Abstract
Development of new approaches for treatment of invasive fungal infections encompasses new delivery systems for approved and investigational compounds. Novel delivery systems consisting of cyclodextrins (CDs), cochleates, nanoparticles, and long-circulating ("stealth") liposomes modulate the pharmacokinetics of existing drugs, and may also be useful to enhance the delivery of antifungal agents to sites of infection. Among several promising new drug-delivery systems, liposomes represent an advanced technology for site-directed delivery of active molecules. Research on liposome technology has progressed from conventional vesicles ("first-generation liposomes") to "second-generation liposomes", in which long-circulating liposomes are obtained by modifying the surface of liposomes using several molecules, such as glycolipids, sialic acid, or synthetic polymer poly-(ethylene glycol) (PEG), resulting in prolonged reticulo-endothelial system uptake and serum half-life, thus increasing the therapeutic efficacy of drugs. At present, several formulations for amphotericin B are in clinical use for fungal infections in Europe and the United States. Nanoformulations have also been applied as drug delivery systems (DDSs), with great success. Finally, progress in the design of DDSs has led to the development of carriers targeted to specific tissues and cells. Efforts are now going on to improve their stability in the biological environment, to mediate the biodistribution of active compounds, and to improve drug loading, targeting, transport, release, and interaction with biological barriers. This chapter discusses the state of the art in the field of DDSs, used for control of systemic fungal infections.