101
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Mbui J, Olobo J, Omollo R, Solomos A, Kip AE, Kirigi G, Sagaki P, Kimutai R, Were L, Omollo T, Egondi TW, Wasunna M, Alvar J, Dorlo TPC, Alves F. Pharmacokinetics, Safety, and Efficacy of an Allometric Miltefosine Regimen for the Treatment of Visceral Leishmaniasis in Eastern African Children: An Open-label, Phase II Clinical Trial. Clin Infect Dis 2019; 68:1530-1538. [PMID: 30188978 PMCID: PMC6481997 DOI: 10.1093/cid/ciy747] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Convenient, safe, and effective treatments for visceral leishmaniasis in Eastern African children are lacking. Miltefosine, the only oral treatment, failed to achieve adequate efficacy, particularly in children, in whom linear dosing (2.5 mg/kg/day for 28 days) resulted in a 59% cure rate, with lower systemic exposure than in adults. METHODS We conducted a Phase II trial in 30 children with visceral leishmaniasis, aged 4-12 years, to test whether 28 days of allometric miltefosine dosing safely achieves a higher systemic exposure than linear dosing. RESULTS Miltefosine accumulated during treatment. Median areas under the concentration time curve from days 0-210 and plasma maximum concentration values were slightly higher than those reported previously for children on linear dosing, but not dose-proportionally. Miltefosine exposure at the start of treatment was increased, with higher median plasma concentrations on day 7 (5.88 versus 2.67 μg/mL). Concentration-time curves were less variable, avoiding the low levels of exposure observed with linear dosing. The 210-day cure rate was 90% (95% confidence interval, 73-98%), similar to that previously described in adults. There were 19 treatment-related adverse events (AEs), but none caused treatment discontinuation. There were 2 serious AEs: both were unrelated to treatment and both patients were fully recovered. CONCLUSIONS Allometric miltefosine dosing achieved increased and less-variable exposure than linear dosing, though not reaching the expected exposure levels. The new dosing regimen safely increased the efficacy of miltefosine for Eastern African children with visceral leishmaniasis. Further development of miltefosine should adopt allometric dosing in pediatric patients. CLINICAL TRIALS REGISTRATION NCT02431143.
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Affiliation(s)
- Jane Mbui
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi
| | - Joseph Olobo
- Department of Medical Microbiology, Leishmaniasis Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Anke E Kip
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek Hospital/the Netherlands Cancer Institute, Amsterdam
| | - George Kirigi
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi
| | | | | | - Lilian Were
- Drugs for Neglected Diseases Initiative, Nairobi, Kenya
| | | | | | | | - Jorge Alvar
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Thomas P C Dorlo
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek Hospital/the Netherlands Cancer Institute, Amsterdam
| | - Fabiana Alves
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
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102
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Iranpour S, Hosseinzadeh A, Alipour A. Efficacy of miltefosine compared with glucantime for the treatment of cutaneous leishmaniasis: a systematic review and meta-analysis. Epidemiol Health 2019; 41:e2019011. [PMID: 30999735 PMCID: PMC6635659 DOI: 10.4178/epih.e2019011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/31/2019] [Indexed: 11/09/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is most common form of leishmaniasis and is characterized by ulcerative skin lesions. The objective of this study was to conduct a systematic review and meta-analysis of clinical trials that compared the efficacy of miltefosine and glucantime for the treatment of CL. We searched the following databases: Cochrane, PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform search portal of World Health Organization, Sid, Irandoc, Magiran, and clinicaltrials.gov. We used keywords including “miltefosine,” “glucantime,” and “Leishmania.” The quality of studies was assessed using the Cochrane risk of bias tool. A random-effects model was employed for the analysis. We assessed heterogeneity by the chi-square test and the I2 index statistic. When heterogeneity was present, meta-regression analyses were performed. The Egger method was used to assess publication bias; when it was significant, the trim-and-fill method was used to test and adjust for publication bias. A total of 1,570 reports were identified, of which 10 studies were included in the meta-analysis. In the meta-analysis, there was no significant difference between the efficacy of miltefosine and glucantime; however, subgroup analysis showed that, regarding parasite species other than Leishmania braziliensis, miltefosine was significantly superior to glucantime (intention to treat; relative risk, 1.15; 95% confidence interval, 1.01 to 1.32). In the meta-regression, only the glucantime injection type was significant at the p=0.1 level. The Egger test found statistically significant publication bias; however, including the 3 missing studies in the trim-and-fill analysis did not change the results. This meta-analysis found that miltefosine seems to be more effective than glucantime, at least in species other than L. braziliensis, for treating CL.
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Affiliation(s)
- Sohrab Iranpour
- Student Research Committee, Department of Epidemiology, Faculty of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Community Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ali Hosseinzadeh
- Research Center for Modeling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Alipour
- Department of Community Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Iran
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103
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Encarnacion-Dimayuga R, Murillo-Álvarez JI, Christophersen C, Chan-Bacab M, Reiriz MLG, Zacchino S. Leishmanicidal, Antifungal, and Cytotoxic Activity of Triterpenoid Glycosides Isolated from the Sea Cucumber Neothyone Gibbosa. Nat Prod Commun 2019. [DOI: 10.1177/1934578x0600100705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neothyosides A - C, isolated from the body walls of the sea cucumber Neothyone gibbosa Deichmann, and a partially purified mixture of these saponins, were tested in vitro against promastigotes of two strains of Leishmania mexicana and a panel of several fungi using the broth microdilution technique. In addition, the cytotoxicity of these saponins was tested against Artemia salina. The IR, 1H and 13C NMR spectroscopic and FAB MS data of neothyoside C revealed that its structure was identical to that of pervicoside B, isolated from another sea cucumber species, Holothuria pervicax. Neothyoside C was the most active antiparasitic compound, inhibiting 100% of the promastigotes at 5 and 10 μg/mL of both L. mexicana strains. The mixture of saponins and pure neothyoside C showed the best activity against Aspergillus niger strains with MIC values between 15.6 μg/mL and 16.7 μg/mL for the mixture, and 4.65 μg/mL and 7.8 μg/mL for neothyoside C. Assays for cytotoxicity using Artemia salina showed that neothyosides A and C caused 50% brine-shrimp deaths at 130 and 63 μg/mL with this cytotoxicity 4 to 6 times greater than the concentration at which these compounds produce an antimicrobial effect. This is the first report describing the antileishmanial, antifungal, and cytotoxic activity of N. gibbosa saponins.
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Affiliation(s)
- Rosalba Encarnacion-Dimayuga
- Universidad Autónoma de Baja California Sur, Departamento de Agronomía, Km 5.5 Carretera al Sur, A. P. 19-B, La Paz B. C. S., C. P. 23080, México
| | - Jesús Iván Murillo-Álvarez
- Universidad Autónoma de Baja California Sur, Departamento de Agronomía, Km 5.5 Carretera al Sur, A. P. 19-B, La Paz B. C. S., C. P. 23080, México
| | - Carsten Christophersen
- University of Copenhagen, Section of Marine Chemistry, Universitetsparken 5, DK-2100, Copenhagen, Denmark
| | - Manuel Chan-Bacab
- Universidad Autónoma de Campeche, Departamento de Microbiología Ambiental y Biotecnología, Av. Agustín Melgar s/n, Campeche, Campeche, C. P. 24030, México
| | - María Luz García Reiriz
- Facultad de Ciencias Farmacéuticas y Bioquímicas, Departamento de Farmacognosia, Suipacha 531, 2000 Rosario, Argentina
| | - Susana Zacchino
- Facultad de Ciencias Farmacéuticas y Bioquímicas, Departamento de Farmacognosia, Suipacha 531, 2000 Rosario, Argentina
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104
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Kwofie KD, Sato K, Sanjoba C, Hino A, Shimogawara R, Amoa-Bosompem M, Ayi I, Boakye DA, Anang AK, Chang KS, Ohashi M, Kim HS, Ohta N, Matsumoto Y, Iwanaga S. Oral activity of the antimalarial endoperoxide 6-(1,2,6,7-tetraoxaspiro[7.11]nonadec-4-yl)hexan-1-ol (N-251) against Leishmania donovani complex. PLoS Negl Trop Dis 2019; 13:e0007235. [PMID: 30908481 PMCID: PMC6433226 DOI: 10.1371/journal.pntd.0007235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/12/2019] [Indexed: 01/16/2023] Open
Abstract
Visceral leishmaniasis (VL) is a major problem worldwide and causes significant morbidity and mortality. Existing drugs against VL have limitations, including their invasive means of administration long duration of treatment regimens. There are also concerns regarding increasing treatment relapses as well as the identification of resistant clinical strains with the use of miltefosine, the sole oral drug for VL. There is, therefore, an urgent need for new alternative oral drugs for VL. In the present study, we show the leishmanicidal effect of a novel, oral antimalarial endoperoxide N-251. In our In vitro studies, N-251 selectively and specifically killed Leishmania donovani D10 amastigotes with no accompanying toxicity toward the host cells. In addition, N-251 exhibited comparable activities against promastigotes of L. donovani D10, as well as other L. donovani complex parasites, suggesting a wide spectrum of activity. Furthermore, even after a progressive infection was established in mice, N-251 significantly eliminated amastigotes when administered orally. Finally, N-251 suppressed granuloma formation in mice liver through parasite death. These findings indicate the therapeutic effect of N-251 as an oral drug, hence suggest N-251 to be a promising lead compound for the development of a new oral chemotherapy against VL.
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Affiliation(s)
- Kofi Dadzie Kwofie
- Section of Environmental Parasitology, Graduate School of Medical Dental Sciences, Tokyo Medical Dental University, Bunkyo-ku, Tokyo, Japan
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kai Sato
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Chizu Sanjoba
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akina Hino
- Section of Environmental Parasitology, Graduate School of Medical Dental Sciences, Tokyo Medical Dental University, Bunkyo-ku, Tokyo, Japan
| | - Rieko Shimogawara
- Section of Environmental Parasitology, Graduate School of Medical Dental Sciences, Tokyo Medical Dental University, Bunkyo-ku, Tokyo, Japan
| | - Michael Amoa-Bosompem
- Section of Environmental Parasitology, Graduate School of Medical Dental Sciences, Tokyo Medical Dental University, Bunkyo-ku, Tokyo, Japan
| | - Irene Ayi
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Daniel A. Boakye
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Abraham K. Anang
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Kyung-Soo Chang
- Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan, Busan, Republic of Korea
| | - Mitsuko Ohashi
- Section of Environmental Parasitology, Graduate School of Medical Dental Sciences, Tokyo Medical Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hye-Sook Kim
- Division of International Infectious Disease Control, Faculty of Pharmaceutical Sciences, Graduate School of Medicine, Dentistry Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Nobuo Ohta
- Section of Environmental Parasitology, Graduate School of Medical Dental Sciences, Tokyo Medical Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yoshitsugu Matsumoto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shiroh Iwanaga
- Section of Environmental Parasitology, Graduate School of Medical Dental Sciences, Tokyo Medical Dental University, Bunkyo-ku, Tokyo, Japan
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105
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Rijal S, Sundar S, Mondal D, Das P, Alvar J, Boelaert M. Eliminating visceral leishmaniasis in South Asia: the road ahead. BMJ 2019; 364:k5224. [PMID: 30670453 PMCID: PMC6340338 DOI: 10.1136/bmj.k5224] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Suman Rijal and colleagues highlight lessons from a regional collaboration to eliminate visceral leishmaniasis and identify priorities for the post-elimination plan
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Affiliation(s)
- Suman Rijal
- Drugs for Neglected Diseases Initiative, New Delhi, India
| | | | - Dinesh Mondal
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Jorge Alvar
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
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106
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Machado GU, Prates FV, Machado PRL. Disseminated leishmaniasis: clinical, pathogenic, and therapeutic aspects. An Bras Dermatol 2019; 94:9-16. [PMID: 30726457 PMCID: PMC6360961 DOI: 10.1590/abd1806-4841.20198775] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/11/2018] [Indexed: 11/22/2022] Open
Abstract
Disseminated leishmaniasis is a severe and emerging form of American tegumentary leishmaniasis. Disseminated leishmaniasis is defined by the presence of more than 10 polymorphic cutaneous lesions, distributed over more than two noncontiguous parts of the body. Nasal mucosal involvement is observed in almost half of cases. Disseminated leishmaniasis patients present with a decreased production of Th1 cytokines in the peripheral blood due to the attraction of leishmania- activated T cells to the multiple cutaneous lesions. Disseminated leishmaniasis development is poorly understood and is related to a complex network involving environmental, host immune response, and parasite factors, in which L. braziliensis polymorphism plays an important role. Disseminated leishmaniasis is a challenging disease to cure, presenting a high failure rate of 75% to pentavalent antimony therapy. Despite its importance and severity, this form of American tegumentary leishmaniasis has been poorly studied and documented, deserving greater attention from professionals working in endemic areas.
