Le développement de nanomédicaments capables de contrecarrer les propriétés biopharmaceutiques défavorables de l'amphotéricine B (AmB) représente un enjeu important. L'AmB est en effet une molécule très efficace pour le traitement des infections fongiques systémiques et aussi pour la leishmaniose, mais difficile à formuler efficacement, quelle que soit la voie d'administration. Cette molécule particulièrement hydrophobe souffre de limitations importantes en raison de sa tendance prononcée à l'agrégation dans les conditions physiologiques. La première partie de cette thèse a consisté à vérifier l'hypothèse selon laquelle le degré d'agrégation de l'AmB pourrait avoir un fort impact sur certaines de ses propriétés biopharmaceutiques et pharmacocinétiques. Dans cet objectif, l'albumine a été utilisée pour produire avec l'AmB des complexes de taille contrôlée. Les caractéristiques morphologiques des objets colloïdaux formés ont été déterminées par spectroscopie UV-Vis et par dichroïsme circulaire. Ainsi, l'impact de l'état de l'agrégation sur la perméabilité intestinale d'une part et la reconnaissance éventuellement des agrégats par le système immunitaire d'autre part a été étudié. La deuxième partie de ce travail a été axée sur le développement des micro et nanotransporteurs destinés à surmonter la barrière d'absorption élevée contre AmB après son administration orale. À cet effet, des micro- et nano-émulsions chargées en AmB ont été préparée afin d'estimer leur capacité à améliorer la perméabilité de l'AmB au travers de l'épithélium digestif de rat. Le modèle de la Chambre d’Ussing a été utilisé à cet effet. Aucun passage de l’AmB n'a pu être détecté dans chacune des conditions expérimentales testées. Toutefois, les données électrophysiologiques ont montré une diminution de la viabilité des tissus, attribuable à la grande toxicité de l'AmB, et dépendante de l'état d'agrégation de l'AmB lorsque ces objets sont au contact avec le tissu. Ces essais de perméation menés sur des tissus sains au niveau jéjunal suggèrent que le transport de l'AmB par les voies paracellulaire et/ou transcellulaire est sans doute marginal. Cependant, la littérature rapporte que qu'une absorption par voie orale de l'AmB, bien que peu importante, peut être observée in vivo. Ceci suggère donc que d'autres voies d'absorption pourraient être mises en oeuvre, parmi lesquelles la capture d'agrégats d'AmB au niveau des plaques de Peyer et l'accès à la voie lymphatique pourraient représenter des voies d'absorption alternatives. Enfin, l'emploi d'un autre système de transporteur conçu pour atteindre le colon et assurer la délivrance colonique grâce à l'action enzymatique bactérienne locale a été envisagé. Dans cet objectif, un biopolymère naturel et dégradable par des enzymes, le xylane, a été sélectionné. Le xylane est un polysaccharide présent dans les grains, de céréales et de plantes angiospermes qui est spécifiquement dégradé dans la région du côlon, grâce à l'action enzymatique du microbiote. Pour cela, un procédé original de préparation de particules a été mis en oeuvre consistant tout d'abord à produire une émulsion eau-dans-eau de xylane en présence de PEG, suivie d'une phase de réticulation du xylane au moyen du trimétaphosphate de trisodium. La méthode a permis la production de nano et de microparticules allant de 380 nm à 4,5 μm et les paramètres contrôlant le processus ont été identifiés. Ce processus, respectueux de l'environnement et ne nécessitant pas l'emploi de solvants organiques, pourrait être appliqué à la délivrance colonique de AmB. / This thesis is part of the development and evaluation of nanomedicines potentially able to overcome unfavorable biopharmaceutical properties of amphotericin B (AmB), a highly effective molecule used for the treatment of systemic fungal infections and leishmaniasis, but difficult to formulate efficiently, whatever the route of delivery. It is believed that this hydrophobic molecule suffers from severe limitations due to its prounounced tendency to aggregate under physiological conditions. The first part of the thesis was driven on the hypothesis that the degree of aggregation of AmB could have a strong impact on some of its pharmacokinetics properties. For this purpose albumin has been used to produce controlled complexes between albumin and AmB in order to control AmB aggregation