151
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Vollmer ME, Glaser C. A Balamuthia survivor. JMM Case Rep 2016; 3:e005031. [PMID: 28348755 PMCID: PMC5330223 DOI: 10.1099/jmmcr.0.005031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/26/2016] [Accepted: 03/14/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction: This case report describes a human survivor of Balamuthia mandrillaris infection. This is a free-living amoeba that can cause infection with the devastating consequence of near universally fatal encephalitis. We report this case to demonstrate the possibility of recovery. Case presentation: A 26-year-old Hispanic male, a landscape gardener, presented to the hospital in March 2010 with a two month history of headache, visual disturbances and new-onset seizures. Brain imaging identified two enhancing central lesions and Balamuthia mandrillaris was later identified by brain biopsy. He received several months of various antimicrobials including miltefosine, a novel use of the drug in this disease at the time. Seven weeks into therapy, considerations were made to switch him to ‘comfort care’ because of worsening clinical status and seemingly lack of response to treatment. The patient finally demonstrated clinical and radiological improvement after eight weeks with modified therapy, despite experiencing some debilitating toxic effects likely to be related to antibiotics. Two years after his initial presentation he made a complete recovery. Conclusion: Balamuthia mandrillaris amoebic encephalitis is considered an almost universally fatal disease; this case demonstrates the possibility of recovery. This report outlines his treatment, drug toxicities and includes additional information regarding the therapeutic use of the drug miltefosine. Whether his survival is related to the specific antimicrobials used in this case is unknown and further investigation is warranted.
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Affiliation(s)
- Michael Eric Vollmer
- Infectious Disease Doctors Medical Group, 365 Lennon Lane Suite 200 , Walnut Creek, CA 94598 , USA
| | - Carol Glaser
- The Permanente Medical Group, Oakland Medical Center , 3505 Broadway St, Oakland, CA 94611 , USA
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152
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Lanza JS, Fernandes FR, Corrêa-Júnior JD, Vilela JM, Magalhães-Paniago R, Ferreira LA, Andrade MS, Demicheli C, Melo MN, Frézard F. Polarity-sensitive nanocarrier for oral delivery of Sb(V) and treatment of cutaneous leishmaniasis. Int J Nanomedicine 2016; 11:2305-18. [PMID: 27307731 PMCID: PMC4887043 DOI: 10.2147/ijn.s105952] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
There is a great need for orally active drugs for the treatment of the neglected tropical disease leishmaniasis. Amphiphilic Sb(V) complexes, such as 1:3 Sb–N-octanoyl-N-methylglucamide complex (SbL8), are promising drug candidates. It has been previously reported that SbL8 forms kinetically stabilized nanoassemblies in water and that this simple dispersion exhibits antileishmanial activity when given by oral route to a murine model of visceral leishmaniasis. The main objective of the present work was to interfere in the structural organization of these nanoassemblies so as to investigate their influence on the oral bioavailability of Sb, and ultimately, optimize an oral formulation of SbL8 for the treatment of cutaneous leishmaniasis. The structural organization of SbL8 nanoassemblies was manipulated through addition of propylene glycol (PG) to the aqueous dispersion of SbL8. The presence of 50% (v/v) PG resulted in the loss of hydrophobic microenvironment, as evidenced by fluorescence probing. However, nanostructures were still present, as demonstrated by dynamic light scattering, small-angle X-ray scattering, and atomic force microscopy (AFM). A remarkable property of these nanoassemblies, as revealed by AFM analysis, is the flexibility of their supramolecular organization, which showed changes as a function of the solvent and substrate polarities. The formulation of SbL8 in 1:1 water:PG given orally to mice promoted significantly higher and more sustained serum levels of Sb, when compared to SbL8 in water. The new formulation, when given as repeated doses (200 mg Sb/kg/day) to BALB/c mice infected with Leishmania amazonensis, was significantly more effective in reducing the lesion parasite burden, compared to SbL8 in water, and even, the conventional drug Glucantime® given intraperitoneally at the same dose. In conclusion, this work introduces a new concept of polarity-sensitive nanocarrier that was successfully applied to optimize an oral formulation of Sb(V) for treating cutaneous leishmaniasis.
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Affiliation(s)
- Juliane S Lanza
- Department of Physiology and Biophysics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Flaviana R Fernandes
- Department of Physiology and Biophysics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - José D Corrêa-Júnior
- Department of Morphology, Instituto de Ciências Biológicas (ICB), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - José Mc Vilela
- Innovation and Technology Center SENAI FIEMG - Campus CETEC, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Rogério Magalhães-Paniago
- Department of Physics, Instituto de Ciências Exatas (ICEX), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Lucas Am Ferreira
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Margareth S Andrade
- Innovation and Technology Center SENAI FIEMG - Campus CETEC, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Cynthia Demicheli
- Department of Chemistry, Instituto de Ciências Exatas (ICEX), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Maria N Melo
- Department of Parasitology, Instituto de Ciências Biológicas (ICB), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Frédéric Frézard
- Department of Physiology and Biophysics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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153
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Coelho AC, Oliveira JC, Espada CR, Reimão JQ, Trinconi CT, Uliana SRB. A Luciferase-Expressing Leishmania braziliensis Line That Leads to Sustained Skin Lesions in BALB/c Mice and Allows Monitoring of Miltefosine Treatment Outcome. PLoS Negl Trop Dis 2016; 10:e0004660. [PMID: 27144739 PMCID: PMC4856402 DOI: 10.1371/journal.pntd.0004660] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/02/2016] [Indexed: 11/18/2022] Open
Abstract
Background Leishmania braziliensis is the most prevalent species isolated from patients displaying cutaneous and muco-cutaneous leishmaniasis in South America. However, there are difficulties for studying L. braziliensis pathogenesis or response to chemotherapy in vivo due to the natural resistance of most mouse strains to infection with these parasites. The aim of this work was to develop an experimental set up that could be used to assess drug efficacy against L. braziliensis. The model was tested using miltefosine. Methodology/Principal Findings A L. braziliensis line, originally isolated from a cutaneous leishmaniasis patient, was passaged repeatedly in laboratory rodents and further genetically manipulated to express luciferase. Once collected from a culture of parasites freshly transformed from amastigotes, 106 wild type or luciferase-expressing stationary phase promastigotes were inoculated subcutaneously in young BALB/c mice or golden hamsters. In both groups, sustained cutaneous lesions developed at the site of inoculation, no spontaneous self- healing being observed 4 months post-inoculation, if left untreated. Compared to the wild type line features, no difference was noted for the luciferase-transgenic line. Infected animals were treated with 5 or 15 mg/kg/day miltefosine orally for 15 days. At the end of treatment, lesions had regressed and parasites were not detected. However, relapses were observed in animals treated with both doses of miltefosine. Conclusions/Significance Here we described experimental settings for a late-healing model of cutaneous leishmaniasis upon inoculation of a luciferase-expressing L. braziliensis line that can be applied to drug development projects. These settings allowed the monitoring of the transient efficacy of a short-term miltefosine administration. Leishmania braziliensis is the most prevalent species isolated from patients displaying either cutaneous or mucocutaneous leishmaniasis in South America. In this study, we developed a transgenic luciferase-expressing L. braziliensis line. These parasites were passaged in hamsters and mice and then transformed back into promastigotes. Once inoculated subcutaneously in the footpad of young laboratory animals—BALB/c mice or golden hamsters, rapid and sustained footpad thickness increase developed. This experimental model was used to monitor the parasite load fluctuations and the response to miltefosine treatment. Mice were treated orally over a two-week period, starting at week 4 post-inoculation. Though such a regimen was shown to display efficacy, the effect was not sustained and both parasite re-expansion and delayed footpad thickness increase were noticed.
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Affiliation(s)
- Adriano C. Coelho
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Jordana C. Oliveira
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Caroline R. Espada
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Juliana Q. Reimão
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Cristiana T. Trinconi
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Silvia R. B. Uliana
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
- * E-mail:
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154
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Mondelaers A, Sanchez-Cañete MP, Hendrickx S, Eberhardt E, Garcia-Hernandez R, Lachaud L, Cotton J, Sanders M, Cuypers B, Imamura H, Dujardin JC, Delputte P, Cos P, Caljon G, Gamarro F, Castanys S, Maes L. Genomic and Molecular Characterization of Miltefosine Resistance in Leishmania infantum Strains with Either Natural or Acquired Resistance through Experimental Selection of Intracellular Amastigotes. PLoS One 2016; 11:e0154101. [PMID: 27123924 PMCID: PMC4849676 DOI: 10.1371/journal.pone.0154101] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/08/2016] [Indexed: 02/06/2023] Open
Abstract
During the last decade miltefosine (MIL) has been used as first-line treatment for visceral leishmaniasis in endemic areas with antimonial resistance, but a decline in clinical effectiveness is now being reported. While only two MIL-resistant Leishmania infantum strains from HIV co-infected patients have been documented, phenotypic MIL-resistance for L. donovani has not yet been identified in the laboratory. Hence, a better understanding of the factors contributing to increased MIL-treatment failure is necessary. Given the paucity of defined MIL-resistant L. donovani clinical isolates, this study used an experimental amastigote-selected MIL-resistant L. infantum isolate (LEM3323). In-depth exploration of the MIL-resistant phenotype was performed by coupling genomic with phenotypic data to gain insight into gene function and the mutant phenotype. A naturally MIL-resistant L. infantum clinical isolate (LEM5159) was included to compare both datasets. Phenotypically, resistance was evaluated by determining intracellular amastigote susceptibility in vitro and actual MIL-uptake. Genomic analysis provided supportive evidence that the resistance selection model on intracellular amastigotes can be a good proxy for the in vivo field situation since both resistant strains showed mutations in the same inward transporter system responsible for the acquired MIL-resistant phenotype. In line with previous literature findings in promastigotes, our data confirm a defective import machinery through inactivation of the LiMT/LiRos3 protein complex as the main mechanism for MIL-resistance also in intracellular amastigotes. Whole genome sequencing analysis of LEM3323 revealed a 2 base pair deletion in the LiMT gene that led to the formation an early stop codon and a truncation of the LiMT protein. Interestingly, LEM5159 revealed mutations in both the LiMT and LiRos3 genes, resulting in an aberrant expression of the LiMT protein. To verify that these mutations were indeed accountable for the acquired resistance, transfection experiments were performed to re-establish MIL-susceptibility. In LEM3323, susceptibility was restored upon expression of a LiMT wild-type gene, whereas the MIL-susceptibility of LEM5159 could be reversed after expression of the LiRos3 wild-type gene. The aberrant expression profile of the LiMT protein could be restored upon rescue of the LiRos3 gene both in the LEM5159 clinical isolate and a ΔLiRos3 strain, showing that expression of LdMT is dependent on LdRos3 expression. The present findings clearly corroborate the pivotal role of the LiMT/LiRos3 complex in resistance towards MIL.
