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Abpeikar Z, Safaei M, Akbar Alizadeh A, Goodarzi A, Hatam G. The novel treatments based on tissue engineering, cell therapy and nanotechnology for cutaneous leishmaniasis. Int J Pharm 2023; 633:122615. [PMID: 36657555 DOI: 10.1016/j.ijpharm.2023.122615] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
Cutaneous leishmaniasis (CL) is a global public health issue. Conventional treatments have substantial costs, side effects, and parasite resistance. Due to easy application and inexpensive cost, topical treatment is the optimal approach for CL. It could be used alone or with systemic treatments. Electrospun fibers as drug release systems in treating skin lesions have various advantages such as adjustable drug release rate, maintaining appropriate humidity and temperature, gas exchange, plasticity at the lesion site, similarity with the skin extracellular matrix (ECM) and drug delivery with high efficiency. Hydrogels are valuable scaffolds in the treatment of skin lesions. The important features of hydrogels include preserving unstable drugs from degradation, absorption of wound secretions, high biocompatibility, improving the re-epithelialization of the wound and preventing the formation of scars. One of the issues in local drug delivery systems for the skin is the low permeability of drugs in the skin. Polymeric scaffolds that are designed as microneedle patches can penetrate the skin and overcome this challenge. Also, drug delivery using nanocarriers increases the effectiveness of drugs in lower and more tolerable doses and reduces the toxicity of drugs. The application of cell therapy in the treatment of parasitic and infectious diseases has been widely investigated. The complexity of leishmaniasis treatment requires identifying new treatment options like cell therapy to overcome the disease. Topics investigated in this study include drug delivery systems based on tissue engineering scaffolds, nanotechnology and cell therapy-based studies to reduce the complications of CL.
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Affiliation(s)
- Zahra Abpeikar
- Department of Tissue Engineering, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Mohsen Safaei
- Department of Pharmaceutics, Faculty of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Akbar Alizadeh
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Medical Science and Technology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Goodarzi
- Department of Tissue Engineering, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran; Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Gholamreza Hatam
- Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Rabia S, Khaleeq N, Batool S, Dar MJ, Kim DW, Din FU, Khan GM. Rifampicin-loaded nanotransferosomal gel for treatment of cutaneous leishmaniasis: passive targeting via topical route. Nanomedicine (Lond) 2020; 15:183-203. [PMID: 31916472 DOI: 10.2217/nnm-2019-0320] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aim: In this study, the targeting of rifampicin (RIF)-loaded nanotransfersomes (NTs) incorporated in chitosan gel for leishmania-infected macrophages via the topical route was investigated. Materials & methods: NTs were prepared through a thin-film hydration process and incorporated into chitosan gel. Results: The mean particle size of the NTs was 190 nm, with 83% encapsulation efficiency. The permeation rate of the NTs was threefold higher than that of the RIF solution. The NTs improved cellular internalization via passive targeting, which was confirmed by macrophage uptake evaluation. A low IC50 value, flow cytometry analysis and in vivo study demonstrated the RIF-loaded NTs enhanced apoptosis and had better antileishmanial effects. Conclusion: RIF-loaded NT gel could be a fitting carrier for the delivery of antileishmanial drugs in cutaneous leishmaniasis.
