Skip to main content
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1992 Jul;36(7):1525–1531. doi: 10.1128/aac.36.7.1525

Comparison of nephrotoxicities of different polyoxyethyleneglycol formulations of amphotericin B in rats.

C Tasset 1, V Preat 1, A Bernard 1, M Roland 1
PMCID: PMC191615  PMID: 1510450

Abstract

The aim of the present study was to assess whether amphotericin B (AmB)-Myrj 59, AmB-polyoxyethyleneglycol 24 cholesterol (PC), and AmB-Synperonic A50 (SA50) were less nephrotoxic than AmB-deoxycholate (DC). Rats were treated with the different AmB formulations (10 mg/kg of body weight) intraperitoneally or with the surfactants alone. A group of control rats receiving the vehicle was also examined. After 6 days of daily intraperitoneal injections of AmB-DC, decreased body weight and glomerular filtration rate as well as increased degree of diuresis, uremia, microalbuminuria, and N-acetyl-beta-D-glucosaminidase excretion in urine were noted. Urinary excretion of potassium and sodium was also decreased in AmB-DC-treated rats. Most of these effects were more pronounced with AmB-PC and AmB-SA50. In contrast, AmB-Myrj 59 was less nephrotoxic than AmB-DC. Indeed, after 6 days of treatment with AmB-Myrj 59, the natriuria, kaliuria, albuminuria, and glomerular filtration rates were unchanged compared with those of controls. Moreover, the body weight loss and uremia increase of the rats treated by AmB-Myrj 59 were less than those of the rats treated with the commercial preparation. Among the surfactants, only PC was toxic for the rats. The intrinsic toxicity of PC and the higher systemic exposure to AmB could contribute to increased toxicities of AmB-PC and AmB-SA50, respectively. AmB-Myrj 59 was less nephrotoxic than AmB-DC at equivalent areas under the plasma concentration-time curves. These preliminary results suggest that this formulation could be a good alternative to the commercial product.