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Affiliation(s)
- Annelies Mondelaers
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Maria P. Sanchez-Cañete
- Instituto de Parasitologia y Biomedicina "Lopez-Neyra", Avda. Conocimiento S/N Parque Tecnológico Ciencias de la Salud, 18016, Granada, Spain
| | - Sarah Hendrickx
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Eline Eberhardt
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Raquel Garcia-Hernandez
- Instituto de Parasitologia y Biomedicina "Lopez-Neyra", Avda. Conocimiento S/N Parque Tecnológico Ciencias de la Salud, 18016, Granada, Spain
| | - Laurence Lachaud
- Laboratoire de Parasitologie-Mycologie et Centre National de Référence des Leishmanioses, Centre Hospitalier Universitaire et Université de Montpellier 39, Avenue Charles Flahault, 34295, Montpellier, France
| | - James Cotton
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, Cambridge, United Kingdom
| | - Mandy Sanders
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, Cambridge, United Kingdom
| | - Bart Cuypers
- Molecular Parasitology Unit (MPU), Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
- Advanced Database Research and Modeling (ADReM) research group, University of Antwerp, Middelheimlaan 1,2020, Antwerpen, Belgium
| | - Hideo Imamura
- Molecular Parasitology Unit (MPU), Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
| | - Jean-Claude Dujardin
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
- Molecular Parasitology Unit (MPU), Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
| | - Peter Delputte
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Guy Caljon
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Francisco Gamarro
- Instituto de Parasitologia y Biomedicina "Lopez-Neyra", Avda. Conocimiento S/N Parque Tecnológico Ciencias de la Salud, 18016, Granada, Spain
| | - Santiago Castanys
- Instituto de Parasitologia y Biomedicina "Lopez-Neyra", Avda. Conocimiento S/N Parque Tecnológico Ciencias de la Salud, 18016, Granada, Spain
- * E-mail:
| | - Louis Maes
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Universiteitsplein 1, B-2610, Wilrijk, Belgium
- * E-mail:
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155
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Sundar S, Singh A. Recent developments and future prospects in the treatment of visceral leishmaniasis. Ther Adv Infect Dis 2016; 3:98-109. [PMID: 27536354 DOI: 10.1177/2049936116646063] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Limited therapeutic options in visceral leishmaniasis (VL) make the treatment of this neglected disease very challenging. In addition to this, long treatment duration and toxic adverse effects make it even more difficult. With no effective vaccine available to date, treatment of VL is based only on chemotherapy. In the Indian subcontinent, a single dose of liposomal amphotericin B (L-AmB) and multidrug therapy (L-AmB + miltefosine, L-AmB + paromomycin [PM], or miltefosine + PM) are the treatments of choice for VL. In East Africa, however, combination therapy of pentavalent antimonials (Sb(v)) and PM remains the treatment of choice, and in the Mediterranean region and South America, L-AmB is the recommended drug. Fexinidazole and PA-824 are new promising drugs which have shown encouraging results in preclinical studies.
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Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005 India
| | - Anup Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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156
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Cope JR, Conrad DA, Cohen N, Cotilla M, DaSilva A, Jackson J, Visvesvara GS. Use of the Novel Therapeutic Agent Miltefosine for the Treatment of Primary Amebic Meningoencephalitis: Report of 1 Fatal and 1 Surviving Case. Clin Infect Dis 2016; 62:774-6. [PMID: 26679626 PMCID: PMC4775347 DOI: 10.1093/cid/civ1021] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/07/2015] [Indexed: 11/15/2022] Open
Abstract
Primary amebic meningoencephalitis (PAM) is a fulminant central nervous system infection caused by the thermophilic free-living ameba Naegleria fowleri. Few survivals have been documented and adequate treatment is lacking. We report 2 PAM cases, 1 fatal and 1 surviving, treated with the novel antiparasitic agent miltefosine.
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Affiliation(s)
- Jennifer R Cope
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Alexandre DaSilva
- Centers for Disease Control and Prevention, Atlanta, Georgia US Food and Drug Administration, Laurel, Maryland
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157
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Singh OP, Singh B, Chakravarty J, Sundar S. Current challenges in treatment options for visceral leishmaniasis in India: a public health perspective. Infect Dis Poverty 2016; 5:19. [PMID: 26951132 PMCID: PMC4782357 DOI: 10.1186/s40249-016-0112-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/02/2016] [Indexed: 12/31/2022] Open
Abstract
Visceral leishmaniasis (VL) is a serious parasitic disease causing considerable mortality and major disability in the Indian subcontinent. It is most neglected tropical disease, particularly in terms of new drug development for the lack of financial returns. An elimination campaign has been running in India since 2005 that aim to reduce the incidence of VL to below 1 per 10,000 people at sub-district level. One of the major components in this endeavor is reducing transmission through early case detection followed by complete treatment. Substantial progress has been made during the recent years in the area of VL treatment, and the VL elimination initiatives have already saved many lives by deploying them effectively in the endemic areas. However, many challenges remain to be overcome including availability of drugs, cost of treatment (drugs and hospitalization), efficacy, adverse effects, and growing parasite resistance. Therefore, better emphasis on implementation research is urgently needed to determine how best to deliver existing interventions with available anti-leishmanial drugs. It is essential that the new treatment options become truly accessible, not simply available in endemic areas so that they may promote healing and save lives. In this review, we highlight the recent advancement and challenges in current treatment options for VL in disease endemic area, and discuss the possible strategies to improve the therapeutic outcome.
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Affiliation(s)
- Om Prakash Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Bhawana Singh
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Jaya Chakravarty
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Shyam Sundar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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158
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No JH. Visceral leishmaniasis: Revisiting current treatments and approaches for future discoveries. Acta Trop 2016; 155:113-23. [PMID: 26748356 DOI: 10.1016/j.actatropica.2015.12.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/24/2015] [Accepted: 12/25/2015] [Indexed: 12/12/2022]
Abstract
The current treatments for visceral leishmaniasis are old and toxic with limited routes of administration. The emergence of drug-resistant Leishmania threatens the efficacy of the existing reservoir of antileishmanials, leading to an urgent need to develop new treatments. It is particularly important to review and understand how the current treatments act against Leishmania in order to identify valid drug targets or essential pathways for next-generation antileishmanials. It is equally important to adapt newly emerging biotechnologies to facilitate the current research on the development of novel antileishmanials in an efficient fashion. This review covers the basic background of the current visceral leishmaniasis treatments with an emphasis on the modes of action. It briefly discusses the role of the immune system in aiding the chemotherapy of leishmaniasis, describes potential new antileishmanial drug targets and pathways, and introduces recent progress on the utilization of high-throughput phenotypic screening assays to identify novel antileishmanial compounds.
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Affiliation(s)
- Joo Hwan No
- Institut Pasteur Korea, Leishmania Research Laboratory, 696 Sampyeong-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
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159
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Trinconi CT, Reimão JQ, Coelho AC, Uliana SRB. Efficacy of tamoxifen and miltefosine combined therapy for cutaneous leishmaniasis in the murine model of infection withLeishmania amazonensis. J Antimicrob Chemother 2016; 71:1314-22. [DOI: 10.1093/jac/dkv495] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/21/2015] [Indexed: 11/13/2022] Open
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160
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Bhattacharya SK, Dash AP. Treatment of visceral leishmaniasis: options and choice. THE LANCET. INFECTIOUS DISEASES 2016; 16:142-3. [PMID: 26867454 DOI: 10.1016/s1473-3099(15)00528-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/13/2015] [Accepted: 12/09/2015] [Indexed: 11/19/2022]
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161
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Melo TS, Gattass CR, Soares DC, Cunha MR, Ferreira C, Tavares MT, Saraiva E, Parise-Filho R, Braden H, Delorenzi JC. Oleanolic acid (OA) as an antileishmanial agent: Biological evaluation and in silico mechanistic insights. Parasitol Int 2016; 65:227-37. [PMID: 26772973 DOI: 10.1016/j.parint.2016.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/23/2015] [Accepted: 01/03/2016] [Indexed: 12/12/2022]
Abstract
Although a worldwide health problem, leishmaniasis is considered a highly neglected disease, lacking efficient and low toxic treatment. The efforts for new drug development are based on alternatives such as new uses for well-known drugs, in silico and synthetic studies and naturally derived compounds. Oleanolic acid (OA) is a pentacyclic triterpenoid widely distributed throughout the Plantae kingdom that displays several pharmacological activities. OA showed potent leishmancidal effects in different Leishmania species, both against promastigotes (IC(50 L. braziliensis) 30.47 ± 6.35 μM; IC(50 L. amazonensis) 40.46 ± 14.21 μM; IC(50 L. infantum) 65.93 ± 15.12 μM) and amastigotes (IC(50 L. braziliensis) 68.75 ± 16.55 μM; IC(50 L. amazonensis) 38.45 ± 12.05 μM; IC(50 L. infantum) 64.08 ± 23.52 μM), with low cytotoxicity against mouse peritoneal macrophages (CC(50) 235.80 ± 36.95 μM). Moreover, in silico studies performed to evaluate OA molecular properties and to elucidate the possible mechanism of action over the Leishmania enzyme sterol 14α-demethylase (CYP51) suggested that OA interacts efficiently with CYP51 and could inhibit the ergosterol synthesis pathway. Collectively, these data indicate that OA is a good candidate as leading compound for the development of a new leishmaniasis treatment.
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Affiliation(s)
- Tahira Souza Melo
- Centro de Ciências Biológicas e da Saúde, Universidade Presbiteriana Mackenzie, São Paulo, Brazil
| | - Cerli Rocha Gattass
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Deivid Costa Soares
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Micael Rodrigues Cunha
- Centro de Ciências Biológicas e da Saúde, Universidade Presbiteriana Mackenzie, São Paulo, Brazil; Laboratório de Planejamento e Síntese de Substâncias Bioativas (LAPESSB), Universidade de São Paulo, São Paulo, Brazil
| | - Christian Ferreira
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maurício Temotheo Tavares
- Laboratório de Planejamento e Síntese de Substâncias Bioativas (LAPESSB), Universidade de São Paulo, São Paulo, Brazil
| | - Elvira Saraiva
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberto Parise-Filho
- Laboratório de Planejamento e Síntese de Substâncias Bioativas (LAPESSB), Universidade de São Paulo, São Paulo, Brazil
| | - Hannah Braden
- Centro de Ciências Biológicas e da Saúde, Universidade Presbiteriana Mackenzie, São Paulo, Brazil; Wright State University, Dayton, OH, United States of America
| | - Jan Carlo Delorenzi
- Centro de Ciências Biológicas e da Saúde, Universidade Presbiteriana Mackenzie, São Paulo, Brazil.
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162
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Vahermo M, Krogerus S, Nasereddin A, Kaiser M, Brun R, Jaffe CL, Yli-Kauhaluoma J, Moreira VM. Antiprotozoal activity of dehydroabietic acid derivatives against Leishmania donovani and Trypanosoma cruzi. MEDCHEMCOMM 2016. [DOI: 10.1039/c5md00498e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Dehydroabietic acid derivatives have potent antiprotozoal activity and selectivity against L. donovani and T. cruzi.