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Affiliation(s)
- Gustavo Uzêda Machado
- Dermatology Service, Escola Bahiana de Medicina e Saúde
Pública, Salvador (BA), Brazil
| | - Fernanda Ventin Prates
- Immunology Service, Hospital Universitário Prof. Edgar
Santos, Universidade Federal da Bahia, Salvador (BA), Brazil
| | - Paulo Roberto Lima Machado
- Immunology Service, Hospital Universitário Prof. Edgar
Santos, Universidade Federal da Bahia, Salvador (BA), Brazil
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107
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Hasnain MG, Nath P, Maruf S, Nabi SG, Hossain AFMA, Ahmed BN, Mondal D, Basher A. Amphotericin B deoxycholate for relapse visceral leishmaniasis in Bangladesh: a cross-sectional study. BMC Res Notes 2018; 11:918. [PMID: 30577877 PMCID: PMC6303843 DOI: 10.1186/s13104-018-4036-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
Objective Based on studies in India (as there was no studies from outside India) amphotericin B deoxycholate has been considered as a backup drug for treatment of visceral leishmaniasis. However, treatment response and adverse effect to anti-leishmanial drugs may vary across different populations and in Bangladesh the effect to amphotericin B deoxycholate for treatment of visceral leishmaniasis is still unknown. Therefore, there is a need to explore cure rate and adverse effects to amphotericin B deoxycholate to justify its use on visceral leishmaniasis patients in Bangladesh. Result Here we report 34 visceral leishmaniasis patients who received treatment with amphotericin B deoxycholate in the Surya Kanta Kala-azar Research Centre from December 2011 to June 2015. The dose of the treatment was 1 mg/kg body weight for 15 days followed up until 12 months after treatment. Response to amphotericin B deoxycholate treatment was excellent as all 34 patients achieved a final cure. Hypokalaemia (47%), shivering (47%), vomiting (35%) and acidity (15%) were most common adverse events. However, we did not observe any serious adverse events. Amphotericin B deoxycholate for relapse visceral leishmaniasis was found to be highly effective and safe. Our study justified to include amphotericin B deoxycholate as a second line drug for visceral leishmaniasis in Bangladesh. Electronic supplementary material The online version of this article (10.1186/s13104-018-4036-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Md Golam Hasnain
- Nutrition and Clinical Service Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. .,Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle (UoN), Callaghan, NSW, Australia.
| | - Proggananda Nath
- Infection and Tropical Medicine, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh
| | - Shomik Maruf
- Nutrition and Clinical Service Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - A F M Akhtar Hossain
- National Kala-azar Elimination Program (NKEP), Directorate General Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GoB), Dhaka, Bangladesh
| | - Be-Nazir Ahmed
- Co-ordination and Support Centre (CSC), Directorate General Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GoB), Dhaka, Bangladesh
| | - Dinesh Mondal
- Nutrition and Clinical Service Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ariful Basher
- Critical Care Medicine (CCM), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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108
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Molecular Basis of the Leishmanicidal Activity of the Antidepressant Sertraline as a Drug Repurposing Candidate. Antimicrob Agents Chemother 2018; 62:AAC.01928-18. [PMID: 30297370 DOI: 10.1128/aac.01928-18] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/28/2018] [Indexed: 12/14/2022] Open
Abstract
Drug repurposing affords the implementation of new treatments at a moderate cost and under a faster time-scale. Most of the clinical drugs against Leishmania share this origin. The antidepressant sertraline has been successfully assayed in a murine model of visceral leishmaniasis. Nevertheless, sertraline targets in Leishmania were poorly defined. In order to get a detailed insight into the leishmanicidal mechanism of sertraline on Leishmania infantum, unbiased multiplatform metabolomics and transmission electron microscopy were combined with a focused insight into the sertraline effects on the bioenergetics metabolism of the parasite. Sertraline induced respiration uncoupling, a significant decrease of intracellular ATP level, and oxidative stress in L. infantum promastigotes. Metabolomics evidenced an extended metabolic disarray caused by sertraline. This encompasses a remarkable variation of the levels of thiol-redox and polyamine biosynthetic intermediates, as well as a shortage of intracellular amino acids used as metabolic fuel by Leishmania Sertraline killed Leishmania through a multitarget mechanism of action, tackling essential metabolic pathways of the parasite. As such, sertraline is a valuable candidate for visceral leishmaniasis treatment under a drug repurposing strategy.
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109
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Kumar V, Sharma M, Rakesh BR, Malik CK, Neelagiri S, Neerupudi KB, Garg P, Singh S. Pyridoxal kinase: A vitamin B6 salvage pathway enzyme from Leishmania donovani. Int J Biol Macromol 2018; 119:320-334. [DOI: 10.1016/j.ijbiomac.2018.07.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 12/21/2022]
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110
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Pinto EG, Tempone AG. Activity of the antiarrhythmic drug amiodarone against Leishmania ( L.) infantum: an in vitro and in vivo approach. J Venom Anim Toxins Incl Trop Dis 2018; 24:29. [PMID: 30386379 PMCID: PMC6203271 DOI: 10.1186/s40409-018-0166-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/05/2018] [Indexed: 12/26/2022] Open
Abstract
Background Considering the high toxicity and limited therapies available for treating visceral leishmaniasis (VL), the drug repositioning approach represents a faster way to deliver new therapies to the market. Methods In this study, we described for the first time the activity of a potent antiarrhythmic, amiodarone (AMD), against L. (L.) infantum and its in vitro and in vivo activity. Results The evaluation against promastigotes has shown that amiodarone presents leishmanicidal effect against the extracellular form, with an IC50 value of 10 μM. The activity was even greater against amastigotes in comparison with promastigotes with an IC50 value of 0.5 μM. The selectivity index in relation to the intracellular form demonstrated that the antiparasitic activity was approximately 56 times higher than its toxicity to mammalian cells. Investigation of the in vivo AMD activity in the L. infantum-infected hamster model showed that 51 days after the initial infection, amiodarone was unable to reduce the parasite burden in the spleen and liver when treated for 10 consecutive days, intraperitoneally, at 50 mg/kg/day, as determined by qPCR. Although not statistically significant, AMD was able to reduce the parasite burden by 20% in the liver when treated for 10 consecutive days, orally, at 100 mg/kg/day; no reduction in the spleen was found by qPCR. Conclusions Our findings may help further drug design studies seeking new AMD derivatives that may provide new candidates with an in vitro selectivity close to or even greater than that observed in the prototype delivering effectiveness in the experimental model of VL.
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Affiliation(s)
- Erika G Pinto
- 1Wellcome Centre for Anti-Infectives Research, School of Life Sciences, University of Dundee, Dundee, UK
| | - Andre G Tempone
- 2Centre for Parasitology and Mycology, Instituto Adolfo Lutz, Avenida Dr. Arnaldo, 351, 8°, Andar. Cerqueira César, São Paulo, SP CEP 01246-902 Brazil
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111
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Lipase Precursor-Like Protein Promotes Miltefosine Tolerance in Leishmania donovani by Enhancing Parasite Infectivity and Eliciting Anti-inflammatory Responses in Host Macrophages. Antimicrob Agents Chemother 2018; 62:AAC.00666-18. [PMID: 30297367 DOI: 10.1128/aac.00666-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/28/2018] [Indexed: 01/02/2023] Open
Abstract
The oral drug miltefosine (MIL) was introduced in the Indian subcontinent in the year 2002 for the treatment of visceral leishmaniasis (VL). However, recent reports on its declining efficacy and increasing relapse rates pose a serious concern. An understanding of the factors contributing to MIL tolerance in Leishmania parasites is critical. In the present study, we assessed the role of the lipase precursor-like protein (Lip) in conferring tolerance to miltefosine by episomally overexpressing Lip in Leishmania donovani (LdLip++). We observed a significant increase (∼3-fold) in the MIL 50% inhibitory concentration (IC50) at both the promastigote (3.90 ± 0.68 µM; P < 0.05) and intracellular amastigote (9.10 ± 0.60 µM; P < 0.05) stages compared to the wild-type counterpart (LdNeo) (MIL IC50s of 1.49 ± 0.20 µM at the promastigote stage and 3.95 ± 0.45 µM at the amastigote stage). LdLip++ parasites exhibited significantly (P < 0.05) increased infectivity to host macrophages and increased metacyclogenesis and tolerance to MIL-induced oxidative stress. The susceptibility of LdLip++ to other antileishmanial drugs (sodium antimony gluconate and amphotericin B) remained unchanged. In comparison to LdNeo, the LdLip++ parasites elicited high host interleukin-10 (IL-10) cytokine expression levels (1.6-fold; P < 0.05) with reduced expression of the cytokine tumor necrosis factor alpha (TNF-α) (1.5-fold; P < 0.05), leading to a significantly (P < 0.01) increased ratio of IL-10/TNF-α. The above-described findings suggest a role of lipase precursor-like protein in conferring tolerance to the oral antileishmanial drug MIL in L. donovani parasites.