states. The morphological characteristics of the resulting colloidal objects have been carefully characterized by UV-Vis spectroscopy and circular dichroism. Furthermore, the impact of aggregation state on both the intestinal permeability and a possibly expected recognition of the aggregates by the immunological system were investigated. The second part of this work was focused on the development of micro- and nanocarriers intended to overcome the absorption barrier raised against AmB after oral delivery. For this purpose, AmB was loaded into micro- and nanoemulsions to evaluate a possible permeability enhancement effect through the intestinal membrane, which was evaluated in ratas using the Ussing chamber model. No detectable permeation was seen in any of the experimental conditions. However, the electrophysiological data showed tissue viability losses due to the strong toxicity of AmB, that were dependent on the agregation state of AmB when in contact with the tissue. It was also concluded from detailed permeation experiments in healthy tissues that paracellular and transcellular routes were likely to be only marginal pathways when oral absorption are observed in vivo, as reported in the literature. The likeness of other possible absorption pathways, including Peyer's patches capture and lymphatic pathway implication for agregated particles has been discussed. Finally, another particulate system intended for colonic delivery and based on xylan, a natural and enzymatically degradable biopolymer, has been investigated. Xylan is a polysaccharide present in grains, cereals and angiosperm plants that is specifically degraded on colon region, by the microbiota. An original process consisting in a water-in-water emulsion of xylan in presence of PEG followed by a crosslinking phase using trisodium trimetaphosphate has been developed, making possible the production of xylan-based biocompatible micro- and nanospheres ranging from 380 nm to 4.5 μm, depending on the parameters in the process. This eco-friendly process is free of harmful solvents and has potential application for the delivery of AmB at the colonic level.

Cromoblastomicose é uma micose crônica que acomete a pele e o tecido subcutâneo. Vários tratamentos têm sido utilizados, mas a eficácia é extremamente baixa, não permitindo eleger uma terapia de escolha. No presente trabalho foram realizados: I – ensaios de suscetibilidade in vitro de agentes da cromoblastomicose contra antifúngicos comerciais; II - caracterização molecular de amostras oriundas de casos clínicos, bem como a descrição destes casos; III - a produção e caracterização de duas nanoemulsões, uma de anfotericina B e uma de itraconazol produzidas pela técnica de homogeneização à alta pressão; IV - a avaliação da atividade antifúngica destas nanoemulsões in vitro e in vivo em agentes da cromoblastomicose; V - a verificação do nível de comprometimento renal e hepático causados pelas nanoemulsões; VI - a avaliação da toxicidade das formulações produzidas. De modo geral, os agentes da cromoblastomicose, apresentaram maior suscetibilidade à terbinafina e ao itraconazol, respectivamente. A combinação de anfotericina B e terbinafina foi sinérgica para quatro dos cinco grupos avaliados. Quanto aos casos clínicos, no primeiro foi identificada uma infecção por E. spinifera e no segundo uma por Fonsecaea monophora. As nanoemulsões foram elaboradas com composição passível de administração parenteral, uma de anfotericina B e uma de itraconazol, pelo método de homogeneização à alta pressão. Não foi possível determinar as CIMs da nanoemulsão de anfotericina B e Abelcet® in vitro, enquanto que a nanoemulsão de itraconazol apresentou CIMs muito semelhantes às do fármaco livre. Em modelo animal de cromoblastomicose, a nanoemulsão de anfotericina B foi mais ativa que o fármaco livre, Fungizone® e Abelcet®. A nanoemulsão de itraconazol também apresentou melhor atividade quando comparada com o fármaco livre. Os níveis de uréia foram mais elevados nos animais que receberam anfotericina B livre e Fungizone®. A enzima alanina aminotransferase foi encontrada em níveis menores nos animais tratados com a nanoemulsão de itraconazol do que naqueles que receberam itraconazol livre. A anfotericina B livre e Fungizone® causaram graves danos aos rins. Nos animais tratados com Abelcet® e com a nanoemulsão de