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Affiliation(s)
- Mikko Vahermo
- Division of Pharmaceutical Chemistry and Technology
- Faculty of Pharmacy
- Viikinkaari 5 E
- Finland
| | - Sara Krogerus
- Division of Pharmaceutical Chemistry and Technology
- Faculty of Pharmacy
- Viikinkaari 5 E
- Finland
| | - Abdelmajeed Nasereddin
- Department of Microbiology and Molecular Genetics
- IMRIC
- Hebrew University-Hadassah Medical School
- 9112102 Jerusalem
- Israel
| | - Marcel Kaiser
- Department of Medical Parasitology and Infection Biology
- Swiss Tropical and Public Health Institute
- 4051 Basel
- Switzerland
| | - Reto Brun
- Department of Medical Parasitology and Infection Biology
- Swiss Tropical and Public Health Institute
- 4051 Basel
- Switzerland
| | - Charles L. Jaffe
- Department of Microbiology and Molecular Genetics
- IMRIC
- Hebrew University-Hadassah Medical School
- 9112102 Jerusalem
- Israel
| | - Jari Yli-Kauhaluoma
- Division of Pharmaceutical Chemistry and Technology
- Faculty of Pharmacy
- Viikinkaari 5 E
- Finland
| | - Vânia M. Moreira
- Division of Pharmaceutical Chemistry and Technology
- Faculty of Pharmacy
- Viikinkaari 5 E
- Finland
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Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India E-mail:
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164
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Teymouri M, Farzaneh H, Badiee A, Golmohammadzadeh S, Sadri K, Jaafari MR. Investigation of Hexadecylphosphocholine (miltefosine) usage in Pegylated liposomal doxorubicin as a synergistic ingredient: In vitro and in vivo evaluation in mice bearing C26 colon carcinoma and B16F0 melanoma. Eur J Pharm Sci 2015; 80:66-73. [DOI: 10.1016/j.ejps.2015.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/10/2015] [Accepted: 08/17/2015] [Indexed: 12/27/2022]
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Ramesh V, Singh R, Avishek K, Verma A, Deep DK, Verma S, Salotra P. Decline in Clinical Efficacy of Oral Miltefosine in Treatment of Post Kala-azar Dermal Leishmaniasis (PKDL) in India. PLoS Negl Trop Dis 2015; 9:e0004093. [PMID: 26492039 PMCID: PMC4619646 DOI: 10.1371/journal.pntd.0004093] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 08/29/2015] [Indexed: 02/04/2023] Open
Abstract
Background Recent studies have shown significant decline in the final cure rate after miltefosine treatment in visceral leishmaniasis. This study evaluates the efficacy of miltefosine in the treatment of post kala-azar dermal leishmaniasis (PKDL) patients recruited over a period of 5 years with 18 months of follow-up. Methodology In this study 86 confirmed cases of PKDL were treated with two different dosage regimens of miltefosine (Regimen I- 50mg twice daily for 90 days and Regimen II- 50 mg thrice for 60 days) and the clinical outcome assessed monthly. Cure/relapse was ascertained by clinical and histopathological examination, and measuring parasite burden by quantitative real-time PCR. In vitro susceptibility of parasites towards miltefosine was estimated at both promastigote and amastigote stages. Results Seventy three of eighty six patients completed the treatment and achieved clinical cure. Approximately 4% (3/73) patients relapsed by the end of 12 months follow-up, while a total of 15% (11/73) relapsed by the end of 18 months. Relapse rate was significantly higher in regimen II (31%) compared to regimen I (10.5%)(P<0.005). Parasite load at the pre-treatment stage was significantly higher (P<0.005) in cases that relapsed compared to the cases that remained cured. In vitro susceptibility towards miltefosine of parasites isolated after relapse was significantly lower (>2 fold) in comparison with the pre-treatment isolates (P<0.005). Conclusion Relapse rate in PKDL following miltefosine treatment has increased substantially, indicating the need of introducing alternate drugs/ combination therapy with miltefosine. Increasing resistance to antimonials has paved the way for the oral drug miltefosine for PKDL treatment. Recent studies show a significant decline in the final cure rate of VL after miltefosine treatment in the Indian subcontinent. This is the first study to evaluate the efficacy of miltefosine treatment in a large number of PKDL cases with 18 months follow-up. PKDL cases that completed miltefosine treatment responded well and showed initial cure; however, with 18 months of follow up period, the final cure rate was only about 85%. Treatment regimen based on high dosage over short duration resulted in high relapse rate. We observed that the parasites isolated from the cases that relapsed were more tolerant to miltefosine (>2 fold) compared to the isolates from pre-treatment stage. Estimation of parasite load at pre-treatment stage indicated that the patients with higher initial parasitic burden were at a higher risk of relapse. The declining efficacy of monotherapy with miltefosine warrants the need of alternate regimens for treatment of PKDL.
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Affiliation(s)
- V. Ramesh
- Dermatology Department, Safdarjung Hospital and Vardhman Mahavir Medical College (VMMC), New Delhi, India
| | - Ruchi Singh
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
| | - Kumar Avishek
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
| | - Aditya Verma
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
| | - Deepak Kumar Deep
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
| | - Sandeep Verma
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
| | - Poonam Salotra
- National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi, India
- * E-mail:
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166
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Ganguly S, Saha P, Chatterjee M, Roy S, Ghosh TK, Guha SK, Kundu PK, Bera DK, Basu N, Maji AK. PKDL--A Silent Parasite Pool for Transmission of Leishmaniasis in Kala-azar Endemic Areas of Malda District, West Bengal, India. PLoS Negl Trop Dis 2015; 9:e0004138. [PMID: 26485704 PMCID: PMC4613818 DOI: 10.1371/journal.pntd.0004138] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 09/14/2015] [Indexed: 11/19/2022] Open
Abstract
Post Kala-azar Dermal Leishmaniasis (PKDL) is a chronic but not life-threatening disease; patients generally do not demand treatment, deserve much more attention because PKDL is highly relevant in the context of Visceral Leishmaniasis (VL) elimination. There is no standard guideline for diagnosis and treatment for PKDL. A species-specific PCR on slit skin smear demonstrated a sensitivity of 93.8%, but it has not been applied for routine diagnostic purpose. The study was conducted to determine the actual disease burden in an endemic area of Malda district, West Bengal, comparison of the three diagnostic tools for PKDL case detection and pattern of lesion regression after treatment. The prevalence of PKDL was determined by active surveillance and confirmed by PCR based diagnosis. Patients were treated with either sodium stibogluconate (SSG) or oral miltefosine and followed up for two years to observe lesion regression period. Twenty six PKDL cases were detected with a prevalence rate of 27.5% among the antileishmanial antibody positive cases. Among three diagnostic methods used, PCR is highly sensitive (88.46%) for case confirmation. In majority of the cases skin lesions persisted after treatment completion which gradually disappeared during 6–12 months post treatment period. Reappearance of lesions noted in two cases after 1.5 years of miltefosine treatment. A significant number of PKDL patients would remain undiagnosed without active mass surveys. Such surveys are required in other endemic areas to attain the ultimate goal of eliminating Kala-azar. PCR-based method is helpful in confirming diagnosis of PKDL, referral laboratory at district or state level can achieve it. So a well-designed study with higher number of samples is essential to establish when/whether PKDL patients are free from parasite after treatment and to determine which PKDL patients need treatment for longer period. A significant number of PKDL patients have been detected in the endemic areas of Malda who would remain undiagnosed without active mass surveys. Such active survey is required in other endemic areas of the country to attain the ultimate goal of eliminating Kala-azar from this part of the world by reducing the source of infection. PCR-based method is helpful in confirming diagnosis of PKDL, which is not applicable at field level. A referral laboratory at district or state level can be a solution to the problem. Since PKDL cases do not have a fatal outcome, treatment administration of these cases can be deferred until confirmed results are obtained, which requires about 7 days’ time. The detection of leishmanial DNA in skin lesions during successive treatment courses is essential to establish whether/ when PKDL patients are parasite free during/after treatment and to determine which PKDL patients need treatment for a longer period.
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Affiliation(s)
- Swagata Ganguly
- Department of Microbiology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
- Department of Microbiology, NRS Medical College & Hospital, Kolkata, West Bengal, India
- * E-mail:
| | - Pabitra Saha
- Department of Microbiology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
- Department of Zoology, A. P. C. Roy Govt. College, Himachal Bihar, Matigara, Siliguri, West Bengal, India
| | - Moytrey Chatterjee
- Department of Microbiology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| | - Surajit Roy
- Department of Microbiology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| | | | - Subhasish K. Guha
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| | - Pratip K. Kundu
- Department of Microbiology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| | - Dilip K. Bera
- Department of Microbiology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| | - Nandita Basu
- Department of Pathology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| | - Ardhendu K. Maji
- Department of Microbiology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
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167
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Aminothiazoles: Hit to lead development to identify antileishmanial agents. Eur J Med Chem 2015; 102:582-93. [DOI: 10.1016/j.ejmech.2015.08.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 12/11/2022]
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Potent In Vitro Antiproliferative Synergism of Combinations of Ergosterol Biosynthesis Inhibitors against Leishmania amazonensis. Antimicrob Agents Chemother 2015; 59:6402-18. [PMID: 26239973 DOI: 10.1128/aac.01150-15] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/21/2015] [Indexed: 12/23/2022] Open
Abstract
Leishmaniases comprise a spectrum of diseases caused by protozoan parasites of the Leishmania genus. Treatments available have limited safety and efficacy, high costs, and difficult administration. Thus, there is an urgent need for safer and more-effective therapies. Most trypanosomatids have an essential requirement for ergosterol and other 24-alkyl sterols, which are absent in mammalian cells. In previous studies, we showed that Leishmania amazonensis is highly susceptible to aryl-quinuclidines, such as E5700, which inhibit squalene synthase, and to the azoles itraconazole (ITZ) and posaconazole (POSA), which inhibit C-14α-demethylase. Herein, we investigated the antiproliferative, ultrastructural, and biochemical effects of combinations of E5700 with ITZ and POSA against L. amazonensis. Potent synergistic antiproliferative effects were observed against promastigotes, with fractional inhibitory concentration (FIC) ratios of 0.0525 and 0.0162 for combinations of E5700 plus ITZ and of E5700 plus POSA, respectively. Against intracellular amastigotes, FIC values were 0.175 and 0.1125 for combinations of E5700 plus ITZ and E5700 plus POSA, respectively. Marked alterations of the ultrastructure of promastigotes treated with the combinations were observed, in particular mitochondrial swelling, which was consistent with a reduction of the mitochondrial transmembrane potential, and an increase in the production of reactive oxygen species. We also observed the presence of vacuoles similar to autophagosomes in close association with mitochondria and an increase in the number of lipid bodies. Both growth arrest and ultrastructural/biochemical alterations were strictly associated with the depletion of the 14-desmethyl endogenous sterol pool. These results suggest the possibility of a novel combination therapy for the treatment of leishmaniasis.
