In vivo activity of Sapindus saponaria against azole-susceptible and -resistant human vaginal Candida species

<p>Abstract</p> <p>Background</p> <p>Study of <it>in vivo </it>antifungal activity of the hydroalcoholic extract (HE) and n-BuOH extract (BUTE) of <it>Sapindus saponaria </it>against azole-susceptible and -resistant human vaginal <it>Candida </it>spp.</p> <p>Methods</p> <p>The <it>in vitro </it>antifungal activity of HE, BUTE, fluconazole (FLU), and itraconazole (ITRA) was determined by the broth microdilution method. We obtained values of minimal inhibitory concentration (MIC) and minimum fungicide concentration (MFC) for 46 strains of <it>C. albicans </it>and 10 of <it>C. glabrata </it>isolated from patients with vulvovaginal candidiasis (VVC). VVC was induced in hyperestrogenic Wistar rats with azole-susceptible <it>C. albicans </it>(SCA), azole-resistant <it>C. albicans </it>(RCA), and azole-resistant <it>C. glabrata </it>(RCG). The rats were treated intravaginally with 0.1 mL of HE or BUTE at concentrations of 1%, 2.5% and 5%; 100 μg/mL of FLU (treatment positive control); or distilled water (negative control) at 1, 24, and 48 h after induction of the infection, and the progress of VVC was monitored by culturing and scanning electron microscopy (SEM). The toxicity was evaluated in cervical cells of the HeLa cell line.</p> <p>Results</p> <p>The extracts showed <it>in vitro </it>inhibitory and fungicidal activity against all the isolates, and the MIC and MFC values for the <it>C. glabrata </it>isolates were slightly higher. <it>In vivo</it>, the SCA, RCA, and RCG infections were eliminated by 21 days post-infection, with up to 5% HE and BUTE, comparable to the activity of FLU. No cytotoxic action was observed for either extract.</p> <p>Conclusions</p> <p>Our results demonstrated that HE and BUTE from <it>S. saponaria </it>show inhibitory and fungicidal activity <it>in vitro</it>, in addition to <it>in vivo </it>activity against azole-resistant vaginal isolates of <it>C. glabrata </it>and azole-susceptible and resistant isolates of <it>C. albicans</it>. Also considering the lack of cytotoxicity and the low concentrations of the extracts necessary to eliminate the infection <it>in vivo</it>, HE and BUTE show promise for continued studies with purified antifungal substances in VVC yeast isolates.</p