Among the different pulmonary fungal infections, aspergillosis, and in particular invasive pulmonary aspergillosis (IPA), are becoming the most worrying diseases in immunocompromised patients. This is due to their high incidence and mortality. Indeed, invasive aspergillosis manifests as invasive pulmonary disease accounting for 50/60% of all cases, with a mortality of 50-90% in severely immunocompromised patients. Triazoles act by inhibiting 14-α demethylase, a fungal cytochrome P450 enzyme implicated in the synthesis of ergosterol, an essential constituent of fungal cell walls. Moreover, they interact with the same cytochrome present in large quantities in the human liver, inducing possible drug-drug interactions in IPA patients. Consequently, interactions resulting from inhibitors, inductors, or substrates of cytochromes can modify the plasmatic concentrations of triazoles or other drugs administered concomitantly. To overcome these important issues, pulmonary delivery of triazoles could be an interesting alternative to conventional routes.The aim of this work was to develop triazole-based dry powders for inhalation able to be deposited adequately in the lungs, with a release of drug and a lung retention that can optimize its pharmacological action. This work focused on two active pharmaceutical ingredients (API): itraconazole (ITZ), for which improved solubility was needed, and voriconazole (VCZ), for which slow release was required.Concerning ITZ, solid dispersions for inhalation (SDIs) comprising ITZ and mannitol were previously developed in our laboratory. The selected SDI showed interesting results in terms of improved dissolution and lung retention in vivo in mice during a pharmacokinetic study. Therefore, this SDI was tested in a murine preclinical model of IPA and showed promising results in terms of prophylaxis efficacy. One aim of this work was to continue the pharmaceutical development of this promising SDI by making a scaling-up study. These methods were intended to improve the SDI’s ecological footprint and productivity by increasing the production yield and decreasing the amount of solvents and time used in its manufacture. During the first step of this study, the obtained SDI showed interesting results obtaining similar powder characteristics (i.e. amorphous content, aerodynamic performance, and dissolution profiles) from concentrated solutions using a laboratory-scale spray-dryer B-290 (Büchi, Switzerland) before using a pilot-scale spray-dryer (GEA Niro, Denmark). Then, the upscaling was performed on the pilot spray-dryer allowing the production of SDIs with increased productivity (yield and process duration). These SDIs had similar powder characteristics than the optimized lab-scale SDIs. During the second part of this work we developed VCZ based dry powder for inhalation. The aim was to slow down the release of this highly permeable and very slightly soluble API and to prolong its lung residence. To this end, various lipidic excipients were chosen. The selection took into account the potential good pulmonary tolerance of the lipids and their hydrophobicity to evaluate their ability to slow down the VCZ release (FPFs 20-25%, slowed release up to 24h, burst effect of ± 58% of VCZ dissolved within 30min). Immediate-release SDIs were also developed to have a comparator reference for the pharmacokinetic and efficacy studies (FPFs of 40%).Then, a pharmacokinetic study in mice was performed following the pulmonary administration of one immediate-release and two sustained-release SDIs (with or without PEG excipient). With an 80-fold higher pulmonary exposure over 24 hours, the slow-release SDIs presented a real interest compared to the immediate-release SDI. Moreover, in accordance with these results, VCZ plasma exposure following the administration of the SDI with PL90-H was more than 1.5-fold higher than its pulmonary exposure (AUC0-24 of 8.70 µg.h/g in the lungs and 14.70 µg.h/mL in the plasma). The slow-release formulations presented plasma exposures at least 15 times lower than their pulmonary exposures (AUC0-24 in lung of 741.40 and 686.85 µg.h/g vs plasmatic AUC0-24 of 37.44 and 42.81 µg.h.mL, respectively with and without PEG excipient). Moreover, the presence of PEG excipient did not influence the residence time and the exposure of the VCZ within the lungs. Finally, the sustained-release SDIs administration by inhalation led to VCZ lung and plasma concentrations higher than the minimal inhibitory concentration (MIC) of VCZ against Aspergillus fumigatus (1 μg/mL) over 24 h. Finally, a murine model of IPA was developed in our lab. The immunosuppression model was fixed and performed by the intraperitoneal (IP) injection of corticosteroids to induce a neutropenia state. Then, different doses of spores (from 1.10^4 to 5.10^6 spores) were inoculated to the neutropenic mice via an endotracheal instillation and the survival rate of each group was observed. Unfortunately, the survival rate resulting from the different infections were not reproducible. Therefore, these models were not suitable to conduct the efficacy study. This underlined the link between the immunosuppressive model and the infection. Indeed, the IPA murine model should be developed according to the immune state of the animal, the Aspergillus conidia species and its concentration to be used. / Doctorat en Sciences biomédicales et pharmaceutiques (Pharmacie) / info:eu-repo/semantics/nonPublished

