Cryptosporidiosis is an intestinal disease that affects a variety of hosts including animals and humans. Since no vaccines exist against the disease till date, drug treatment is the mainstay of disease control. Nitazoxanide (NTZ) is the only FDA-approved drug for the treatment of human cryptosporidiosis. However, its efficacy in immunocompromised people such as those with AIDS, in malnourished children, or those with concomitant cryptosporidiosis is limited. In the absence of effective drugs against cryptosporidiosis, improving the efficacy of existing drugs may offer an attractive alternative. In the present work, we have assessed the potential of the cell-penetrating peptide (CPP) octaarginine (R8) to increase the uptake of NTZ. Octaarginine (R8) was synthetically attached to NTZ in an enzymatically releasable manner and used to inhibit growth of Cryptosporidium parvum in an in vitro culture system using human ileocecal adenocarcinoma (HCT-8) cell line. We observed a significant concentration-dependent increase in drug efficacy. We conclude that coupling of octaarginine to NTZ is beneficial for drug activity and it represents an attractive strategy to widen the repertoire of anti-cryptosporidial therapeutics. Further investigations such as in vivo studies with the conjugate drug will help to further characterize this strategy for the treatment of cryptosporidiosis

Increased understanding of the molecular mechanisms underlying cancer development has shifted drug discovery towards target driven drug development the last decades, but the development of effective cancer drugs has been hampered by the lack of predictive preclinical models. 3-D cultures, considered to more accurately reflect solid tumors in vivo, have been proposed as one way to increase the predictability of clinical efficacy in cancer drug discovery and development. The aims of this thesis were to improve preclinical models for cancer drug development, with focus on colorectal cancer (CRC) and use of multicellular tumor spheroids (MCTS), and also to mechanistically characterize some potentially new anticancer drugs (papers I – IV). The most important technical improvement was the development of direct measurement of green fluorescent protein (GFP) marked cells in spheroids, simplifying live collection of viability data and enabling high-throughput screening (HTS) in the MCTS model (paper I). In paper III and IV, the 3-D model was adapted to enable studies on the interaction between drugs and radiation. Two potentially new anticancer drugs, VLX50 and VLX60, were mechanistically characterized. VLX60, a novel copper containing thiosemicarbazone, induced reactive oxygen species (ROS) formation, was selectively active against BRAF mutated colon cancer cells and exhibited anticancer activity in vivo (paper II). Furthermore, two potentially new anticancer drugs were found suitable for further development for use in combination with radiation (papers III and IV). In paper III, synergy with radiation in spheroids compared to monolayer cultured colon cancer cells was shown with the novel iron-chelating inhibitor of oxidative phosphorylation, VLX600. In paper IV, the antiprotozoal drug nitazoxanide was shown to sensitize quiescent clonogenic colon cancer cells to radiation. In conclusion, introduction of measurement of fluorescence of GFP marked cells in spheroids makes clinically relevant 3-D models feasible for HTS experiments and characterization of candidate drugs and radiosensitizers in early cancer drug discovery and development. VLX60 has several characteristics suitable for further development into a cancer drug, notably against BRAF mutated colorectal cancer cells. VLX600 and nitazoxanide show radiosensitizing properties making them promising for further development for use as cancer drugs in combination with radiation.