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112
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Maji K, Abbasi M, Podder D, Datta R, Haldar D. Potential Antileishmanial Activity of a Triazole-Based Hybrid Peptide against Leishmania major. ChemistrySelect 2018. [DOI: 10.1002/slct.201802002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Krishnendu Maji
- Department of Chemical Sciences; Indian Institute of Science Education and Research Kolkata; Mohanpur 741246, West Bengal India
| | - Mazharul Abbasi
- Department of Biological Sciences; Indian Institute of Science Education and Research Kolkata; Mohanpur 741246, West Bengal India
| | - Debasish Podder
- Department of Chemical Sciences; Indian Institute of Science Education and Research Kolkata; Mohanpur 741246, West Bengal India
| | - Rupak Datta
- Department of Biological Sciences; Indian Institute of Science Education and Research Kolkata; Mohanpur 741246, West Bengal India
| | - Debasish Haldar
- Department of Chemical Sciences; Indian Institute of Science Education and Research Kolkata; Mohanpur 741246, West Bengal India
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113
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Carnielli JBT, Crouch K, Forrester S, Silva VC, Carvalho SFG, Damasceno JD, Brown E, Dickens NJ, Costa DL, Costa CHN, Dietze R, Jeffares DC, Mottram JC. A Leishmania infantum genetic marker associated with miltefosine treatment failure for visceral leishmaniasis. EBioMedicine 2018; 36:83-91. [PMID: 30268832 PMCID: PMC6197651 DOI: 10.1016/j.ebiom.2018.09.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 11/22/2022] Open
Abstract
Background Miltefosine has been used successfully to treat visceral leishmaniasis (VL) in India, but it was unsuccessful for VL in a clinical trial in Brazil. Methods To identify molecular markers that predict VL treatment failure whole genome sequencing of 26 L. infantum isolates, from cured and relapsed patients allowed a GWAS analysis of SNPs, gene and chromosome copy number variations. Findings A strong association was identified (p = 0·0005) between the presence of a genetically stable L. infantumMiltefosine Sensitivity Locus (MSL), and a positive response to miltefosine treatment. The risk of treatment failure increased 9·4-fold (95% CI 2·11–53·54) when an isolate did not have the MSL. The complete absence of the MSL predicted miltefosine failure with 0·92 (95% CI 0·65–0·996) sensitivity and 0·78 (95% CI 0·52–0·92) specificity. A genotyping survey of L. infantum (n = 157) showed that the frequency of MSL varies in a cline from 95% in North East Brazil to <5% in the South East. The MSL was found in the genomes of all L. infantum and L. donovani sequenced isolates from the Old World (n = 671), where miltefosine can have a cure rate higher than 93%. Interpretation Knowledge on the presence or absence of the MSL in L. infantum will allow stratification of patients prior to treatment, helping to establish better therapeutic strategies for VL treatment. Fund CNPq, FAPES, GCRF MRC and Wellcome Trust.
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Affiliation(s)
- Juliana B T Carnielli
- Laboratório de Leishmanioses, Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.; Centre for Immunology and Infection, Department of Biology, University of York, United Kingdom.; Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom..
| | - Kathryn Crouch
- Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom
| | - Sarah Forrester
- Centre for Immunology and Infection, Department of Biology, University of York, United Kingdom
| | - Vladimir Costa Silva
- Laboratório de Pesquisas em Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, PI, Brazil
| | - Sílvio F G Carvalho
- Hospital Universitário Clemente de Faria, Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil
| | - Jeziel D Damasceno
- Laboratório de Biologia Molecular de Leishmania, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Elaine Brown
- Centre for Immunology and Infection, Department of Biology, University of York, United Kingdom
| | - Nicholas J Dickens
- Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom
| | - Dorcas L Costa
- Laboratório de Pesquisas em Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, PI, Brazil
| | - Carlos H N Costa
- Laboratório de Pesquisas em Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, PI, Brazil
| | - Reynaldo Dietze
- Laboratório de Leishmanioses, Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.; Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Daniel C Jeffares
- Centre for Immunology and Infection, Department of Biology, University of York, United Kingdom
| | - Jeremy C Mottram
- Centre for Immunology and Infection, Department of Biology, University of York, United Kingdom.; Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom..
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Riaz MS, Kaur A, Shwayat SN, Behboudi S, Kishore U, Pathan AA. Direct Growth Inhibitory Effect of Platelet Activating Factor C-16 and Its Structural Analogs on Mycobacteria. Front Microbiol 2018; 9:1903. [PMID: 30258409 PMCID: PMC6143801 DOI: 10.3389/fmicb.2018.01903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/27/2018] [Indexed: 12/14/2022] Open
Abstract
Mycobacterium tuberculosis, the causative agent of tuberculosis, is one of the leading causes of human deaths due to a single infectious agent. M. tuberculosis infection of the host initiates a local inflammatory response, resulting in the production of a range of inflammatory factors at the site of infection. These inflammatory factors may come in direct contact with M. tuberculosis and immune cells to activate different signaling pathways. One such factor produced in excess during inflammation is a phospholipid compound, Platelet Activating Factor C-16 (PAF C-16). In this study, PAF C-16 was shown to have a direct inhibitory effect on the growth of Mycobacterium bovis BCG (M. bovis BCG) and Mycobacterium smegmatis (M. smegmatis) in a dose- and time-dependent manner. Use of a range of PAF C-16 structural analogs, including the precursor form Lyso-PAF, revealed that small modifications in the structure of PAF C-16 did not alter its mycobacterial growth inhibitory properties. Subsequent experiments suggested that the attachment of aliphatic carbon tail via ether bond to the glycerol backbone of PAF C-16 was likely to play a vital role in its growth inhibition ability against mycobacteria. Fluorescence microscopy and flow cytometry using Propidium iodide (PI) indicated that PAF C-16 treatment had a damaging effect on the cell membrane of M. bovis BCG and M. smegmatis. Furthermore, the growth inhibitory effect of PAF C-16 was partially mitigated by treatment with membrane-stabilizing agents, α-tocopherol and Tween-80, which further suggests that the growth inhibitory effect of PAF C-16 was mediated through bacterial cell membrane damage.
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Affiliation(s)
- Muhammad S Riaz
- College of Health and Life Sciences, Division of Biosciences, Brunel University London, Uxbridge, United Kingdom.,Department of Biotechnology, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Anuvinder Kaur
- College of Health and Life Sciences, Division of Biosciences, Brunel University London, Uxbridge, United Kingdom
| | - Suha N Shwayat
- College of Health and Life Sciences, Division of Biosciences, Brunel University London, Uxbridge, United Kingdom
| | - Shahriar Behboudi
- The Pirbright Institute, Pirbright, United Kingdom.,Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Uday Kishore
- College of Health and Life Sciences, Division of Biosciences, Brunel University London, Uxbridge, United Kingdom
| | - Ansar A Pathan
- College of Health and Life Sciences, Division of Biosciences, Brunel University London, Uxbridge, United Kingdom
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115
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Recent Development of Visceral Leishmaniasis Treatments: Successes, Pitfalls, and Perspectives. Clin Microbiol Rev 2018; 31:31/4/e00048-18. [PMID: 30158301 DOI: 10.1128/cmr.00048-18] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Research in visceral leishmaniasis in the last decade has been focused on how better to use the existing medicines as monotherapy or in combination. Systematic research by geographical regions has shown that a universal treatment is far from today's reality. Substantial progress has been made in the elimination of kala-azar in South Asia, with a clear strategy on first- and second-line therapy options of single-dose liposomal amphotericin B and a combination of paromomycin and miltefosine, respectively, among other interventions. In Eastern Africa, sodium stibogluconate (SSG) and paromomycin in combination offer an advantage compared to the previous SSG monotherapy, although not exempted of limitations, as this therapy requires 17 days of painful double injections and bears the risk of SSG-related cardiotoxicity. In this region, attempts to improve the combination therapy have been unsuccessful. However, pharmacokinetic studies have led to a better understanding of underlying mechanisms, like the underexposure of children to miltefosine treatment, and an improved regimen using an allometric dosage. Given this global scenario of progress and pitfalls, we here review what steps need to be taken with existing medicines and highlight the urgent need for oral drugs. Furthermore, it should be noted that six candidates belonging to five new chemical classes are reaching phase I, ensuring an optimistic near future.
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116
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Lahiry S, Das AK, Das SN, Manna M. Ethanolic leaf extract of Coccinia grandis is effective against both drug resistant and drug sensitive clinical isolates of Indian Kala-azar. J Parasit Dis 2018; 42:433-441. [PMID: 30166791 DOI: 10.1007/s12639-018-1021-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/04/2018] [Indexed: 12/18/2022] Open
Abstract
The emergence of resistance to the current available drugs used for treatment against Indian Kala-azar (KA) or Visceral Leishmaniasis makes the control strategy inadequate for the disease. This grave epidemiological situation directed researches towards alternative treatments including herbal therapy. In this background, the aim of the present study was to evaluate the antileishmanial activity of the leaves of Coccinia grandis (a tropical vine) against both the Sodium Stibo Gluconate (SSG) sensitive and resistant as well as Miltefosine (MIL) sensitive and resistant field isolates of Leishmania donovani. The cytotoxicity effect of ethanolic extract of leaves of C. grandis (Cg-LE) against the clinical isolates of L. donovani was checked both in promastigotes and intracellular amastigotes stages. In both sensitive and resistant promastigotes, Cg-LE stimulated reactive oxygen species generation and apoptosis. Parasites infected macrophages showing enhanced nitric oxide production after Cg-LE treatment suggested the leishmanicidal activity of the leaf extract. Furthermore, Cg-LE treatment led to mitochondrial membrane damage and DNA fragmentation in promastigotes. The present study is very encouraging for the fact that Cg-LE showed promising antileishmanial activity against both SSG and MIL drug resistant clinical isolates of Indian KA.
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Affiliation(s)
- Sangita Lahiry
- 1Department of Zoology, Bidhannagar College, EB 2, Sector I, Salt Lake, Kolkata, West Bengal 700064 India
| | - Anjan K Das
- 2Department of Pathology, Calcutta National Medical College, 32 Gorachand Road, Kolkata, West Bengal 700014 India
| | - Sachindra N Das
- 3Department of Instrumental Science, Jadavpur University, 188, Raja S.C. Mallick Road, Kolkata, West Bengal 700032 India
| | - Madhumita Manna
- 1Department of Zoology, Bidhannagar College, EB 2, Sector I, Salt Lake, Kolkata, West Bengal 700064 India
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117
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dos Santos IB, da Silva DAM, Paz FACR, Garcia DM, Carmona AK, Teixeira D, Longo-Maugéri IM, Katz S, Barbiéri CL. Leishmanicidal and Immunomodulatory Activities of the Palladacycle Complex DPPE 1.1, a Potential Candidate for Treatment of Cutaneous Leishmaniasis. Front Microbiol 2018; 9:1427. [PMID: 30018604 PMCID: PMC6038773 DOI: 10.3389/fmicb.2018.01427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/11/2018] [Indexed: 01/18/2023] Open
Abstract
The present study focused on the activity of the palladacycle complex DPPE 1.1 on Leishmania (Leishmania) amazonensis. Promastigotes of L. (L.) amazonensis were destroyed in vitro by nanomolar concentrations of DPPE 1.1, whereas intracellular amastigotes were killed at drug concentrations fivefold less toxic than those harmful to macrophages. L. (L.) amazonensis-infected BALB/c mice were treated by intralesional injection of DPPE 1.1. Animals treated with 3.5 and 7.0 mg/kg of DPPE 1.1 showed a significant decrease of foot lesion sizes and a parasite load reduction of 93 and 99%, respectively, when compared to untreated controls. Furthermore, DPPE 1.1 was non-toxic to treated animals. The cathepsin B activity of L. (L.) amazonensis amastigotes was inhibited by DPPE 1.1 as demonstrated spectrofluorometrically by use of a specific fluorogenic substrate. Analysis of T-cells populations in mice treated with DPPE 1.1 and untreated controls was performed by fluorescence-activated cell sorter (FACS). IFN-γ was measured in supernatants of lymphocytes from popliteal and inguinal lymph nodes isolated from treated and untreated mice and stimulated with L. (L.) amazonensis amastigotes extract and active TGF-β was evaluated in supernatants of foot lesions; both dosages were carried out by means of a double-sandwich ELISA assay. A significant increase of TCD4+ and TCD8+ lymphocytes and IFN-γ secretion was displayed in mice treated with DPPE 1.1 compared to untreated animals, whereas a significant reduction of active TGF-β was observed in treated mice. These findings open perspectives for further investment in DPPE 1.1 as an alternative option for the chemotherapy of cutaneous leishmaniasis.