Effective prevention, or treatment, of invasive fungal infection in the neutropenic patient has hitherto been unsatisfactory because of either an inadequate anti-fungal spectrum of the agent or important toxicity. Itraconazole is effective against a broad spectrum of the opportunistic pathogens seen in Europe and North America. Prior problems with absorption, e.g. in the marrow transplant recipient, have been overcome with the introduction of an oral solution and an i.v. preparation. The deliberations of an expert meeting held in June, 1998 include recommendations on which patient requires one of these new preparations based on clinical trials, the dose and route. Important drug interactions are also detailed. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

O estudo de dissolução in vitro é uma ferramenta importante utilizada para o controle de qualidade lote-a-Iote dos medicamentos, como guia no desenvolvimento de novas formulações e para assegurar a qualidade e performance do produto após certas alterações. O itraconazol é um fármaco com baixa solubilidade em meio aquoso (classe 11), dessa forma, alguns problemas de solubilidade podem ser detectados no ensaio de dissolução. A proposta deste trabalho foi a realização de uma avaliação biofarmacêutica in vitro de cápsulas contendo péletes de itraconazol comercializadas no mercado brasileiro por laboratórios farmacêuticos e farmácias magistrais. O medicamento de referência, registrado com o nome de Sporanox® (Janssen-Cilag), uma formulação genérica, duas formulações similares e quatro formulações magistrais, foram submetidas a ensaios de doseamento, perfil de dissolução, eficiência de dissolução, cinética de dissolução, fator de diferença (f1) e fator de semelhança (f2). Os resultados demonstraram diferenças de liberação entre as formulações sugerindo que as mesmas não são equivalentes ao medicamento de referência. / Dissolution testing is an important tool used as a quality control procedure in pharmaceutical production, as guide in the development of new formulations and to assure the quality and performance of the product after certain modifications. Itraconazol is a poorly water-solubility drug (class 11) and the dissolution studies are very important to detect solubility problems. The purpose of this work was the in vitro biopharmaceutical evaluation of capsules containing Itraconazole pellets manufactured by Brazilian pharmaceutical laboratories and compounding pharmacies. The reference product, registered as Sporanox® (Janssen-Cilag), a generic product, a similar formulation and four compounding formulations were submitted to assay, dissolution profile, dissolution efficiency, dissolution kinetics, difference factor (f1) and similarity factor (f2). The results demonstrated different releases among the formulations suggesting that they are not equivalent to the reference product.

O estudo de dissolução in vitro é uma ferramenta importante utilizada para o controle de qualidade lote-a-Iote dos medicamentos, como guia no desenvolvimento de novas formulações e para assegurar a qualidade e performance do produto após certas alterações. O itraconazol é um fármaco com baixa solubilidade em meio aquoso (classe 11), dessa forma, alguns problemas de solubilidade podem ser detectados no ensaio de dissolução. A proposta deste trabalho foi a realização de uma avaliação biofarmacêutica in vitro de cápsulas contendo péletes de itraconazol comercializadas no mercado brasileiro por laboratórios farmacêuticos e farmácias magistrais. O medicamento de referência, registrado com o nome de Sporanox® (Janssen-Cilag), uma formulação genérica, duas formulações similares e quatro formulações magistrais, foram submetidas a ensaios de doseamento, perfil de dissolução, eficiência de dissolução, cinética de dissolução, fator de diferença (f1) e fator de semelhança (f2). Os resultados demonstraram diferenças de liberação entre as formulações sugerindo que as mesmas não são equivalentes ao medicamento de referência. / Dissolution testing is an important tool used as a quality control procedure in pharmaceutical production, as guide in the development of new formulations and to assure the quality and performance of the product after certain modifications. Itraconazol is a poorly water-solubility drug (class 11) and the dissolution studies are very important to detect solubility problems. The purpose of this work was the in vitro biopharmaceutical evaluation of capsules containing Itraconazole pellets manufactured by Brazilian pharmaceutical laboratories and compounding pharmacies. The reference product, registered as Sporanox® (Janssen-Cilag), a generic product, a similar formulation and four compounding formulations were submitted to assay, dissolution profile, dissolution efficiency, dissolution kinetics, difference factor (f1) and similarity factor (f2). The results demonstrated different releases among the formulations suggesting that they are not equivalent to the reference product.

