Inhalation Chamber Apparatus for

Transcription

1 Diagnostics of Invasive Aspergillosis: From Experimental Models to Clinical i l Evaluation Scott Filler, UCLA Laura Najvar, UTHSCSA 1

2 Inhalation Chamber Apparatus for Aspergillosis Acrylic chamber for up to 4 mice Standard respiratory therapy nebulizer Compressed air tank with regulator Sheppard. AAC 24;48:198

3 Inhalational Models Advantages Relatively low inoculum (~ conidia) delivered to alveoli Recapitulates human disease Reproducible outcome between different experiments and laboratories Late mortality Allows multiple time point sampling without survivor bias Mortality complete by 14 days Sheppard. AAC 24;48:198 Sheppard. AAC 26;5:351

4 Key Question: Model Refinement/Diagnostic Targets Neutropenic vs. Non-neutropenic Model Neutropenic: Cyclophosphamide at 25 mg/kg SC on day -2 and 2 mg/kg SC on day +3 of infection Cortisone acetate at 5 mg/mouse SC on days -2 and +3 of infection Non-neutropenic: Cortisone acetate at 1 mg/mouse SC on days -4, -2, 2+2+4, +2, +4 of fif infection Ceftazidime IP while immunosuppressed

5 Effects of Different Types of Immunosuppression on Mouse Survival Neutropenic (Cortisone Acetate + Cyclophosphamide) Non-neutropenic (Cortisone Acetate) % Survival 5 25 Survival % Spikes. JID 28;197:479

6 More Rapid Development of Disease in Day 4 Neutropenic (Cortisone Acetate + Cyclophosphamide) the Non-neutropenic Model Non-neutropenic (Cortisone Acetate) Chiang. I&I 28;76:3429

7 Lung GM Levels are Higher in Non- Neutropenic Mice Neutropenic (Cortisone Acetate + Cyclophosphamide) Non-neutropenic (Cortisone Acetate) GM Con ncentration n (U/g lung) Infected Uninfected

8 Serum GM Levels are Higher in Neutropenic Mice Neutropenic Non-neutropenic (Cortisone Acetate (Cortisone Acetate) + Cyclophosphamide) 4 4 GM Conce entration (U/m ml)

9 The Pulmonary Cytokine Response is Different in Neutropenic vs. Non-neutropenic Mice Infected Uninfected Day 2 Day 4 Day 6 Day 8 Day 2 Day 4 Day 6 Day 2 Day 4 Day 6 Day 8 Day 2 Day 4 Day 6 Chiang. I&I 28;76:3429

10 Effects of Different Types of Immuno- suppression on Virulence Mechanisms Neutropenic Non-neutropenic 75 AF293 glip mutant 75 % Survival 5 % Survival AF293 ace2 mutant 75 % Survival 5 % Survival Spikes. JID 28;197:479; Ejzykowicz. Molec Microbiol 29;72:155

11 Posaconazole is Highly Efficacious in the Neutropenic Model Percent Su urvival AF293 Controls 8 PSC 4 mg/kg LAMB 1 mg/kg 6 AMB 3 mg/kg Days Post Challenge Lungs Log 1 CFU/g AF293 1 h Controls PSC 4 mg/kg LAMB 1 mg/kg AMB 3 mg/kg N>18 mice/group. All treatments prolonged survival p<.15. N= 15 for 1h. N>3 mice/group. All treatments reduced lung fungal burden compared to controls p<.213. Najvar LK, et al, ICCAC 27 (abstract M-1848)

12 Posaconazole is Less Efficacious in the Non-neutropenic Model Percent Surv vival A Inoc: 5.3 x 1 8 Conidia/mL Control PSC 4 mg/kg LAMB 1 mg/kg g AMB 3 mg/kg Uninfected Controls ival Percent Survi B Inoc: 7.4 x 1 7 Conidia/mL 8 Controls PSC 4 mg/kg 6 LAMB 1 mg/kg AMB 3 mg/kg 4 Uninfected Controls Days Post Challenge Days Post Challenge N=1 mice/group. Controls all succumbed by day 4 or 8. The median survival was prolonged for LAMB (p=.6) in A and both PSC (p=.7) and LAMB (p=.9) prolonged survival in B. Najvar LK, et al, ICCAC/IDSA 28 (abstract M-1561) 12

13 No Therapy Reduced Pulmonary Tissue Burden in the Non-neutropenic Model CFU CE Log 1 CFU/g Lun ngs h Controls PSC 4 LAMB 1 AMB 3 Lo og1ce/g Lungs h Controls PSC 4 LAMB 1 AMB 3 Inoculum: 7.4 x 1 7 Conidia/mL. N= 5-1 mice/group. No therapy reduced the fungal burden. Najvar LK, et al, ICCAC/IDSA 28 (abstract M-1561) 13

14 Summary Neutropenic Non- neutropenic Mortality Late Early Pulmonary GM Low High Serum GM High Low Influence of AF virulence factors on mortality Low High Response to posaconazole Good Poor

15 Contributors t and Collaborators Harbor-UCLA Hong Liu Lisa Chiang Norma Solis Daniele Ejzykowics McGill University Don Sheppard Fabrice Gravelat UT San Antonio Tom Patterson Laura Najvar William Kirkpatrick Ana Vallor Rosie Bocanegra Marcos Olivo Destiny Molina