c Amphotericin B (AMB) is an effective antifungal agent. However, its therapeutic use is hampered by its toxicity, mainly due to channel formation across kidney cell membranes and the disruption of postendocytic trafficking. We previously described a safe injectable AMB-arabinogalactan (AG) conjugate with neutralized toxicity. Here we studied the mechanism of the toxicity of free AMB and its neutralization by conjugation with AG. AMB treatment of a kidney cell line modulated the trafficking of three receptors (C-X-C chemokine receptor type 4 [CXCR4], M1 receptor, and human transferrin receptor [hTfnR]) due to an increase in endosomal pH. Similar data were also obtained in yeast but with an increase in vacuolar pH and the perturbation of Hxt2-green fluorescent protein (GFP) trafficking. The conjugation of AMB with AG neutralized all elements of the toxic activity of AMB in mammalian but not in fungal cells. Based on these results, we provide an explanation of how the conjugation of AMB with AG neutralizes its toxicity in mammalian cells and add to the knowledge of the mechanism of action of free AMB in both fungal and mammalian cells.
Opportunistic fungal infections have emerged as an important cause of morbidity and mortality in immunodeficient patients (34). Amphotericin B (AMB) is considered one of the most effective antifungal agents; it exhibits wide-spectrum activity against both filamentous and yeast-like fungi, its pharmacokinetic and pharmacodynamic profiles are superior to those of other antifungal agents, and it is fungicidal, in contrast to most azoles which are fungistatic (3,39,53). The fungicidal effect is important, since most patients suffering from invasive fungal infections are immunocompromised (34). However, the infusionrelated and cumulative toxicities, particularly nephrotoxicity (14,20,30), of AMB have resulted in reductions in the routine use of deoxycholate micellar AMB formulations and the development of less-toxic high-cost lipid AMB formulations (16,36). To develop a soluble, less-toxic, and less costly formulation, AMB has been conjugated with various soluble macromolecules (18,37,(47)(48)(49).We conjugated AMB with arabinogalactan (AG) (18), which significantly increased the water solubility of AMB, reduced its toxicity, and resulted in an efficacy similar to that of Fungizone (a deoxycholate micellar formulation) and AmBisome (a lipid-based formulation) (18). AMB-related toxicity is associated with the inductions of interleukin 1 (IL-1), tumor necrosis factor ␣ (TNF-␣), and apoptosis in organs. These effects were not observed with the AMB-AG conjugate (AMB-AGC), suggesting its potential as a safer formulation for therapeutic use (19). AG is an inexpensive natural product, and the conjugation reactions are performed at room temperature, revealing promise for a potentially low-cost drug. AMB penetrates the plasma membrane (PM) and interacts with its sterols to form transmembrane channels, resulting in the leakage of monovalent ions and metabolites, which leads to cell death (5,22,4...