N-acetylcysteine reduces amphotericin B deoxycholate nephrotoxicity and improves the outcome of murine cryptococcosis.

Research paper by Thais Furtado Ferreira TFF Magalhães, Marliete Carvalho MC Costa, Rodrigo Assunção RA Holanda, Gabriela Freitas GF Ferreira, Vanessa Silva Dutra VSD Carvalho, Gustavo Jose Cota GJC Freitas, Noelly Queiroz NQ Ribeiro, Elúzia Castro Peres ECP Emídio, Paulo Henrique Fonseca PHF Carmo, Camila Bernardo CB de Brito, Daniele Glória DG de Souza, Cláudia Emanuela Viana CEV Rocha, Tatiane Alves TA Paixão, Maria Aparecida MA de Resende-Stoianoff, Daniel Assis DA Santos

Indexed on: 12 Jan '20Published on: 11 Jan '20Published in: Medical mycology


Cryptococcosis is a life-threatening fungal infection, and its current treatment is toxic and subject to resistance. Drug repurposing represents an interesting approach to find drugs to reduce the toxicity of antifungals. In this study, we evaluated the combination of N-acetylcysteine (NAC) with amphotericin B (AMB) for the treatment of cryptococcosis. We examined the effects of NAC on fungal morphophysiology and on the macrophage fungicidal activity 3 and 24 hours post inoculation. The therapeutic effects of NAC combination with AMB were investigated in a murine model with daily treatments regimens. NAC alone reduced the oxidative burst generated by AMB in yeast cells, but did not inhibit fungal growth. The combination NAC + AMB decreased capsule size, zeta potential, superoxide dismutase activity and lipid peroxidation. In macrophage assays, NAC + AMB did not influence the phagocytosis, but induced fungal killing with different levels of oxidative bursts when compared to AMB alone: there was an increased reactive oxygen species (ROS) after 3 hours and reduced levels after 24 hours. By contrast, ROS remained elevated when AMB was tested alone, demonstrating that NAC reduced AMB oxidative effects without influencing its antifungal activity. Uninfected mice treated with NAC + AMB had lower concentrations of serum creatinine and glutamate-pyruvate transaminase in comparison to AMB. The combination of NAC + AMB was far better than AMB alone in increasing survival and reducing morbidity in murine-induced cryptococcosis, leading to reduced fungal burden in lungs and brain and also lower concentrations of pro-inflammatory cytokines in the lungs. In conclusion, NAC + AMB may represent an alternative adjuvant for the treatment of cryptococcosis. © The Author(s) 2020. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.