anfotericina B foi possível verificar apenas necrose focal. Da mesma forma, a nanoemulsão de itraconazol protegeu os animais contra danos hepáticos quando comparada com o fármaco livre. Em relação aos ensaios de toxicidade, a anfotericina B foi citotóxica em concentrações a partir de 4μg/mL, sendo que com a nanoemulsão esta toxicidade não foi observada em concentrações mais elevadas. O itraconazol foi citotóxico, sendo que este efeito não foi visto com a nanoemulsão. É de extrema importância a avaliação da suscetibilidade dos agentes da cromoblastomicose a fim de orientar a clínica. A identificação molecular de agentes isolados de casos clínicos pode contribuir para delinear o perfil epidemiológico da doença. As nanoemulsões de anfotericina B e itraconazol apresentaram atividades superiores in vivo quando comparadas aos demais tratamentos e foram capazes de reduzir os efeitos adversos causados por estes antifúngicos. Através de ensaios in vitro foi confirmada a redução da citotoxidade do fármaco quando veiculado na nanoemulsão. Assim, as nanoemulsões produzidas poderiam ser alternativas terapêuticas para o tratamento da cromoblatomicose. / Chromoblastomycosis is a chronic mycosis that affects the skin and subcutaneous tissue. Various treatments have been used, but the efficacy is extremely low and does not allow choosing a therapy of choice. In the present work was performed: I - in vitro susceptibility testing for chromoblastomycosis agents against commercial antifungal; II - molecular characterization of samples from clinical cases as well as the description of these cases III - production and characterization of two nanoemulsions , one of amphotericin B and one of itraconazole, produced by high pressure homogenization technique; IV - assessing the in vitro and in vivo antifungal activity of these nanoemulsions against chromoblastomycosis agents; V - checking the level of impairment caused in the kidney and liver by nanoemulsions; VI - evaluation of toxicity of the formulations produced. In general, the chromoblastomycosis agents showed greater susceptibility to terbinafine and to itraconazole, respectively. The combination of amphotericin B and terbinafine was synergistic to four of the five groups. As for clinical cases, in the first was identified an infection by E. spinifera and in the second one by Fonsecaea monophora. The nanoemulsions were prepared with composition amenable of parenteral administration, one of amphotericin B and one of itraconazole, by the at high pressure homogenization method. Could not be determined the MIC of amphotericin B nanoemulsion and Abelcet® in vitro, while the itraconazole nanoemulsion showed MICs very similar to free drug. In a chromoblastomycosis animal model, the amphotericin B nanoemulsion was more active than free drug, Abelcet® and Fungizone®. The nanoemulsion of itraconazole also showed better activity compared to the free drug. Urea levels were higher in the animals receiving amphotericin B free and Fungizone®. The enzyme alanine aminotransferase was found in lower levels in animals treated with itraconazole nanoemulsion than in those who received itraconazole free. Amphotericin B free and Fungizone® caused severe damage to the kidneys. Already in animals treated with Abelcet® and the amphotericin B nanoemulsion was verified only focal necrosis. Likewise, the itraconazole nanoemulsion protected against liver damage when compared with the free drug. Regarding toxicity assays, amphotericin B was cytotoxic at concentrations from 4 μg/mL, while with the nanoemulsion this toxicity was not observed at higher concentrations. Itraconazole was cytotoxic, and this effect was not observed with the nanoemulsion. It is extremely important to evaluate the susceptibility of chromoblastomycosis agents to guide the clinic. Molecular identification of agents isolated from clinical cases can contribute to outline an epidemiological profile of the disease. The amphotericin B and itraconazole nanoemulsions showed higher activities in vivo when compared to other treatments and were able to reduce the adverse effects caused by these antifungals. Through in vitro assays were confirmed the reduction of the cytotoxicity of the drug when vehiculated in the nanoemulsion. Therefore, the nanoemulsions may be produced therapeutic alternatives for the chromoblastomycosis treatment.

