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Questions And Answer

• Overview

  Fumagillin is an antibiotic derived from the fungus Aspergillus fumigatus. It has widely been used both in human and veterinary medicine. It has appeared to be the most effective medicine in supressing cryptosporidiosis and microsporidiosis caused by Enterocytozoon bieneusi which can be fatal in HIV-infected persons^{[1, 2]}. Due to its antiparasitic efficacy fumagillin has also been widely applied in veterinary medicine against microsporidiosis of bees and fish^[3-5]. Fumagillin is very stable in honey^[6] even at higher temperatures; for example it was detectable after having been kept at 80oC for 35 days^[7]. Mixed with syrup it is very effective in supressing Nosema in hibernating honeybee colonies. However, it has not been effective against dormant spores of Nosema apis, thus has never eliminated the disease in the bee colony entirely.
  Fumagillin has also been used in the treatment of microsporidiosis in fish including the ones caused by Myxobolus cerebralis^[4,8] and Tetracapsuloides bryosalmona^[9-11]. It is effective in curing microsporidial keratoconjunctivitis^{[12, 13]}. Taken in orally it has appeared highly effective against chronic Enterocytozoon bieneusi infections in patients with AIDS and other types of immunodeficiencies^[14]. For further administration, however, appropriate therapeutical models should be completely improved and side effects of the treatment should be eliminated^[15].
  
  Figure 1 the chemical structure of fumagillin;;

• Indications and usage

  Fumagillin is applied against microsporidian infections and diseases in apiculture and in human medicine. Nosema disease is one of the most prevalent diseases encountered in apiculture1 and is now known to be caused by two species of single-cellular microsporidian parasites, N. apis and N. ceranae^[16]. The phylum Microsporidia is composed of more than 160 genera and about 1300 different species^{[17, 18]}. On the basis of molecular evidence, microsporidia are now considered to be highly specialized parasitic fungi^{[19, 20]}. N. ceranae infects the bee digestive tract midgut epithelial cells[ventriculus] of adult workers and queens^[21]. Similar to N. apis, the mature spores burst forth by rupturing the epithelial cells and spill into the midgut lumen, followed by defecation with the fecal matter. Infection spreads via a fecal−oral route when adult worker bees contract the infection by cleaning up fecal material originating from infected bees or through trophallaxis of contaminated food^{[22, 23]}. Infection with N. ceranae has been shown to increase precocious foraging in worker bees, resulting in reduced life expectancy by 9 days on average in cage trials as compared with control groups^[24]. Although outward signs of Nosema spp. infection cannot typically be seen, the inhibition of pollen digestion caused by the parasites leads to poor nourishment, smaller populations, reduced honey production, and higher winter colony mortality^[25].
  Fumagillin is a naturally occurring antibiotic compound that was first isolated in 1949 from an Aspergillus species, designated H-346 and later identified as Aspergillus fumigatus^[26]. The drug was also discovered to be a potent amebicide^[27]. The structure of fumagillin was eventually elucidated^[28] through an extensive series of chemical manipulations, including the hydrolysis of fumagillin to yield the alcohol fumagillol. The importance of fumagillin as a treatment against the microsporidian fungal disease N. apis plaguing the European honey bee[A. mellifera L.] was soon recognized^[29]. Fumagillin is also currently the only effective drug treatment available against N. ceranae^{[30, 31]}. The commercial formulation of fumagillin consists of the dicyclohexylamine[DCH] salt of fumagillin. Fumagillin was also tested for the treatment of microsporidian infections in fish^[32].
  In human medicine, fumagillin is used as an inhibitor of microsporidian infections in patients with compromised immune systems due to acquired immunodeficiency syndrome(AIDS) or to relieve symptoms of intestinal microsporidiosis that occur after organ transplant procedures^{[33, 34]}. More interestingly, though, fumagillin and its analogues are used to treat various cancers by inhibiting the formation of new blood vessels around growing tumors(angiogenesis), thereby limiting their blood supply^[35]. ;

• Mode of action

  Fumagillin binds only to the MetAP-2 enzyme via the epoxide group located on the cyclohexane core ring structure and not to the MetAP-1 enzyme^[36]. The other remaining epoxide on the molecule is not crucial for the binding to take place and is therefore dispensable.
  MetAP-2 enzymes are found ubiquitously in all organisms^[37]. Fumagillin acts against microsporidian as well as mammalian MetAP-2 enzyme, and the low selectivity of fumagillin between human and microsporidian MetAP-2 is the cause of its toxicity to humans as it also inhibits the human MetAP-2 enzyme necessary in protein maturation and post-translation processes^[38]. A similar observation was recently reported whereby it was shown that fumagillin is active against honey-bee MetAP2 at low concentrations, whereas it has no therapeutic activity at those concentrations against N. ceranae MetAP-2^[38]. ;

