Antifungal activity of linalool against fluconazole-resistant clinical strains of vulvovaginal Candida albicans and its predictive mechanism of action

Candida albicans is the most frequently isolated opportunistic pathogen in the female genital tract, with 92.3% of cases in Brazil associated with vulvovaginal candidiasis (VVC). Linalool is a monoterpene compound from plants of the genera Cinnamomum, Coriandrum, Lavandula, and Citrus that has demonstrated a fungicidal effect on strains of Candida spp., but its mechanism of action is still unknown. For this purpose, broth microdilution techniques were applied, as well as molecular docking in a predictive manner for this mechanism. The main results of this study indicated that the C. albicans strains analyzed were resistant to fluconazole and sensitive to linalool at a dose of 256 µg/mL. Furthermore, the increase in the minimum inhibitory concentration (MIC) of linalool in the presence of sorbitol and ergosterol indicated that this molecule possibly affects the cell wall and plasma membrane integrity of C. albicans. Molecular docking of linalool with proteins that are key in the biosynthesis and maintenance of the cell wall and the fungal plasma membrane integrity demonstrated the possibility of linalool interacting with three important enzymes: 1,3-β-glucan synthase, lanosterol 14α-demethylase, and Δ 14-sterol reductase. In silico analysis showed that this monoterpene has theoretical but significant oral bioavailability, low toxic potential, and high similarity to pharmaceuticals. Therefore, the findings of this study indicated that linalool probably causes damage to the cell wall and plasma membrane of C. albicans, possibly by interaction with important enzymes involved in the biosynthesis of these fungal structures, in addition to presenting low in silico toxic potential.

Análise sobre a fitoterapia como prática integrativa no Sistema Único de Saúde / Analysis about phytotherapy as an integrating practice in the Brazilian Unified Health System (UHS)

É notável o crescente uso da fitoterapia como prática médica integrativa em diversos países. A utilização de plantas medicinais no Brasil tem como facilitadores a grande diversidade vegetal e o baixo custo associado à terapêutica, o que vem despertando a atenção dos programas de assistência à saúde e profissionais. O Ministério da Saúde, com a finalidade de evitar o uso inadequado desta prática medicinal, tem demonstrado interesse por meio do incentivo de pesquisas relacionadas ao assunto, favorecendo a implantação de programas de saúde visando à distribuição e utilização destes medicamentos de forma racional. Baseado neste contexto foi realizado levantamento de como esta temática vem sendo abordada e implementada no Sistema Único de Saúde (SUS). Trata-se de estudo descritivo com abordagem qualitativa, realizado através de levantamento bibliográfico em bases de dados relacionado ao tema "medicamentos fitoterápicos no sistema único de saúde". Os descritores utilizados durante toda a pesquisa foram fitoterapia, medicamentos fitoterápicos, medicina integrativa, medicamentos, medicina herbária, fitoterapia no SUS, medicina integrativa e sistemas públicos de saúde. Observou-se que o governo tem demonstrado interesse no desenvolvimento de políticas que associem o avanço tecnológico ao conhecimento popular em prol de procedimentos assistenciais em saúde que apresentem eficácia, abrangência, humanização e menor dependência com relação à indústria farmacêutica. Nas duas últimas décadas, alguns estados e municípios brasileiros vêm realizando a implantação de Programas de Fitoterapia na atenção primária à saúde, com o intuito de suprir as carências medicamentosas de suas comunidades. Apesar da crescente busca por integrativas medicamentosas, os estudos acerca da fitoterapia ainda são precários no Brasil, fazendo-se ainda necessárias pesquisas nesta área, de modo a ampliar o conhecimento dos profissionais e estudantes da saúde, auxiliando e tornando mais sólidas as bases de segurança e eficácia para implementação das praticas fitoterápicas no SUS.

The growing use of phytotherapy as an integrating medical practice in several countries has been remarkable. The use of medicinal plants in Brazil is facilitated by the plant diversity and low cost associated with therapeutics, which has called the attention of health assistance programs and professionals. The Brazilian Ministry of Health, in order to avoid misuse of this medical practice, has demonstrated interest, developing policies that encourage research related to this issue and favoring the establishment of health programs focused on the distribution and use of these drugs in a rational way. Based on this context, a survey about how this issue has been addressed and implemented in the Unified Health System (UHS) was carried out. This was a descriptive study of qualitative approach, performed through a literature review in databases, related to the theme "phytotherapic medicines in the unified health system". The key words used throughout the study were: phytotherapy, phytomedicines, integrating medicine, medicines, herbal medicine, phytotherapy in the UHS, integrating medicine and public health systems. The government has shown interest in developing policies which combine technological advances with common knowledge for the sake of assistance health procedures that show effectiveness, coverage, humanization and less dependence on the pharmaceutical industry. In the last two decades, some Brazilian states and municipalities have implemented Phytotherapy Programs in primary health care in order to meet the drug needs of their communities. Despite the growing search for integrating drugs, studies about phytotherapy are still limited in Brazil, with the need of research in this area in order to increase the knowledge of health professionals and students, helping and making more solid the safety and efficacy bases for the implementation of phytotherapic practices in the UHS.