Safety, tolerability and efficacy of itraconazole and amphotericin B (AMB) were compared for empirical antifungal treatment of febrile neutropenic cancer patients. Patients and Methods: In an open, randomised study, 162 patients with at least 72 h of antimicrobial treatment received either intravenous followed by oral itraconazole suspension or intravenous AMB for a maximum of 28 days. Permanent discontinuation of study medication due to any adverse event was the primary safety parameter. Efficacy parameters included response and success rate for both treatment groups. Results: Significantly fewer itraconazole patients discontinued treatment due to any adverse event (22.2 vs. 56.8% AMB; p < 0.0001). The main reason for discontinuation was a rise in serum creatinine (1.2% itraconazole vs. 23.5% AMB). Renal toxicity was significantly higher and more drug-related adverse events occurred in the AMB group. Intention-to-treat (ITT) analysis showed favourable efficacy for itraconazole: response and success rate were both significantly higher than for AMB (61.7 vs. 42% and 70.4 vs. 49.3%, both p < 0.0001). Treatment failure was markedly reduced in itraconazole patients (25.9 vs. 43.2%), largely due to the better tolerability. Conclusions: Itraconazole was tolerated significantly better than conventional AMB and also showed advantages regarding efficacy. This study confirms the role of itraconazole as a useful and safe agent in empirical antifungal therapy of febrile neutropenic cancer patients. / Hintergrund: Es wurden die Sicherheit, Verträglichkeit und Wirksamkeit von Itraconazol und Amphotericin B (AMB) in der antimykotischen Therapie der persistierend febrilen Neutropenie verglichen. Patienten und Methoden: In einer offenen, randomisierten Studie erhielten 162 Patienten mit mindestens 72-stündiger antibiotischer Therapie entweder Itraconazol (erst intravenös, dann oral) oder AMB (intravenös) für maximal 28 Tage. Primärer Sicherheitsparameter war die dauerhafte Unterbrechung der Studienmedikation aufgrund von Nebenwirkungen. Die Wirksamkeitsparameter umfassten die Ansprech- und Erfolgsrate für beide Behandlungsgruppen. Ergebnisse: Signifikant weniger Itraconazol-Patienten brachen die Behandlung wegen Nebenwirkungen ab (22,2 vs. 56,8% AMB; p < 0,0001). Hauptursache für Studienabbrüche war der Anstieg des Serum-Kreatinin-Spiegels (1,2% Itraconazol vs. 23,5% AMB). Nephrotoxische und weitere Nebenwirkungen traten im AMB-Studienarm signifikant häufiger auf. Intention-to-Treat (ITT)-Analysen zeigten eine bessere Wirksamkeit von Itraconazol: Ansprech- und Erfolgsrate waren signifikant höher als unter AMB (61,7 vs. 42% und 70,4 vs. 49,3%, beide p < 0,0001). Behandlungsversagen trat bei Itraconazol-Patienten merklich weniger auf (25,9 vs. 43,2%). Schlussfolgerungen: Die Verträglichkeit von Itraconazol war signifikant höher als beim herkömmlichen AMB. Itraconazol zeigte ebenfalls Vorteile in der Wirksamkeit. Diese Studie bestätigt die Rolle von Itraconazol als sinnvolles und sicheres Medikament in der empirischen antimykotischen Therapie von fiebrigen neutropenischen Tumorpatienten. