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9 protocols using caspofungin cas

1

Caspofungin Susceptibility of C. auris Biofilm

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The susceptibility of a C. auris biofilm grown in the presence of Van PP to the antifungal caspofungin (CAS) (Sigma-Aldrich Co, St. Louis, MO, USA) was evaluated. Aiming at this, the C. auris biofilms were grown for 72 h, as previously described with or without Van at PP concentration, washed with NaCl 0.9%, and treated with CAS (ranging from 2.5 to 50 µg mL−1). After 24 h further incubation, total biofilm biomass was quantified.
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2

Antifungal Susceptibility of Candida parapsilosis

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We calculated the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) of the twelve clinical strains of C. parapsilosis using Fluconazole (FLZ; Sigma-Aldrich, St. Louis, MO, USA), Amphotericin B (AmB; Sigma-Aldrich, USA), Nystatin (NYST; Sigma-Aldrich, USA), and Caspofungin (CAS; Sigma-Aldrich, USA). A broth microdilution assay was performed under the guidelines recommended in the standard M27 document (4th ed.) presented by the Clinical and Laboratory Standard Institute [14 ]. The stock solution of the prior mentioned drugs was prepared using dimethyl sulfoxide (DMSO; Merck, RSA) and the test concentration ranged from 1250 to 9.77 µg/mL for FLZ, 62.5 to 0.49 µg/mL for AmB, 250 to 19.5 µg/mL for NYST, and 8 to 0.06 µg/mL for CAS. Sterility and growth control were included for comparison. The plates were incubated at 37 °C for 48 h. The MIC results were determined by visual observation, where antifungal drugs with the lowest concentration inhibited the fungal growth when compared to the growth control was considered as MIC value.
For estimating MFC, 10 µL from the wells with different concentrations of antifungal drugs were subcultured onto Sabouraud dextrose agar (SDA; Merck, RSA) plates followed by incubation at 37 °C for 48 h. The MFC was determined by observing the lowest concentration with no growth on the agar plate [15 (link)].
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3

Thermal and Cell Wall Stress Response

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To analyze the impact of thermal treatment on conidiation, wild-type and relevant strains were cultured at 30, 37 and 42 °C. To obtain the impact of cell wall stress, we tested the condition of fungal growth on a medium supplemented with the following agents: calcofluor white (CFW), congo red (CR), and caspofungin (CAS) (Sigma-Aldrich, St. Louis, MO, USA). In order to test the restorative effect of calcium on fungal growth, 50 mM of CaCl2 was added to the medium. The operation process was as follows: 2.5 μL of the conidia (1 × 106 conidia·mL−1) of the indicated strains were spotted onto relevant media and cultured for 2.5 days. Finally, the colony diameter was measured, and the total spore quantity of all strains was counted. At least three replicates were performed for each experiment.
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4

Synthesis and Evaluation of Azole Derivatives

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Azole derivatives 1–28 were purchased or chemically synthesized as described above. A 5 mg/mL stock solution of compounds 1–28 was prepared in DMSO and stored at −20 °C in the dark (foiled wrapped). The antifungal agents amphotericin B (AmB), fluconazole (FLC), and voriconazole (VOR) were obtained from AK Scientific Inc. (Mountain View, CA). The antifungal agent caspofungin (CAS) was purchased from Sigma-Aldrich (St. Louis, MO). AmB, FLC, VOR, and CAS were dissolved in DMSO at final concentrations of 5 mg/mL and were stored at −20 °C.
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5

Antimicrobial Compound Preparation and Dissolution

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1R-Myrtenol, 96% purity, was procured from Sigma-Aldrich (Sigma-Aldrich Co., St. Louis, MO, USA) and dissolved in 5% dimethyl sulfoxide (DMSO) and 2% Tween 80 at a final concentration of 100 mg mL−1. Stock solutions of antimicrobial drugs caspofungin (CAS) (Sigma-Aldrich Co., St. Louis, MO, USA), and meropenem (MEM) (TCI EUROPE N.V. Boerenveldseweg, Zwijndrecht, Belgium) were used in this study and were dissolved in 5% DMSO at 25 mg mL−1 and 20 mg mL−1, respectively.
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6

Antifungal Combination Screening Protocol

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In this study, seven antifungal agents representing the four major antifungal classes were tested alone or in combinations, forming 21 different combinations. The antifungals tested were caspofungin (CAS; Sigma–Aldrich, St. Louis, MO, USA), fluconazole (FLC; Sigma–Aldrich), itraconazole (ITC; Sigma–Aldrich), voriconazole (VRC; TCI America, Portland, OR, USA), posaconazole (POS; Sigma–Aldrich), amphotericin B (AMB; Sigma–Aldrich), and 5-flucytosine (5FC; Sigma–Aldrich). All antifungals were preserved in a dark environment in specific temperatures as recommended by the manufacturer.
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7

Antifungal Drug Susceptibility Assay

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Antifungal drug susceptibility was determined following EUCAST EDef 7.2 standards [28 (link)]. Amphotericin B (AMB), fluconazole (FLZ), posaconazole (POS), and voriconazole (VRZ) were obtained from Discovery Fine Chemicals Ltd. (Bournemouth, UK), caspofungin (CAS) from Merck Sharp & Dohme Corp (MSD, Haar, Germany), and micafungin (MFG) from Astellas. Minimum inhibitory concentration (MIC) values were determined after 24 h at 37 °C.
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8

Antifungal Drugs Preparation Protocol

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Amphotericin B (AMB) (Sigma Chemical Co. – St. Louis, MO, USA), fluconazole (FCZ) (Sigma Chemical Co. – St. Louis, MO, USA), itraconazole (ITZ) (Frangon of Brazil, Pharmaceutical, Ltd., São Paulo, Brazil), caspofungin (CAS) (Merck, Darmstadt, Germany), and tacrolimus (FK506) (Janssen-Cilag Pharmaceutica, Beerse, Belgium) were employed.
The stock solutions of the drugs were prepared in dimethyl sulfoxide (DMSO, Sigma Chemical Co.), except for FCZ, which was diluted in sterile distilled water. FK506 was dissolved in methanol. Working solutions were prepared according to the document M27-A3 of the Clinical and Laboratory Standards Institute.21
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9

Antifungal Susceptibility Testing Protocol

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The 227 isolates were tested for in vitro antifungal susceptibility using the broth microdilution method as recommended by the protocol E.DEF9.3 of European Committee on Antimicrobial Susceptibility Testing (EUCAST) (EUCAST-E.DEF 9.3)1. The reference powders of amphotericin B (AMB, Sigma-Aldrich), L-AMB (Gilead), ANI (Pfizer), caspofungin (CAS, Merck), ITZ (Sigma-Aldrich), VCZ (Pfizer), PCZ (Fluka, Sigma-Aldrich), and ICZ (Basilea Pharmaceutica) were tested with a final concentration of 0.032-16 mg/L. Minimal inhibitory concentrations (MICs) for AMB, L-AMB, and azoles, and minimal effective concentrations (MECs) for ANI and CAS were assessed. Quality control was assured using the strains recommended by EUCAST: Candida krusei ATCC6258 and A. fumigatus ATCC204305.
Considering the clinical breakpoints (CBPs) and epidemiological cut-offs (ECOFFs), available on EUCAST website (2017), was assessed the presence of resistant (R) and non-wild type (NWT) strains, respectively. For all Aspergillus species without CBPs or ECOFFs, were adopted the values established for A. fumigatus.
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