A nitazoxanida é um novo antiparasitário de amplo espectro e pertence à classe dos nitrotiazóis. No Brasil, encontra-se disponível na forma de comprimidos revestidos e pó para suspensão oral, sob nome cormercial de Annita . A análise de fármacos é necessária em todas as fases do desenvolvimento farmacêutico e na manutenção da segurança e eficácia terapêutica dos produtos comercializados. Assim, o presente trabalho objetivou o desenvolvimento e validação de métodos para análise qualitativa e quantitativa da nitazoxanida nas formas farmacêuticas comerciais e a avaliação da estabilidade do fármaco em condições de degradação forçada, contemplando a determinação da cinética de fotodegradação e o isolamento, identificação e estudo da citotoxicidade do produto de degradação majoritário. As análises por espectrometria de massas (MS/MS), infravermelho (IV), ressonância magnética nuclear (RMN 1H e 13C) e calorimetria exploratória diferencial permitiram identificar a nitazoxanida utilizada como substância química de referência. Os métodos por cromatografia em camada delgada, espectrofotometria no ultravioleta (UV), cromatografia líquida de alta eficiência (CLAE) e eletroforese capilar (EC) foram utilizados para identificação do fármaco nas formas farmacêuticas. Os métodos quantitativos validados foram: UV, CLAE e EC. Todos cumpriram com os parâmetros descritos pelas guias de validação e não apresentaram diferença estatística significativa na determinação do fármaco. O estudo preliminar de estabilidade frente à degradação oxidativa, ácida, básica, térmica e fotolítica demonstrou que o fármaco é instável em todas as condições testadas, sendo que os meios oxidativo, alcalino e fotolítico foram os fatores de maior importância. A cinética de fotodegradação da nitazoxanida apresentou cinética de ordem zero para ambas as formas farmacêuticas. Em todas as condições de degradação testadas ocorreu a formação de um produto de degradação majoritário, chamado de PD1, o qual precipitou nas condições analíticas e foi isolado por filtração. O mesmo foi identificado por RMN 1H e 13C, EM/EM e IV como o derivado desacetilado da nitazoxanida, a tizoxanida. A avaliação preliminar da citotoxicidade indicou que o produto isolado apresenta maior toxicidade celular in vitro após 48 horas de incubação frente à células mononucleares, quando comparado à nitazoxanida. Os resultados obtidos neste trabalho demonstram a importância do aprofundamento dos estudos nesta área para garantir a segurança e eficácia terapêutica dos produtos farmacêuticos comercializados. / Nitazoxanide is a new broad-spectrum antiparasitic drug and it belongs to the class of nitrothiazol. In Brazil, it is available as tablets and powder for oral suspension, under the cormercial name of Annita . Drug analysis is needed in all phases of pharmaceutical development and maintenance of marketed products safety and efficacy. Thus, the present study aimed the methods development and validation for qualitative and quantitative analysis of nitazoxanide in commercial pharmaceutical forms and evaluation of drug stability in forced degradation conditions, comprising the photodegradation kinetics determination and the isolation, identification and the cytotoxicity study of the major degradation product. The analysis by mass spectrometry (MS/MS), infrared (IR), nuclear magnetic resonance (1H and 13C NMR) and differential scanning calorimetry allows to identify the nitazoxanide chemical reference structure. The methods by thin layer chromatography, spectrophotometry (UV), high performance liquid chromatography (HPLC) and capillary electrophoresis (CE) were used to identify the drug in pharmaceutical formulations. Quantitative methods have been validated: UV, HPLC and CE. All methods met the criteria described by the validation guidelines and showed no significant statistically difference in the drug determination. The preliminary stability study of nitazoxanide under oxidative, acidic, basic, thermal and photolytic conditions showed that the drug is unstable in all tested conditions, and oxidative, alkaline and photolytic conditions are the factors of major importance. The photodegradation kinetics of nitazoxanide showed zero-order kinetics for both dosage forms. In all tested degradation conditions it was formed a majority degradation product, named PD1, which precipitated in the analytical conditions and it was isolated by filtration. The same product was identified by 1H and 13C NMR, MS/MS and IR as deacetylated derivative of nitazoxanide, the Tizoxanide. The preliminary citotoxicity evaluation indicated that the isolated product has a higher cellular toxicity in vitro after 48 hours of incubation, when compared to nitazoxanide. The results demonstrate the importance of this type of study to ensure the safety and efficacy of marketed pharmaceutical products.