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Affiliation(s)
- Isabela B. dos Santos
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Danielle A. M. da Silva
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fabiana A. C. R. Paz
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Daniel M. Garcia
- Departamento de Farmacologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Adriana K. Carmona
- Departamento de Biofísica, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Daniela Teixeira
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ieda M. Longo-Maugéri
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Simone Katz
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Clara L. Barbiéri
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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118
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Abstract
Even after 70 years, pentavalent antimonials sodium stibogluconate and meglumine antimoniate remain the most important and cost-effective antileishmanial drugs. However, the drugs cannot be delivered orally and treatment involves intravascular or intramuscular injections for 28 days under strict medical monitoring due to the toxicity of Sb(III). The main alternatives, amphotericin B, pentamidine and miltefosine, are expensive and not without their own problems. Bismuth sits below antimony in the periodic table and is considered to be relatively nontoxic to humans while being capable of providing powerful antimicrobial activity. This review describes recent efforts into developing antileishmanial Bi(III) and Bi(V) drugs, which may resemble Sb analogs in effect and mode-of-action while providing lower mammalian cell toxicity and opportunities of oral delivery. Within the last 10 years, various studies concerning bismuth-based compounds as potential antileishmanial agents have been published. This review seeks to summarize the relevant studies and draw a conclusion as to whether bismuth complexes have the potential to be effective drugs.
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119
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Amphotericin B for treatment of visceral leishmaniasis: systematic review and meta-analysis of prospective comparative clinical studies including dose-ranging studies. Clin Microbiol Infect 2018; 24:591-598. [DOI: 10.1016/j.cmi.2017.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/02/2017] [Accepted: 11/05/2017] [Indexed: 02/06/2023]
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120
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Abstract
INTRODUCTION Parasitic diseases that pose a threat to human life include leishmaniasis - caused by protozoan parasite Leishmania species. Existing drugs have limitations due to deleterious side effects like teratogenicity, high cost and drug resistance. This calls for the need to have an insight into therapeutic aspects of disease. Areas covered: We have identified different drug targets via. molecular, imuunological, metabolic as well as by system biology approaches. We bring these promising drug targets into light so that they can be explored to their maximum. In an effort to bridge the gaps between existing knowledge and prospects of drug discovery, we have compiled interesting studies on drug targets, thereby paving the way for establishment of better therapeutic aspects. Expert opinion: Advancements in technology shed light on many unexplored pathways. Further probing of well established pathways led to the discovery of new drug targets. This review is a comprehensive report on current and emerging drug targets, with emphasis on several metabolic targets, organellar biochemistry, salvage pathways, epigenetics, kinome and more. Identification of new targets can contribute significantly towards strengthening the pipeline for disease elimination.
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Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, UP, India
| | - Bhawana Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, UP, India
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121
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Sunyoto T, Potet J, Boelaert M. Why miltefosine-a life-saving drug for leishmaniasis-is unavailable to people who need it the most. BMJ Glob Health 2018; 3:e000709. [PMID: 29736277 PMCID: PMC5935166 DOI: 10.1136/bmjgh-2018-000709] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/13/2018] [Indexed: 11/08/2022] Open
Abstract
Miltefosine, the only oral drug approved for the treatment of leishmaniasis-a parasitic disease transmitted by sandflies-is considered as a success story of research and development (R&D) by a public-private partnership (PPP). It epitomises the multiple market failures faced by a neglected disease drug: patients with low ability to pay, neglect by authorities and uncertain market size. Originally developed as an anticancer agent in the 1990s, the drug was registered in India in 2002 to treat the fatal visceral leishmaniasis. At the time, miltefosine was considered a breakthrough in the treatment, making it feasible to eliminate a regional disease. Today, access to miltefosine remains far from secure. The initial PPP agreement which includes access to the public sector is not enforced. The reality on the ground has been challenging: shortages due to inefficient supply chains, and use of a substandard product which led to a high number of treatment failures and deaths. Miltefosine received orphan drug status in the USA; when it was registered there in 2014, a priority review voucher (PRV) was awarded. The PRV, meant to facilitate drug development for neglected disease, was subsequently sold to another company for US$125 million without, to date, any apparent impact on drug access. At the heart of these concerns are questions on how to protect societal benefit of a drug developed with public investment, while clinicians worldwide struggle with its lack of affordability, limited availability and sustainability of access. This article analyses the reasons behind the postregistration access failure of miltefosine and provides the lessons learnt.
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Affiliation(s)
- Temmy Sunyoto
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- Policy Department, Médecins Sans Frontières- Campaign for Access to Medicines, Geneva, Switzerland
| | - Julien Potet
- Policy Department, Médecins Sans Frontières- Campaign for Access to Medicines, Geneva, Switzerland
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
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122
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Abstract
Treatment of Visceral Leishmaniasis (VL), a neglected tropical disease, is very challenging with few treatment options. Long duration of treatment and drug toxicity further limit the target of achieving VL elimination. Chemotherapy remains the treatment of choice. Single dose of liposomal amphotericin B (LAmB) and multidrug therapy (LAmB + miltefosine, LAmB + paromomycin (PM), or miltefosine + PM) are recommended treatment regimen for treatment of VL in Indian sub-continent. Combination therapy of pentavalent antimonials (Sbv) and PM in East Africa and LAmB in the Mediterranean region/South America remains the treatment of choice. Various drugs having anti-leishmania properties are in preclinical phase and need further development. An effective treatment and secondary prophylaxis of HIV-VL co-infection should be developed to decrease treatment failure and drug resistance.
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Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005
| | - Anup Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005
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123
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Successful Treatment of Disseminated Cutaneous Leishmaniasis With Liposomal Amphotericin B and Miltefosine in an Eight-year-old Girl. Pediatr Infect Dis J 2018; 37:275-277. [PMID: 29424815 DOI: 10.1097/inf.0000000000001741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This case report presents an 8-year-old girl, from Fars province in Iran, diagnosed with cutaneous leishmaniasis in the form of multiple nodular, ulcerative and crusted lesions disseminated on the face, trunk and extremities. The result of direct smear of ulcers was positive for Leishmania parasite. The patient had no immunodeficiency or relevant family history making her susceptible for disseminated cutaneous leishmaniasis. The skin lesions failed to respond to multiple treatment courses of meglumine antimoniate or amphotericin B but were successfully treated with simultaneous miltefosine and liposomal amphotericin B.
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124
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Ventin F, Cincurá C, Machado PRL. Safety and efficacy of miltefosine monotherapy and pentoxifylline associated with pentavalent antimony in treating mucosal leishmaniasis. Expert Rev Anti Infect Ther 2018; 16:219-225. [PMID: 29411659 DOI: 10.1080/14787210.2018.1436967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Mucosal Leishmaniasis (ML) is a difficult to treat and severe form of Leishmaniasis. In general, more than 40% of subjects with ML have therapeutic failure upon the use of pentavalent antimony (Sbv) at 20mg/kg/day during 30 days. Additionally, Sbv is a toxic drug that requires parenteral administration, and many patients will need several courses to be cured. In cases that cannot be treated or cured by Sbv, the alternative is amphotericin B, another toxic and parenteral drug. As a consequence, many ML patients will be cured only after years of disease and may present several morbidities due to the aggressiveness of the disease or toxicity related to the treatment. Areas covered: We aimed to review clinical trials with Miltefosine or Sbv associated with pentoxifylline in the treatment of ML. Expert commentary: There are few studies to define more effective and safer therapy in mucosal disease caused by Leishmania, with an urgent need to supporting and funding well designed trials. Miltefosine monotherapy, as well as pentoxifylline combined with Sbv are promising therapeutic approaches to increase the cure rate of this neglected disease.
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Affiliation(s)
- Fernanda Ventin
- a Serviço de Imunologia , Complexo Hospitalar Universitário Professor Edgard Santos , Salvador , Brazil
| | - Carolina Cincurá
- a Serviço de Imunologia , Complexo Hospitalar Universitário Professor Edgard Santos , Salvador , Brazil
| | - Paulo Roberto Lima Machado
- a Serviço de Imunologia , Complexo Hospitalar Universitário Professor Edgard Santos , Salvador , Brazil.,b Serviço de Imunologia , National Institute of Science and Technology in Tropical Diseases (INCT-DT), CNPq/MCT , Salvador , Brazil
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125
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Mina JGM, Denny PW. Everybody needs sphingolipids, right! Mining for new drug targets in protozoan sphingolipid biosynthesis. Parasitology 2018; 145:134-147. [PMID: 28637533 PMCID: PMC5964470 DOI: 10.1017/s0031182017001081] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/15/2017] [Accepted: 05/18/2017] [Indexed: 12/18/2022]
Abstract
Sphingolipids (SLs) are an integral part of all eukaryotic cellular membranes. In addition, they have indispensable functions as signalling molecules controlling a myriad of cellular events. Disruption of either the de novo synthesis or the degradation pathways has been shown to have detrimental effects. The earlier identification of selective inhibitors of fungal SL biosynthesis promised potent broad-spectrum anti-fungal agents, which later encouraged testing some of those agents against protozoan parasites. In this review we focus on the key enzymes of the SL de novo biosynthetic pathway in protozoan parasites of the Apicomplexa and Kinetoplastidae, outlining the divergence and interconnection between host and pathogen metabolism. The druggability of the SL biosynthesis is considered, alongside recent technology advances that will enable the dissection and analyses of this pathway in the parasitic protozoa. The future impact of these advances for the development of new therapeutics for both globally threatening and neglected infectious diseases is potentially profound.