• Toxicity

  Although fumagillin is an extremely beneficial compound in human medicine and in apiculture, some undesirable side effects cannot be ignored^[33-35], Extended usage of fumagillin over prolonged periods of time, as required by chemotherapy, caused severe body weight loss of >15% from the starting weight in human test subjects^[40]. In 1952, it was reported that fumagillin was essentially nontoxic to humans at oral doses of up to 50 mg daily for durations of 2 weeks to treat intestinal amebiasis^[39]. Although no weight loss was observed in test subjects. A more recent study administered fumagillin orally up to 60 mg daily for 2 weeks to treat microsporidiosis in patients with HIV infection^[33]. The authors acknowledged significant bone marrow toxicity of fumagillin with 4 patients of a group of 11 developing severe toxic side effects at the highest dosage administered (60 mg). These effects ceased within days of the treatment being terminated.
  Common side effects in human trials in which fumagillin is administered orally are gastrointestinal-related cramping, diarrhea, and significant loss of body weight^[40]. This undesirable weight loss side effect prompted recent, perhaps ethically questionable, trial use of fumagillin as a chemical mitigation for obesity^[41].
  Fumagillin was observed to exhibit significant negative chromosomal aberration effects at 50−75 mg/kg body weight in mice. Concentrations of 25, 50, and 75 mg/kg body weight were administered by gavage^[42]. All experimental dosages listed above induced significant antiproliferative and genotoxic potential in mice^[43]. Fumagillin exhibited clastogenic activity in human lymphocytes at concentrations equivalent to the therapeutic dose in beekeeping^[44]. Genotoxicity to mouse bone marrow cells at concentrations of 10−20 mg/kg body weight administered in vivo to mice by gastric probe (5, 10, and 20 mg/kg concentrations tested), as compared to a control group, was also observed^[45]. These results were confirmed with fumagillin-induced chromosomal aberrations at 10−20 mg/kg in mouse bone marrow cells^[46]. In summary, the Stanimirovic? group concluded that fumagillin DCH is a mutagenic formulation, both in vitro and in vivo.
  After the treatment of Nosema apis-infected bees with fumagillin the electron-density of the mitochondrial matrix in corpora allata increased and the dimensions of the mitochondria diminished in comparison with untreated infected bees.^[47]. Fumagillin produced certain effects on secretion granules of hypopharyngeal glands of bees which increased and had homogeneous structure, which is explained by the changes in secretory activities of gland^[48]. It was confirmed that fumagillin largely increased mortality in bees as well as the number of fungi. ;