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Machado PDA, Mota VZ, Cavalli ACDL, de Carvalho GSG, Da Silva AD, Gameiro J, Cuin A, Coimbra ES. High selective antileishmanial activity of vanadium complex with stilbene derivative. Acta Trop 2015; 148:120-7. [PMID: 25917716 DOI: 10.1016/j.actatropica.2015.04.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 04/09/2015] [Accepted: 04/19/2015] [Indexed: 11/15/2022]
Abstract
Leishmaniasis is a group of disease caused by different species of the parasite Leishmania affecting millions of people worldwide. Conventional therapy relies on multiple parenteral injections with pentavalent antimonials which exhibit high toxicity and various side effects have been reported. Hence, the research for an effective and low toxic effect drug is necessary. In the present work, the synthesis, spectroscopic and analytical characterizations of stilbene derivative (H2Salophen) and its vanadium complex (VOSalophen) are reported. Besides the chemical ancillary information, investigation of the leishmanicidal effects of these compounds were provided. The biological assays against promastigote and amastigote forms of L. amazonensis have been shown that VOSalophen exhibited a strong antiparasitic activity (IC50 of 6.65 and 3.51 μM, respectively). Furthermore, the leishmanicidal activity was concentration and time-dependent. Regarding toxicity and selectivity on mammalian cells, VOSalophen have not caused significant damage to human erythrocytes in all concentrations tested and VOSalophen was almost seven times more destructive for the intracellular parasite than for macrophages. Furthermore, the leishmanicidal activity of VOSalophen in promastigote forms of L. amazonensis could be associated to mitochondrial dysfunction and increase of the reactive oxygen species (ROS) production. In L. amazonensis-infected macrophages, VOSalophen induces ROS production and a microbicidal action NO-dependent. Our biological results indicate the effective and selective action of VOSalophen against L. amazonensis and the leishmanicidal effect can be associated to parasite disorders and immumodulatory effects.
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Affiliation(s)
- Patrícia de Almeida Machado
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, 33036-900 Juiz de Fora, MG, Brazil
| | - Vinícius Zamprogno Mota
- LQBin - Laboratório de Química BioInorgânica, Departamento de Química, Instituto de Ciências Exatas, Universidade Federal de Juiz de Fora, 33036-900 Juiz de Fora, MG, Brazil
| | - Ana Clara de Lima Cavalli
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, 33036-900 Juiz de Fora, MG, Brazil
| | | | - Adilson David Da Silva
- Departamento de Química, Instituto de Ciências Exatas, Universidade Federal de Juiz de Fora, 36036-900 Juiz de Fora, MG, Brazil
| | - Jacy Gameiro
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, 33036-900 Juiz de Fora, MG, Brazil
| | - Alexandre Cuin
- LQBin - Laboratório de Química BioInorgânica, Departamento de Química, Instituto de Ciências Exatas, Universidade Federal de Juiz de Fora, 33036-900 Juiz de Fora, MG, Brazil
| | - Elaine Soares Coimbra
- Departamento de Parasitologia, Microbiologia e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, 33036-900 Juiz de Fora, MG, Brazil.
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Antinarelli LM, Pinto NC, Scio E, Coimbra ES. Antileishmanial activity of some Brazilian plants, with particular reference to Casearia sylvestris. ACTA ACUST UNITED AC 2015; 87:733-42. [DOI: 10.1590/0001-3765201520140288] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/06/2014] [Indexed: 12/27/2022]
Abstract
Leishmaniasis is a complex of diseases caused by Leishmania protozoa which treatment is restricted to a limited number of drugs that exhibit high toxicity, collateral effects and are often costly. There are a variety of tropical plants distributed in Brazil, and for many poor people the therapy for several diseases is based mainly on the use of traditional herbal remedies. In this work, the cytotoxic activity of 17 plant methanol extracts was evaluated on several Leishmania species and murine macrophages. Among them, the extract of Casearia sylvestris, Piptocarpha macropoda, Trembleya parviflora, Samanea tubulosa and Plectranthus neochilus showed a promissing leishmanicidal activity, exhibiting IC50 values below of 20 µg/mL against at least one species of Leishmania. Casearia sylvestris showed the most expressive activity against all promastigote forms of Leishmania species (IC50 values of 5.4 µg/mL, 5.0 µg/mL, 8.5 µg/mL and 7.7 µg/mL for L. amazonensis, L. braziliensis, L. chagasi and L. major, respectively), being more effective than the reference drug miltefosine. In spite of the cytotoxic effect on macrophages (CC50 value of 5.2 µg/mL), C. sylvestris exhibited a strong inhibition against intracellular amastigotes of L. braziliensis (IC50 value of 1.3 µg/mL). Further studies, including bio-guided fractionation will be conducted to identify the active compounds.
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Affiliation(s)
| | | | - Elita Scio
- Universidade Federal de Juiz de Fora, Brasil
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172
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Vakil NH, Fujinami N, Shah PJ. Pharmacotherapy for Leishmaniasis in the United States: Focus on Miltefosine. Pharmacotherapy 2015; 35:536-45. [DOI: 10.1002/phar.1585] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Niyati H. Vakil
- Department of Pharmacy; Cedars-Sinai Medical Center; Los Angeles California
| | - Noriko Fujinami
- Department of Pharmacy; Cedars-Sinai Medical Center; Los Angeles California
| | - Punit J. Shah
- Department of Pharmacy; Alexian Brothers Health System; Elk Grove Village Illinois
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Kaur H, Seifert K, Hawkes GE, Coumbarides GS, Alvar J, Croft SL. Chemical and bioassay techniques to authenticate quality of the anti-leishmanial drug miltefosine. Am J Trop Med Hyg 2015; 92:31-38. [PMID: 25897058 PMCID: PMC4455076 DOI: 10.4269/ajtmh.14-0586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/23/2015] [Indexed: 01/29/2023] Open
Abstract
Miltefosine, an effective oral treatment of visceral leishmaniasis (VL), was selected in May 2005, by the governments of India, Nepal, and Bangladesh for the elimination of VL. However, abnormally high treatment failure rates reported in patients in Bangladesh, given a miltefosine generic product (“Miltefos”, Popular Pharmaceuticals Ltd.) during 2008, led the World Health Organization (WHO) to procure this formulation for quality testing. Proton (1H) and phosphorous (31P) nuclear magnetic resonance (NMR) analyses of the Miltefos™ capsules did not give the peaks defined for Impavido®, the quality assured VL treatment product from Aeterna Zentaris. Contents of capsules of Impavido® yielded expected peaks for miltefosine (m/z 408.33 for the protonated parent ion and m/z 183.99 plus m/z 124.8 the fragment ions) that were absent in the Miltefos™ capsules. Furthermore, testing using an in vitro Leishmania donovani intracellular amastigote—macrophage model, yielded EC50 values of between 2.55 and 4.06 μg/mL and 3.02 to 5.92 μg/mL for extracts from the Impavido® capsules and the miltefosine standard, respectively. Lack of significant anti-leishmanial activity of Miltefos™ capsules was identified in this assay even at concentrations up to 100 μg/mL. Capsules of Miltefos™ were classified as falsified (absence of stated active pharmaceutical ingredient) by three methods—NMR and mass spectrometry analysis and bioassay.
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Affiliation(s)
- Harparkash Kaur
- *Address correspondence to Harparkash Kaur, London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, UK. E-mail:
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Antinarelli LMR, Dias RMP, Souza IO, Lima WP, Gameiro J, da Silva AD, Coimbra ES. 4-Aminoquinoline Derivatives as Potential Antileishmanial Agents. Chem Biol Drug Des 2015; 86:704-14. [DOI: 10.1111/cbdd.12540] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/18/2014] [Accepted: 01/29/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Luciana M. R. Antinarelli
- Departamento de Parasitologia Microbiologia e Imunologia; Instituto de Ciências Biológicas; Universidade Federal de Juiz de Fora; Cidade Universitária 36036-900 Juiz de Fora Brazil
| | - Rafael M. P. Dias
- Departamento de Química; Instituto de Ciências Exatas; Universidade Federal de Juiz de Fora; Cidade Universitária 36036-900 Juiz de Fora Brazil
| | - Isabela O. Souza
- Departamento de Química; Instituto de Ciências Exatas; Universidade Federal de Juiz de Fora; Cidade Universitária 36036-900 Juiz de Fora Brazil
| | - Wallace P. Lima
- Laboratório de Imunofarmacologia; Instituto de Biofísica Carlos Chagas Filho; Universidade Federal do Rio de Janeiro; 21941-902 Rio de Janeiro Brazil
| | - Jacy Gameiro
- Departamento de Parasitologia Microbiologia e Imunologia; Instituto de Ciências Biológicas; Universidade Federal de Juiz de Fora; Cidade Universitária 36036-900 Juiz de Fora Brazil
| | - Adilson D. da Silva
- Departamento de Química; Instituto de Ciências Exatas; Universidade Federal de Juiz de Fora; Cidade Universitária 36036-900 Juiz de Fora Brazil
| | - Elaine S. Coimbra
- Departamento de Parasitologia Microbiologia e Imunologia; Instituto de Ciências Biológicas; Universidade Federal de Juiz de Fora; Cidade Universitária 36036-900 Juiz de Fora Brazil
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175
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Monge-Maillo B, López-Vélez R. Miltefosine for visceral and cutaneous leishmaniasis: drug characteristics and evidence-based treatment recommendations. Clin Infect Dis 2015; 60:1398-404. [PMID: 25601455 DOI: 10.1093/cid/civ004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 12/23/2014] [Indexed: 12/25/2022] Open
Abstract
Miltefosine is the only recognized oral agent with potential to treat leishmaniasis. Miltefosine had demonstrated very good cure rates for visceral leishmaniasis (VL) in India, Nepal, and Bangladesh, but high rates of clinical failures have been recently reported. Moderate efficacy has been observed for VL in East Africa, whereas data from Mediterranean countries and Latin America are scarce. Results have not been very promising for patients coinfected with VL and human immunodeficiency virus. However, miltefosine's long half-life and its oral administration could make it a good option for maintenance prophylaxis. Good evidence of efficacy has been documented in Old World cutaneous leishmaniasis (CL), and different cure rates among New World CL have been obtained depending on the geographical areas and species involved. Appropriate regimens for New World mucocutaneous leishmaniasis need to be established, although longer treatment duration seems to confer better results. Strategies to prevent the development and spread of miltefosine resistance are urgently needed.