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Affiliation(s)
- Samreen Rabia
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45230, Pakistan
| | - Nadra Khaleeq
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45230, Pakistan
| | - Sibgha Batool
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45230, Pakistan
| | | | - Dong Wuk Kim
- College of Pharmacy, Kyungpook National University, Daegu, South Korea
| | - Fakhar-Ud Din
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45230, Pakistan
| | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45230, Pakistan
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Van Bocxlaer K, Gaukel E, Hauser D, Park SH, Schock S, Yardley V, Randolph R, Plattner JJ, Merchant T, Croft SL, Jacobs RT, Wring SA. Topical Treatment for Cutaneous Leishmaniasis: Dermato-Pharmacokinetic Lead Optimization of Benzoxaboroles. Antimicrob Agents Chemother 2018; 62:e02419-17. [PMID: 29507073 PMCID: PMC5923108 DOI: 10.1128/aac.02419-17] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/24/2018] [Indexed: 11/20/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is caused by several species of the protozoan parasite Leishmania, affecting an estimated 10 million people worldwide. Previously reported strategies for the development of topical CL treatments have focused primarily on drug permeation and formulation optimization as the means to increase treatment efficacy. Our approach aims to identify compounds with antileishmanial activity and properties consistent with topical administration. Of the test compounds, five benzoxaboroles showed potent activity (50% effective concentration [EC50] < 5 μM) against intracellular amastigotes of at least one Leishmania species and acceptable activity (20 μM < EC50 < 30 μM) against two more species. Benzoxaborole compounds were further prioritized on the basis of the in vitro evaluation of progression criteria related to skin permeation, such as the partition coefficient and solubility. An MDCKII-hMDR1 cell assay showed overall good permeability and no significant interaction with the P-glycoprotein transporter for all substrates except LSH002 and LSH031. The benzoxaboroles were degraded, to some extent, by skin enzymes but had stability superior to that of para-hydroxybenzoate compounds, which are known skin esterase substrates. Evaluation of permeation through reconstructed human epidermis showed LSH002 to be the most permeant, followed by LSH003 and LSH001. Skin disposition studies following finite drug formulation application to mouse skin demonstrated the highest permeation for LSH001, followed by LSH003 and LSH002, with a significantly larger amount of LSH001 than the other compounds being retained in skin. Finally, the efficacy of the leads (LSH001, LSH002, and LSH003) against Leishmania major was tested in vivo LSH001 suppressed lesion growth upon topical application, and LSH003 reduced the lesion size following oral administration.
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Affiliation(s)
- Katrien Van Bocxlaer
- London School of Hygiene & Tropical Medicine, Faculty of Infections and Tropical Diseases, London, United Kingdom
| | - Eric Gaukel
- Scynexis Inc., Research Triangle Park, North Carolina, USA
| | - Deirdre Hauser
- Scynexis Inc., Research Triangle Park, North Carolina, USA
| | - Seong Hee Park
- Scynexis Inc., Research Triangle Park, North Carolina, USA
| | - Sara Schock
- Scynexis Inc., Research Triangle Park, North Carolina, USA
| | - Vanessa Yardley
- London School of Hygiene & Tropical Medicine, Faculty of Infections and Tropical Diseases, London, United Kingdom
| | - Ryan Randolph
- Scynexis Inc., Research Triangle Park, North Carolina, USA
| | | | - Tejal Merchant
- Anacor Pharmaceuticals, Inc., Palo Alto, California, USA
| | - Simon L Croft
- London School of Hygiene & Tropical Medicine, Faculty of Infections and Tropical Diseases, London, United Kingdom
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Amat Sain A, Amanah A, Zahari Z, Mohd Salim RJ, Mansor SM, Adenan MI. (+)-Spectaline, a Piperidine Alkaloid from Senna spectabilis DC. Effective in Reducing the In Vitro Infection of Leishmania major. ACTA ACUST UNITED AC 2016. [DOI: 10.18052/www.scipress.com/ijppe.3.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Senna spectabilisis known to have antimicrobial, laxative, antiulcerogenic, analgesic, and anti-inflammatory properties in folk medicine. Piperidine alkaloids extracted from various parts of this plant have been shown to have anticonvulsant (iso-6-spectaline), antinociceptive [(-)-spectaline] and lipid peroxidation [(+)-3-O-feruloylcassine, (-)-spectaline and (-)-3-O-acetylspectaline] activities. In our study, the ethyl acetate extract fromS. spectabilisexhibited antileishmanial activity via intracellular promastigote assay or leishmanicidal assay and was further fractionated by using bioassay-guided isolation approach. The antiprotozoal principle was isolated from the ethyl acetate portion through solvent fractionation and a few series of chromatographic processes. The isolated active compound 1 was identified as (+)-spectaline on the basis of its spectral analysis (MS, 1D & 2D NMR) with EC50value of 0.063 ± 0.005 µM for antileishmanial activity and selectivity index of 3.76.