Introduction: The pathogenesis and treatment of allergic bronchopulmonary aspergillosis (ABPA), severe asthma-non fungal sensitised (SANFS) and severe asthma with fungal sensitization (SAFS) is poorly understood. IL-17A, IgE and microbiome may be associated with pathogenesis of asthma, but their role in fungal-associated asthma is uncertain. Further, the efficacy of voriconazole, posaconazole and nebulised amphotericin B (NAB) in ABPA and SAFS has not been fully studied. Aims and objectives: The aim of this PhD thesis was to evaluate the role of IL-17A, IgE and lung microbiome in patients with SANFS, SAFS and ABPA. We also studied the efficacy and safety of NAB, voriconazole and posaconazole. Methods: Airway lymphocytes and peripheral blood mononuclear cells (PBMC) from patients with ABPA (n=16), SAFS (n=15), SANFS (n=11), mild asthma (MA) (n=6) and NH (n=11) were characterized by flow cytometric analysis (FACS) to determine the % of CD (+) IL-17A expressing cells. We also evaluated microbiome population using culture and PCR plus sequencing from BAL of these patients. In chapter 3, we analysed total and specific IgE in blood from adult cohorts of SAFS (n=34) and ABPA (n=48) using ImmunoCAP 100. In chapter 5 we studied the efficacy of voriconazole and posaconazole and in chapter 6; we studied the efficacy of NAB.Results: %CD4+IL-17A expressing cells were significantly higher in patients with severe asthma and correlated positively with serum neutrophil and presence of fungi in the airways. ABPA, SAFS and SANFS were similar but all were significantly higher than MA and NH. There were no differences in IL-17A expression between blood and the lung. Fungi were more frequently associated with severe asthma and low FEV1. Steroid treatment significantly increased airway fungal load. IgE against staphylococcal aureus (SE-IgE) correlated positively with FEV1 and OCS dose. Voriconazole and posaconazole improved asthma severity and radiological abnormalities. NAB was associated bronchospasm, but was extrely effective in the few patients (n=3) that took treatment for >12 months. These responders had unique characteristics. Conclusions: IL-17A, SE-IgE, and lung microbiome are associated with asthma severity. Steroid use in these patients may increase airway fungal load. Whereas voriconazole and posaconazole are efficacious, the use of NAB is associated with significant bronchospasm. SE-IgE -high asthma patients may be a distinct asthma phenotype. Larger studies are needed.

Cromoblastomicose é uma micose crônica que acomete a pele e o tecido subcutâneo. Vários tratamentos têm sido utilizados, mas a eficácia é extremamente baixa, não permitindo eleger uma terapia de escolha. No presente trabalho foram realizados: I – ensaios de suscetibilidade in vitro de agentes da cromoblastomicose contra antifúngicos comerciais; II - caracterização molecular de amostras oriundas de casos clínicos, bem como a descrição destes casos; III - a produção e caracterização de duas nanoemulsões, uma de anfotericina B e uma de itraconazol produzidas pela técnica de homogeneização à alta pressão; IV - a avaliação da atividade antifúngica destas nanoemulsões in vitro e in vivo em agentes da cromoblastomicose; V - a verificação do nível de comprometimento renal e hepático causados pelas nanoemulsões; VI - a avaliação da toxicidade das formulações produzidas. De modo geral, os agentes da cromoblastomicose, apresentaram maior suscetibilidade à terbinafina e ao itraconazol, respectivamente. A combinação de anfotericina B e terbinafina foi sinérgica para quatro dos cinco grupos avaliados. Quanto aos casos clínicos, no primeiro foi identificada uma infecção por E. spinifera e no segundo uma por Fonsecaea monophora. As nanoemulsões foram elaboradas com composição passível de administração parenteral, uma de anfotericina B e uma de itraconazol, pelo método de homogeneização à alta pressão. Não foi possível determinar as CIMs da nanoemulsão de anfotericina B e Abelcet® in vitro, enquanto que a nanoemulsão de itraconazol apresentou CIMs muito semelhantes às do fármaco livre. Em modelo animal de cromoblastomicose, a nanoemulsão de anfotericina B foi mais ativa que o fármaco livre, Fungizone® e Abelcet®. A nanoemulsão de itraconazol também apresentou melhor atividade quando comparada com o fármaco livre. Os níveis de uréia foram mais elevados nos animais que receberam anfotericina B livre e Fungizone®. A enzima alanina aminotransferase foi encontrada em níveis menores nos animais tratados com a nanoemulsão de itraconazol