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Affiliation(s)
- John G M Mina
- Department of Biosciences,Lower Mountjoy,Stockton Road,Durham DH1 3LE,UK
| | - P W Denny
- Department of Biosciences,Lower Mountjoy,Stockton Road,Durham DH1 3LE,UK
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126
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Hematologic Aspects of Parasitic Diseases. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00158-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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127
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Ponte-Sucre A, Gamarro F, Dujardin JC, Barrett MP, López-Vélez R, García-Hernández R, Pountain AW, Mwenechanya R, Papadopoulou B. Drug resistance and treatment failure in leishmaniasis: A 21st century challenge. PLoS Negl Trop Dis 2017; 11:e0006052. [PMID: 29240765 PMCID: PMC5730103 DOI: 10.1371/journal.pntd.0006052] [Citation(s) in RCA: 519] [Impact Index Per Article: 74.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Reevaluation of treatment guidelines for Old and New World leishmaniasis is urgently needed on a global basis because treatment failure is an increasing problem. Drug resistance is a fundamental determinant of treatment failure, although other factors also contribute to this phenomenon, including the global HIV/AIDS epidemic with its accompanying impact on the immune system. Pentavalent antimonials have been used successfully worldwide for the treatment of leishmaniasis since the first half of the 20th century, but the last 10 to 20 years have witnessed an increase in clinical resistance, e.g., in North Bihar in India. In this review, we discuss the meaning of “resistance” related to leishmaniasis and discuss its molecular epidemiology, particularly for Leishmania donovani that causes visceral leishmaniasis. We also discuss how resistance can affect drug combination therapies. Molecular mechanisms known to contribute to resistance to antimonials, amphotericin B, and miltefosine are also outlined. Chemotherapy is central to the control and management of leishmaniasis. Antimonials remain the primary drugs against different forms of leishmaniasis in several regions. However, resistance to antimony has necessitated the use of alternative medications, especially in the Indian subcontinent (ISC). Compounds, notably the orally available miltefosine (MIL), parenteral paromomycin, and amphotericin B (AmB), are increasingly used to treat leishmaniasis. Although treatment failure (TF) has been observed in patients treated with most anti-leishmanials, its frequency of appearance may be important in patients treated with MIL, which has replaced antimonials within the kala-azar elimination program in the ISC. AmB is highly efficacious, and the associated toxic effects—when administered in its free deoxycholate form—are somewhat ameliorated in its liposomal formulation. Regrettably, laboratory experimentation has demonstrated a risk of resistance towards AmB as well. The rise of drug resistance impacts treatment outcome, and understanding its causes, spread, and impact will help us manage the risks it imposes. Here, we review the problem of TF in leishmaniasis and the contribution of drug resistance to the problem. Molecular mechanisms causing resistance to anti-leishmanials are discussed along with the appropriate use of additional available drugs, as well as the urgent need to consolidate strategies to monitor drug efficacy, epidemiological surveillance, and local policies. Coordination of these activities in national and international programs against leishmaniasis might represent a successful guide to further research and prevention activities.
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Affiliation(s)
- Alicia Ponte-Sucre
- Department of Physiological Sciences, Laboratory of Molecular Physiology, Institute of Experimental Medicine, Luis Razetti School of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
- * E-mail: (BP); (APS)
| | - Francisco Gamarro
- Department of Biochemistry and Molecular Pharmacology, Instituto de Parasitología y Biomedicina López-Neyra, Spanish National Research Council (IPBLN-CSIC), Granada, Spain
| | - Jean-Claude Dujardin
- Molecular Parasitology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Michael P. Barrett
- Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Rogelio López-Vélez
- Department of Infectious Diseases, National Referral Unit for Tropical Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| | - Raquel García-Hernández
- Department of Biochemistry and Molecular Pharmacology, Instituto de Parasitología y Biomedicina López-Neyra, Spanish National Research Council (IPBLN-CSIC), Granada, Spain
| | - Andrew W. Pountain
- Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Roy Mwenechanya
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Barbara Papadopoulou
- Research Center in Infectious Diseases, CHU de Quebec Research Center and Department of Microbiology-Infectious Disease and Immunology, University Laval, Quebec, Canada
- * E-mail: (BP); (APS)
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Rawling T, Choucair H, Koolaji N, Bourget K, Allison SE, Chen YJ, Dunstan CR, Murray M. A Novel Arylurea Fatty Acid That Targets the Mitochondrion and Depletes Cardiolipin To Promote Killing of Breast Cancer Cells. J Med Chem 2017; 60:8661-8666. [DOI: 10.1021/acs.jmedchem.7b00701] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Tristan Rawling
- School
of Mathematical and Physical Sciences, Faculty of Science, University of Technology Sydney, Ultimo, New South Wales 2007, Australia
| | - Hassan Choucair
- Discipline
of Pharmacology, School of Medical Sciences, Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Nooshin Koolaji
- Discipline
of Pharmacology, School of Medical Sciences, Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Kirsi Bourget
- Discipline
of Pharmacology, School of Medical Sciences, Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Sarah E. Allison
- Discipline
of Pharmacology, School of Medical Sciences, Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Yong-Juan Chen
- School
of Aerospace, Mechanical and Mechatronic Engineering, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Colin R. Dunstan
- School
of Aerospace, Mechanical and Mechatronic Engineering, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Michael Murray
- Discipline
of Pharmacology, School of Medical Sciences, Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia
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Patel TA, Scadding GK, Phillips DE, Lockwood DN. Case Report: Old World Mucosal Leishmaniasis: Report of Five Imported Cases to the Hospital for Tropical Diseases, London, United Kingdom. Am J Trop Med Hyg 2017; 97:1116-1119. [PMID: 29031288 PMCID: PMC5637608 DOI: 10.4269/ajtmh.17-0162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/10/2017] [Indexed: 11/07/2022] Open
Abstract
Old World species of Leishmania typically cause visceral and cutaneous leishmaniasis. Mucosal involvement is typically seen with infection by Leishmania species found in South America, usually after the healing of cutaneous leishmaniasis. We present five imported cases of mucosal leishmaniasis caused by Old World Mediterranean Leishmania infantum exclusively affecting the nasal mucosa or vocal cord. In only one case was there a recollection of a preceding cutaneous lesion compatible with cutaneous Leishmaniasis. Of significance was that four out of five cases were receiving local corticosteroids for chronic lung disorders and four were systemically immunosuppressed. This report highlights the importance of considering mucosal leishmaniasis in the differential diagnosis in those presenting with upper respiratory tract mucosal lesions with a relevant travel history to the Mediterranean and in whom malignancy has been excluded.
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Affiliation(s)
- Trupti A. Patel
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Glenis K. Scadding
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - David E. Phillips
- Department of Ear, Nose and Throat Surgery, Warwick Hospital, Warwick, United Kingdom
| | - Diana N. Lockwood
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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130
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Hirve S, Kroeger A, Matlashewski G, Mondal D, Banjara MR, Das P, Be-Nazir A, Arana B, Olliaro P. Towards elimination of visceral leishmaniasis in the Indian subcontinent-Translating research to practice to public health. PLoS Negl Trop Dis 2017; 11:e0005889. [PMID: 29023446 PMCID: PMC5638223 DOI: 10.1371/journal.pntd.0005889] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The decade following the Regional Strategic Framework for Visceral Leishmaniasis (VL) elimination in 2005 has shown compelling progress in the reduction of VL burden in the Indian subcontinent. The Special Programme for Research and Training in Tropical Diseases (TDR), hosted by the World Health Organization (WHO) and other stakeholders, has coordinated and financed research for the development of new innovative tools and strategies to support the regional VL elimination initiative. This paper describes the process of the TDR's engagement and contribution to this initiative. METHODOLOGY/PRINCIPAL FINDINGS Multiple databases were searched to identify 152 scientific papers and reports with WHO funding or authorship affiliation around the following 3 framework strategies: detection of new cases, morbidity reduction, and prevention of infection. TDR has played a critical role in the evaluation and subsequent use of the 39-aminoacid-recombinant kinesin antigen (rK39) rapid diagnostic test (RDT) as a confirmatory test for VL in the national program. TDR has supported the clinical research and development of miltefosine and single-dose liposomal amphotericin B as a first-line treatment against VL. TDR has engaged with in-country researchers, national programme managers, and partners to generate evidence-based interventions for early detection and treatment of VL patients. TDR evaluated the quality, community acceptance, and cost effectiveness of indoor residual spraying, insecticide-treated bed nets, insecticide-impregnated durable wall linings, insecticidal paint, and environmental management as tools for integrated vector management in reducing sandfly density. CONCLUSIONS/SIGNIFICANCE TDR's engagement with country policy makers, scientists, and clinicians in the development of effective diagnosis, treatment, case detection, and vector control represents an important example of TDR's stewardship toward the elimination of VL in the Indian subcontinent.
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Affiliation(s)
| | - Axel Kroeger
- Centre for Medicine and Society and Centre for Anthropology, Freiburg University, Freiburg, Germany
- Special Programme for Research and Training in Tropical Diseases (TDR), hosted by the World Health Organization, Geneva, Switzerland
| | - Greg Matlashewski
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
| | - Dinesh Mondal
- Nutrition and Clinical Services division, International Center for Diarrheal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Patna, India
| | - Ahmed Be-Nazir
- Department of Microbiology and Parasitology, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | - Byron Arana
- Cutaneous Leishmaniasis unit, Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Piero Olliaro
- Special Programme for Research and Training in Tropical Diseases (TDR), hosted by the World Health Organization, Geneva, Switzerland
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131
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Salama IC, Arrais-Lima C, Arrais-Silva WW. Evaluation of Boldine Activity against Intracellular Amastigotes of Leishmania amazonensis. THE KOREAN JOURNAL OF PARASITOLOGY 2017; 55:337-340. [PMID: 28719960 PMCID: PMC5523901 DOI: 10.3347/kjp.2017.55.3.337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/02/2017] [Accepted: 03/10/2017] [Indexed: 01/30/2023]
Abstract
Leishmaniasis is a neglected and endemic disease that affects poorest population mainly in developing countries. A lack of adequate and definitive chemotherapeutic agents to fight against this infection has led to the investigation of numerous compounds. The aim of this study was to investigate in vitro activity of boldine against Leishmania amazonensis murine cell infection. Boldine ((S)-2,9-dihydroxy-1,10-dimethoxy-aporphine) is an aporphine alkaloid found abundantly in the leaves/bark of boldo (Peumus boldus Molina), a widely distributed tree native to Chile. The in vitro system consisted of murine macrophage infection with amastigotes of L. amazonensis treated with different concentrations from 50 to 600 μg/ml of boldine for 24 hr. Intracellular parasite destruction was assessed by morphological examination and boldine cytotoxicity to macrophages was tested by the MTT viability assay. When cells were treated with 100 μg/ml of boldine the reduction of parasite infection was 81% compared with untreated cultures cells. Interestingly, boldine-treatment caused a concentration-dependent decrease of macrophage infection that culminated with 96% of reduction when cells were submitted to 600 μg/ml of boldine. Cell cultures exposed to 100 μg/ml of boldine and 300 μg/ml of Glucantime® during 24 hr showed a significant reduction of 50% in parasitized cells compared with cell cultures exposed just to Glucantime®. The study showed that treatment with boldine produces a better effect than treatment with the reference antimonial drug, glucantime, in L. amazonensis infected macrophage. Our results suggest that boldine is a potentially useful agent for the treatment of leishmaniasis.