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Costa ISF, de Souza GFP, de Oliveira MG, Abrahamsohn IDA. S-nitrosoglutathione (GSNO) is cytotoxic to intracellular amastigotes and promotes healing of topically treated Leishmania major or Leishmania braziliensis skin lesions. J Antimicrob Chemother 2013; 68:2561-8. [DOI: 10.1093/jac/dkt210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Triphenylmethane derivatives have high in vitro and in vivo activity against the main causative agents of cutaneous leishmaniasis. PLoS One 2013; 8:e51864. [PMID: 23341885 PMCID: PMC3544846 DOI: 10.1371/journal.pone.0051864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 11/13/2012] [Indexed: 11/21/2022] Open
Abstract
The current standard of care for cutaneous leishmaniasis (CL) is organic antimonial compounds, but the administration of these compounds is complicated by a low therapeutic - toxic index, as well as parenteral administration. Thus, there is an urgent need for the development of new and inexpensive therapies for the treatment of CL. In this study, we evaluate the activity of the triphenylmethane (TPM) class of compounds against three species of Leishmania which are pathogenic in humans. The TPM have a history of safe use in humans, dating back to the use of the original member of this class, gentian violet (GV), from the early 20th century. Initially, the in vitro efficacy against Leishmania (Viannia) braziliensis, L. (Leishmania) amazonensis and L. (L.) major of 9 newly synthesized TPM, in addition to GV, was tested. Inhibitory concentrations (IC) IC50 of 0.025 to 0.84 µM had been found in promastigotes in vitro assays. The four most effective compounds were then tested in amastigote intracellular assays, resulting in IC50 of 0.10 to 1.59 µM. A high degree of selectivity of antiparasitic activity over toxicity to mammalian cells was observed. Afterwards, GV and TPM 6 were tested in a topical formulation in mice infected with L. (L.) amazonensis leading to elimination of parasite burdens at the site of lesion/infection. These results demonstrated that TPM present significant anti-leishmanial activities and provide a rationale for human clinical trials of GV and other TPM. TPM are inexpensive and safe, thus using them for treatment of CL may have a major impact on public health.
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Carneiro G, Aguiar MG, Fernandes AP, Ferreira LAM. Drug delivery systems for the topical treatment of cutaneous leishmaniasis. Expert Opin Drug Deliv 2012; 9:1083-97. [PMID: 22724539 DOI: 10.1517/17425247.2012.701204] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The parenteral administration of pentavalent antimonials for the treatment of all forms of leishmaniasis, including cutaneous leishamniasis (CL), has several limitations. Therapy is long, requiring repeated doses and the adverse reactions are frequent. Topical treatment is an attractive alternative for CL, offering significant advantages over systemic therapy: fewer adverse effects, ease of administration, and lower costs. AREAS COVERED This review covers, from 1984 to the present, the progress achieved for the development of topical treatment for CL, using different drugs such as paromomycin (PA), imiquimod, amphotericin B (AmB), miltefosine, and buparvaquone. PA is the most commonly studied drug, followed by AmB and Imiquimod. These drugs were incorporated in conventional dosage forms or loaded in lipid nanocarries, which have been used mainly for improved skin delivery and antileishmanial activity. EXPERT OPINION Developing an effective topical treatment for CL using these antileishmanial drugs still remains a great challenge. Insights into the most promising delivery strategies to improve treatment of CL with PA and AmB using conventional dosage forms, lipid nanocarriers, and combined therapy are presented and discussed. The results obtained with combined therapy and alternative delivery systems are promising perspectives for improving topical treatment of CL.