do que naqueles que receberam itraconazol livre. A anfotericina B livre e Fungizone® causaram graves danos aos rins. Nos animais tratados com Abelcet® e com a nanoemulsão de anfotericina B foi possível verificar apenas necrose focal. Da mesma forma, a nanoemulsão de itraconazol protegeu os animais contra danos hepáticos quando comparada com o fármaco livre. Em relação aos ensaios de toxicidade, a anfotericina B foi citotóxica em concentrações a partir de 4μg/mL, sendo que com a nanoemulsão esta toxicidade não foi observada em concentrações mais elevadas. O itraconazol foi citotóxico, sendo que este efeito não foi visto com a nanoemulsão. É de extrema importância a avaliação da suscetibilidade dos agentes da cromoblastomicose a fim de orientar a clínica. A identificação molecular de agentes isolados de casos clínicos pode contribuir para delinear o perfil epidemiológico da doença. As nanoemulsões de anfotericina B e itraconazol apresentaram atividades superiores in vivo quando comparadas aos demais tratamentos e foram capazes de reduzir os efeitos adversos causados por estes antifúngicos. Através de ensaios in vitro foi confirmada a redução da citotoxidade do fármaco quando veiculado na nanoemulsão. Assim, as nanoemulsões produzidas poderiam ser alternativas terapêuticas para o tratamento da cromoblatomicose. / Chromoblastomycosis is a chronic mycosis that affects the skin and subcutaneous tissue. Various treatments have been used, but the efficacy is extremely low and does not allow choosing a therapy of choice. In the present work was performed: I - in vitro susceptibility testing for chromoblastomycosis agents against commercial antifungal; II - molecular characterization of samples from clinical cases as well as the description of these cases III - production and characterization of two nanoemulsions , one of amphotericin B and one of itraconazole, produced by high pressure homogenization technique; IV - assessing the in vitro and in vivo antifungal activity of these nanoemulsions against chromoblastomycosis agents; V - checking the level of impairment caused in the kidney and liver by nanoemulsions; VI - evaluation of toxicity of the formulations produced. In general, the chromoblastomycosis agents showed greater susceptibility to terbinafine and to itraconazole, respectively. The combination of amphotericin B and terbinafine was synergistic to four of the five groups. As for clinical cases, in the first was identified an infection by E. spinifera and in the second one by Fonsecaea monophora. The nanoemulsions were prepared with composition amenable of parenteral administration, one of amphotericin B and one of itraconazole, by the at high pressure homogenization method. Could not be determined the MIC of amphotericin B nanoemulsion and Abelcet® in vitro, while the itraconazole nanoemulsion showed MICs very similar to free drug. In a chromoblastomycosis animal model, the amphotericin B nanoemulsion was more active than free drug, Abelcet® and Fungizone®. The nanoemulsion of itraconazole also showed better activity compared to the free drug. Urea levels were higher in the animals receiving amphotericin B free and Fungizone®. The enzyme alanine aminotransferase was found in lower levels in animals treated with itraconazole nanoemulsion than in those who received itraconazole free. Amphotericin B free and Fungizone® caused severe damage to the kidneys. Already in animals treated with Abelcet® and the amphotericin B nanoemulsion was verified only focal necrosis. Likewise, the itraconazole nanoemulsion protected against liver damage when compared with the free drug. Regarding toxicity assays, amphotericin B was cytotoxic at concentrations from 4 μg/mL, while with the nanoemulsion this toxicity was not observed at higher concentrations. Itraconazole was cytotoxic, and this effect was not observed with the nanoemulsion. It is extremely important to evaluate the susceptibility of chromoblastomycosis agents to guide the clinic. Molecular identification of agents isolated from clinical cases can contribute to outline an epidemiological profile of the disease. The amphotericin B and itraconazole nanoemulsions showed higher activities in vivo when compared to other treatments and were able to reduce the adverse effects caused by these antifungals. Through in vitro assays were confirmed the reduction of the cytotoxicity of the drug when vehiculated in the nanoemulsion. Therefore, the nanoemulsions may be produced therapeutic alternatives for the chromoblastomycosis treatment.