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Affiliation(s)
- Isabel Cristina Salama
- Laboratório de Parasitos e Vetores (LAPAV), Instituto de Ciências Biológicas e da Saúde, Campus Universitário do Araguaia, Universidade Federal de Mato Grosso, Avenida Valdon Varjão, 6390 - Barra do Garças, Mato Grosso, CEP 78600-000, Brazil
| | - Cristina Arrais-Lima
- Laboratório de Parasitos e Vetores (LAPAV), Instituto de Ciências Biológicas e da Saúde, Campus Universitário do Araguaia, Universidade Federal de Mato Grosso, Avenida Valdon Varjão, 6390 - Barra do Garças, Mato Grosso, CEP 78600-000, Brazil
| | - Wagner Welber Arrais-Silva
- Laboratório de Parasitos e Vetores (LAPAV), Instituto de Ciências Biológicas e da Saúde, Campus Universitário do Araguaia, Universidade Federal de Mato Grosso, Avenida Valdon Varjão, 6390 - Barra do Garças, Mato Grosso, CEP 78600-000, Brazil.,Departamento de Morfologia, Centro de Ciências Biológicas e da Saúde, Universidade Federal de Sergipe, Avenida Marechal Rondon, S/N - Jardim Rosa Elze - São Cristóvão, SE, CEP 49100-000, Brazil
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132
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Deep DK, Singh R, Bhandari V, Verma A, Sharma V, Wajid S, Sundar S, Ramesh V, Dujardin JC, Salotra P. Increased miltefosine tolerance in clinical isolates of Leishmania donovani is associated with reduced drug accumulation, increased infectivity and resistance to oxidative stress. PLoS Negl Trop Dis 2017; 11:e0005641. [PMID: 28575060 PMCID: PMC5470736 DOI: 10.1371/journal.pntd.0005641] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 06/14/2017] [Accepted: 05/13/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Miltefosine (MIL) is an oral antileishmanial drug used for treatment of visceral leishmaniasis (VL) in the Indian subcontinent. Recent reports indicate a significant decline in its efficacy with a high rate of relapse in VL as well as post kala-azar dermal leishmaniasis (PKDL). We investigated the parasitic factors apparently involved in miltefosine unresponsiveness in clinical isolates of Leishmania donovani. METHODOLOGY L. donovani isolated from patients of VL and PKDL at pretreatment stage (LdPreTx, n = 9), patients that relapsed after MIL treatment (LdRelapse, n = 7) and parasites made experimentally resistant to MIL (LdM30) were included in this study. MIL uptake was estimated using liquid chromatography coupled mass spectrometry. Reactive oxygen species and intracellular thiol content were measured fluorometrically. Q-PCR was used to assess the differential expression of genes associated with MIL resistance. RESULTS LdRelapse parasites exhibited higher IC50 both at promastigote level (7.92 ± 1.30 μM) and at intracellular amastigote level (11.35 ± 6.48 μM) when compared with LdPreTx parasites (3.27 ± 1.52 μM) and (3.85 ± 3.11 μM), respectively. The percent infectivity (72 hrs post infection) of LdRelapse parasites was significantly higher (80.71 ± 5.67%, P<0.001) in comparison to LdPreTx (60.44 ± 2.80%). MIL accumulation was significantly lower in LdRelapse parasites (1.7 fold, P<0.001) and in LdM30 parasites (2.4 fold, P<0.001) when compared with LdPreTx parasites. MIL induced ROS levels were significantly lower (p<0.05) in macrophages infected with LdRelapse while intracellular thiol content were significantly higher in LdRelapse compared to LdPreTx, indicating a better tolerance for oxidative stress in LdRelapse isolates. Genes associated with oxidative stress, metabolic processes and transporters showed modulated expression in LdRelapse and LdM30 parasites in comparison with LdPreTx parasites. CONCLUSION The present study highlights the parasitic factors and pathways responsible for miltefosine unresponsiveness in VL and PKDL.
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Affiliation(s)
- Deepak Kumar Deep
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
- Department of Biotechnology, Faculty of Science, Jamia Hamdard, New Delhi, India
| | - Ruchi Singh
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
| | - Vasundhra Bhandari
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
| | - Aditya Verma
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
| | - Vanila Sharma
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
| | - Saima Wajid
- Department of Biotechnology, Faculty of Science, Jamia Hamdard, New Delhi, India
| | - Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - V. Ramesh
- Dermatology Department, Safdarjung Hospital and Vardhman Mahavir Medical College (VMMC), New Delhi, India
| | - Jean Claude Dujardin
- Unit of Molecular Parasitology, Department of Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Poonam Salotra
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
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Rahman R, Goyal V, Haque R, Jamil K, Faiz A, Samad R, Ellis S, Balasegaram M, den Boer M, Rijal S, Strub-Wourgaft N, Alves F, Alvar J, Sharma B. Safety and efficacy of short course combination regimens with AmBisome, miltefosine and paromomycin for the treatment of visceral leishmaniasis (VL) in Bangladesh. PLoS Negl Trop Dis 2017; 11:e0005635. [PMID: 28558062 PMCID: PMC5466346 DOI: 10.1371/journal.pntd.0005635] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 06/09/2017] [Accepted: 05/10/2017] [Indexed: 01/24/2023] Open
Abstract
Background AmBisome therapy for VL has an excellent efficacy and safety profile and has been adopted as a first-line regimen in Bangladesh. Second-line treatment options are limited and should preferably be given in short course combinations in order to prevent the development of resistant strains. Combination regimens including AmBisome, paromomycin and miltefosine have proved to be safe and effective in the treatment of VL in India. In the present study, the safety and efficacy of these same combinations were assessed in field conditions in Bangladesh. Methods The safety and efficacy of three combination regimens: a 5 mg/kg single dose of AmBisome + 7 subsequent days of miltefosine (2.5 mg/kg/day), a 5 mg/kg single dose of AmBisome + 10 subsequent days of paromomycin (15 mg/kg/day) and 10 days of paromomycin (15 mg/kg/day) + miltefosine (2.5 mg/kg/day), were compared with a standard regimen of AmBisome 15 mg/kg given in 5 mg/kg doses on days 1, 3 and 5. This was a phase III open label, individually randomized clinical trial. Patients from 5 to 60 years with uncomplicated primary VL were recruited from the Community Based Medical College Bangladesh (CBMC,B) and the Upazila Health Complexes of Trishal, Bhaluka and Fulbaria (all located in Mymensingh district), and randomly assigned to one of the treatments. The objective was to assess safety and definitive cure at 6 months after treatment. Results 601 patients recruited between July 2010 and September 2013 received either AmBisome monotherapy (n = 158), AmBisome + paromomycin (n = 159), AmBisome + miltefosine (n = 142) or paromomycin + miltefosine (n = 142). At 6 months post- treatment, final cure rates for the intention-to-treat population were 98.1% (95%CI 96.0–100) for AmBisome monotherapy, 99.4% (95%CI 98.2–100) for the AmBisome + paromomycin arm, 94.4% (95%CI 90.6–98.2) for the AmBisome + miltefosine arm, and 97.9% (95%CI 95.5–100) for paromomycin + miltefosine arm. There were 12 serious adverse events in the study in 11 patients that included 3 non-study drug related deaths. There were no relapses or PKDL up to 6 months follow-up. All treatments were well tolerated with no unexpected side effects. Adverse events were most frequent during treatment with miltefosine + paromomycin, three serious adverse events related to the treatment occurred in this arm, all of which resolved. Conclusion None of the combinations were inferior to AmBisome in both the intention-to-treat and per-protocol populations. All the combinations demonstrated excellent overall efficacy, were well tolerated and safe, and could be deployed under field conditions in Bangladesh. The trial was conducted by the International Centre for Diarrhoeal Disease Research (ICDDR,B) and the Shaheed Suhrawardy Medical College (ShSMC), Dhaka, in collaboration with the trial sites and sponsored by the Drugs for Neglected Diseases initiative (DNDi). Trial registration ClinicalTrials.gov NCT01122771 Treatment is one of the key strategies for visceral leishmaniasis control and elimination. Historically a number of monotherapy drugs for VL treatment were used in Bangladesh, including pentavalent antimonials, amphotericin B deoxycholate (AmB), and miltefosine (MF). With the limited number of drugs available, it was necessary to preserve existing drugs and also to develop shorter and safer treatment regimens. At the time the study was initiated, miltefosine monotherapy was a recommended first-line treatment in Bangladesh. The present study aimed to provide safety and efficacy data for three short-course combination regimens including AmBisome, miltefosine and paromomycin when rolled out in field conditions in Bangladesh, and to compare these to AmBisome monotherapy. All combinations proved non-inferior to AmBisome monotherapy and were safe and well tolerated. This study was implemented in field conditions at Upazila level with treatment provided by government doctors, providing further evidence for scaling up new regimens in national program contexts within the public health sector.
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Affiliation(s)
- Ridwanur Rahman
- Shaheed Suhrawardy Medical College (ShSMC), University of Dhaka, Dhaka, Bangladesh
| | - Vishal Goyal
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
- * E-mail:
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Kazi Jamil
- Kuwait institute for Scientific Research, Environment and Life Sciences Research centre, Food and Nutrition Program formerly ICDDR,B, Dhaka, Bangladesh
| | - Abul Faiz
- Dev Care Foundation, Dhaka, Bangladesh and Retired Ministry of Health, Government official Dhaka, Bangladesh
| | | | - Sally Ellis
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | | | - Suman Rijal
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Bhawna Sharma
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Abstract
Leishmaniasis is caused by an intracellular parasite transmitted to humans by the bite of a sand fly. It is endemic in Asia, Africa, the Americas, and the Mediterranean region. Worldwide, 1.5 to 2 million new cases occur each year, 350 million are at risk of acquiring the disease, and leishmaniasis causes 70,000 deaths per year. Clinical features depend on the species of
Leishmania involved and the immune response of the host. Manifestations range from the localized cutaneous to the visceral form with potentially fatal outcomes. Many drugs are used in its treatment, but the only effective treatment is achieved with current pentavalent antimonials.
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Affiliation(s)
- Edoardo Torres-Guerrero
- Sección de Micología, Hospital "Manuel Gea González" Secretaría de Salud, Calz. de Tlalpan 4800, Ciudad de México 14080, Mexico
| | | | - Julieta Ruiz-Esmenjaud
- Sección de Micología, Hospital "Manuel Gea González" Secretaría de Salud, Calz. de Tlalpan 4800, Ciudad de México 14080, Mexico
| | - Roberto Arenas
- Sección de Micología, Hospital "Manuel Gea González" Secretaría de Salud, Calz. de Tlalpan 4800, Ciudad de México 14080, Mexico
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135
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Espada CR, Ribeiro-Dias F, Dorta ML, Pereira LIDA, Carvalho EMD, Machado PR, Schriefer A, Yokoyama-Yasunaka JKU, Coelho AC, Uliana SRB. Susceptibility to Miltefosine in Brazilian Clinical Isolates of Leishmania ( Viannia) braziliensis. Am J Trop Med Hyg 2017; 96:656-659. [PMID: 28070006 DOI: 10.4269/ajtmh.16-0811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Leishmania (Viannia) braziliensis is the main causative species of tegumentary leishmaniasis in Brazil. In this study, we evaluated the susceptibility of 16 clinical isolates of L. (V.) braziliensis from different regions of Brazil to miltefosine in vitro. Half-maximal inhibitory concentrations of miltefosine varied from 22.9 to 144.2 μM against promastigotes and from 0.3 to 4.2 μM against intracellular amastigotes. No significant differences were found between isolates of different geographical origins. A clear correlation between the EC50 against promastigotes and amastigotes within each isolate was found. These findings contribute to the evaluation of miltefosine's potential and limitations for the treatment of tegumentary leishmaniasis in Brazil.