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Affiliation(s)
- Guilherme Carneiro
- Federal University of Minas Gerais, Faculty of Pharmacy, Belo Horizonte, Minas Gerais, Brazil
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Hobbie SN, Kaiser M, Schmidt S, Shcherbakov D, Janusic T, Brun R, Böttger EC. Genetic reconstruction of protozoan rRNA decoding sites provides a rationale for paromomycin activity against Leishmania and Trypanosoma. PLoS Negl Trop Dis 2011; 5:e1161. [PMID: 21629725 PMCID: PMC3101183 DOI: 10.1371/journal.pntd.0001161] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 03/17/2011] [Indexed: 12/04/2022] Open
Abstract
Aminoglycoside antibiotics target the ribosomal decoding A-site and are active against a broad spectrum of bacteria. These compounds bind to a highly conserved stem-loop-stem structure in helix 44 of bacterial 16S rRNA. One particular aminoglycoside, paromomycin, also shows potent antiprotozoal activity and is used for the treatment of parasitic infections, e.g. by Leishmania spp. The precise drug target is, however, unclear; in particular whether aminoglycoside antibiotics target the cytosolic and/or the mitochondrial protozoan ribosome. To establish an experimental model for the study of protozoan decoding-site function, we constructed bacterial chimeric ribosomes where the central part of bacterial 16S rRNA helix 44 has been replaced by the corresponding Leishmania and Trypanosoma rRNA sequences. Relating the results from in-vitro ribosomal assays to that of in-vivo aminoglycoside activity against Trypanosoma brucei, as assessed in cell cultures and in a mouse model of infection, we conclude that aminoglycosides affect cytosolic translation while the mitochondrial ribosome of trypanosomes is not a target for aminoglycoside antibiotics. Rational design of novel therapeutics relies on the knowledge and understanding of potential drug targets. Historically, the majority of therapeutics have not been rationally designed, but empirically discovered. Paromomycin, an aminoglycoside with antibacterial activity, has been found to show considerable activity against leishmaniasis, a disease caused by the protozoan parasite Leishmania. However, the mechanisms of aminoglycoside action against protozoan parasites have in part remained unclear. In this study we demonstrate that the cytosolic ribosome is the preferred drug target, and that the mitochondrial ribosome does not contribute to the antiprotozoal activity of aminoglycosides. As the cytosolic ribosome of Trypanosoma, the causative agent of sleeping sickness and Chagas disease, resembles that of Leishmania, we tested the efficacy of paromomycin against Trypanosoma. We found that paromomycin not only inhibits the growth of Trypanosoma in culture, but also suppresses trypanosomiasis in a mouse infection model. Our results point to the cytosolic ribosome as a promising drug target for antiprotozoal drug development.
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MESH Headings
- Animals
- Antiprotozoal Agents/pharmacology
- Disease Models, Animal
- Female
- Leishmania/drug effects
- Mice
- Parasitic Sensitivity Tests
- Paromomycin/pharmacology
- Protein Biosynthesis/drug effects
- RNA, Bacterial/genetics
- RNA, Bacterial/metabolism
- RNA, Protozoan/genetics
- RNA, Protozoan/metabolism
- RNA, Ribosomal/genetics
- RNA, Ribosomal/metabolism
- Recombination, Genetic
- Rodent Diseases/drug therapy
- Rodent Diseases/parasitology
- Trypanosoma brucei brucei/drug effects
- Trypanosomiasis, African/drug therapy
- Trypanosomiasis, African/parasitology
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Affiliation(s)
- Sven N. Hobbie
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Marcel Kaiser
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sebastian Schmidt
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Dmitri Shcherbakov
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Tanja Janusic
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Reto Brun
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Erik C. Böttger
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
- * E-mail:
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Fernández MM, Malchiodi EL, Algranati ID. Differential effects of paromomycin on ribosomes of Leishmania mexicana and mammalian cells. Antimicrob Agents Chemother 2011; 55:86-93. [PMID: 20956601 PMCID: PMC3019668 DOI: 10.1128/aac.00506-10] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 06/16/2010] [Accepted: 10/10/2010] [Indexed: 11/20/2022] Open
Abstract
Paromomycin, an aminoglycoside antibiotic having low mammalian cell toxicity, is one of the drugs currently used in the chemotherapy of cutaneous and visceral leishmaniasis. In order to understand the mode of action of this antibiotic at the molecular level, we have investigated the effects of paromomycin on protein synthesis in Leishmania and its mammalian hosts. We were able to demonstrate that in vivo protein synthesis in the promastigote stage of the parasite and its proliferation rate are markedly inhibited by paromomycin while being only slightly affected by other aminoglycoside antibiotics, such as streptomycin and neomycin B. Furthermore, both in vitro polypeptide synthesis induced by poly(U) as mRNA and accuracy of translation are significantly decreased by paromomycin in cell-free systems containing ribosomal particles of Leishmania promastigotes. Conversely, when ribosomes from mammalian cells are used instead of the protozoan particles, polyphenylalanine synthesis is only barely reduced by the antibiotic and the translation misreading remains almost unaltered. Surface plasmon resonance analysis of the interaction between paromomycin and protozoan or mammalian cell ribosomal RNAs shows a strong binding of antibiotic to the parasite ribosomal decoding site and practically no interaction with the mammalian cell counterpart. Our results indicating differential effects of paromomycin on the translation processes of the Leishmania parasite and its mammalian hosts can explain the therapeutic efficiency of this antibiotic as an antileishmaniasis agent.
