Therapeutic targeting of growth factor receptors to treat Mucormycosis

项目总结/摘要 毛霉菌病是一种致命的侵袭性感染所造成的几种真菌生物属于亚门 毛霉亚门，毛霉目。主要的风险因素包括不受控制的糖尿病， 高血糖症和酮症酸中毒（DKA），其他形式的酸中毒，皮质类固醇治疗，实体器官或 骨髓移植、中性粒细胞减少症、创伤和烧伤（例如，在伊拉克和阿富汗受伤的士兵）， 血液透析患者的恶性血液病和去铁胺治疗。的 感染通常是通过吸入孢子获得的，孢子在自然界中无处不在， 眼眶（几乎仅在DKA患者中）或肺部（主要在血小板减少性白血病患者中）疾病。 毛霉菌病的治疗选择是有限的。目前没有疫苗，只有两种抗真菌药物 美国FDA批准用于治疗这种疾病的药物。第一种是两性霉素B（AmB）， 副作用，包括肾毒性，以及非常有限的临床成功。艾沙康唑最近在 被批准用于治疗毛霉菌病，但并不优于AmB治疗的上级。在没有手术切除 感染病灶（如鼻脑毛霉菌病患者的眼部切除），抗真菌治疗 单独治疗很少有效。即使手术清创结合大剂量抗真菌治疗， 与毛霉菌病相关的死亡率> 50%。在长期中性粒细胞减少或弥漫性 发病后，死亡率为90- 100%。此外，由于没有联邦要求报告真菌感染， 毛霉菌病的真实流行率可能比目前报告的要高得多。高得令人无法接受的 死亡率，有限的治疗选择和高度毁容手术治疗的极端发病率， 必须寻找治疗和预防毛霉菌病替代策略。我们最近发表的作品 表明毛霉目物种与宿主细胞受体结合，以便通过血管侵入宿主组织。 内皮和肺上皮。在目标1中，我们将探索阻断 毛霉目真菌与宿主细胞受体之间的相互作用。目标2将侧重于识别和表征 真菌编码的药物靶点，目的是验证新的，迫切需要的抗- 真菌疗法本文提出的工作的最终目标是开发新的抗真菌策略， 杀死真菌或破坏对肺部疾病进展重要的分子相互作用， 毛霉菌病

PROJECT SUMMARY/ABSTRACT Mucormycosis is a deadly invasive infection caused by several fungal organisms belonging to the subphylum Mucormycotina, order Mucorales. The major risk factors include uncontrolled diabetes mellitus that results in hyperglycemia and ketoacidosis (DKA), other forms of acidosis, treatment with corticosteroids, solid organ or bone marrow transplantation, neutropenia, trauma and burns (e.g., wounded soldiers in Iraq and Afghanistan), malignant haematological disorders and deferoxamine therapy in patients receiving haemodialysis. The infection is generally acquired by inhalation of spores that are ubiquitous in nature and cause either rhino- orbital (almost exclusively in DKA patients) or pulmonary (mainly in neutropenic leukemic patients) disease. The treatment options for Mucormycosis are limited. There are currently no vaccines and only two antifungal agents approved by the USA FDA to treat this disease. The first is Amphotericin B (AmB) which has serious adverse effects, including nephrotoxicity, and very limited clinical success. Isavuconazole was recently approved to treat mucormycosis but it is not superior to AmB treatment. In the absence of surgical removal of the infected focus (such as excision of the eye in patients with rhinocerebral mucormycosis), antifungal therapy alone is rarely curative. Even when surgical debridement is combined with high-dose antifungal therapy, the mortality associated with mucormycosis is >50%. In patients with prolonged neutropenia or disseminated disease, mortality is 90-100%. Furthermore, since there are no federal requirements to report fungal infections, the true prevalence of mucormycosis is likely to be much higher than currently reported. The unacceptably high mortality rate, limited options for therapy and the extreme morbidity of highly disfiguring surgical therapy make it imperative to look for alternative strategies to treat and prevent mucormycosis. Our recently published work suggests that Mucorales species engage host cell receptors in order to invade host tissue through the vascular endothelium and the pulmonary epithelium. In Aim 1, we will explore the therapeutic potential of blocking the interaction between Mucorales fungi and host cell receptors. Aim 2 will focus on identifying and characterizing fungal-encoded drug targets with the goal of validating additional targets for novel, desperately needed anti- fungal therapies. The ultimate goal of the work proposed here is to develop novel antifungal strategies to either kill the fungus or disrupt molecular interactions that are important for disease progression of pulmonary mucormycosis.