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Affiliation(s)
- Caroline R Espada
- Laboratório de Leishmanioses, Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Fatima Ribeiro-Dias
- Laboratório de Imunobiologia das Leishmanioses, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | - Miriam L Dorta
- Laboratório de Imunobiologia das Leishmanioses, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | - Ledice Inácia de Araújo Pereira
- Laboratório de Imunobiologia das Leishmanioses, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | - Edgar M de Carvalho
- Centro de Pesquisas Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil.,Serviço de Imunologia, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Paulo R Machado
- Serviço de Imunologia, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Albert Schriefer
- Serviço de Imunologia, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Jenicer K U Yokoyama-Yasunaka
- Laboratório de Leishmanioses, Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Adriano C Coelho
- Laboratório de Leishmanioses, Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil.,Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, Brazil
| | - Silvia R B Uliana
- Laboratório de Leishmanioses, Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
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136
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Masood MM, Hasan P, Tabrez S, Ahmad MB, Yadava U, Daniliuc CG, Sonawane YA, Azam A, Rub A, Abid M. Anti-leishmanial and cytotoxic activities of amino acid-triazole hybrids: Synthesis, biological evaluation, molecular docking and in silico physico-chemical properties. Bioorg Med Chem Lett 2017; 27:1886-1891. [PMID: 28359789 DOI: 10.1016/j.bmcl.2017.03.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/17/2017] [Accepted: 03/20/2017] [Indexed: 11/17/2022]
Abstract
According to WHO, leishmaniasis is a major tropical disease, ranking second after malaria. Significant efforts have been therefore invested into finding potent inhibitors for the treatment. In this work, eighteen novel 1,2,3-triazoles appended with l-amino acid (Phe/Pro/Trp) tail were synthesized via azide-alkyne click chemistry with moderate to good yield, and evaluated for their anti-leishmanial activity against promastigote form of Leishmania donovani (Dd8 strain). Among all, compounds 40, 43, and 53 were identified with promising anti-leishmanial activity with IC50=88.83±2.93, 96.88±12.88 and 94.45±6.51μM respectively and displayed no cytotoxicity towards macrophage cells. Moreover, compound 43 showed highest selectivity index (SI=8.05) among all the tested compounds. Supported by docking studies, the lead inhibitors (40, 43 and 53) showed interactions with key residues in the catalytic site of trypanothione reductase. The results of pharmacokinetic parameters suggest that these selected inhibitors can be carried forward for further structural optimization and pharmacological investigation.
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Affiliation(s)
- Mir Mohammad Masood
- Medicinal Chemistry Lab, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India; Department of Chemistry, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Phool Hasan
- Medicinal Chemistry Lab, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India; Department of Chemistry, TNB College, TM Bhagalpur University, Bhagalpur 812007, Bihar, India
| | - Shams Tabrez
- Infection and Immunity Lab, Department of Biotechnology, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Md Bilal Ahmad
- Department of Chemistry, TNB College, TM Bhagalpur University, Bhagalpur 812007, Bihar, India
| | - Umesh Yadava
- Department of Physics, Deen Dayal Upadhyay Gorakhpur University, Gorakhpur, UP 273009, India
| | - Constantin G Daniliuc
- Organisch-Chemisches Institut, Westfälische Wilhelm-Universität Münster, 48149, Germany
| | - Yogesh A Sonawane
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198-6805, USA
| | - Amir Azam
- Department of Chemistry, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Abdur Rub
- Infection and Immunity Lab, Department of Biotechnology, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Mohammad Abid
- Medicinal Chemistry Lab, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India; Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198-6805, USA.
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Paladi CS, da Silva DAM, Motta PD, Garcia DM, Teixeira D, Longo-Maugéri IM, Katz S, Barbiéri CL. Treatment of Leishmania (Leishmania) Amazonensis-Infected Mice with a Combination of a Palladacycle Complex and Heat-Killed Propionibacterium acnes Triggers Protective Cellular Immune Responses. Front Microbiol 2017; 8:333. [PMID: 28321209 PMCID: PMC5337482 DOI: 10.3389/fmicb.2017.00333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/17/2017] [Indexed: 12/12/2022] Open
Abstract
Palladacycle complex DPPE 1.2 was previously reported to inhibit the in vitro and in vivo infection by Leishmania (Leishmania) amazonensis. The aim of the present study was to compare the effect of DPPE 1.2, in association with heat-killed Propionibacterium acnes, on L. (L.) amazonensis infection in two mouse strains, BALB/c and C57BL/6, and to evaluate the immune responses of the treated animals. Foot lesions of L. (L.) amazonensis-infected mice were injected with DPPE 1.2 alone, or associated with P. acnes as an adjuvant. Analysis of T-cell populations in the treated mice and in untreated controls was performed by FACS. Detection of IFN-γ-secreting lymphocytes was carried out by an ELISPOT assay and active TGF-β was measured by means of a double-sandwich ELISA test. The treatment with DPPE 1.2 resulted in a significant reduction of foot lesion sizes and parasite burdens in both mouse strains, and the lowest parasite burden was found in mice treated with DPPE 1.2 plus P. acnes. Mice treated with DPPE 1.2 alone displayed a significant increase of TCD4+ and TCD8+ lymphocytes and IFN-γ secretion which were significantly higher in animals treated with DPPE 1.2 plus P. acnes. A significant reduction of active TGF-β was observed in mice treated with DPPE 1.2 alone or associated with P. acnes. Moreover, DPPE 1.2 associated to P. acnes was non-toxic to treated animals. The destruction of L. (L.) amazonensis by DPPE 1.2 was followed by host inflammatory responses which were exacerbated when the palladacycle complex was associated with P. acnes.
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Affiliation(s)
- Carolina S Paladi
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Danielle A M da Silva
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Priscila D Motta
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Daniel M Garcia
- Departamento de Farmacologia, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Daniela Teixeira
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Ieda M Longo-Maugéri
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Simone Katz
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Clara L Barbiéri
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
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138
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Samuels MA, Gonzalez RG, Makadzange AT, Hedley-Whyte ET. Case 3-2017. A 62-Year-Old Man with Cardiac Sarcoidosis and New Diplopia and Weakness. N Engl J Med 2017; 376:368-379. [PMID: 28121502 DOI: 10.1056/nejmcpc1610713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Martin A Samuels
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
| | - R Gilberto Gonzalez
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
| | - Azure T Makadzange
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
| | - E Tessa Hedley-Whyte
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
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Abstract
Cutaneous and visceral leishmaniasis are amongst the most devastating infectious diseases of our time, affecting millions of people worldwide. The treatment of these serious diseases rely on a few chemotherapeutic agents, most of which are of parenteral use and induce severe side-effects. Furthermore, rates of treatment failure are high and have been linked to drug resistance in some areas. Here, we reviewed data on current chemotherapy practice in leishmaniasis. Drug resistance and mechanisms of resistance are described as well as the prospects for applying drug combinations for leishmaniasis chemotherapy. It is clear that efforts for discovering new drugs applicable to leishmaniasis chemotherapy are essential. The main aspects on the various steps of drug discovery in the field are discussed.
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140
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Pérez-Jacoiste Asín MA, Carrasco-Antón N, Fernández-Ruiz M, San Juan R, Alonso-Moralejo R, González E, Andrés A, López-Medrano F, Aguado JM. Experience with miltefosine for persistent or relapsing visceral leishmaniasis in solid organ transplant recipients: A case series from Spain. Transpl Infect Dis 2017; 19. [PMID: 27768239 DOI: 10.1111/tid.12623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/08/2016] [Accepted: 09/25/2016] [Indexed: 12/25/2022]
Abstract
The incidence of visceral leishmaniasis (VL) after solid organ transplantation (SOT) is increasing. The optimal therapy for post-transplant VL remains unclear, as relapses after liposomal amphotericin B (L-AmB) are common. Miltefosine has been shown to be effective for treating VL in immunocompetent patients, although data in the specific population of SOT recipients are lacking. In the setting of an outbreak of leishmaniasis occurring in Southwest Madrid, we reviewed our experience in 6 SOT recipients with persistent or relapsing VL who received a 28-day course of miltefosine (2.5 mg/kg/day) as salvage therapy. All patients had been treated previously with L-AmB as first-line therapy. The incident episode of VL occurred at a median of 14 months after transplantation. Two patients experienced persistent infection and the remaining 4 had a relapse after a median interval of 168 days since the completion of the course of L-AmB. All the patients had an apparent initial clinical improvement with miltefosine. However, VL relapsed in 3 of them (after a median interval of 46 days), which required retreatment with L-AmB-based regimens. Miltefosine therapy was followed by a prolonged secondary prophylaxis with L-AmB in the only 2 cases with sustained clinical response and ongoing immunosuppression. No adverse effects associated with miltefosine were observed. Albeit limited, our experience suggests that miltefosine monotherapy likely has a limited utility to obtain a long-lasting clinical response in complicated (persistent or relapsing) forms of post-transplant VL, although its role in association with L-AmB-based secondary prophylaxis may merit further investigation.
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Affiliation(s)
- Maria A Pérez-Jacoiste Asín
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Nerea Carrasco-Antón
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Rafael San Juan
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Rodrigo Alonso-Moralejo
- Department of Respiratory Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Esther González
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Amado Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Jose M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
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141
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Dalberto PF, Martinelli LKB, Bachega JFR, Timmers LFSM, Pinto AFM, Dadda ADS, Petersen GO, Subtil FT, Galina L, Villela AD, Pissinate K, Machado P, Bizarro CV, de Souza ON, de Carvalho Filho EM, Basso LA, Santos DS. Thermodynamics, functional and structural characterization of inosine–uridine nucleoside hydrolase from Leishmania braziliensis. RSC Adv 2017. [DOI: 10.1039/c7ra07268f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Inosine–uridine nucleoside hydrolase fromLeishmania braziliensisis a nonspecific enzyme that contains a disulfide bond not needed for tetramer stabilization.
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142
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Khanra S, Sarraf NR, Das S, Das AK, Roy S, Manna M. Genetic markers for antimony resistant clinical isolates differentiation from Indian Kala-azar. Acta Trop 2016; 164:177-184. [PMID: 27629023 DOI: 10.1016/j.actatropica.2016.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/09/2016] [Accepted: 09/09/2016] [Indexed: 02/07/2023]
Abstract
Visceral Leishmaniasis or Kala-azar is caused by the protozoan parasites belonging to the Genus Leishmania. Once thought eradicated from the Indian subcontinent, the disease came back with drug resistance to almost all prevalent drugs. Molecular epidemiological studies revealed the polymorphic nature of the population of the main player of the disease, Leishmania donovani and involvement of other species (L. tropica) and other genus (Leptomonas) with the disease. This makes control measures almost futile. It also strongly demands the characterization of each and every isolate mandatory which is not done. In this background, the present study has been carried out to assess the genetic attributes of each clinical isolates (n=26) of KA and PKDL patients from India and Bangladesh. All the isolates were characterized through Restriction Fragment Length Polymorphism (RFLP) analysis to ascertain their species identity. 46.2% of the isolates were found to be Sodium Stibogluconate (SSG) resistant by amastigote-macrophage model. When the clinical isolates were subjected to Single Stranded Conformation Polymorphism (SSCP) of Internal Transcribed Spacer 1 (ITS1), Internal Transcribed Spacer 2 (ITS2) and some anonymous markers, the drug resistant Leishmania isolates of SSG can be distinguished from the sensitive isolates distinctly. This study showed for the first time, the genetic markers for SSG drug resistance of Indian Kala-azar clinical isolates.
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Affiliation(s)
- Supriya Khanra
- Department of Zoology, Barasat Govt. College, 10, K.N.C Road, Kolkata 700124, India
| | | | - Shantanabha Das
- Department of Infectious Diseases & Immunology, Indian Institute of Chemical Biology, 4, Raja S.C. Mullick Road, Kolkata 700032, India
| | - Anjan Kumar Das
- Department of Medicine, Calcutta National Medical College, 32, Gorachand Road, Kolkata 700014, India
| | - Syamal Roy
- Department of Infectious Diseases & Immunology, Indian Institute of Chemical Biology, 4, Raja S.C. Mullick Road, Kolkata 700032, India
| | - Madhumita Manna
- Department of Zoology, Barasat Govt. College, 10, K.N.C Road, Kolkata 700124, India.
