Yeast and plant membranes contain rather small amounts of cytochrome P–450 as compared with membrane fractions prepared from bovine adrenal cortex, piglet testis and rabbit liver. The agricultural fungicides azaconazole, penconazole, propiconazole and imazalil showed a much greater affinity for microsomal cytochrome P–450 isozymes of Saccharomyces cerevisiae and Candida albicans (ATCC 28516) than for cytochrome P–450 in microsomal fractions prepared from Jerusalem artichoke tubers, maize shoots, pea seedlings or tulip bulbs and for cytochrome P–450 isozymes in mitochondrial or microsomal fractions from rabbit liver, piglet testis and bovine adrenals. The medicinal azole antifungals miconazole, clotrimazole, ketoconazole, fluconazole and itraconazole also interacted at much lower concentrations with the microsomal cytochrome P–450 isozymes from S. cerevisiae and C. albicans (ATCC‐28516, ATCC 44859, B 34226/1) than with those in mammalian membranes. Itraconazole showed the highest selectivity; bifonazole was much less selective. The microsomal fraction prepared from C. albicans (isolate B 41628) contained cytochrome P–450 isozymes with a lower affinity than the microsomal fractions from other isolates for miconazole, ketoconazole, fluconazole and itraconazole. However, itraconazole showed still high affinity for these cytochrome P–450 isozymes. In animal models this C. albicans isolate was less pathogenic and was shown to be less sensitive to azole antifungals both in vitro and in vivo. Azole antifungals inhibited ergosterol synthesis at nanomolar concentrations whereas almost micromolor concentrations were needed to obtain a similar inhibition of cholesterol or phytosterol synthesis. This inhibition coincided with the accumulation of 14α‐methylsterols such as 14‐methyl‐fecosterol, 14‐methyl‐24‐methylene‐ergosterol, 14‐methyl‐ergosta‐8, 24 (28)‐dien‐3β, 6α‐diol, obtusifoliol, lanosterol and 24‐methylenedihydro‐lanosterol. In 24‐h‐old cultures of C. albicans the 3β, 6α‐diol was the major sterol. It is speculated that by making the 14α‐methylsterols less lipophilic the cells are trying to eliminate these membrane‐disturbing compounds. This suggests that the azole‐induced ergosterol depletion might represent a greater contribution to their fungicidal activity than the accumulation of 14α‐methylsterols.
Cytochrome P-450: Target for itraconazole. Drug Dev. Res. 8:287-298, 1986.The N-substituted triazole, itraconazole, has high affinity for the cytochrome P-450 (cyt. P-450) isozyme involved in the 14a-demethylation of lanosterol in Candida albicans microsomes. Fifty per cent inhibition was already observed at itraconazole concentations < 5x lo-' M. Higher concentrations (> lo-' M) of this antifungal are needed to interfere with the 14 a-demethylation in mammalian cells. Unlike ketoconazole, itraconazole does not significantly affect in vitro androgen, gluco-and mineralocorticoid steroidogenesis. ltraconazole also does not affect the cyt. P-450-dependent 19-hydroxylation of testosterone, a step in the conversion of androgens to estrogens. The l-hydroxylation of testosterone by pig testes microscomes is only slightly inhibited. It is hypothesized that itraconazole's selective activity on ergosterol biosynthesis is due to its high affinity for the apoprotein of the C. albicans cyt. P-450 involved in the 1401-demethylation of lanosterol.
As in other pathogenic fungi, the major sterol synthesized by Cryptococcus neoformans var. neoformans is ergosterol. This yeast also shares with most pathogenic fungi a susceptibility of its cytochrome P-450-dependent ergosterol synthesis to nanomolar concentrations of itraconazole. Fifty percent inhibition of ergosterol synthesis was reached after 16 h of growth in the presence of 6.0 +/- 4.7 nM itraconazole, and complete inhibition was reached at approximately 100 nM itraconazole. This inhibition coincided with the accumulation of mainly eburicol and the 3-ketosteroid obtusifolione. The radioactivity incorporated from [14C]acetate in both compounds represents 64.2% +/- 12.9% of the radioactivity incorporated into the sterols plus squalene extracted from cells incubated in the presence of 10 nM itraconazole. The accumulation of obtusifolione as well as eburicol indicates that itraconazole inhibits not only the 14 alpha-demethylase but also (directly or indirectly) the NADPH-dependent 3-ketosteroid reductase, i.e., the enzyme catalyzing the last step in the demethylation at C-4. This latter inhibition obviates the synthesis of 4,4-demethylated 14 alpha-methylsterols that may function at least partly as surrogates of ergosterol. Eburicol and obtusifolione are unable to support cell growth, and the 3-ketosteroid has been shown to disturb membranes. The complete inhibition of ergosterol synthesis and the accumulation of the 4,4,14-trimethylsterol and of the 3-ketosteroid together with the absence of sterols, such as 14 alpha-methylfecosterol and lanosterol, which can partly fulfill some functions of ergosterol, are at the origin of the high activity of itraconazole against C. neoformans. Fifty percent inhibition of growth achieved after 16 h of incubation in the presence of 3.2 +/- 2.6 nM itraconazole.
Two Candida krusei isolates were used to compare the effects of fluconazole, ketoconazole and itraconazole on growth and ergosterol synthesis, and to measure intracellular drug contents. Fifty per cent inhibition (IC50) of growth was achieved at 0.05-0.08 microM itraconazole and 0.56-1.2 microM ketoconazole, whereas 91-->100 microM fluconazole was needed to reach the IC50 value. Similar differences in sensitivity to these azole antifungal agents were seen when their effects on ergosterol synthesis from [14C]acetate were measured after 4 h and 24 h of growth. However, when the effects of the azoles on ergosterol synthesis from [14C]mevalonate by subcellular fractions were measured, fluconazole was only 2.3-6.1 times less active than itraconazole, and the IC50 values for ketoconazole were almost similar to those obtained with itraconazole. These results indicate that differences in susceptibility to itraconazole and ketoconazole are unrelated to differences in affinity for the C. krusei cytochrome P450. The much lower growth-inhibitory effects of fluconazole can also be explained partly only by a lower affinity for the P450-dependent 14 alpha-demethylase. The differences in sensitivity of both C. krusei isolates appeared to arise from differences in the intracellular itraconazole, ketoconazole and fluconazole contents. Depending on the experimental conditions, these isolates accumulated 6-41 times more itraconazole than ketoconazole and the intracellular ketoconazole content was 3.0-19.0 times higher than that of fluconazole.
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