A nitazoxanida é um novo antiparasitário de amplo espectro e pertence à classe dos nitrotiazóis. No Brasil, encontra-se disponível na forma de comprimidos revestidos e pó para suspensão oral, sob nome cormercial de Annita . A análise de fármacos é necessária em todas as fases do desenvolvimento farmacêutico e na manutenção da segurança e eficácia terapêutica dos produtos comercializados. Assim, o presente trabalho objetivou o desenvolvimento e validação de métodos para análise qualitativa e quantitativa da nitazoxanida nas formas farmacêuticas comerciais e a avaliação da estabilidade do fármaco em condições de degradação forçada, contemplando a determinação da cinética de fotodegradação e o isolamento, identificação e estudo da citotoxicidade do produto de degradação majoritário. As análises por espectrometria de massas (MS/MS), infravermelho (IV), ressonância magnética nuclear (RMN 1H e 13C) e calorimetria exploratória diferencial permitiram identificar a nitazoxanida utilizada como substância química de referência. Os métodos por cromatografia em camada delgada, espectrofotometria no ultravioleta (UV), cromatografia líquida de alta eficiência (CLAE) e eletroforese capilar (EC) foram utilizados para identificação do fármaco nas formas farmacêuticas. Os métodos quantitativos validados foram: UV, CLAE e EC. Todos cumpriram com os parâmetros descritos pelas guias de validação e não apresentaram diferença estatística significativa na determinação do fármaco. O estudo preliminar de estabilidade frente à degradação oxidativa, ácida, básica, térmica e fotolítica demonstrou que o fármaco é instável em todas as condições testadas, sendo que os meios oxidativo, alcalino e fotolítico foram os fatores de maior importância. A cinética de fotodegradação da nitazoxanida apresentou cinética de ordem zero para ambas as formas farmacêuticas. Em todas as condições de degradação testadas ocorreu a formação de um produto de degradação majoritário, chamado de PD1, o qual precipitou nas condições analíticas e foi isolado por filtração. O mesmo foi identificado por RMN 1H e 13C, EM/EM e IV como o derivado desacetilado da nitazoxanida, a tizoxanida. A avaliação preliminar da citotoxicidade indicou que o produto isolado apresenta maior toxicidade celular in vitro após 48 horas de incubação frente à células mononucleares, quando comparado à nitazoxanida. Os resultados obtidos neste trabalho demonstram a importância do aprofundamento dos estudos nesta área para garantir a segurança e eficácia terapêutica dos produtos farmacêuticos comercializados. / Nitazoxanide is a new broad-spectrum antiparasitic drug and it belongs to the class of nitrothiazol. In Brazil, it is available as tablets and powder for oral suspension, under the cormercial name of Annita . Drug analysis is needed in all phases of pharmaceutical development and maintenance of marketed products safety and efficacy. Thus, the present study aimed the methods development and validation for qualitative and quantitative analysis of nitazoxanide in commercial pharmaceutical forms and evaluation of drug stability in forced degradation conditions, comprising the photodegradation kinetics determination and the isolation, identification and the cytotoxicity study of the major degradation product. The analysis by mass spectrometry (MS/MS), infrared (IR), nuclear magnetic resonance (1H and 13C NMR) and differential scanning calorimetry allows to identify the nitazoxanide chemical reference structure. The methods by thin layer chromatography, spectrophotometry (UV), high performance liquid chromatography (HPLC) and capillary electrophoresis (CE) were used to identify the drug in pharmaceutical formulations. Quantitative methods have been validated: UV, HPLC and CE. All methods met the criteria described by the validation guidelines and showed no significant statistically difference in the drug determination. The preliminary stability study of nitazoxanide under oxidative, acidic, basic, thermal and photolytic conditions showed that the drug is unstable in all tested conditions, and oxidative, alkaline and photolytic conditions are the factors of major importance. The photodegradation kinetics of nitazoxanide showed zero-order kinetics for both dosage forms. In all tested degradation conditions it was formed a majority degradation product, named PD1, which precipitated in the analytical conditions and it was isolated by filtration. The same product was identified by 1H and 13C NMR, MS/MS and IR as deacetylated derivative of nitazoxanide, the Tizoxanide. The preliminary citotoxicity evaluation indicated that the isolated product has a higher cellular toxicity in vitro after 48 hours of incubation, when compared to nitazoxanide. The results demonstrate the importance of this type of study to ensure the safety and efficacy of marketed pharmaceutical products.