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143
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Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2016; 63:e202-e264. [PMID: 27941151 DOI: 10.1093/cid/ciw670] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022] Open
Abstract
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Naomi Aronson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Michael Libman
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Peter Weina
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Selma Jeronimo
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - Alan Magill
- Bill and Melinda Gates Foundation, Seattle, Washington
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144
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Carrijo-Carvalho LC, Sant'ana VP, Foronda AS, de Freitas D, de Souza Carvalho FR. Therapeutic agents and biocides for ocular infections by free-living amoebae of Acanthamoeba genus. Surv Ophthalmol 2016; 62:203-218. [PMID: 27836717 DOI: 10.1016/j.survophthal.2016.10.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Abstract
Acanthamoeba keratitis is a sight-threatening infectious disease. Resistance of the cystic form of the protozoan to biocides and the potential toxicity of chemical compounds to corneal cells are the main concerns related to long-term treatment with the clinically available ophthalmic drugs. Currently, a limited number of recognized antimicrobial agents are available to treat ocular amoebic infections. Topical application of biguanide and diamidine antiseptic solutions is the first-line therapy. We consider the current challenges when treating Acanthamoeba keratitis and review the chemical properties, toxicities, and mechanisms of action of the available biocides. Antimicrobial therapy using anti-inflammatory drugs is controversial, and aspects related to this topic are discussed. Finally, we offer our perspective on potential improvement of the effectiveness and safety of therapeutic profiles, with the focus on the quality of life and the advancement of individualized medicine.
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Affiliation(s)
- Linda Christian Carrijo-Carvalho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Viviane Peracini Sant'ana
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Annette Silva Foronda
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Denise de Freitas
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Fabio Ramos de Souza Carvalho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
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145
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Ullah N, Nadhman A, Siddiq S, Mehwish S, Islam A, Jafri L, Hamayun M. Plants as Antileishmanial Agents: Current Scenario. Phytother Res 2016; 30:1905-1925. [DOI: 10.1002/ptr.5710] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/18/2016] [Accepted: 08/12/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Nazif Ullah
- Department of Biotechnology, Faculty of Chemical and Life Sciences; Abdul Wali Khan University Mardan; Mardan Pakistan
| | - Akhtar Nadhman
- Sulaiman Bin Abdullah Aba Al Khail Centre for Interdisciplinary Research in Basic Sciences (SA-CIRBS); International Islamic University; Islamabad 44000 Pakistan
| | - Sumaira Siddiq
- Department of Biotechnology, Faculty of Chemical and Life Sciences; Abdul Wali Khan University Mardan; Mardan Pakistan
| | - Shaila Mehwish
- Department of Biotechnology, Faculty of Chemical and Life Sciences; Abdul Wali Khan University Mardan; Mardan Pakistan
| | - Arshad Islam
- Laboratório de Immunopatologia, Núcleo de Pesquisa em Ciências Biológicas, (NUPEB), Programa de Pós-graduação em Ciências Biológicas; Universidade Federal de Ouro Preto; Ouro Preto Minas Gerais 35.400-000 Brazil
| | - Laila Jafri
- Department of Biochemistry, Faculty of Sciences; Bahauddin Zakariya University; Multan Pakistan
| | - Muhammad Hamayun
- Department of Botany, Faculty of Chemical and Life Sciences; Abdul Wali Khan University; Mardan Pakistan
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146
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Laffitte MCN, Leprohon P, Papadopoulou B, Ouellette M. Plasticity of the Leishmania genome leading to gene copy number variations and drug resistance. F1000Res 2016; 5:2350. [PMID: 27703673 PMCID: PMC5031125 DOI: 10.12688/f1000research.9218.1] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 01/04/2023] Open
Abstract
Leishmania has a plastic genome, and drug pressure can select for gene copy number variation (CNV). CNVs can apply either to whole chromosomes, leading to aneuploidy, or to specific genomic regions. For the latter, the amplification of chromosomal regions occurs at the level of homologous direct or inverted repeated sequences leading to extrachromosomal circular or linear amplified DNAs. This ability of
Leishmania to respond to drug pressure by CNVs has led to the development of genomic screens such as Cos-Seq, which has the potential of expediting the discovery of drug targets for novel promising drug candidates.
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Affiliation(s)
- Marie-Claude N Laffitte
- Centre de Recherche en Infectiologie du Centre de Recherche du CHU Québec, and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Philippe Leprohon
- Centre de Recherche en Infectiologie du Centre de Recherche du CHU Québec, and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Barbara Papadopoulou
- Centre de Recherche en Infectiologie du Centre de Recherche du CHU Québec, and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Marc Ouellette
- Centre de Recherche en Infectiologie du Centre de Recherche du CHU Québec, and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
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147
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Efficacy and Safety of AmBisome in Combination with Sodium Stibogluconate or Miltefosine and Miltefosine Monotherapy for African Visceral Leishmaniasis: Phase II Randomized Trial. PLoS Negl Trop Dis 2016; 10:e0004880. [PMID: 27627654 PMCID: PMC5023160 DOI: 10.1371/journal.pntd.0004880] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/06/2016] [Indexed: 01/31/2023] Open
Abstract
Background SSG&PM over 17 days is recommended as first line treatment for visceral leishmaniasis in eastern Africa, but is painful and requires hospitalization. Combination regimens including AmBisome and miltefosine are safe and effective in India, but there are no published data from trials of combination therapies including these drugs from Africa. Methods A phase II open-label, non-comparative randomized trial was conducted in Sudan and Kenya to evaluate the efficacy and safety of three treatment regimens: 10 mg/kg single dose AmBisome plus 10 days of SSG (20 mg/kg/day), 10 mg/kg single dose AmBisome plus 10 days of miltefosine (2.5mg/kg/day) and miltefosine alone (2.5 mg/kg/day for 28 days). The primary endpoint was initial parasitological cure at Day 28, and secondary endpoints included definitive cure at Day 210, and pharmacokinetic (miltefosine) and pharmacodynamic assessments. Results In sequential analyses with 49–51 patients per arm, initial cure was 85% (95% CI: 73–92) in all arms. At D210, definitive cure was 87% (95% CI: 77–97) for AmBisome + SSG, 77% (95% CI 64–90) for AmBisome + miltefosine and 72% (95% CI 60–85) for miltefosine alone, with lower efficacy in younger patients, who weigh less. Miltefosine pharmacokinetic data indicated under-exposure in children compared to adults. Conclusion No major safety concerns were identified, but point estimates of definitive cure were less than 90% for each regimen so none will be evaluated in Phase III trials in their current form. Allometric dosing of miltefosine in children needs to be evaluated. Trial Registration The study was registered with ClinicalTrials.gov, number NCT01067443 Visceral leishmaniasis, or kala-azar, is a parasitic disease which is fatal without treatment. A 17-day treatment of sodium stibogluconate (SSG) with paromomycin (PM) is the recommended treatment in eastern Africa, but requires painful injections, causes adverse events, and patients need to stay in the hospital during treatment. An affordable, safe and effective oral treatment would be preferable. Whilst research to identify entirely new drugs is underway, existing treatments are being optimized as a short-term solution. Combination regimens based on AmBisome and miltefosine have been shown to be safe and effective in treating Indian patients, but there are no published data from use of these drugs in combination regimens from Africa, where efficacy of treatments can be different from India. Three regimens were evaluated for treating VL in eastern Africa, using AmBisome in combination with SSG or miltefosine, or miltefosine alone. Once again, drugs which are effective in India were found to be less so in African patients, and none of the regimes tested showed sufficiently high definitive cure rates to evaluate in Phase III trials. The results also suggest miltefosine was under-dosed in children and so allometric dosing, which takes into account the differences in drug metabolism seen in children compared to adults, needs to be studied.
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148
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Valicherla GR, Tripathi P, Singh SK, Syed AA, Riyazuddin M, Husain A, Javia D, Italiya KS, Mishra PR, Gayen JR. Pharmacokinetics and bioavailability assessment of Miltefosine in rats using high performance liquid chromatography tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1031:123-130. [DOI: 10.1016/j.jchromb.2016.07.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/19/2016] [Accepted: 07/23/2016] [Indexed: 01/01/2023]
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149
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Shivahare R, Ali W, Singh US, Natu SM, Khattri S, Puri SK, Gupta S. Immunoprotective effect of lentinan in combination with miltefosine on Leishmania-infected J-774A.1 macrophages. Parasite Immunol 2016; 38:618-27. [PMID: 27387601 DOI: 10.1111/pim.12346] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/04/2016] [Indexed: 11/29/2022]
Abstract
Rejuvenation of deteriorated host immune functions is imperative for successful annihilation of Leishmania parasites. The use of immunomodulatory agents may have several advantages as they conquer immunosuppression and, when given in combination, improve current therapeutic regimens. We herein investigated the immunostimulatory potency of a β-glucan, lentinan either alone or in combination with short dose of standard drug, miltefosine on Leishmania-infected J-774A.1 macrophages. Our study shows that infected macrophages when stimulated with 2.5 μg/mL and above concentrations of lentinan secreted significant amount of host-protective molecules. The in vitro interaction between lentinan and miltefosine showed some synergy (mean sum of fractional inhibitory concentration [mean ∑FIC] 0.87) at IC50 level. Lentinan (2.5 μg/mL) plus low-dose miltefosine (2 μM) displayed heightened level of pro-inflammatory cytokines, IL-12 (13.6-fold) and TNF-α (6.8-fold) along with nitric oxide (7.2-fold higher) when compared with infected control. In combination group, we also observed remarkably (P<.001) suppressed levels of anti-inflammatory cytokines, IL-10 and TGF-β, than that of untreated macrophages. Additionally, in comparison with infected group, we observed significant induction in phagocytic activity of macrophages in combination with treated group. Collectively, these findings emphasize the immunostimulatory effect of lentinan alone and in combination with low dose of miltefosine against Leishmania donovani.
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Affiliation(s)
- R Shivahare
- Department of Pathology, King George's Medical University, Lucknow, India.
| | - W Ali
- Department of Pathology, King George's Medical University, Lucknow, India.
| | - U S Singh
- Department of Pathology, King George's Medical University, Lucknow, India
| | - S M Natu
- Department of Pathology, King George's Medical University, Lucknow, India
| | - S Khattri
- Department of Pharmacology and Therapeutics, King George's Medical University, Lucknow, India
| | - S K Puri
- Division of Parasitology, CSIR- Central Drug Research Institute, Lucknow, India
| | - S Gupta
- Division of Parasitology, CSIR- Central Drug Research Institute, Lucknow, India
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150
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Enciso E, Sarmiento-Sánchez JI, López-Moreno HS, Ochoa-Terán A, Osuna-Martínez U, Beltrán-López E. Synthesis of new quinazolin-2,4-diones as anti-Leishmania mexicana agents. Mol Divers 2016; 20:821-828. [DOI: 10.1007/s11030-016-9693-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/07/2016] [Indexed: 11/24/2022]
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