The Antifungal effect of antimicrobial peptide LL-37 on the fungal infections in acute myeloid leukemia patients | ||||
| Microbes and Infectious Diseases | ||||
| Articles in Press, Accepted Manuscript, Available Online from 05 July 2025 | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/mid.2025.396361.2930 | ||||
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| Authors | ||||
Mohammed Khudhair Alwan  1; Kais Kassim Ghaima1; Bassam Francis Matti2
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| 1Institute of Genetic Engineering and Biotechnology for Postgraduate Studies, University of Baghdad, Baghdad, Iraq | ||||
| 2Baghdad Teaching Hospital, Clinical Hematology Department, Medical City, Baghdad, Iraq | ||||
| Abstract | ||||
| Background: Acute myeloid Leukemia (AML) is a type of blood cancer leading to abnormal function of blood and immunity cells. Chemotherapy represents the most effective approach for AML; however, it occurs at the expense of a decreased immune defence and thus increases the susceptibility to microbial infections, which contributes to high mortality and morbidity in AML patients. Objectives: The epidemiology of fungal strains varies globally and is influenced by multiple factors. Antifungal susceptibility testing (AFST) is essential for assessing disease burden and developing treatment strategies, especially with rising resistance to conventional therapies. The antimicrobial peptide ll-37 is a promising alternative due to its ability to disrupt microbial membranes and enhance immune responses. Methods: 130 specimens from 100 AML patients’ post-induction chemotherapy in the medical city of the capital Baghdad were collected and cultured on desired fungal media. Isolation, identification, and AFST were conducted using the d2mini Microbial ID/AST System following Clinical and Laboratory Standards Institute (CLSI) guidelines. The minimum inhibitory concentration (MIC) of peptide LL-37 was determined using the microdilution assay with resazurin dye. Results: The female AML patients were 58 (58%), while males were 42 (42%) with a median age of 45.5 years, and the most prevalent age was adults. Fungal cultures were positive in 27(20.76%) of samples. The samples were collected from various sites, sputum being the most common as positive culture10(37.04%), followed by nasal and respiratory secretion 7(25.92%), wound swabs and urine were 3(11.11%), and blood and skin were 2(7.41%) for each one. Yeast fungi accounted for 17(62.96 %) of isolates, including Candida albicans 9(33.34%), Candida tropicalis 5(18.52%) and Candida parapsilosis 3(11.11%). Filamentous fungi made up10(37.04%), were Aspergillus fumigatus 4(14.81%) Aspergillus flavus 4(14.81%) and Aspergillus niger 2(7.41%). The study revealed significant variability in antifungal susceptibility among the tested isolates. According to the findings, Candida albicans showed the highest susceptibility to fluconazole (77.78%), while C. parapsilosis was resistant (100%), and C. tropicalis was highly resistant (80%). Of the Aspergillus spp, A. fumigatus demonstrated the greatest resistance to voriconazole (75%) and posaconazole (50%), although all isolates were wild type (WT) for isavuconazole and amphotericin B. All A. niger isolates were 100% WT for voriconazole, isavuconazole, and caspofungin, whereas it had 50% NWT rates for itraconazole, posaconazole, and amphotericin B. Isavuconazole and amphotericin B were 100% WT against A. flavus and had high NWT rates against caspofungin (75%). It was found that the antimicrobial peptide LL-37 demonstrated excellent fungicidal activity against most of these planktonic Candida isolates. The MICs of the antimicrobial peptide LL-37 for Candida spp isolates ranged from (15.62 – 125) µg/ml, while Aspergillus spp isolates were from (31.25 – 250) µg/ml. Conclusion: Understanding local epidemiology and utilizing ll-37 as an effective antifungal treatment can improve infection management, particularly in AML patients, potentially enhancing survival rates through better therapeutic and prophylactic strategies. | ||||
| Keywords | ||||
| Acute myeloid leukemia; (AML); Antimicrobial peptides (AMPs); Antifungal susceptibility test (AFST). Peptide LL-37 | ||||
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