Made available in DSpace on 2014-12-17T14:13:48Z (GMT). No. of bitstreams: 1 AcariliaES_TESE.pdf: 9221805 bytes, checksum: 71876e327362584aeb9dcac7d3652c4d (MD5) Previous issue date: 2013-04-05 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / This thesis was devoted to the development of innovative oral delivery systems for two different molecules. In the first part, microparticles (MPs) based on xylan and Eudragit? S- 100 were produced and used to encapsulate 5-aminosalicylic acid for colon delivery. Xylan was extracted from corn cobs and characterized in terms of its physicochemical, rheological and toxicological properties. The polymeric MPs were prepared by interfacial cross-linking polymerization and spray-drying and characterized for their morphology, mean size and distribution, thermal stability, crystallinity, entrapment efficiency and in vitro drug release. MPs with suitable physical characteristics and satisfactory yields were prepared by both methods, although the spray-dried systems showed higher thermal stability. In general, spraydried MPs would be preferable systems due to their thermal stability and absence of toxic agents used in their preparation. However, drug loading and release need to be optimized. In the second part of this thesis, oil-in-water microemulsions (O/W MEs) based on mediumchain triglycerides were formulated as drug carriers and solubility enhancers for amphotericin B (AmB). Phase diagrams were constructed using surfactant blends with hydrophiliclipophilic balance values between 9.7 and 14.4. The drug-free and drug-loaded MEs presented spherical non-aggregated droplets around 80 and 120 nm, respectively, and a low polydispersity index. The incorporation of AmB was high and depended on the volume fraction of the disperse phase. These MEs did not reduce the viability of J774.A1 macrophage-like cells for concentrations up to 25 μg/mL of AmB. Therefore, O/W MEs based on propylene glycol esters of caprylic acid may be considered as suitable delivery systems for AmB / Esta tese teve como objetivo o desenvolvimento de novos sistemas de libera??o para duas mol?culas distintas. Na primeira parte, micropart?culas ? base de xilana e Eudragit? S-100 foram produzidas para encapsular ?cido 5-aminosalic?lico visando ? libera??o c?lonespec?fica. A xilana foi extra?da de sabugos de milho e caracterizada quanto ?s suas propriedades f?sico-qu?micas, reol?gicas e toxicol?gicas. Em seguida, dois m?todos de microencapsula??o foram utilizados: reticula??o interfacial polim?rica e secagem por aspers?o. Os sistemas produzidos foram caracterizados quanto ? morfologia, tamanho m?dio e distribui??o, estabilidade t?rmica, cristalinidade, taxa de encapsula??o e libera??o do f?rmaco in vitro. Foram obtidas micropart?culas com adequadas caracter?sticas f?sicas e rendimentos satisfat?rios atrav?s dos dois m?todos, embora os sistemas aspergidos tenham apresentado maior estabilidade t?rmica e sejam considerados mais interessantes devido a sua maior estabilidade t?rmica e aus?ncia de agentes t?xicos. No entanto, ajustes precisam ser feitos para melhorar a encapsula??o e libera??o do f?rmaco. Na segunda parte, microemuls?es do tipo ?leo em ?gua (MEs O/A) com base em triglicer?deos de cadeia m?dia (MCT) foram produzidas visando ao carreamento de anfotericina B (AmB) e aumento da sua solubilidade. Foram obtidas MEs O/A sem e com AmB com got?culas em torno de 80 e 120 nm, respectivamente, e ?ndices de polidispers?o de 0,25 e 0,31, respectivamente. A taxa de incorpora??o da AmB foi alta e dependente do volume da fase dispersa. A viabilidade celular n?o foi afetada at? 25 μg/mL da AmB. Portanto, MEs O/A a partir de MCT podem ser promissores sistemas de libera??o para AmB

Cromoblastomicose é uma micose crônica que acomete a pele e o tecido subcutâneo. Vários tratamentos têm sido utilizados, mas a eficácia é extremamente baixa, não permitindo eleger uma terapia de escolha. No presente trabalho foram realizados: I – ensaios de suscetibilidade in vitro de agentes da cromoblastomicose contra antifúngicos comerciais; II - caracterização molecular de amostras oriundas de casos clínicos, bem como a descrição destes casos; III - a produção e caracterização de duas nanoemulsões, uma de anfotericina B e uma de itraconazol produzidas pela técnica de homogeneização à alta pressão; IV - a avaliação da atividade antifúngica destas nanoemulsões in vitro e in vivo em agentes da cromoblastomicose; V - a verificação do nível de comprometimento renal e hepático causados pelas nanoemulsões; VI - a avaliação da toxicidade das formulações produzidas. De modo geral, os agentes da cromoblastomicose, apresentaram maior suscetibilidade à terbinafina e ao itraconazol, respectivamente. A combinação de anfotericina B e terbinafina foi sinérgica para quatro dos cinco grupos avaliados. Quanto aos casos clínicos, no primeiro foi identificada uma infecção por E. spinifera e no segundo uma por Fonsecaea monophora. As nanoemulsões foram elaboradas com composição passível de administração parenteral, uma de anfotericina B e uma de itraconazol, pelo método de homogeneização à alta pressão. Não foi possível