A nitazoxanida é um novo antiparasitário de amplo espectro e pertence à classe dos nitrotiazóis. No Brasil, encontra-se disponível na forma de comprimidos revestidos e pó para suspensão oral, sob nome cormercial de Annita . A análise de fármacos é necessária em todas as fases do desenvolvimento farmacêutico e na manutenção da segurança e eficácia terapêutica dos produtos comercializados. Assim, o presente trabalho objetivou o desenvolvimento e validação de métodos para análise qualitativa e quantitativa da nitazoxanida nas formas farmacêuticas comerciais e a avaliação da estabilidade do fármaco em condições de degradação forçada, contemplando a determinação da cinética de fotodegradação e o isolamento, identificação e estudo da citotoxicidade do produto de degradação majoritário. As análises por espectrometria de massas (MS/MS), infravermelho (IV), ressonância magnética nuclear (RMN 1H e 13C) e calorimetria exploratória diferencial permitiram identificar a nitazoxanida utilizada como substância química de referência. Os métodos por cromatografia em camada delgada, espectrofotometria no ultravioleta (UV), cromatografia líquida de alta eficiência (CLAE) e eletroforese capilar (EC) foram utilizados para identificação do fármaco nas formas farmacêuticas. Os métodos quantitativos validados foram: UV, CLAE e EC. Todos cumpriram com os parâmetros descritos pelas guias de validação e não apresentaram diferença estatística significativa na determinação do fármaco. O estudo preliminar de estabilidade frente à degradação oxidativa, ácida, básica, térmica e fotolítica demonstrou que o fármaco é instável em todas as condições testadas, sendo que os meios oxidativo, alcalino e fotolítico foram os fatores de maior importância. A cinética de fotodegradação da nitazoxanida apresentou cinética de ordem zero para ambas as formas farmacêuticas. Em todas as condições de degradação testadas ocorreu a formação de um produto de degradação majoritário, chamado de PD1, o qual precipitou nas condições analíticas e foi isolado por filtração. O mesmo foi identificado por RMN 1H e 13C, EM/EM e IV como o derivado desacetilado da nitazoxanida, a tizoxanida. A avaliação preliminar da citotoxicidade indicou que o produto isolado apresenta maior toxicidade celular in vitro após 48 horas de incubação frente à células mononucleares, quando comparado à nitazoxanida. Os resultados obtidos neste trabalho demonstram a importância do aprofundamento dos estudos nesta área para garantir a segurança e eficácia terapêutica dos produtos farmacêuticos comercializados. / Nitazoxanide is a new broad-spectrum antiparasitic drug and it belongs to the class of nitrothiazol. In Brazil, it is available as tablets and powder for oral suspension, under the cormercial name of Annita . Drug analysis is needed in all phases of pharmaceutical development and maintenance of marketed products safety and efficacy. Thus, the present study aimed the methods development and validation for qualitative and quantitative analysis of nitazoxanide in commercial pharmaceutical forms and evaluation of drug stability in forced degradation conditions, comprising the photodegradation kinetics determination and the isolation, identification and the cytotoxicity study of the major degradation product. The analysis by mass spectrometry (MS/MS), infrared (IR), nuclear magnetic resonance (1H and 13C NMR) and differential scanning calorimetry allows to identify the nitazoxanide chemical reference structure. The methods by thin layer chromatography, spectrophotometry (UV), high performance liquid chromatography (HPLC) and capillary electrophoresis (CE) were used to identify the drug in pharmaceutical formulations. Quantitative methods have been validated: UV, HPLC and CE. All methods met the criteria described by the validation guidelines and showed no significant statistically difference in the drug determination. The preliminary stability study of nitazoxanide under oxidative, acidic, basic, thermal and photolytic conditions showed that the drug is unstable in all tested conditions, and oxidative, alkaline and photolytic conditions are the factors of major importance. The photodegradation kinetics of nitazoxanide showed zero-order kinetics for both dosage forms. In all tested degradation conditions it was formed a majority degradation product, named PD1, which precipitated in the analytical conditions and it was isolated by filtration. The same product was identified by 1H and 13C NMR, MS/MS and IR as deacetylated derivative of nitazoxanide, the Tizoxanide. The preliminary citotoxicity evaluation indicated that the isolated product has a higher cellular toxicity in vitro after 48 hours of incubation, when compared to nitazoxanide. The results demonstrate the importance of this type of study to ensure the safety and efficacy of marketed pharmaceutical products.

