICs were measured for ITZ and AMB with a no-growth end point. Ranges and geometric mean (GM) MECs were from 0.0018 to >0.5 and 0.0039 mg/liter and from 0.0018 to >0.5 and 0.008 mg/liter for LY in AM3 and LY in CAS, respectively. Differences between species were apparent, with A. flavus being significantly less susceptible to LY than any other species tested with both media (P ≤ 0.05). Ranges and GM MICs were from 0.125 to >16 and 0.7 mg/liter for ITZ and from 0.25 to 16 and 1.78 mg/liter for AMB. Minimal fungicidal concentrations (MFCs) were also determined for all drugs. GM MFCs were 0.018, 0.09, 19.76, and 12.64 mg/liter for LY in AM3, LY in CAS, ITZ, and AMB, respectively. LY in AM3 and LY in CAS were fungicidal for 86.7 and 68% of isolates, respectively (98% killing). In comparison, ITZ and AMB were fungicidal for 35 and 70% of isolates, respectively (99.99% killing). A reproducibility study was performed on 20% of the isolates. For 12 isolates retested, the MEC or MIC was the same or was within 1 dilution of the original value for 11, 11, 10, and 9 isolates for LY in AM3, LY in CAS, ITZ, and AMB, respectively. In conclusion, LY seems to be a promising antifungal agent with excellent in vitro activity against Aspergillus spp.

Invasive aspergillosis is now one of the most common fungal infections found in immunocompromised patients (1) and is also one of the most fatal (2). Treatment of Aspergillus infections is still not ideal, and the two currently used antifungal drugs have a variety of associated problems. Amphotericin B (AMB) can cause serious side effects due to its toxicity and itraconazole (ITZ) is not always absorbed in high enough quantities to be therapeutic, especially in certain patient groups, e.g., AIDS patients.The rise in serious fungal infection over the past decade has prompted the development of new antifungal agents with novel modes of action. LY303,366 (LY) is a semisynthetic derivative of a natural product class of antifungal agents belonging to the new class of drugs known as echinocandins. Echinocandins are noncompetitive inhibitors of (1,3)-β-d-glucan synthase which produces glucan polymers, a major component of the fungal cell wall (3). LY has been reported to have excellent activity against a wide range of fungal pathogens, including Aspergillus species (12) and Candida species (8, 10, 12).In this study we evaluated the in vitro activity of LY against a variety of Aspergillus species and compared it with the activity of currently used antifungal agents, ITZ and AMB.