• References

  1. MOLINA, J.M., L. GOGUEL, C. SARFATI, J.F. MICHIELS, I. DESPORTES-LIVAGEL, S. BALKAN et al.[2000]: Trial of oral fumagillin for the treatment of intestinal microsporidiosis in patients with HIV infection. AIDS 14, 1341-1348.
  2. CONTEAS, C.N., O.G. BERLIN, L.R. ASH, J.S. PRUTHI[2000]: Therapy for human gastrointestinal microsporidiosis. Am J Trop Med Hyg. 63, 121-127.
  3. BAILEY, L.[1953]: Effect of fumagillin upon Nosema apis[Zander]. Nature 171:112-213.
  4. EL-MATBOULI, M., R.W. HOFFMANN[1991]: Prevention of experimentally induced whirling disease in rainbow trout Oncorhynchus mykss by Fumagillin. Dis Aquat Organ. 10, 109-113.
  5. MORRIS, D.J., A. ADAMS, P. SMITH, R.H. RICHARDS[2003]: Effects of oral treatment with TNP-470 on rainbow trout[Oncorhynchus myksis] infected with T etracapsuloides bryosalmonae[Malacosporea], the causative agent of proliferative kidney disease. Aquaculture 221, 51-64.
  6. FURGALA, B.[1962]: Residual fumagillin activity in sugar syrup stored by wintering honeybee colonies. J Apic Res. 1, 35-37.
  7. ASSIL, H.I., P. SPORNS[1991]: ELISA and HPLC methods for analysis of fumagillin and its decomposition products in honey. J Agr Food Chem. 39, 2206-2213.
  8. KATZNELSON, H., C.A. JAMIESON[1952]: Control of Nosema disease of honey-bees with fumagillin. Science 115, 70-71.
  9. HEDRICK, R.P., J.M. GROFF, T. MCDOWELL[1988]: Oral administration of Fumagillin DCH protects Chinook salmon Oncorhynchus tshawytscha from experimentally-induced proliferative kidney disease. Dis Aquat Organ. 4, 165-168.
  10. KENT, M.L., S.C. DAWE[1994]: Efficacy of fumagillin DCH against experimentally-induced Loma salmonee[Microsporea] infections in Chinook salmon Oncorhynchus tshawytscha. Dis Aquat Organ. 20,231-133.
  11. LE GOUVELLO, R., T. POBEL, R.H. RICHARDS, C. GOULD[1999]: Field efficacy of a 10-day treatment of fumagillin against proliferative kidney disease in rainbow trout Oncorhynchus mykiss. Aquaculture 171, 27-20.
  12. ROSERGER, D.F., O.N. SERDARA VIC, R.A. EVLANDSON, R.T. BRY AN, D.A. SCHW ARTZ et al.[1993]: Successful tretmant of mikrosporidial keratoconjuctivitis with topical fumagillin in a patient with AIDS. Cornea 12, 261-265.
  13. WILKINS, J.H., N. JOSHI, T.P. MARGOLIS, V. CEVALLOS, D.R. DAWSON[1994]: Microsporidial keratoconjunctivitis treated successfully with a short coures of fumagillin. Eye 8: 703-704.
  14. MOLINA, J.M., M. TOURNEUR, C. SARFATI, S. CHEVRET, A. DE GOUVELLO et al.[2002]: Fumagillin treatment of intestinal microsporidiosis. New Engl J Med. 346, 1963-1969.
  15. CONTEAS, C.N., O.G. BERLIN, L.R. ASH, J.S. PRUTHI[2000]: Therapy for human gastrointestinal microsporidiosis. Am J Trop Med Hyg. 63, 121-127.
  16. Genersch, E. Honey bee pathology: current threats to honey bees and beekeeping. Appl. Microbiol. Biotechnol. 2010, 87, 87−97.
  17. Didier, E. S.; Weiss, L. M. Overview of microsporidia and microsporidiosis. Protistology 2008, 5, 243−255.
  18. Franzen, C. Microsporidia: a review of 150 years of research. Open Parasitol. J. 2008, 2, 1−34.
  19. Weiss, L. M.; Edlind, T. D.; Vossbrinck, C. R.; Hashimoto, T. Microsporidian molecular phylogeny: the fungal connection. J. Eukaryot. Microbiol. 1999, 46, 17S−18S.
  20. Sina, M.; Alastair, G.; Farmer, M.; Andersen, R.; Anderson, O.; Barta, J.; Bowser, S.; Brugerolle, G.; Fensome, R.; Fredericq, S.; James, T.; Karpov, S.; Kugrens, P.; Krug, J.; Lane, C.; Lewis, L.; Lodge, J.; Lynn, D.; Mann, D.; Maccourt, R.; Mendoza, L.; Moestrup, O.; Mozley, S.; Nerad, T.; Shearer, C.; Smirnov, A.; Spiegel, F.; Taylor, M. The new higher level classification of eukaryotes with emphasis on the taxonomy of protists. J. Eukaryot. Microbiol. 2005, 52, 399−451.
  21. Traver, B. E.; Fell, R. D. Low natural levels of Nosema ceranae in Apis mellifera queens. J. Invertebr. Pathol. 2012, 110, 408−410.
  22. Higes,M.;Marti?n-Hernan?dez,R.;Garcia-Palencia,P.;Martin, P.; Meana, A. Horizontal transmission of Nosema ceranae[Microsporidia] from worker honeybees to queens[Apis mellifera]. Environ. Microbiol. Rep. 2009, 1, 495−498.
  23. Smith, M. L. The honey bee parasite Nosema ceranae: transmissible via food exchange? PLoS One 2012, 7, e43319[accessed Feb 25, 2014].
  24. Goblirsch, M.; Huang, Z. Y.; Spivak, M. Physiological and behavioral changes in honey bees[Apis mellifera] induced by Nosema ceranae infection. PLoS One 2013, 8, e58165[accessed Feb 25, 2014] DOI: 10.1371/journal.pone.0058165.
  25. Bailey, L.; Ball, B. V. Honey Bee Pathology, 2nd ed.; Academic Press: London, UK, 1991.
  26. Eble, T. E.; Hanson, F. R. Fumagillin, an antibiotic from Aspergillus fumigatus H-3. Antibiot. Chemother. 1951, 1, 54−58.
  27. McCowan, M. C.; Callender, M. E.; Lawlis, J. F. Fumagillin[H3], a new antibiotic with amebicidal properties. Science 1951, 113, 202−203.
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