Introduction: Cryptosporidium parvum is one of the most common causes of diarrhea worldwide in neonatal calves. This pathogen is also life-threatening in malnourished children and immunodeficient patients. There is no vaccine and a single drug nitazoxanide (NTZ), of only the moderate efficacy has been approved by FDA for cryptosporidiosis treatment in human. Octaarginine is known to facilitate the transport of other molecules across cell membranes and has been use to transfect protozoan organisms. It is also proposed to increase the efficacy of drugs against intracellular pathogens. Aims of the study: The capacity of octaarginine to support transfection of C. parvum as an alternative to electroporation was evaluated. Furthermore, it was studied whether octaarginine covalently bound to NTZ (NTZ-R8) improves efficacy against the parasite. Animals, materials and methods: FAM-octaarginine was added to either intact oocysts, short-time excystation exposed (STE) oocysts, excysted sporozoites, intracellular stages of C. parvum to assess the permeability of the Cryptosporidium membrane to the peptide. The optimal conditions for condensation of plasmid for transfection experiments were evaluated by testing different N/P ratios applying by gel retardation assay. The transfection complex octaarginine/polyethyleneimine (PEI)/DNA was also incubated with intact oocysts, STE oocysts, and excysted sporozoites. Transfected parasites were transferred to HCT-8 cell cultures and further incubated for 24 h. Immunoflourescence assay (IFA) was performed to detect successfully transfected parasites. To evaluate the suitability of octaarginine as a vehicle supporting transport of NTZ across membranes, octaarginine was coupled to NTZ to produce NTZ-R8. Cryptosporidium oocysts were inoculated into HCT-8 cell monolayers in the presence of NTZ and NTZ-R8 at concentrations of 1, 5, 10, 50, 100 or 1000 ng/ml. Parasite growth was monitored by RT- qPCR after RNA extraction from C. parvum exposed HTC-8 cell cultures. RT-qPCR was performed on the target gene 18S rRNA of Cryptosporidium and normalized to the expression of the housekeeping gene 18S rRNA of host cells. To evaluate the efficacy of NTZ-R8 in vivo, IFN-γ knockout mice were orally inoculated with 1000 oocysts each, except for the non-infected controls. Infected mice were treated with NTZ (10 mg/kg BW) or NTZ-R8 (2 mg/kg BW) in 7 days. The efficacy of treatment was evaluated by oocyst excretion, survival rate, clinical symptoms, and histopathological changes in the ileum. Results: Octaarginine easily penetrated into Cryptosporidium sporozoites and STE oocysts, and intracellular stages while the membrane of intact oocysts remained impermeable. The optimal N/P ratio for the full DNA plasmid condensation starts from 10 when octaarginine was also added to the complex. Successful transfection of excysted sporozoites and STE oocysts was observed with only 1µg plasmid in the transfection complex. Transfection was not achieve when intact oocysts were used. The half-maximal inhibition concentration (IC50) of NTZ and NTZ-R8 was 60.54 ng/ml (197 nM) and 4.499 ng/ml (2.9 nM), respectively. Therefore, octaarginine significantly improved inhibition C. parvum growth by NTZ around 68 times (P < 0.05). During in vivo studies, it was observed that infected mice displayed symptoms of cryptosporidiosis such as anorexia, weight loss and ruffled fur. Mice treated with NTZ at 10 mg/kg BW displayed in 40% survival while mice treated with NTZ-R8 at 2 mg/ kg BW showed a distinctly higher survival rate of 80%, albeit non- significant (P > 0.05). Conclusion: DNA condensation by PEI and DNA delivery by octaarginine allows simple and rapid transfection that requires a small amount of plasmid DNA only and does not depend on sophisticated equipment. Best results were obtained using STE oocysts. Octaarginine also successfully transported the anticryptosporidial compound NTZ into extracellular and intracellular stages of C. parvum and is therefore a suitable vehicle for drug delivery, thus being a promising tool for improvement of treatment efficacy.

Introdução: O Clostridium difficile é um bacilo Gram-positivo, anaeróbio estrito, formador de esporos, que produz toxinas que podem causar diarreia, colite pseudomembranosa, dilatação do cólon, sepse e até morte. Nos últimos anos o quadro clínico e epidemiológico das infecções por Clostridium difficile tem se modificado e as limitações das opções terapêuticas tornaram-se mais evidentes. Objetivo Primário: Comparar as metodologias de disco-difusão e ágar-diluição na detecção de sensibilidade/resistência de isolados de Clostridium difficile. Objetivos Secundários: Avaliar prospectivamente o perfil de sensibilidade/resistência de isolados clínicos hospitalares de Clostridium difficile provenientes de seis hospitais terciários da cidade de São Paulo e fornecer evidências para fundamentar o diagnóstico e o tratamento empírico das diarreias causadas por Clostridium difficile. Métodos: utilizamos os métodos de disco-difusão e ágar-diluição, de acordo com os critérios estabelecidos pelo CLSI e