Full text

PDF
1525

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andreoli T. E. On the anatomy of amphotericin B-cholesterol pores in lipid bilayer membranes. Kidney Int. 1973 Nov;4(5):337–345. doi: 10.1038/ki.1973.126. [DOI] [PubMed] [Google Scholar]
  2. Arning M., Scharf R. E. Prevention of amphotericin-B-induced nephrotoxicity by loading with sodium chloride: a report of 1291 days of treatment with amphotericin B without renal failure. Klin Wochenschr. 1989 Oct 17;67(20):1020–1028. doi: 10.1007/BF01727003. [DOI] [PubMed] [Google Scholar]
  3. BELL N. H., ANDRIOLE V. T., SABESIN S. M., UTZ J. P. On the nephrotoxicity of amphotericin B in man. Am J Med. 1962 Jul;33:64–69. doi: 10.1016/0002-9343(62)90277-2. [DOI] [PubMed] [Google Scholar]
  4. BUTLER W. T., BENNETT J. E., ALLING D. W., WERTLAKE P. T., UTZ J. P., HILL G. J., 2nd NEPHROTOXICITY OF AMPHOTERICIN B; EARLY AND LATE EFFECTS IN 81 PATIENTS. Ann Intern Med. 1964 Aug;61:175–187. doi: 10.7326/0003-4819-61-2-175. [DOI] [PubMed] [Google Scholar]
  5. BUTLER W. T., BENNETT J. E., HILL G. J., 2nd ELECTROCARDIOGRAPHIC AND ELECTROLYTE ABNORMALITIES CAUSED BY AMPHOTERICIN B IN DOG AND MAN. Proc Soc Exp Biol Med. 1964 Aug-Sep;116:857–863. doi: 10.3181/00379727-116-29391. [DOI] [PubMed] [Google Scholar]
  6. Barbour G. L., Straub K. D., O'Neal B. L., Leatherman J. W. Vasopressin-resistant nephrogenic diabetes insipidus. A result of amphotericin B therapy. Arch Intern Med. 1979 Jan;139(1):86–88. [PubMed] [Google Scholar]
  7. Barton C. H., Pahl M., Vaziri N. D., Cesario T. Renal magnesium wasting associated with amphotericin B therapy. Am J Med. 1984 Sep;77(3):471–474. doi: 10.1016/0002-9343(84)90106-2. [DOI] [PubMed] [Google Scholar]
  8. Bernard A. M., Lauwerys R. R. Continuous-flow system for automation of latex immunoassay by particle counting. Clin Chem. 1983 Jun;29(6):1007–1011. [PubMed] [Google Scholar]
  9. Bondiou M. T., Bourbouze R., Bernard M., Percheron F., Perez-Gonzalez N., Cabezas J. A. Inhibition of A and B N-acetyl-beta-D-glucosaminidase urinary isoenzymes by urea. Clin Chim Acta. 1985 Jun 30;149(1):67–73. doi: 10.1016/0009-8981(85)90274-8. [DOI] [PubMed] [Google Scholar]
  10. Branch R. A., Jackson E. K., Jacqz E., Stein R., Ray W. A., Ohnhaus E. E., Meusers P., Heidemann H. Amphotericin-B nephrotoxicity in humans decreased by sodium supplements with coadministration of ticarcillin or intravenous saline. Klin Wochenschr. 1987 Jun 1;65(11):500–506. doi: 10.1007/BF01721035. [DOI] [PubMed] [Google Scholar]
  11. Branch R. A. Prevention of amphotericin B-induced renal impairment. A review on the use of sodium supplementation. Arch Intern Med. 1988 Nov;148(11):2389–2394. [PubMed] [Google Scholar]
  12. Brassinne C., Laduron C., Coune A., Sculier J. P., Hollaert C., Collette N., Meunier F. High-performance liquid chromatographic determination of amphotericin B in human serum. J Chromatogr. 1987 Aug 7;419:401–407. doi: 10.1016/0378-4347(87)80307-9. [DOI] [PubMed] [Google Scholar]
  13. Burgess J. L., Birchall R. Nephrotoxicity of amphotericin B, with emphasis on changes in tubular function. Am J Med. 1972 Jul;53(1):77–84. [PubMed] [Google Scholar]
  14. Butler W. T. Pharmacology, toxicity, and therapeutic usefulness of amphotericin B. JAMA. 1966 Jan 31;195(5):371–375. [PubMed] [Google Scholar]
  15. Cheng J. T., Witty R. T., Robinson R. R., Yarger W. E. Amphotericin B nephrotoxicity: increased renal resistance and tubule permeability. Kidney Int. 1982 Dec;22(6):626–633. doi: 10.1038/ki.1982.221. [DOI] [PubMed] [Google Scholar]
  16. Douglas J. B., Healy J. K. Nephrotoxic effects of amphotericin B, including renal tubular acidosis. Am J Med. 1969 Jan;46(1):154–162. doi: 10.1016/0002-9343(69)90067-9. [DOI] [PubMed] [Google Scholar]
  17. Ellis W. G., Sobel R. A., Nielsen S. L. Leukoencephalopathy in patients treated with amphotericin B methyl ester. J Infect Dis. 1982 Aug;146(2):125–137. doi: 10.1093/infdis/146.2.125. [DOI] [PubMed] [Google Scholar]
  18. Gerkens J. F., Branch R. A. The influence of sodium status and furosemide on canine acute amphotericin B nephrotoxicity. J Pharmacol Exp Ther. 1980 Aug;214(2):306–311. [PubMed] [Google Scholar]
  19. Gil F. Z., Malnic G. Effect of amphotericin B on renal tubular acidification in the rat. Pflugers Arch. 1989 Jan;413(3):280–286. doi: 10.1007/BF00583542. [DOI] [PubMed] [Google Scholar]