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Affiliation(s)
- Begoña Monge-Maillo
- Tropical Medicine Centre, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Rogelio López-Vélez
- Tropical Medicine Centre, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
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176
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Neves BJ, Braga RC, Bezerra JCB, Cravo PVL, Andrade CH. In silico repositioning-chemogenomics strategy identifies new drugs with potential activity against multiple life stages of Schistosoma mansoni. PLoS Negl Trop Dis 2015; 9:e3435. [PMID: 25569258 PMCID: PMC4287566 DOI: 10.1371/journal.pntd.0003435] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/23/2014] [Indexed: 12/12/2022] Open
Abstract
Morbidity and mortality caused by schistosomiasis are serious public health problems in developing countries. Because praziquantel is the only drug in therapeutic use, the risk of drug resistance is a concern. In the search for new schistosomicidal drugs, we performed a target-based chemogenomics screen of a dataset of 2,114 proteins to identify drugs that are approved for clinical use in humans that may be active against multiple life stages of Schistosoma mansoni. Each of these proteins was treated as a potential drug target, and its amino acid sequence was used to interrogate three databases: Therapeutic Target Database (TTD), DrugBank and STITCH. Predicted drug-target interactions were refined using a combination of approaches, including pairwise alignment, conservation state of functional regions and chemical space analysis. To validate our strategy, several drugs previously shown to be active against Schistosoma species were correctly predicted, such as clonazepam, auranofin, nifedipine, and artesunate. We were also able to identify 115 drugs that have not yet been experimentally tested against schistosomes and that require further assessment. Some examples are aprindine, gentamicin, clotrimazole, tetrabenazine, griseofulvin, and cinnarizine. In conclusion, we have developed a systematic and focused computer-aided approach to propose approved drugs that may warrant testing and/or serve as lead compounds for the design of new drugs against schistosomes. Schistosomiasis is a neglected tropical disease caused by schistosome parasites that affects millions of people worldwide. The current reliance on a single drug (Praziquantel) for treatment and control of the disease calls for the urgent discovery of novel schistosomicidal agents. One approach that can expedite drug discovery is to find new uses for existing approved drugs, a practice known as drug repositioning. Currently, modern drug repositioning strategies entail the search for compounds that act on a specific target, often a protein known or suspected to be required for survival of the parasite. Drug repositioning approaches for schistosomiasis are now greatly facilitated by the availability of comprehensive schistosome genome data in user-friendly databases. Here, we report a drug repositioning computational strategy that involves identification of novel schistosomicidal drug candidates using similarity between schistosome proteins and known drug targets. Researchers can now use the list of predicted drugs as a basis for deciding which potential schistosomicidal candidates can be tested experimentally.
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Affiliation(s)
- Bruno J. Neves
- LabMol – Laboratory for Drug Design and Modeling, Faculdade de Farmácia, Universidade Federal de Goiás, Goiânia, Brazil
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | - Rodolpho C. Braga
- LabMol – Laboratory for Drug Design and Modeling, Faculdade de Farmácia, Universidade Federal de Goiás, Goiânia, Brazil
- Instituto de Química, Universidade Federal de Goiás, Goiaânia, Brazil
| | - José C. B. Bezerra
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | - Pedro V. L. Cravo
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
- Centro de Malária e Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Carolina H. Andrade
- LabMol – Laboratory for Drug Design and Modeling, Faculdade de Farmácia, Universidade Federal de Goiás, Goiânia, Brazil
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
- * E-mail:
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Omer A, Suryanarayanan V, Selvaraj C, Singh SK, Singh P. Explicit Drug Re-positioning: Predicting Novel Drug-Target Interactions of the Shelved Molecules with QM/MM Based Approaches. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2015; 100:89-112. [PMID: 26415842 DOI: 10.1016/bs.apcsb.2015.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
With the demand to enhance the speed of the drug discovery process there has been an increased usage of computational approaches in drug discovery studies. However because of their probabilistic outcomes, the challenge is to exactly mimic the natural environment which can provide the exact charge polarization effect while estimating the binding energy between protein and ligand. There has been a large number of scoring functions from simple one to the complex one available for estimating binding energy. The quantum mechanics/molecular mechanics (QM/MM) hybrid approach has been the preferred choice of interest since last decade for modeling reactions in biomolecular systems. The application of QM/MM approach has been expanded right from rescoring the already known complexes and depicting the correct position of some novel molecule to ranking a large number of molecules. It is expected that the application of QM/MM-based scoring will grow in all areas of drug discovery. However, the most promising area will be its application in repositioning, that is, assigning novel functions or targets to the already existing drugs, as this would stop the rising attrition rates as well as reduce the overall time and cost of drug discovery procedure.
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Affiliation(s)
- Ankur Omer
- Division of Toxicology, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India; Academy of Scientific & Innovative Research (AcSIR), New Delhi, India
| | - Venkatesan Suryanarayanan
- Department of Bioinformatics, Computer Aided Drug Design and Molecular Modeling Lab, Science Block, Alagappa University, Karaikudi, Tamil Nadu, India
| | - Chandrabose Selvaraj
- Department of Bioinformatics, Computer Aided Drug Design and Molecular Modeling Lab, Science Block, Alagappa University, Karaikudi, Tamil Nadu, India
| | - Sanjeev Kumar Singh
- Department of Bioinformatics, Computer Aided Drug Design and Molecular Modeling Lab, Science Block, Alagappa University, Karaikudi, Tamil Nadu, India.
| | - Poonam Singh
- Division of Toxicology, CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India; Academy of Scientific & Innovative Research (AcSIR), New Delhi, India.
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Efficacy and safety of miltefosine in treatment of post-kala-azar dermal leishmaniasis. ScientificWorldJournal 2015; 2015:414378. [PMID: 25685839 PMCID: PMC4313722 DOI: 10.1155/2015/414378] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/04/2014] [Accepted: 12/12/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Long regimens for the treatment of post-kala-azar dermal leishmaniasis (PKDL) result in noncompliance. A safe, effective, and acceptable regimen for the treatment of PKDL is still to be developed. Miltefosine has been found to be effective in the treatment of Visceral Leishmaniasis (VL). Hence, its efficacy was tested in patients of PKDL. Methods. In this exploratory study, 33 patients with PKDL aged 10 years and above were administered miltefosine (50 mg for those weighing <25 kg or 100 mg in divided doses for those ≥25 kg and 2.5 mg per kg for children) for 12 weeks and followed up for one year to find out the efficacy. Results. Out of 33 patients, 3 patients withdrew consent. Treatment was stopped due to adverse effect in 1 patient. 28 (96.6%) got cured with complete disappearance of lesion while 1 patient (3.4%) failed treatment by protocol analysis. Conclusion. Miltefosine was found to be effective and safe in the treatment of PKDL.
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Affiliation(s)
- Jonathan Berman
- *Address correspondence to Jonathan Berman, Fast Track Drugs and Biologics, North Potomac, MD 20878. E-mail:
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180
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Nagle A, Khare S, Kumar AB, Supek F, Buchynskyy A, Mathison CJN, Chennamaneni N, Pendem N, Buckner FS, Gelb M, Molteni V. Recent developments in drug discovery for leishmaniasis and human African trypanosomiasis. Chem Rev 2014; 114:11305-47. [PMID: 25365529 PMCID: PMC4633805 DOI: 10.1021/cr500365f] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Advait
S. Nagle
- Genomics
Institute of the Novartis Research Foundation, 10675 John Jay Hopkins Drive, San Diego, California 92121, United States
| | - Shilpi Khare
- Genomics
Institute of the Novartis Research Foundation, 10675 John Jay Hopkins Drive, San Diego, California 92121, United States
| | - Arun Babu Kumar
- Departments of Chemistry, Biochemistry, and Medicine, University
of Washington, Seattle, Washington 98195, United States
| | - Frantisek Supek
- Genomics
Institute of the Novartis Research Foundation, 10675 John Jay Hopkins Drive, San Diego, California 92121, United States
| | - Andriy Buchynskyy
- Departments of Chemistry, Biochemistry, and Medicine, University
of Washington, Seattle, Washington 98195, United States
| | - Casey J. N. Mathison
- Genomics
Institute of the Novartis Research Foundation, 10675 John Jay Hopkins Drive, San Diego, California 92121, United States
| | - Naveen
Kumar Chennamaneni
- Departments of Chemistry, Biochemistry, and Medicine, University
of Washington, Seattle, Washington 98195, United States
| | - Nagendar Pendem
- Departments of Chemistry, Biochemistry, and Medicine, University
of Washington, Seattle, Washington 98195, United States
| | - Frederick S. Buckner
- Departments of Chemistry, Biochemistry, and Medicine, University
of Washington, Seattle, Washington 98195, United States
| | - Michael
H. Gelb
- Departments of Chemistry, Biochemistry, and Medicine, University
of Washington, Seattle, Washington 98195, United States
| | - Valentina Molteni
- Genomics
Institute of the Novartis Research Foundation, 10675 John Jay Hopkins Drive, San Diego, California 92121, United States
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181
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Das S, Rani M, Rabidas V, Pandey K, Sahoo GC, Das P. TLR9 and MyD88 are crucial for the maturation and activation of dendritic cells by paromomycin-miltefosine combination therapy in visceral leishmaniasis. Br J Pharmacol 2014; 171:1260-74. [PMID: 24670148 DOI: 10.1111/bph.12530] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 10/30/2013] [Accepted: 11/08/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND PURPOSE The combination of paromomycin-miltefosine is a successful anti-leishmanial therapy in visceral leishmaniasis (VL). This encouraged us to study its effect on Toll-like receptor (TLR)-mediated immunomodulation of dendritic cells (DC), as DC maturation and activation is crucial for anti-leishmanial activity. EXPERIMENTAL APPROACH In silico protein-ligand interaction and biophysical characterization of TLR9-drug interaction was performed. Interaction assays of HEK293 cells with different concentrations of miltefosine and/or paromomycin were performed, and NF-κB promoter activity measured. The role of TLR9 and MyD88 in paromomycin/miltefosine-induced maturation and activation of DCs was evaluated through RNA interference techniques. The effect of drugs on DCs was measured in terms of counter-regulatory production of IL-12 over IL-10, and characterized by chromatin immunoprecipitation assay at the molecular level. KEY RESULTS Computational and biophysical studies revealed that paromomycin/miltefosine interact with TLR9. Both drugs, as a monotherapy/combination, induced TLR9-dependent NF-κB promoter activity through MyD88. Moreover, the drug combination induced TLR9/MyD88-dependent functional maturation of DCs, evident as an up-regulation of co-stimulatory markers, enhanced antigen presentation by increasing MHC II expression, and increased stimulation of naive T-cells to produce IFN-γ. Both drugs, by modifying histone H3 at the promoter level, increased the release of IL-12, but down-regulated IL-10 in a TLR9-dependent manner. CONCLUSIONS AND IMPLICATIONS These results provide the first evidence that the combination of paromomycin-miltefosine critically modifies the maturation, activation and development of host DCs through a mechanism dependent on TLR9 and MyD88. This has implications for evaluating the success of other combination anti-leishmanial therapies that act by targeting host DCs.
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Affiliation(s)
- Sushmita Das
- Department of Molecular Parasitology, Rajendra Memorial Research Institute of Medical Sciences, Indian Council of Medical Research, Bihar, India
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Abstract
INTRODUCTION Leishmaniasis broadly manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis. The treatment of leishmaniasis is challenging and the armamentarium of drugs is small, duration of treatment is long, and most drugs are toxic. AREAS COVERED A literature search on treatment of leishmaniasis was done on PubMed. Single dose of liposomal amphotericin B (L-AmB) and multidrug therapy (L-AmB + miltefosine, L-AmB + paromomycin (PM), or miltefosine + PM) are the treatment of choice for VL in the Indian subcontinent. A 17-day combination therapy of pentavalent antimonials (Sb(v)) and PM remains the treatment of choice for East African VL. L-AmB at a total dose of 18 - 21 mg/kg is the recommended regimen for VL in the Mediterranean region and South America. Treatment of CL should be decided by the severity of clinical lesions, etiological species and its potential to develop into mucosal leishmaniasis. EXPERT OPINION There is an urgent need to implement a single-dose L-AmB or combination therapy in the Indian subcontinent. Shorter and more acceptable regimens are needed for the treatment of post - kala-azar dermal leishmaniasis. Combination therapy with newer drugs needs to be tested in Africa. Due to the toxicity of systemic therapy, a trend toward local treatment for New World CL is preferred in patients without risk of mucosal disease.
