Paracoccidioidomycosis is a deep mycosis that is endemic in Latin America. This disease is caused by Paracoccidioides brasiliensis, a fungus that undergoes thermal dimorphism, developing as yeast at body temperature and as a mycelium at room temperature (16). This fungus causes natural infections by inhalation of conidia or mycelial elements. These conidia convert to the parasitic yeast form in the lungs of mice (39). Ingested conidia or yeast-forms of P. brasiliensis readily multiplied inside murine alveolar or peritoneal macrophages; however, if they were activated by cytokines, such as IFN-γ, the multiplication was limited and conidia or yeast cells were killed (5,10). Similarly, the interaction of human phagocytic cells and yeastform of P. brasiliensis was studied in vitro and yeast cells were readily ingested by monocytes or monocytederived macrophages. However, these cells allowed P. brasiliensis multiplication, unless they were activated with IFN-γ or culture supernatants from concanavalin-A-stimulated mononuclear cells, suggesting that this activation could be responsible for iron restriction and the consequent decrease in the survival of P. brasiliensis Abstract: The mechanisms used by Paracoccidioides brasiliensis (Pb 18) to survive into monocytes are not clear. Cellular iron metabolism is of critical importance to the growth of several intracellular pathogens, including P. brasiliensis, whose capacity to multiply in mononuclear phagocytes is dependent on the availability of intracellular iron. Chloroquine, by virtue of its basic properties, has been shown to prevent release of iron from holotransferrin by raising endocytic and lysosomal pH, and thereby interfering with normal iron metabolism. Then, in view of this, we have studied the effects of CHLOR on P. brasiliensis multiplication in human monocytes and its effect on the murine paracoccidioidomycosis. CHLOR induced human monocytes to kill P. brasiliensis. The effect of CHLOR was reversed by FeNTA, an iron compound that is soluble at neutral to alkaline pH, but not by holotransferrin, which releases iron only in an acidic environment. CHLOR treatment of Pb 18-infected BALB/c mice significantly reduced the viable fungi recovery from lungs, during three different periods of evaluation, in a dose-dependent manner. This study demonstrates that iron is of critical importance to the survival of P. brasiliensis yeasts within human monocytes and the CHLOR treatment in vitro induces Pb 18 yeast-killing by monocytes by restricting the availability of intracellular iron. Besides, the CHLOR treatment in vivo significantly reduces the number of organisms in the lungs of Pb-infected mice protecting them from several infections. Thus, CHLOR was effective in the treatment of murine paracoccidioidomycosis, suggesting the potential use of this drug in patients' treatment.
Chloroquine Inhibits Paracoccidioides brasiliensis