determinar as CIMs da nanoemulsão de anfotericina B e Abelcet® in vitro, enquanto que a nanoemulsão de itraconazol apresentou CIMs muito semelhantes às do fármaco livre. Em modelo animal de cromoblastomicose, a nanoemulsão de anfotericina B foi mais ativa que o fármaco livre, Fungizone® e Abelcet®. A nanoemulsão de itraconazol também apresentou melhor atividade quando comparada com o fármaco livre. Os níveis de uréia foram mais elevados nos animais que receberam anfotericina B livre e Fungizone®. A enzima alanina aminotransferase foi encontrada em níveis menores nos animais tratados com a nanoemulsão de itraconazol do que naqueles que receberam itraconazol livre. A anfotericina B livre e Fungizone® causaram graves danos aos rins. Nos animais tratados com Abelcet® e com a nanoemulsão de anfotericina B foi possível verificar apenas necrose focal. Da mesma forma, a nanoemulsão de itraconazol protegeu os animais contra danos hepáticos quando comparada com o fármaco livre. Em relação aos ensaios de toxicidade, a anfotericina B foi citotóxica em concentrações a partir de 4μg/mL, sendo que com a nanoemulsão esta toxicidade não foi observada em concentrações mais elevadas. O itraconazol foi citotóxico, sendo que este efeito não foi visto com a nanoemulsão. É de extrema importância a avaliação da suscetibilidade dos agentes da cromoblastomicose a fim de orientar a clínica. A identificação molecular de agentes isolados de casos clínicos pode contribuir para delinear o perfil epidemiológico da doença. As nanoemulsões de anfotericina B e itraconazol apresentaram atividades superiores in vivo quando comparadas aos demais tratamentos e foram capazes de reduzir os efeitos adversos causados por estes antifúngicos. Através de ensaios in vitro foi confirmada a redução da citotoxidade do fármaco quando veiculado na nanoemulsão. Assim, as nanoemulsões produzidas poderiam ser alternativas terapêuticas para o tratamento da cromoblatomicose. / Chromoblastomycosis is a chronic mycosis that affects the skin and subcutaneous tissue. Various treatments have been used, but the efficacy is extremely low and does not allow choosing a therapy of choice. In the present work was performed: I - in vitro susceptibility testing for chromoblastomycosis agents against commercial antifungal; II - molecular characterization of samples from clinical cases as well as the description of these cases III - production and characterization of two nanoemulsions , one of amphotericin B and one of itraconazole, produced by high pressure homogenization technique; IV - assessing the in vitro and in vivo antifungal activity of these nanoemulsions against chromoblastomycosis agents; V - checking the level of impairment caused in the kidney and liver by nanoemulsions; VI - evaluation of toxicity of the formulations produced. In general, the chromoblastomycosis agents showed greater susceptibility to terbinafine and to itraconazole, respectively. The combination of amphotericin B and terbinafine was synergistic to four of the five groups. As for clinical cases, in the first was identified an infection by E. spinifera and in the second one by Fonsecaea monophora. The nanoemulsions were prepared with composition amenable of parenteral administration, one of amphotericin B and one of itraconazole, by the at high pressure homogenization method. Could not be determined the MIC of amphotericin B nanoemulsion and Abelcet® in vitro, while the itraconazole nanoemulsion showed MICs very similar to free drug. In a chromoblastomycosis animal model, the amphotericin B nanoemulsion was more active than free drug, Abelcet® and Fungizone®. The nanoemulsion of itraconazole also showed better activity compared to the free drug. Urea levels were higher in the animals receiving amphotericin B free and Fungizone®. The enzyme alanine aminotransferase was found in lower levels in animals treated with itraconazole nanoemulsion than in those who received itraconazole free. Amphotericin B free and Fungizone® caused severe damage to the kidneys. Already in animals treated with Abelcet® and the amphotericin B nanoemulsion was verified only focal necrosis. Likewise, the itraconazole nanoemulsion protected against liver damage when compared with the free drug. Regarding toxicity assays, amphotericin B was cytotoxic at concentrations from 4 μg/mL, while with the nanoemulsion this toxicity was not observed at higher concentrations. Itraconazole was cytotoxic, and this effect was not observed with the nanoemulsion. It is extremely important to evaluate the susceptibility of chromoblastomycosis agents to guide the clinic. Molecular identification of agents isolated from clinical cases can contribute to outline an epidemiological profile of the disease. The amphotericin B and itraconazole nanoemulsions showed higher activities in vivo when compared to other treatments and were able to reduce the adverse effects caused by these antifungals. Through in vitro assays were confirmed the reduction of the cytotoxicity of the drug when vehiculated in the nanoemulsion. Therefore, the nanoemulsions may be produced therapeutic alternatives for the chromoblastomycosis treatment.