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Affiliation(s)
- Shyam Sundar
- Banaras Hindu University, Institute of Medical Sciences, Department of Medicine , Varanasi , India +91 542 2369632 ;
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Leprohon P, Fernandez-Prada C, Gazanion É, Monte-Neto R, Ouellette M. Drug resistance analysis by next generation sequencing in Leishmania. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2014; 5:26-35. [PMID: 25941624 PMCID: PMC4412915 DOI: 10.1016/j.ijpddr.2014.09.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/04/2014] [Accepted: 09/08/2014] [Indexed: 12/30/2022]
Abstract
WGS revealed the complexity of resistance which is often polyclonal in Leishmania. An impressive variation in chromosome copy numbers exist between Leishmania species. The genotype heterogeneity complicates the analysis of resistance in field isolates.
The use of next generation sequencing has the power to expedite the identification of drug resistance determinants and biomarkers and was applied successfully to drug resistance studies in Leishmania. This allowed the identification of modulation in gene expression, gene dosage alterations, changes in chromosome copy numbers and single nucleotide polymorphisms that correlated with resistance in Leishmania strains derived from the laboratory and from the field. An impressive heterogeneity at the population level was also observed, individual clones within populations often differing in both genotypes and phenotypes, hence complicating the elucidation of resistance mechanisms. This review summarizes the most recent highlights that whole genome sequencing brought to our understanding of Leishmania drug resistance and likely new directions.
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Affiliation(s)
- Philippe Leprohon
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec, 2705 Laurier Blvd., Québec G1V 4G2, Canada
| | - Christopher Fernandez-Prada
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec, 2705 Laurier Blvd., Québec G1V 4G2, Canada
| | - Élodie Gazanion
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec, 2705 Laurier Blvd., Québec G1V 4G2, Canada
| | - Rubens Monte-Neto
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec, 2705 Laurier Blvd., Québec G1V 4G2, Canada
| | - Marc Ouellette
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec, 2705 Laurier Blvd., Québec G1V 4G2, Canada
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Sundar S, Pandey K, Thakur CP, Jha TK, Das VNR, Verma N, Lal CS, Verma D, Alam S, Das P. Efficacy and safety of amphotericin B emulsion versus liposomal formulation in Indian patients with visceral leishmaniasis: a randomized, open-label study. PLoS Negl Trop Dis 2014; 8:e3169. [PMID: 25233346 PMCID: PMC4169371 DOI: 10.1371/journal.pntd.0003169] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/04/2014] [Indexed: 11/18/2022] Open
Abstract
Background India is home to 60% of the total global visceral leishmaniasis (VL) population. Use of long-term oral (e.g. miltefosine) and parenteral drugs, considered the mainstay for treatment of VL, is now faced with increased resistance, decreased efficacy, low compliance and safety issues. The authors evaluated the efficacy and safety of an alternate treatment option, i.e. single infusion of preformed amphotericin B (AmB) lipid emulsion (ABLE) in comparison with that of liposomal formulation (LAmB). Methods In this multicentric, open-label study, 500 patients with VL were randomly assigned in a 3∶1 ratio to receive 15 mg/kg single infusion of either ABLE (N = 376) or LAmB (N = 124). Initial cure (Day 30/45), clinical improvement (Day 30) and long term definitive cure (Day 180) were assessed. Findings A total of 326 (86.7%) patients in the ABLE group and 122 (98.4%) patients in the LAmB group completed the study. Initial cure was achieved by 95.9% of patients in the ABLE group compared to 100% in the LAmB group (p = 0.028; 95% CI: −0.0663, −0.0150). Clinical improvement was comparable between treatments (ABLE: 98.9% vs. LAmB: 98.4%). Definitive cure was achieved in 85.9% with ABLE compared to 98.4% with LAmB. Infusion-related pyrexia (37.2% vs. 32.3%) and chills (18.4% vs. 18.5%) were comparable between ABLE and LAmB, respectively. Treatment-related serious adverse events were fewer in ABLE (0.3%) compared to LAmB (1.6%). Two deaths occurred in the ABLE group, of which one was probably related to the study drug. Nephrotoxicity and hepatotoxicity was not observed in either group. Conclusions ABLE 15 mg/kg single infusion had favorable efficacy and was well tolerated. Considering the demographic profile of the population in this region, a single dose treatment offers advantages in terms of compliance, cost and applicability. Trial Registration www.clinicaltrials.govNCT00876824 Visceral leishmaniasis (VL) is highly prevalent in northeastern India, particularly the state of Bihar and its bordering areas with Bangladesh and Nepal. The current standards of treatment, namely, miltefosine (oral) and pentavalent antimonials (parenteral) have long treatment durations and are faced with increasing resistance, decreased efficacy, low compliance and safety issues. In this regard, lipid formulations of amphotericin B (AmB) have become an attractive treatment option due to their high efficacy, shorter treatment regimens and favorable safety profiles. This Phase III study evaluated the efficacy and safety of preformed AmB lipid emulsion (ABLE) versus liposomal AmB (LAmB) (both 15 mg/kg single dose infusions) in the treatment of VL. ABLE showed favorable efficacy measured in terms of initial cure at Day 30/45, and overall clinical improvement. ABLE was well tolerated and its adverse event profile was consistent with previously documented findings. Based on the favorable efficacy and safety profile of ABLE, and considering the demographic profile of the population in the endemic region, a single dose treatment may offer advantages in terms of compliance, cost and applicability.
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Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
- * E-mail:
| | | | - Tara Kant Jha
- Kalazar Research Centre, Brahmpura, Muzaffarpur, Bihar, India
| | - Vidya Nand Ravi Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Neena Verma
- Department of Pathology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Chandra Shekhar Lal
- Department of Biochemistry, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Deepak Verma
- Kala-azar Medical Research Center, Muzaffarpur, Bihar, India
| | - Shahnawaz Alam
- Kala-azar Medical Research Center, Muzaffarpur, Bihar, India
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
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185
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A mechanistic approach to understanding oral drug absorption in pediatrics: an overview of fundamentals. Drug Discov Today 2014; 19:1322-36. [DOI: 10.1016/j.drudis.2014.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/18/2014] [Accepted: 03/14/2014] [Indexed: 01/04/2023]
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186
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Abstract
Visceral leishmaniasis (VL), also known as Kala-Azar, is a disseminated protozoal infection caused principally by Leishmania donovani and Leishmania infantum (known as Leishmania chagasi in South America). The therapeutic options for VL are diverse and depend on different factors, such as the geographical area of the infection, development of resistance to habitual treatments, HIV co-infection, malnourishment and other concomitant infections. This article provides an exhaustive review of the literature regarding studies published on the treatment of VL, and gives therapeutic recommendations stratified according to their level of evidence, the species of Leishmania implicated and the geographical location of the infection.
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Affiliation(s)
- Begoña Monge-Maillo
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera de Colmenar Km 9,1, 28034, Madrid, Spain
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187
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Proteomic analysis of the soluble proteomes of miltefosine-sensitive and -resistant Leishmania infantum chagasi isolates obtained from Brazilian patients with different treatment outcomes. J Proteomics 2014; 108:198-208. [DOI: 10.1016/j.jprot.2014.05.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/16/2014] [Accepted: 05/17/2014] [Indexed: 01/12/2023]
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188
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Coelho AC, Trinconi CT, Costa CHN, Uliana SRB. In vitro and in vivo miltefosine susceptibility of a Leishmania amazonensis isolate from a patient with diffuse cutaneous leishmaniasis. PLoS Negl Trop Dis 2014; 8:e2999. [PMID: 25033218 PMCID: PMC4102453 DOI: 10.1371/journal.pntd.0002999] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/31/2014] [Indexed: 11/25/2022] Open
Abstract
Miltefosine was the first oral compound approved for visceral leishmaniasis chemotherapy, and its efficacy against Leishmania donovani has been well documented. Leishmania amazonensis is the second most prevalent species causing cutaneous leishmaniasis and the main etiological agent of diffuse cutaneous leishmaniasis in Brazil. Driven by the necessity of finding alternative therapeutic strategies for a chronic diffuse cutaneous leishmaniasis patient, we evaluated the susceptibility to miltefosine of the Leishmania amazonensis line isolated from this patient, who had not been previously treated with miltefosine. In vitro tests against promastigotes and intracellular amastigotes showed that this parasite isolate was less susceptible to miltefosine than L. amazonensis type strains. Due to this difference in susceptibility, we evaluated whether genes previously associated with miltefosine resistance were involved. No mutations were found in the miltefosine transporter gene or in the Ros3 or pyridoxal kinase genes. These analyses were conducted in parallel with the characterization of L. amazonensis mutant lines selected for miltefosine resistance using a conventional protocol to select resistance in vitro, i.e., exposure of promastigotes to increasing drug concentrations. In these mutant lines, a single nucleotide mutation G852E was found in the miltefosine transporter gene. In vivo studies were also performed to evaluate the correlation between in vitro susceptibility and in vivo efficacy. Miltefosine was effective in the treatment of BALB/c mice infected with the L. amazonensis type strain and with the diffuse cutaneous leishmaniasis isolate. On the other hand, animals infected with the resistant line bearing the mutated miltefosine transporter gene were completely refractory to miltefosine chemotherapy. These data highlight the difficulties in establishing correlations between in vitro susceptibility determinations and response to chemotherapy in vivo. This study contributed to establish that the miltefosine transporter is essential for drug activity in L. amazonensis and a potential molecular marker of miltefosine unresponsiveness in leishmaniasis patients. Leishmania amazonensis is the etiological agent of diffuse cutaneous leishmaniasis. The disease is extremely difficult to treat and frequently relapses once the treatment is interrupted. Although not yet approved in Brazil, miltefosine is an attractive alternative for leishmaniasis treatment due to its oral administration and low incidence of side effects. Here, we evaluated the efficacy of miltefosine against a L. amazonensis line that was isolated from a chronic diffuse cutaneous leishmaniasis patient to ascertain whether miltefosine could be considered as a therapeutic option in this case. Parasites isolated from this patient were less susceptible to miltefosine than a reference strain in vitro. The mechanisms underlying this decreased susceptibility were studied in this natural parasite isolate in parallel with mutant strains selected in vitro for miltefosine resistance. A mutation in the gene encoding the miltefosine transporter was identified in the mutants selected in vitro but not in the line isolated from the patient. Notwithstanding the decreased susceptibility in vitro, when used to treat infected mice, miltefosine was equally effective against the isolate from the patient and the type strain, but completely ineffective against the resistant line.
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Affiliation(s)
- Adriano C. Coelho
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- * E-mail:
| | - Cristiana T. Trinconi
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Carlos H. N. Costa
- Departamento de Medicina Comunitária, Universidade Federal do Piauí, Teresina, Piauí, Brazil
| | - Silvia R. B. Uliana
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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189
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Mohapatra S. Drug resistance in leishmaniasis: Newer developments. Trop Parasitol 2014; 4:4-9. [PMID: 24754020 PMCID: PMC3992802 DOI: 10.4103/2229-5070.129142] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/20/2014] [Indexed: 11/06/2022] Open
Abstract
Leishmaniasis is a vector borne protozoan disease and it remains a major public health problem world-wide. Lack of an effective vaccine and vector control program makes the chemotherapy as the primary tool for leishmaniasis. Antimonials were used as the first line of treatment for many years. Emergence of resistance against this drug has become a major concern. Literatures and studies published on anti-leishmanial drug resistance, newer drug discovery for leishmanial resistance etc., in PubMed, Medline and Google search and reviewed thoroughly. Various newer drugs have been identified but, are in limited use because of high cost, toxicity, resistance etc., Recently, many newer mechanisms of drug resistance have been identified which may boost in future designing and development of drugs.
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Affiliation(s)
- Sarita Mohapatra
- Department of Microbiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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190
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Ostyn B, Hasker E, Dorlo TPC, Rijal S, Sundar S, Dujardin JC, Boelaert M. Failure of miltefosine treatment for visceral leishmaniasis in children and men in South-East Asia. PLoS One 2014; 9:e100220. [PMID: 24941345 PMCID: PMC4062493 DOI: 10.1371/journal.pone.0100220] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 05/25/2014] [Indexed: 12/22/2022] Open
Abstract
Background High frequency of relapse in miltefosine-treated visceral leishmaniasis (VL) patients in India and Nepal followed up for twelve months. Objective To identify epidemiological and clinical risk factors for relapse of VL in patients recently treated with standard dosing of miltefosine in India and Nepal. Design Prospective observational study in three Primary Health Centers and one reference center in Muzaffarpur district, Bihar, India; and two zonal hospitals and a university hospital in South-east Nepal; records of all consenting patients diagnosed with VL and treated with miltefosine according to the current treatment guidelines of the Kala azar elimination program between 2009 and 2011. Results We compared the clinical records of 78 cases of relapse with those of 775 patients who had no record of subsequent relapse. Relapse was 2 times more common amongst male patients (IRR 2.14, 95% CI 1.27–3.61), and 2 to 3 times more frequent in the age groups below 15 compared to the over 25 year olds (age 10 to 14: IRR 2.53; 95% CI 1.37–4.65 and Age 2 to 9: IRR 3.19; 95% CI 1.77–5.77). History of earlier VL episodes, or specific clinical features at time of diagnosis such as duration of symptoms or spleen size were no predictors of relapse. Conclusions Young age and male gender were associated with increased risk of VL relapse after miltefosine, suggesting that the mechanism of relapse is mainly host-related i.e. immunological factors and/or drug exposure (pharmacokinetics). The observed decrease in efficacy of miltefosine may be explained by the inclusion of younger patients compared to the earlier clinical trials, rather than by a decreased susceptibility of the parasite to miltefosine. Our findings highlight the importance of proper clinical trials in children, including pharmacokinetics, to determine the safety, efficacy, drug exposure and therapeutic response of new drugs in this age group.
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Affiliation(s)
- Bart Ostyn
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thomas P. C. Dorlo
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Suman Rijal
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Jean-Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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191
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Roatt BM, Aguiar-Soares RDDO, Coura-Vital W, Ker HG, Moreira NDD, Vitoriano-Souza J, Giunchetti RC, Carneiro CM, Reis AB. Immunotherapy and Immunochemotherapy in Visceral Leishmaniasis: Promising Treatments for this Neglected Disease. Front Immunol 2014; 5:272. [PMID: 24982655 PMCID: PMC4055865 DOI: 10.3389/fimmu.2014.00272] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/27/2014] [Indexed: 11/25/2022] Open
Abstract
Leishmaniasis has several clinical forms: self-healing or chronic cutaneous leishmaniasis or post-kala-azar dermal leishmaniasis; mucosal leishmaniasis; visceral leishmaniasis (VL), which is fatal if left untreated. The epidemiology and clinical features of VL vary greatly due to the interaction of multiple factors including parasite strains, vectors, host genetics, and the environment. Human immunodeficiency virus infection augments the severity of VL increasing the risk of developing active disease by 100–2320 times. An effective vaccine for humans is not yet available. Resistance to chemotherapy is a growing problem in many regions, and the costs associated with drug identification and development, make commercial production for leishmaniasis, unattractive. The toxicity of currently drugs, their long treatment course, and limited efficacy are significant concerns. For cutaneous disease, many studies have shown promising results with immunotherapy/immunochemotherapy, aimed to modulate and activate the immune response to obtain a therapeutic cure. Nowadays, the focus of many groups centers on treating canine VL by using vaccines and immunomodulators with or without chemotherapy. In human disease, the use of cytokines like interferon-γ associated with pentavalent antimonials demonstrated promising results in patients that did not respond to conventional treatment. In mice, immunomodulation based on monoclonal antibodies to remove endogenous immunosuppressive cytokines (interleukin-10) or block their receptors, antigen-pulsed syngeneic dendritic cells, or biological products like Pam3Cys (TLR ligand) has already been shown as a prospective treatment of the disease. This review addresses VL treatment, particularly immunotherapy and/or immunochemotherapy as an alternative to conventional drug treatment in experimental models, canine VL, and human disease.
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Affiliation(s)
- Bruno Mendes Roatt
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto , Ouro Preto , Brazil ; Laboratório de Pesquisas Clínicas, Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto , Ouro Preto , Brazil ; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais , Belo Horizonte , Brazil
| | | | - Wendel Coura-Vital
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto , Ouro Preto , Brazil ; Laboratório de Pesquisas Clínicas, Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto , Ouro Preto , Brazil
| | - Henrique Gama Ker
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto , Ouro Preto , Brazil ; Laboratório de Pesquisas Clínicas, Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto , Ouro Preto , Brazil
| | - Nádia das Dores Moreira
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto , Ouro Preto , Brazil
| | - Juliana Vitoriano-Souza
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto , Ouro Preto , Brazil
| | - Rodolfo Cordeiro Giunchetti
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto , Ouro Preto , Brazil ; Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Cláudia Martins Carneiro
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto , Ouro Preto , Brazil ; Laboratório de Pesquisas Clínicas, Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto , Ouro Preto , Brazil
| | - Alexandre Barbosa Reis
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto , Ouro Preto , Brazil ; Laboratório de Pesquisas Clínicas, Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto , Ouro Preto , Brazil ; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais , Belo Horizonte , Brazil
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Verhaar AP, Wildenberg ME, Peppelenbosch MP, Hommes DW, van den Brink GR. Repurposing miltefosine for the treatment of immune-mediated disease? J Pharmacol Exp Ther 2014; 350:189-95. [PMID: 24833702 DOI: 10.1124/jpet.113.212654] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Miltefosine is an ether lipid that was initially developed for cancer treatment in the early 1980s. Miltefosine largely failed development for oncology, although it was approved for the topical treatment of breast cancer metastasis. It was subsequently discovered that miltefosine is a highly effective treatment of visceral Leishmaniasis, a parasitic disease that affects millions worldwide and causes an estimated 30,000 fatalities each year. Oral treatment with miltefosine is generally well tolerated and has relatively few adverse effects. The exact mechanism of action of miltefosine treatment is still under investigation. Its close resemblance to phospholipids allows it to be quickly taken up by cell membranes and affect related processes, such as lipid metabolism and signaling through lipid rafts. These processes play an important role in the immune response and it comes as no surprise that miltefosine has been successfully tested for the treatment of a number of immune-mediated diseases in preclinical models of disease. Drug repurposing of miltefosine for immune-mediated diseases may provide an opportunity to expand the limited number of drugs that are currently available for therapeutic use.
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Affiliation(s)
- Auke P Verhaar
- Department of Gastroenterology and Hepatology, Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, The Netherlands (A.P.V., M.E.W., G.R.v.d.B.); Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands (A.P.V., D.W.H.); Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.P.P.); and Center for Inflammatory Bowel Diseases, University of California Los Angeles, Los Angeles, California (D.W.H.)
| | - Manon E Wildenberg
- Department of Gastroenterology and Hepatology, Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, The Netherlands (A.P.V., M.E.W., G.R.v.d.B.); Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands (A.P.V., D.W.H.); Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.P.P.); and Center for Inflammatory Bowel Diseases, University of California Los Angeles, Los Angeles, California (D.W.H.)
| | - Maikel P Peppelenbosch
- Department of Gastroenterology and Hepatology, Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, The Netherlands (A.P.V., M.E.W., G.R.v.d.B.); Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands (A.P.V., D.W.H.); Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.P.P.); and Center for Inflammatory Bowel Diseases, University of California Los Angeles, Los Angeles, California (D.W.H.)
| | - Daniel W Hommes
- Department of Gastroenterology and Hepatology, Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, The Netherlands (A.P.V., M.E.W., G.R.v.d.B.); Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands (A.P.V., D.W.H.); Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.P.P.); and Center for Inflammatory Bowel Diseases, University of California Los Angeles, Los Angeles, California (D.W.H.)
| | - Gijs R van den Brink
- Department of Gastroenterology and Hepatology, Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, The Netherlands (A.P.V., M.E.W., G.R.v.d.B.); Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands (A.P.V., D.W.H.); Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.P.P.); and Center for Inflammatory Bowel Diseases, University of California Los Angeles, Los Angeles, California (D.W.H.)