EUCAST. Resultados: Os coeficientes de correlação observados entre os diâmetros dos halos de inibição e Concentração Inibitória Mínima foram abaixo do esperado tornando inviável o método de disco-difusão para determinação de sensibilidade aos antimicrobianos nitazoxanida, teicoplanina e tigeciclina. Todas as 50 cepas deste estudo foram sensíveis ao metronidazol (MIC50 foi de 1 ?g/mL a MIC90 foi de 2 ug/mL). Para o método de disco-difusão, sugerimos que halos de inibição >= 33mm possam ser interpretados como sensíveis. Devido à moderada correlação, significância estatística e distribuição de halos de inibição das amostras próximos aos valores encontrados utilizando a cepa ATTC, sugere-se a utilização do método de disco-difusão para vancomicina, onde halos com diâmetro >= 22mm possam ser considerados como sensíveis pelo método. Para o moxifloxacino houve uma boa correlação entre as duas metodologias: discodifusão e de ágar-diluição (O coeficiente de Pearson foi de -0,84, e o valor de p foi menor que 0,00001), sugerindo que halos de inibição >= 18mm possam ser interpretados como sensíveis pela metodologia de disco-difusão. A nitazoxanida foi à droga que mostrou melhor atividade in vitro (MIC50 foi 0,06 ?g/mL e a MIC90 de 0,12 ug/mL). Por se mostrar uma droga com potente atividade in vitro (MIC50 e a MIC90 foi de 0,12 ug/mL), a tigeciclina poderia ser mais uma opção terapêutica em infecções por Clostridium difficile, dependendo de mais estudos para avaliar sua real eficácia clínica e segurança. Conclusão: Os resultados verificados neste estudo indicam a necessidade de mais estudos in vitro e clínicos para definir os limites de sensibilidade/resistência para a teicoplanina e a nitazoxanida, pois faltam critérios de interpretação tanto para disco-difusão quanto para ágar-diluição. Os resultados deste trabalho in vitro confirmaram a utilidade do metronidazol como uma droga eficaz no tratamento de infecção por Clostridium difficile. A nitazoxanida foi à droga que mostrou melhor atividade in vitro por método dilucional. Sugerimos a utilização do método de disco-difusão para: metronidazol, vancomicina e moxifloxacino. Os resultados desse trabalho sugerem que halos de inibição para metronidazol ( >= 33mm), moxifloxacino ( >= 18mm) e vancomicina ( >= 22mm) poderiam ser considerados como sensíveis pelo método de disco-difusão. O método de ágardiluição é um método de boa acurácia, porém trabalhoso para ser executado na rotina laboratorial / Introduction: Clostridium difficile is a Gram-positive bacillus, strictly anaerobic, spore-forming, which produces toxins that can cause diarrhea, colitis pseudomembranous, colon expansion, sepsis and even death. In recent years the clinical and epidemiological picture of infection by Clostridium difficile has been modified and limitations of therapeutic options have become more evident. Primary Objective: Comparing the methods of disk diffusion and agar dilution in the detection sensitivity/resistance isolates of Clostridium difficile. Secondary Objectives: Prospectively evaluate the profile of sensitivity/resistance of hospital clinical isolates of Clostridium difficile from six tertiary hospitals in São Paulo city and provide evidence to support the diagnosis and empirical treatment of diarrhea caused by Clostridium difficile. Methods: We use the disk diffusion method and agar dilution method, according to the established criteria by CLSI and EUCAST. Results: The observed correlation coefficients between the inhibitions diameter zone of the and Minimum Inhibitory Concentration were under expectations impeding the disk diffusion method for determining sensitivity to nitazoxanide antimicrobial, teicoplanin and tigecycline. All 50 strains of this study were sensitive to metronidazole (MIC50 was 1 Ug/ml to MIC90 was 2 ug/ml). For the method disk diffusion, we suggest that inhibition zones >= 33mm can be interpreted as sensitive. Due to the moderate correlation, statistical significance and distribution of zones of inhibition on samples of the next found values using the strain ATTC, we suggest using the disk diffusion method for vancomycin where halos diameter >= 22mm can be considered as sensitive by the method. There was a good correlation to moxifloxacin between the two methodologies: disk diffusion and agar dilution (Pearson\'s coefficient was -0.84 , and the \"p\" value was less than 0.00001), suggesting that inhibition zones >= 18mm can be interpreted as sensitive by disk diffusion method. Nitazoxanide was the drug that showed a better performance in vitro activity (MIC50 was 0.06 ?g/ml and MIC90 0.12 ug/ml). For a drug that shows potent activity in vitro (MIC50 and MIC90 was 0.12 ug/ml), the tigecycline could be a therapeutic option in infection by Clostridium difficile, depending on further studies to evaluate their real clinical efficacy and security. Conclusion: Obtained results in this study indicate the need for further studies in vitro and clinicians to define the limits