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Safety, tolerability and efficacy of itraconazole and amphotericin B (AMB) were compared for empirical antifungal treatment of febrile neutropenic cancer patients. Patients and Methods: In an open, randomised study, 162 patients with at least 72 h of antimicrobial treatment received either intravenous followed by oral itraconazole suspension or intravenous AMB for a maximum of 28 days. Permanent discontinuation of study medication due to any adverse event was the primary safety parameter. Efficacy parameters included response and success rate for both treatment groups. Results: Significantly fewer itraconazole patients discontinued treatment due to any adverse event (22.2 vs. 56.8% AMB; p < 0.0001). The main reason for discontinuation was a rise in serum creatinine (1.2% itraconazole vs. 23.5% AMB). Renal toxicity was significantly higher and more drug-related adverse events occurred in the AMB group. Intention-to-treat (ITT) analysis showed favourable efficacy for itraconazole: response and success rate were both significantly higher than for AMB (61.7 vs. 42% and 70.4 vs. 49.3%, both p < 0.0001). Treatment failure was markedly reduced in itraconazole patients (25.9 vs. 43.2%), largely due to the better tolerability. Conclusions: Itraconazole was tolerated significantly better than conventional AMB and also showed advantages regarding efficacy. This study confirms the role of itraconazole as a useful and safe agent in empirical antifungal therapy of febrile neutropenic cancer patients. / Hintergrund: Es wurden die Sicherheit, Verträglichkeit und Wirksamkeit von Itraconazol und Amphotericin B (AMB) in der antimykotischen Therapie der persistierend febrilen Neutropenie verglichen. Patienten und Methoden: In einer offenen, randomisierten Studie erhielten 162 Patienten mit mindestens 72-stündiger antibiotischer Therapie entweder Itraconazol (erst intravenös, dann oral) oder AMB (intravenös) für maximal 28 Tage. Primärer Sicherheitsparameter war die dauerhafte Unterbrechung der Studienmedikation aufgrund von Nebenwirkungen. Die Wirksamkeitsparameter umfassten die Ansprech- und Erfolgsrate für beide Behandlungsgruppen. Ergebnisse: Signifikant weniger Itraconazol-Patienten brachen die Behandlung wegen Nebenwirkungen ab (22,2 vs. 56,8% AMB; p < 0,0001). Hauptursache für Studienabbrüche war der Anstieg des Serum-Kreatinin-Spiegels (1,2% Itraconazol vs. 23,5% AMB). Nephrotoxische und weitere Nebenwirkungen traten im AMB-Studienarm signifikant häufiger auf. Intention-to-Treat (ITT)-Analysen zeigten eine bessere Wirksamkeit von Itraconazol: Ansprech- und Erfolgsrate waren signifikant höher als unter AMB (61,7 vs. 42% und 70,4 vs. 49,3%, beide p < 0,0001). Behandlungsversagen trat bei Itraconazol-Patienten merklich weniger auf (25,9 vs. 43,2%). Schlussfolgerungen: Die Verträglichkeit von Itraconazol war signifikant höher als beim herkömmlichen AMB. Itraconazol zeigte ebenfalls Vorteile in der Wirksamkeit. Diese Studie bestätigt die Rolle von Itraconazol als sinnvolles und sicheres Medikament in der empirischen antimykotischen Therapie von fiebrigen neutropenischen Tumorpatienten. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Blastomycosis is an endemic systemic fungal infection that usually involves the lungs and superficial skin. Although head and neck involvement has been reported in the literature, no previous cases of neck mass resulting from direct extension of a pulmonary lesion have been published. We encountered an immunocompetent 31-year-old woman with a rapidly enlarging subcutaneous neck mass and a chronic upper lung infiltrate. Imaging studies showed contiguity between both lesions. Blastomyces dermatitidis was recovered from the sputum, and typical yeast was observed in fungal stains of needle aspirate from the neck mass. The patient responded favorably to a 6-month course of itraconazole. Blastomycosis should be considered in patients with subcutaneous neck masses in areas where this disease is endemic.

Les acides biliaires sont reconnus comme des tensioactifs d’origine biologique potentiellement applicables dans le domaine pharmaceutique. Leurs structures en font une plateforme idéale pour l’obtention de nouvelles architectures polymères. Des composés synthétisés par polymérisation anionique de dérivés d’oxirane comme l’oxyde d’éthylène, offre des dérivés amphiphiles pegylés démontrant des propriétés d’agrégation intéressantes en vue d’une amélioration de la biocompatibilité et de la capacité d’encapsulation médicamenteuse. Une large gamme d’acides biliaires pegylés (BA(EGn)x) a été préparée avec comme objectif premier leurs applications dans la formulation de principes actifs problématiques. Pour cela, une caractérisation rigoureuse du comportement de ces dérivés (modulation de la longueur (2 < n < 19) et du nombre de bras (2 < x < 4) de PEG) en solution a été réalisée. Dans le but d’améliorer la biodisponibilité de principes actifs lipophiles (cas de l’itraconazole), des nanoémulsions spontanées, composées de BA(EGn)x et d’acide oléique, ont été développées. L’évaluation in vitro, de la toxicité (cellulaire), et de la capacité de solubilisation des systèmes BA(EGn)x, ainsi que les paramètres pharmacocinétiques in vivo (chez le rat), suggèrent une livraison contrôlée par nos systèmes auto-assemblés lors de l’administration orale et intraveineuse. Aussi, la synthèse de copolymères en blocs en étoile à base d’acide cholique pegylés a été effectuée par polymérisation anionique par addition d’un second bloc au caractère hydrophobe de poly(éther d’allyle et de glycidyle) (CA(EGn-b-AGEm)4). Selon le ratio de blocs hydrophiles-hydrophobes CA(EGn-b-AGEm)4, des réponses thermiques en solution (LCST) ont été observées par un point de trouble (Cp) entre 8 oC et 37 oC. Un mécanisme de formation d’agrégats en plusieurs étapes est suggéré. La thiolation des allyles des PAGE permet une fonctionnalisation terminale à haute densité, comparable aux dendrimères. Les caractérisations physico-chimiques des CA(EGn-b-AGEm-NH2)4 et CA(EGn-b-AGEm-COOH)4 indiquent la formation de structures auto-assemblées en solution, sensibles à la température ou au pH. Cette fonctionnalisation élargie le domaine d’application des dérivés d’acides biliaires pegylés en étoile vers la transfection d’ADN, la livraison de siRNA thérapeutiques ou encore à une sélectivité de livraison médicamenteux (ex. sensibilité au pH, greffage ligands). / Bile acids are natural compounds and may have potential for pharmaceutical applications. Their structures provide an interesting platform for polymerization to obtain well-defined architectures. The anionic polymerization of oxirane derivatives, mainly PEG derivatives, endowed new aggregation properties and improvement of biocompatibility of the new amphiphilic polymers based on bile acids. A library of pegylated bile acids (BA(EGn)x) was prepared for the formulation of lipophilic drugs. The aqueous physicochemical behaviors of these derivatives (modulation of the length (2 < n < 19) and the number (2 < x < 4) of PEG arm) were investigated. In order to improve the bioavailability of insoluble active compounds (itraconazole, an antifungal drug), a binary system based on the association of BA(EGn)x and oleic acid, formed self-emulsifying drug delivery systems. The in vitro evaluation of cell toxicity and solubilization capacities of the BA(EGn)x systems followed by the in vivo evaluation in rats of the pharmacokinetic parameters demonstrated the advantages of our self-assembled system for controlled drug delivery for both oral and intravenous administration. Star-shaped block copolymers of pegylated cholic acid (CA(EGn-b-AGEm)4) were prepared by the introduction of a second hydrophobic block of PAGE poly(allyl glycidyl ether). They demonstrated thermosensitivity (8 oC < LCST < 37 oC) in aqueous solution, suggesting a mechanism based on the formation of aggregates in two steps. The PAGE block with pendant groups may facilitate futher functionalization. The thiolation of allyl yields a new class of charged PEGylated star polymers (with multiple amines or carboxylic groups). CA(EGn-b-AGEm-NH2)4 and CA(EGn-b-AGEm-COOH)4 derivatives showed self-assembled structures in solution with temperature and pH responsiveness, respectively. This functionalization may lead to broader application of pegylated star derivatives in DNA transfection systems, siRNA delivery systems or as selective delivery system (pH-dependent).