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193
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Gopinath VS, Rao M, Shivahare R, Vishwakarma P, Ghose S, Pradhan A, Hindupur R, Sarma KD, Gupta S, Puri SK, Launay D, Martin D. Design, synthesis, ADME characterization and antileishmanial evaluation of novel substituted quinoline analogs. Bioorg Med Chem Lett 2014; 24:2046-52. [DOI: 10.1016/j.bmcl.2014.03.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
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Species-directed therapy for leishmaniasis in returning travellers: a comprehensive guide. PLoS Negl Trop Dis 2014; 8:e2832. [PMID: 24787001 PMCID: PMC4006727 DOI: 10.1371/journal.pntd.0002832] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/14/2014] [Indexed: 02/06/2023] Open
Abstract
Background Leishmaniasis is increasingly reported among travellers. Leishmania species vary in sensitivity to available therapies. Fast and reliable molecular techniques have made species-directed treatment feasible. Many treatment trials have been designed poorly, thus developing evidence-based guidelines for species-directed treatment is difficult. Published guidelines on leishmaniasis in travellers do not aim to be comprehensive or do not quantify overall treatment success for available therapies. We aimed at providing comprehensive species-directed treatment guidelines. Methodology/Principal Findings English literature was searched using PubMed. Trials and observational studies were included if all cases were parasitologically confirmed, the Leishmania species was known, clear clinical end-points and time points for evaluation of treatment success were defined, duration of follow-up was adequate and loss to follow-up was acceptable. The proportion of successful treatment responses was pooled using mixed effects methods to estimate the efficacy of specific therapies. Final ranking of treatment options was done by an expert panel based on pooled efficacy estimates and practical considerations. 168 studies were included, with 287 treatment arms. Based on Leishmania species, symptoms and geography, 25 clinical categories were defined and therapy options ranked. In 12/25 categories, proposed treatment agreed with highest efficacy data from literature. For 5/25 categories no literature was found, and in 8/25 categories treatment advise differed from literature evidence. For uncomplicated cutaneous leishmaniasis, combination of intralesional antimony with cryotherapy is advised, except for L. guyanensis and L. braziliensis infections, for which systemic treatment is preferred. Treatment of complicated (muco)cutaneous leishmaniasis differs per species. For visceral leishmaniasis, liposomal amphotericin B is treatment of choice. Conclusions/Significance Our study highlights current knowledge about species-directed therapy of leishmaniasis in returning travellers and also demonstrates lack of evidence for treatment of several clinical categories. New data can easily be incorporated in the presented overview. Updates will be of use for clinical decision making and for defining further research. Human leishmaniasis is caused by unicellular parasites that are injected into the skin by sand-flies, small, flying insects. Many different Leishmania species cause various manifestations of disease, both of the skin and internal organs. Leishmaniasis is a curable disease but clear guidelines on the best available treatment are lacking. Leishmania species differ in sensitivity to available drugs. Until recently, identification of the infecting Leishmania parasite was laborious, thus therapy could not precisely be targeted to the infecting species, in contrast to many other infectious diseases. Nowadays, Leishmania parasites can be identified relatively easily with new DNA techniques. We studied efficacy of therapies for diseases due to different Leishmania species, limited to the English literature. Efficacy was summarized and presented in an easy to read format. Because of difficulties with identification of parasite species in earlier studies, quality of evidence was often limited. Our findings are a major help for clinicians to easily find optimal treatment for specific patients. Moreover, our results demonstrate where additional research is needed to further improve treatment of leishmaniasis.
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195
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Ferreira WA, Islam A, Andrade APS, Fernandes FR, Frézard F, Demicheli C. Mixed antimony(V) complexes with different sugars to modulate the oral bioavailability of pentavalent antimonial drugs. Molecules 2014; 19:5478-89. [PMID: 24786687 PMCID: PMC6270655 DOI: 10.3390/molecules19055478] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/15/2014] [Accepted: 04/24/2014] [Indexed: 11/16/2022] Open
Abstract
Previous studies have shown that the association of the drug meglumine antimoniate (MA) with β-cyclodextrin can improve its bioavailability by the oral route. In this work, ribose and maltose were investigated for their ability to form mixed or association complexes with MA, release MA and modulate the serum levels of Sb after oral administration in mice. Analysis of the MA/ribose composition by high performance liquid chromatography coupled to mass spectrometry (LCMS-IT-TOF) revealed the presence of mixed meglumine-Sb-ribose and Sb-ribose complexes. Analysis of the MA/maltose composition suggested the formation of MA-maltose association compounds. Circular dichroism characterization of these compositions following dilution in water at 37 °C suggested a partial and slow dissociation of the association compounds. When the MA/ribose composition was administered orally and compared to MA, the serum concentration of Sb was significantly lower after 1 h and greater after 3 h. On the other hand, the MA/maltose composition showed similar serum Sb concentration after 1 h and higher level of Sb after 3 h, when compared to MA. In conclusion, the present study has demonstrated the formation of mixed or association complexes of MA with sugars, such as maltose and ribose, which promoted sustained serum level of Sb after oral administration.
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Affiliation(s)
- Weverson A Ferreira
- Department of Chemistry, Institute of Exact Sciences - Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, Belo Horizonte 31270-901, MG, Brazil
| | - Arshad Islam
- Department of Chemistry, Institute of Exact Sciences - Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, Belo Horizonte 31270-901, MG, Brazil
| | - Aretha Priscilla S Andrade
- Department of Chemistry, Institute of Exact Sciences - Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, Belo Horizonte 31270-901, MG, Brazil
| | - Flaviana R Fernandes
- Department of Physiology and Biophysics, Institute of Biological Sciences - Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, Belo Horizonte 31270-901, MG, Brazil
| | - Frédéric Frézard
- Department of Physiology and Biophysics, Institute of Biological Sciences - Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, Belo Horizonte 31270-901, MG, Brazil
| | - Cynthia Demicheli
- Department of Chemistry, Institute of Exact Sciences - Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, Belo Horizonte 31270-901, MG, Brazil.
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196
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Canuto GAB, Castilho-Martins EA, Tavares MFM, Rivas L, Barbas C, López-Gonzálvez Á. Multi-analytical platform metabolomic approach to study miltefosine mechanism of action and resistance in Leishmania. Anal Bioanal Chem 2014; 406:3459-76. [PMID: 24722876 DOI: 10.1007/s00216-014-7772-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/03/2014] [Accepted: 03/17/2014] [Indexed: 12/26/2022]
Abstract
Miltefosine (MT) (hexadecylphosphocholine) was implemented to cope with resistance against antimonials, the classical treatment in Leishmaniasis. Given the scarcity of anti- Leishmania (L) drugs and the increasing appearance of resistance, there is an obvious need for understanding the mechanism of action and development of such resistance. Metabolomics is an increasingly popular tool in the life sciences due to it being a relatively fast and accurate technique that can be applied either with a particular focus or in a global manner to reveal new knowledge about biological systems. Three analytical platforms, gas chromatography (GC), liquid chromatography (LC) and capillary electrophoresis (CE) have been coupled to mass spectrometry (MS) to obtain a broad picture of metabolic changes in the parasite. Impairment of the polyamine metabolism from arginine (Arg) to trypanothione in susceptible parasites treated with MT was in some way expected, considering the reactive oxygen species (ROS) production described for MT. Importantly, in resistant parasites an increase in the levels of amino acids was the most outstanding feature, probably related to the adaptation of the resistant strain for its survival inside the parasitophorous vacuole.
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Affiliation(s)
- Gisele A B Canuto
- Centro de Metabolómica y Bioanálisis (CEMBIO), Unidad Metabolómica, Interacciones y Bioanálisis (UMIB), Facultad de Farmacia, Universidad CEU San Pablo, Campus Monteprincipe, Boadilla del Monte, 28668, Madrid, Spain
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197
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Brilhante RSN, Malaquias ÂDM, Caetano ÉP, Castelo-Branco DDSCM, Lima RACD, Marques FJDF, Silva NF, Alencar LPD, Monteiro AJ, Camargo ZPD, Bandeira TDJPG, Rodrigues AM, Cordeiro RDA, Moreira JLB, Sidrim JJC, Rocha MFG. In vitro inhibitory effect of miltefosine against strains of Histoplasma capsulatum var. capsulatum and Sporothrix spp. Med Mycol 2014; 52:320-5. [DOI: 10.1093/mmy/myt027] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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198
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Hendrickx S, Boulet G, Mondelaers A, Dujardin JC, Rijal S, Lachaud L, Cos P, Delputte P, Maes L. Experimental selection of paromomycin and miltefosine resistance in intracellular amastigotes of Leishmania donovani and L. infantum. Parasitol Res 2014; 113:1875-81. [PMID: 24615359 DOI: 10.1007/s00436-014-3835-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/21/2014] [Indexed: 01/01/2023]
Abstract
Although widespread resistance of Leishmania donovani and L. infantum against miltefosine (MIL) and paromomycin (PMM) has not yet been demonstrated, both run the risk of resistance selection. Unraveling the dynamics and mechanisms of resistance development is key to preserve drug efficacy in the field. In this study, resistance against PMM and MIL was experimentally selected in vitro in intracellular amastigotes of several strains of both species with different antimony susceptibility background. To monitor amastigote susceptibility, microscopic determination of IC50-values and promastigote back-transformation assays were performed. Both techniques were also used to evaluate the susceptibility of field isolates from MIL-relapse patients. PMM-resistance could readily be selected in all species/strains, although promastigotes remained fully PMM-susceptible. Successful MIL-resistance selection was demonstrated only by promastigote back-transformation at increasing MIL-concentrations upon successive selection cycles. Important to note is that amastigotes with the MIL-resistant phenotype could not be visualized after Giemsa staining; hence, MIL-IC50-values showed no shift. The same phenomenon was observed in a set of recent clinical isolates from MIL-relapse patients. This study clearly endorses the need to use intracellular amastigotes for PMM- and MIL-susceptibility testing. When monitoring MIL-resistance, promastigote back-transformation should be used instead of the standard Giemsa staining. In-depth exploration of the mechanistic background of this finding is warranted.
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Affiliation(s)
- S Hendrickx
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
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Tung D, Ciallella J, Hain H, Cheung PH, Saha S. Possible therapeutic effect of trilostane in rodent models of inflammation and nociception. CURRENT THERAPEUTIC RESEARCH 2014; 75:71-6. [PMID: 24465047 PMCID: PMC3898193 DOI: 10.1016/j.curtheres.2013.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/26/2013] [Indexed: 11/25/2022]
Abstract
Background Trilostane was identified in an in vivo screen of compounds in a lipopolysaccharide model of inflammation to support a repurposing effort. There is no previous documentation of any anti-inflammatory effects of trilostane. Objective The aim of this study was to elucidate the novel pharmacologic activity of trilostane in a series of inflammation and nociception signal-finding models. Methods Anti-inflammatory effects of trilostane were evaluated in lipopolysaccharide-induced systemic and lung inflammation models and in a 2,4-dinitrofluorobenzene–induced delayed-type hypersensitivity (DTH) model in the mouse ear. The analgesic activities of trilostane were evaluated in a hot plate nociception model as a function of paw-withdrawal latency and in the formalin-induced nociception model with a behavioral end point. In all studies, trilostane was administered 15 minutes before challenge. In the DTH model, the animals were given a second dose 24 hours after the first dose. Results Trilostane inhibited tumor necrosis factor-α and monocyte chemoattractant protein-1 production in the lipopolysaccharide-induced systemic and pulmonary inflammation models. It also significantly reduced ear swelling in the 2,4-dinitrofluorobenzene–induced DTH model. In the hot plate nociception model, trilostane increased the latency of paw-licking behavior. Trilostane also significantly reduced the duration of pain behaviors in the late phase of the formalin-induced inflammatory pain model. Conclusions These signal-finding studies suggest that trilostane has novel anti-inflammatory and analgesic properties.
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Affiliation(s)
- David Tung
- BioMed Valley Discoveries, Kansas City, Missouri
| | | | | | | | - Saurabh Saha
- BioMed Valley Discoveries, Kansas City, Missouri
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Dorlo TPC, Rijal S, Ostyn B, de Vries PJ, Singh R, Bhattarai N, Uranw S, Dujardin JC, Boelaert M, Beijnen JH, Huitema ADR. Failure of Miltefosine in Visceral Leishmaniasis Is Associated With Low Drug Exposure. J Infect Dis 2014; 210:146-53. [DOI: 10.1093/infdis/jiu039] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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