  20. Gouge T. H., Andriole V. T. An experimental model of amphotericin B nephrotoxicity with renal tubular acidosis. J Lab Clin Med. 1971 Nov;78(5):713–724. [PubMed] [Google Scholar]
  21. Granich G. G., Kobayashi G. S., Krogstad D. J. Sensitive high-pressure liquid chromatographic assay for amphotericin B which incorporates an internal standard. Antimicrob Agents Chemother. 1986 Apr;29(4):584–588. doi: 10.1128/aac.29.4.584. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Heidemann H. T., Gerkens J. F., Spickard W. A., Jackson E. K., Branch R. A. Amphotericin B nephrotoxicity in humans decreased by salt repletion. Am J Med. 1983 Sep;75(3):476–481. doi: 10.1016/0002-9343(83)90353-4. [DOI] [PubMed] [Google Scholar]
  23. Heidemann H. Prevention of amphotericin B nephrotoxicity: the effect of salt loading and flucytosine. Mycoses. 1988;31 (Suppl 2):39–44. [PubMed] [Google Scholar]
  24. Jacqz E., Branch R. A., Heidemann H., Aujard Y. Prévention de la néphrotoxicité de l'amphotéricine B au cours du traitement des candidoses profondes. Ann Biol Clin (Paris) 1987;45(6):689–693. [PubMed] [Google Scholar]
  25. Joly V., Dromer F., Barge J., Yeni P., Seta N., Molas G., Carbon C. Incorporation of amphotericin B (AMB) into liposomes alters AMB-induced acute nephrotoxicity in rabbits. J Pharmacol Exp Ther. 1989 Oct;251(1):311–316. [PubMed] [Google Scholar]
  26. Keim G. R., Jr, Poutsiaka J. W., Kirpan J., Keysser C. H. Amphotericin B methyl ester hydrochloride and amphotericin B: comparative acute toxicity. Science. 1973 Feb 9;179(4073):584–585. doi: 10.1126/science.179.4073.584. [DOI] [PubMed] [Google Scholar]
  27. Keim G. R., Sibley P. L., Yoon Y. H., Kulesza J. S., Zaidi I. H., Miller M. M., Poutsiaka J. W. Comparative toxicological studies of amphotericin B methyl ester and amphotericin B in mice, rats, and dogs. Antimicrob Agents Chemother. 1976 Oct;10(4):687–690. doi: 10.1128/aac.10.4.687. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Kirsh R., Goldstein R., Tarloff J., Parris D., Hook J., Hanna N., Bugelski P., Poste G. An emulsion formulation of amphotericin B improves the therapeutic index when treating systemic murine candidiasis. J Infect Dis. 1988 Nov;158(5):1065–1070. doi: 10.1093/infdis/158.5.1065. [DOI] [PubMed] [Google Scholar]
  29. Kotler-Brajtburg J., Price H. D., Medoff G., Schlessinger D., Kobayashi G. S. Molecular basis for the selective toxicity of amphotericin B for yeast and filipin for animal cells. Antimicrob Agents Chemother. 1974 Apr;5(4):377–382. doi: 10.1128/aac.5.4.377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. LEABACK D. H., WALKER P. G. Studies on glucosaminidase. 4. The fluorimetric assay of N-acetyl-beta-glucosaminidase. Biochem J. 1961 Jan;78:151–156. doi: 10.1042/bj0780151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. LITTMAN M. L., HOROWITZ P. L., SWADEY J. G. Coccidioidomycosis and its treatment with amphotericin B. Am J Med. 1958 Apr;24(4):568–592. doi: 10.1016/0002-9343(58)90297-3. [DOI] [PubMed] [Google Scholar]
  32. Lawrence R. M., Hoeprich P. D. Comparison of amphotericin B and amphotericin B methyl ester: efficacy in murine coccidioidomycosis and toxicity. J Infect Dis. 1976 Feb;133(2):168–174. doi: 10.1093/infdis/133.2.168. [DOI] [PubMed] [Google Scholar]
  33. Lockwood T. D., Bosmann H. B. The use of urinary N-acetyl-beta-glucosaminidase in human renal toxicology. I. Partial biochemical characterization and excretion in humans and release from the isolated perfused rat kidney. Toxicol Appl Pharmacol. 1979 Jun 30;49(2):323–336. doi: 10.1016/0041-008x(79)90257-6. [DOI] [PubMed] [Google Scholar]
  34. Lopez-Berestein G., Bodey G. P., Fainstein V., Keating M., Frankel L. S., Zeluff B., Gentry L., Mehta K. Treatment of systemic fungal infections with liposomal amphotericin B. Arch Intern Med. 1989 Nov;149(11):2533–2536. [PubMed] [Google Scholar]
  35. Lopez-Berestein G., Fainstein V., Hopfer R., Mehta K., Sullivan M. P., Keating M., Rosenblum M. G., Mehta R., Luna M., Hersh E. M. Liposomal amphotericin B for the treatment of systemic fungal infections in patients with cancer: a preliminary study. J Infect Dis. 1985 Apr;151(4):704–710. doi: 10.1093/infdis/151.4.704. [DOI] [PubMed] [Google Scholar]
  36. Luke D. R., Wasan K. M., McQueen T. J., Lopez-Berestein G. Enhancement of the treatment of experimental candidiasis with vascular decongestants. J Infect Dis. 1990 Jul;162(1):211–214. doi: 10.1093/infdis/162.1.211. [DOI] [PubMed] [Google Scholar]