<p>Mnogi lekovi registrovani za razne druge indikacije mogu da deluju selektivno na tumorske receptore, signalne puteve, metaboličke procese, bioenergetske faktore, enzime, proteine, gene koji reguli&scaron;u proliferaciju, apoptozu i neoangiogenezu tumora ne pogađajući ove procese kod zdravih ćelija. Uvođenje novih lekova je izrazito dug, složen i skup proces istraživanja. Kori&scaron;ćenjem principa otkrivanja antikancerskog efekta kod već registrovanih lekova za druge indikacije, direktno se utiče na skraćivanje vremena i tro&scaron;kova istraživanja. Eksperimentalno je ispitana efikasnost antitumorskog delovanja mebendazola, metformina, itrakonazola, diklofenaka, nitroglicerina i deoksiholne kiseline na fibrosarkom hrčka izazvan BHK21/C13 tumorskom ćelijskom linijom praćenjem veličine i histologije lečenih tumora. Eksperimentalno je ispitana mogućnost primene deoksiholne kiseline, nitroglicerina, kofeina i itrakonazola kao adjuvansa u kombinaciji sa pojedinim ispitivanim lekovima (metformin, itrakonazol, diklofenak) za lečenje fibrosarkoma hrčka. Kako je ispitivanje vr&scaron;eno na mladuncima imladim hrčkovima i kako su sarkomi najče&scaron;ći u dečijem uzrastu, definisanje potencijalne antikancerske uloge ispitivanih lekova se odnosi prvenstveno na njihovu primenu u pedijatriji. Pokazano je da metformin, kombinacije metformina sa kofeinom, metformina sa itrakonazolom i metformina sa nitroglicerinom deluju u pogledu svih ispitivanih parametara tumora antitumorski na fibrosarkom hrčka. Kofein, itrakonazol i nitroglicerin pojačavaju antitumorsko dejstvo metformina na fibrosarkom hrčka. Tokom svih eksperimenata realizovanih u okviru ove disertacije, pokazalo se da nije bilo delotvornog tretmana, koji ne sadrži metformin.</p> / <p>Many drugs registered for various other indications can act selectively to tumor receptors, signaling pathways, metabolic processes, bioenergetic factors, enzymes, proteins, genes that regulate proliferation, apoptosis, and neoangiogenesis of the tumor without affecting these processes in the healthy cells. The introduction of new drugs is a very long, complex and expensive process of research. Using the principle of detecting the anticancer effect in already registered drugs for other indications, directly affects the reduction of time and cost of research. The efficacy of mebendazole, metformin, itraconazole, diclofenac, nitroglycerin and deoxycholic acid antitumor activity on hamster fibrosarcinoma induced experimentally by the BHK21/C13 tumor cell line was tested by monitoring the size and histology of the treated tumors. The possibility of using deoxycholic acid, nitroglycerin, caffeine and itraconazole as an adjuvant in combination with investigated drugs (metformin, itraconazole, diclofenac) for the treatment of hamster fibrosarcoma has been experimentally tested. As the examination was carried out on young cubs and young hamsters and that sarcomas are the most common in childhood, defining the potential anti-cancer role of the investigated drugs relates primarily to their application in pediatrics. Metformin, combinations of metformin with caffeine, metformin with itraconazole and metformin with nitroglycerin have shown antitumor action on the hamster fibrosarcoma in terms of all tested tumor parameters. Caffeine, itraconazole and nitroglycerin increase the antitumor effect of metformin on the hamster fibrosarcoma. During all the experiments carried out within this dissertation, there has been no effective treatment, which does not contain metformin.</p>

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.