of sensitivity/resistance to teicoplanin and nitazoxanide, so there is no interpretation criteria for both disk diffusion and for agar dilution. Results of this work in vitro study confirmed the utility of metronidazole as an effective drug in the treatment of infection by Clostridium difficile. Nitazoxanide was the drug that showed better performance in vitro by dilutional method. We suggest the use of disk diffusion method: metronidazole, vancomycin and moxifloxacin. This work suggest that inhibition zones for metronidazole ( >= 33mm), moxifloxacin ( >= 18mm) and vancomycin ( >= 22mm) could be considered as sensitive by disk diffusion method. The agar dilution method is a method to be accurate, but laborious to run in the laboratory routine

Introdução: O Clostridium difficile é um bacilo Gram-positivo, anaeróbio estrito, formador de esporos, que produz toxinas que podem causar diarreia, colite pseudomembranosa, dilatação do cólon, sepse e até morte. Nos últimos anos o quadro clínico e epidemiológico das infecções por Clostridium difficile tem se modificado e as limitações das opções terapêuticas tornaram-se mais evidentes. Objetivo Primário: Comparar as metodologias de disco-difusão e ágar-diluição na detecção de sensibilidade/resistência de isolados de Clostridium difficile. Objetivos Secundários: Avaliar prospectivamente o perfil de sensibilidade/resistência de isolados clínicos hospitalares de Clostridium difficile provenientes de seis hospitais terciários da cidade de São Paulo e fornecer evidências para fundamentar o diagnóstico e o tratamento empírico das diarreias causadas por Clostridium difficile. Métodos: utilizamos os métodos de disco-difusão e ágar-diluição, de acordo com os critérios estabelecidos pelo CLSI e EUCAST. Resultados: Os coeficientes de correlação observados entre os diâmetros dos halos de inibição e Concentração Inibitória Mínima foram abaixo do esperado tornando inviável o método de disco-difusão para determinação de sensibilidade aos antimicrobianos nitazoxanida, teicoplanina e tigeciclina. Todas as 50 cepas deste estudo foram sensíveis ao metronidazol (MIC50 foi de 1 ?g/mL a MIC90 foi de 2 ug/mL). Para o método de disco-difusão, sugerimos que halos de inibição >= 33mm possam ser interpretados como sensíveis. Devido à moderada correlação, significância estatística e distribuição de halos de inibição das amostras próximos aos valores encontrados utilizando a cepa ATTC, sugere-se a utilização do método de disco-difusão para vancomicina, onde halos com diâmetro >= 22mm possam ser considerados como sensíveis pelo método. Para o moxifloxacino houve uma boa correlação entre as duas metodologias: discodifusão e de ágar-diluição (O coeficiente de Pearson foi de -0,84, e o valor de p foi menor que 0,00001), sugerindo que halos de inibição >= 18mm possam ser interpretados como sensíveis pela metodologia de disco-difusão. A nitazoxanida foi à droga que mostrou melhor atividade in vitro (MIC50 foi 0,06 ?g/mL e a MIC90 de 0,12 ug/mL). Por se mostrar uma droga com potente atividade in vitro (MIC50 e a MIC90 foi de 0,12 ug/mL), a tigeciclina poderia ser mais uma opção terapêutica em infecções por Clostridium difficile, dependendo de mais estudos para avaliar sua real eficácia clínica e segurança. Conclusão: Os resultados verificados neste estudo indicam a necessidade de mais estudos in vitro e clínicos para definir os limites de sensibilidade/resistência para a teicoplanina e a nitazoxanida, pois faltam critérios de interpretação tanto para disco-difusão quanto para ágar-diluição. Os resultados deste trabalho in vitro confirmaram a utilidade do metronidazol como uma droga eficaz no tratamento de infecção por Clostridium difficile. A nitazoxanida foi à droga que mostrou melhor atividade in vitro por método dilucional. Sugerimos a utilização do método de disco-difusão para: metronidazol, vancomicina e moxifloxacino. Os resultados desse trabalho sugerem que halos de inibição para metronidazol ( >= 33mm), moxifloxacino ( >= 18mm) e vancomicina ( >= 22mm) poderiam ser considerados como sensíveis pelo método de disco-difusão. O método de ágardiluição é um método de boa acurácia, porém trabalhoso para ser executado na rotina laboratorial / Introduction: Clostridium difficile is a Gram-positive bacillus, strictly anaerobic, spore-forming, which produces toxins that can cause diarrhea, colitis pseudomembranous, colon expansion, sepsis and even death. In recent years the clinical and epidemiological picture of infection by Clostridium difficile has been modified and limitations of therapeutic options have become more evident. Primary Objective: Comparing the methods of disk diffusion and agar dilution in the detection sensitivity/resistance isolates of Clostridium difficile. Secondary Objectives: Prospectively evaluate the profile of sensitivity/resistance of hospital clinical isolates of Clostridium difficile from six tertiary hospitals in São Paulo city and provide evidence to support the diagnosis