Orientador: Fernando Lucas Primo / Resumo: O avanço tecnológico cresce rapidamente no mundo, inclusive na área farmacêutica. Nesse contexto, sistemas nanoestruturados ganham progressivo destaque, porquanto carregam um enorme potencial para o aperfeiçoamento das práticas terapêuticas atuais. A administração de fármacos na forma livre pode apresentar problemas como baixa concentração no sítio ativo, inadequada distribuição pelo organismo, baixa biodisponibilidade, presença de efeitos adversos, entre outros. As nanocápsulas poliméricas são capazes de contornar tais vieses, possibilitando, inclusive, a diminuição da toxicidade com a diminuição de doses e aumento da estabilidade de fármacos em meios biológicos. Foram desenvolvidas nanocápsulas poliméricas contendo Anfotericina B (AMB) e Fenil-tio-ftalocianina de zinco (ZnS4Pc) na concentração teórica de 0,05 mg.mL-1 objetivando, com a associação entre os dois ativos, melhorar a atividade antifúngica conseguida pelo antifúngico isoladamente utilizando-se a Terapia Fotodinâmica Antimicrobiana. A avaliação das características físico-químicas das nanocápsulas mostraram diâmetro médio de partícula de 253,8 ± 17,3 nm, índice de polidispersidade médio de 0,36 ± 0,01 e potencial Zeta médio de – 31,03 ± 5,54 mV. Tais análises revelaram-se satisfatórias já que o diâmetro de partícula conseguido pelo método de deposição interfacial de polímero pré-formado utilizado na produção das nanocápsulas varia de 250 a 500 nm (MORA-HUERTAS et. al., 2010), enquanto que o potencial zeta considera... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Technological advancement is growing rapidly in the world, including the pharmaceutical area. In this context, nanostructured systems gains progressive prominence, as they carry enormous potential for the improvement of current therapeutic practices. The drugs administration in the free-form may present problems such as low active site concentration, inadequate distribution throughout body, low bioavailability, presence of adverse effects, among others. Polymeric nanocapsules allowing the reduction of toxicity with decreasing doses and increasing the stability of drugs in biologic media. Polymeric nanocapsules containing Amphotericin B (AMB) and zinc phenyl-thio-phthalocyanine (ZnS4Pc) were developed at a 0.05 mg/mL theoretical concentration to improve antifungal activity with the association between the two actives over antifungal alone. The nanocapsules physical-chemical characteristics showed an average particle diameter of 253,8 ± 17,3 nm, an average polydispersity index of 0,36 ± 0,01 and negative Zeta potential -31,03 ± 5,54 mV. These analyzes proved satisfactory since the particle diameter achieved by the preformed polymer interfacial deposition method used in nanocapsule production ranges from 250 to 500 nm (MORA-HUERTAS et. al., 2010), while the Zeta potential considered for a stable formulation should be bigger than 30 mV in modulus (RAVAL et al., 2019). Absorption and emission spectroscopy analyzes performed in the UV-Vis region found no changes in the steady state... (Complete abstract click electronic access below) / Mestre