C-reactive protein interacts with amphotericin B liposomes and its potential clinical consequences

What is it about?

Amphotericin B (AmB) is the gold standard for treating invasive fungal infections. New liposomal AmB formulations have been developed to improve efficacy and tolerability. C-reactive protein (CRP) values are widely used for monitoring infections and inflammation. CRP shows a high affinity to phosphocholine and it aggregates liposomes bearing this ligand. We studied the interaction between CRP and phosphocholine-containing liposomal AmB. Liposomal AmB (L-AmB, AmBisome®) was spiked to CRP-containing serum. CRP was monitored in patients receiving either L-Amb or AmB lipid complex (ABLC). Following addition of L-AmB to CRP-containing plasma, complex formation was observed. Also, in vivo effects were observed following intravenous AmBisome® administration: a decline in CRP values was observed. In patients receiving L-Amb, decline of CRP concentration was faster than in patients receiving ABLC. In vitro experiments suggest a complexation between CRP and liposomes in plasma. Interpretation of CRP values following administration of AmBisome® might be impaired. In vivo formation of complexes between liposomes and CRP might lead to microembolisms. Similar effects have been described following administration of Intralipid® and other liposomes.

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