and empirical treatment of diarrhea caused by Clostridium difficile. Methods: We use the disk diffusion method and agar dilution method, according to the established criteria by CLSI and EUCAST. Results: The observed correlation coefficients between the inhibitions diameter zone of the and Minimum Inhibitory Concentration were under expectations impeding the disk diffusion method for determining sensitivity to nitazoxanide antimicrobial, teicoplanin and tigecycline. All 50 strains of this study were sensitive to metronidazole (MIC50 was 1 Ug/ml to MIC90 was 2 ug/ml). For the method disk diffusion, we suggest that inhibition zones >= 33mm can be interpreted as sensitive. Due to the moderate correlation, statistical significance and distribution of zones of inhibition on samples of the next found values using the strain ATTC, we suggest using the disk diffusion method for vancomycin where halos diameter >= 22mm can be considered as sensitive by the method. There was a good correlation to moxifloxacin between the two methodologies: disk diffusion and agar dilution (Pearson\'s coefficient was -0.84 , and the \"p\" value was less than 0.00001), suggesting that inhibition zones >= 18mm can be interpreted as sensitive by disk diffusion method. Nitazoxanide was the drug that showed a better performance in vitro activity (MIC50 was 0.06 ?g/ml and MIC90 0.12 ug/ml). For a drug that shows potent activity in vitro (MIC50 and MIC90 was 0.12 ug/ml), the tigecycline could be a therapeutic option in infection by Clostridium difficile, depending on further studies to evaluate their real clinical efficacy and security. Conclusion: Obtained results in this study indicate the need for further studies in vitro and clinicians to define the limits of sensitivity/resistance to teicoplanin and nitazoxanide, so there is no interpretation criteria for both disk diffusion and for agar dilution. Results of this work in vitro study confirmed the utility of metronidazole as an effective drug in the treatment of infection by Clostridium difficile. Nitazoxanide was the drug that showed better performance in vitro by dilutional method. We suggest the use of disk diffusion method: metronidazole, vancomycin and moxifloxacin. This work suggest that inhibition zones for metronidazole ( >= 33mm), moxifloxacin ( >= 18mm) and vancomycin ( >= 22mm) could be considered as sensitive by disk diffusion method. The agar dilution method is a method to be accurate, but laborious to run in the laboratory routine

High-throughput drug screening (HTS) in live cells is often a vital part of the preclinical anticancer drug discovery process. So far, two-dimensional (2D) monolayer cell cultures have been the most prevalent model in HTS endeavors. However, 2D cell cultures often fail to recapitulate the complex microenvironments of in vivo tumors. Monolayer cultures are highly proliferative and generally do not contain quiescent cells, thought to be one of the main reasons for the anticancer therapy failure in clinic. Thus, there is a need for in vitro cellular models that would increase predictive value of preclinical research results. The utilization of more complex three-dimensional (3D) cell cultures, such as multicellular tumor spheroids (MCTS), which contain both proliferating and quiescent cells, has therefore been proposed. However, difficult handling and high costs still pose significant hurdles for application of MCTS for HTS. In this work, we aimed to develop novel assays to apply MCTS for HTS and drug evaluation. We also set out to identify cellular processes that could be targeted to selectively eradicate quiescent cancer cells. In Paper I, we developed a novel MCTS-based HTS assay and found that nutrient-deprived and hypoxic cancer cells are selectively vulnerable to treatment with inhibitors of mitochondrial oxidative phosphorylation (OXPHOS). We also identified nitazoxanide, an FDA-approved anthelmintic agent, to act as an OXPHOS inhibitor and to potentiate the effects of standard chemotherapy in vivo. Subsequently, in Paper II we applied the high-throughput gene-expression profiling method for MCTS-based drug screening. This led to discovery that quiescent cells up-regulate the mevalonate pathway upon OXPHOS inhibition and that the combination of OXPHOS inhibitors and mevalonate pathway inhibitors (statins) results in synergistic toxicity in this cell population. In Paper III, we developed a novel spheroid-based drug combination-screening platform and identified a set of molecules that synergize with nitazoxanide to eradicate quiescent cancer cells. Finally, in Paper IV, we applied our MCTS-based methods to evaluate the effects of phosphodiesterase (PDE) inhibitors in PDE3A-expressing cell lines. In summary, this work illustrates how MCTS-based HTS yields potential to reveal and exploit previously unrecognized tumor-specific vulnerabilities. It also underscores the importance of cell culture conditions in preclinical drug discovery endeavors.