  37. MCCHESNEY J. A., MARQUARDT J. F. HYPOKALEMIC PARALYSIS INDUCED BY AMPHOTERICIN B. JAMA. 1964 Sep 28;189:1029–1031. doi: 10.1001/jama.1964.03070130049020. [DOI] [PubMed] [Google Scholar]
  38. McCurdy D. K., Frederic M., Elkinton J. R. Renal tubular acidosis due to amphotericin B. N Engl J Med. 1968 Jan 18;278(3):124–130. doi: 10.1056/NEJM196801182780302. [DOI] [PubMed] [Google Scholar]
  39. Medoff G., Kobayashi G. S. Strategies in the treatment of systemic fungal infections. N Engl J Med. 1980 Jan 17;302(3):145–155. doi: 10.1056/NEJM198001173020304. [DOI] [PubMed] [Google Scholar]
  40. Meunier F., Sculier J. P., Coune A., Brassinne C., Heyman C., Laduron C., Collette N., Hollaert C., Bron D., Klastersky J. Amphotericin B encapsulated in liposomes administered to cancer patients. Ann N Y Acad Sci. 1988;544:598–610. doi: 10.1111/j.1749-6632.1988.tb40460.x. [DOI] [PubMed] [Google Scholar]
  41. Nilsson-Ehle I., Yoshikawa T. T., Edwards J. E., Schotz M. C., Guze L. B. Quantitation of amphotericin B with use of high-pressure liquid chromatography. J Infect Dis. 1977 Mar;135(3):414–422. doi: 10.1093/infdis/135.3.414. [DOI] [PubMed] [Google Scholar]
  42. Ohnishi A., Ohnishi T., Stevenhead W., Robinson R. D., Glick A., O'Day D. M., Sabra R., Jackson E. K., Branch R. A. Sodium status influences chronic amphotericin B nephrotoxicity in rats. Antimicrob Agents Chemother. 1989 Aug;33(8):1222–1227. doi: 10.1128/aac.33.8.1222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Parekh A. C., Creno R. J., Dave C. V., Marakarian B., Mathur R. K. Long-term effect of amphotericin B on serum cholesterol in the rat. Arch Int Pharmacodyn Ther. 1975 Jan;213(1):121–127. [PubMed] [Google Scholar]
  44. Rubin S. I., Krawiec D. R., Gelberg H., Shanks R. D. Nephrotoxicity of amphotericin B in dogs: a comparison of two methods of administration. Can J Vet Res. 1989 Jan;53(1):23–28. [PMC free article] [PubMed] [Google Scholar]
  45. Sabra R., Branch R. A. Amphotericin B nephrotoxicity. Drug Saf. 1990 Mar-Apr;5(2):94–108. doi: 10.2165/00002018-199005020-00003. [DOI] [PubMed] [Google Scholar]
  46. Sabra R., Takahashi K., Branch R. A., Badr K. F. Mechanisms of amphotericin B-induced reduction of the glomerular filtration rate: a micropuncture study. J Pharmacol Exp Ther. 1990 Apr;253(1):34–37. [PubMed] [Google Scholar]
  47. Sculier J. P., Coune A., Meunier F., Brassinne C., Laduron C., Hollaert C., Collette N., Heymans C., Klastersky J. Pilot study of amphotericin B entrapped in sonicated liposomes in cancer patients with fungal infections. Eur J Cancer Clin Oncol. 1988 Mar;24(3):527–538. doi: 10.1016/s0277-5379(98)90033-5. [DOI] [PubMed] [Google Scholar]
  48. Stamm A. M., Diasio R. B., Dismukes W. E., Shadomy S., Cloud G. A., Bowles C. A., Karam G. H., Espinel-Ingroff A. Toxicity of amphotericin B plus flucytosine in 194 patients with cryptococcal meningitis. Am J Med. 1987 Aug;83(2):236–242. doi: 10.1016/0002-9343(87)90691-7. [DOI] [PubMed] [Google Scholar]
  49. Tasset C., Préat V., Roland M. The influence of Myrj 59 on the solubility, toxicity and activity of amphotericin B. J Pharm Pharmacol. 1991 May;43(5):297–302. doi: 10.1111/j.2042-7158.1991.tb06693.x. [DOI] [PubMed] [Google Scholar]
  50. Tolins J. P., Raij L. Chronic amphotericin B nephrotoxicity in the rat, protective effect of prophylactic salt loading. Am J Kidney Dis. 1988 Apr;11(4):313–317. doi: 10.1016/s0272-6386(88)80136-7. [DOI] [PubMed] [Google Scholar]
  51. UTZ J. P. AMPHOTERICIN B TOXICITY; GENERAL SIDE EFFECTS. Ann Intern Med. 1964 Aug;61:340–343. doi: 10.7326/0003-4819-61-2-340. [DOI] [PubMed] [Google Scholar]
  52. Vigano A., Cavanna G., Capodaglio P., Assael B. M., Salmona M. Methodological and clinical aspects of urinary N-acetyl-glucosaminidase in pediatric subjects. Biochem Med. 1981 Feb;25(1):26–33. doi: 10.1016/0006-2944(81)90057-0. [DOI] [PubMed] [Google Scholar]
  53. Weber R. S., Lopez-Berestein G. Treatment of invasive Aspergillus sinusitis with liposomal-amphotericin B. Laryngoscope. 1987 Aug;97(8 Pt 1):937–941. [PubMed] [Google Scholar]
  54. Weldon M. W., Schultz M. E. Renal ultrastructure after amphotericin B. Pathology. 1974 Apr;6(2):191–200. doi: 10.3109/00313027409068984. [DOI] [PubMed] [Google Scholar]
  55. Wellwood J. M., Price R. G., Ellis B. G., Thompson A. E. A note on the practical aspects of the assay of N-acetyl-beta-glucosaminidase in human urine. Clin Chim Acta. 1976 May 17;69(1):85–91. doi: 10.1016/0009-8981(76)90475-7. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES