In vitro susceptibility assays of antifungal activity do not always accurately predict in vivo efficacy. As well as having a clear clinical importance, the ability to predict efficacy is also essential for effective screening of novel drug compounds. Initial screening of novel compounds must often be based on in vitro data. The present report describes the use of serum-MIC, an in vitro test of antifungal susceptibility, to accurately predict in vivo efficacy of echinocandin drugs in a mouse model of disseminated candidiasis. The basis of the serum-MIC method was to measure the inhibitory activity of a test compound against Candida albicans hyphal growth in the presence of pooled mouse serum. For 13 previously uncharacterized echinocandin compounds, as well as for the known echinocandin drugs, micafungin and caspofungin, serum-MIC determinations were shown to give better correlation to efficacy in the animal model than conventional, CLSI standard, in vitro antifungal susceptibility tests. The most accurate prediction of efficacy was obtained when the serum-MIC was adjusted in relation to the serum concentration at 30 min post-treatment. Furthermore, when the efficacy of micafungin was determined by measuring C. albicans kidney burden in the mouse model of infection, the adjusted serum-MIC consistently reflected the effective serum concentrations. Our data indicate that determination of serum-MIC values will facilitate prediction of the in vivo potency of new antifungal compounds such as novel echinocandins. Candida albicans, echinocandin, pharmacodynamics, serum-MIC. Echinocandins are a new class of antifungal lipopeptide which inhibit the synthesis of 1,3-β-D-glucan, a component of the cell wall in many medically important fungi (1-5). They have potent and broad-spectrum antifungal activity which is fungicidal to many Candida Correspondence Katsuyuki Maki, Pharmacology Research Laboratories, Department of Infectious Diseases, Astellas Pharma Inc., 1-6, Kashima 2-chome, Yodogawa-ku, Osaka 532-8514, Japan. Tel: +81 6 6390 1158; fax: +81 6 6304 5367; email: katsuyuki.maki@jp.astellas.com List of Abbreviations: AUC, area under the serum concentration-time curve; c.f.u., colony forming unit; CLSI, Clinical and Laboratory Standards Institute; C max , maximal serum concentration after administration; C 0.5 hr , serum concentration at 0.5 hr after administration; ED 50 , 50% effective dose of compound in mouse model of disseminated infection; HPLC, high performance liquid chromatography; MIC, minimal inhibitory concentration; RPMI-MIC, MIC determined in modified CLSI M27-A2 protocol; SDA, Sabouraud dextrose agar; serum-MIC, MIC determined from the inhibition of mycelial elongation in the presence of pooled mouse serum; sub-MIC, sub-minimal inhibitory concentration; t 1/2 , half-life of serum concentration after administration.
Key wordsspp. and fungistatic to Aspergillus spp. Clinically available echinocandin drugs include caspofungin, micafungin, and anidulafungin. Micafungin (FK463) (6, 7) was developed fro...