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Affiliation(s)
- Marisa M. Fernández
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral (IDEHU), CONICET-UBA, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 1113 Buenos Aires, Fundación Instituto Leloir, Patricias Argentinas 435, 1405 Buenos Aires, Argentina
| | - Emilio L. Malchiodi
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral (IDEHU), CONICET-UBA, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 1113 Buenos Aires, Fundación Instituto Leloir, Patricias Argentinas 435, 1405 Buenos Aires, Argentina
| | - Israel D. Algranati
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral (IDEHU), CONICET-UBA, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 1113 Buenos Aires, Fundación Instituto Leloir, Patricias Argentinas 435, 1405 Buenos Aires, Argentina
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Ameen M. Cutaneous and mucocutaneous leishmaniasis: emerging therapies and progress in disease management. Expert Opin Pharmacother 2010; 11:557-69. [DOI: 10.1517/14656560903555219] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kim DH, Chung HJ, Bleys J, Ghohestani RF. Is paromomycin an effective and safe treatment against cutaneous leishmaniasis? A meta-analysis of 14 randomized controlled trials. PLoS Negl Trop Dis 2009; 3:e381. [PMID: 19221595 PMCID: PMC2637543 DOI: 10.1371/journal.pntd.0000381] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 01/20/2009] [Indexed: 11/19/2022] Open
Abstract
Background High cost, poor compliance, and systemic toxicity have limited the use of pentavalent antimony compounds (SbV), the treatment of choice for cutaneous leishmaniasis (CL). Paromomycin (PR) has been developed as an alternative to SbV, but existing data are conflicting. Methodology/Principal Findings We searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials, without language restriction, through August 2007, to identify randomized controlled trials that compared the efficacy or safety between PR and placebo or SbV. Primary outcome was clinical cure, defined as complete healing, disappearance, or reepithelialization of all lesions. Data were extracted independently by two investigators, and pooled using a random-effects model. Fourteen trials including 1,221 patients were included. In placebo-controlled trials, topical PR appeared to have therapeutic activity against the old world and new world CL, with increased local reactions, when used with methylbenzethonium chloride (MBCL) compared to when used alone (risk ratio [RR] for clinical cure, 2.58 versus 1.01: RR for local reactions, 1.60 versus 1.07). In SbV-controlled trials, the efficacy of topical PR was not significantly different from that of intralesional SbV in the old world CL (RR, 0.70; 95% confidence interval, 0.26–1.89), whereas topical PR was inferior to parenteral SbV in treating the new world CL (0.67; 0.54–0.82). No significant difference in efficacy was found between parenteral PR and parenteral SbV in the new world CL (0.88; 0.56–1.38). Systemic side effects were fewer with topical or parenteral PR than parenteral SbV. Conclusions/Significance Topical PR with MBCL could be a therapeutic alternative to SbV in selected cases of the old world CL. Development of new formulations with better efficacy and tolerability remains to be an area of future research. Millions of people worldwide are suffering from cutaneous leishmaniasis that is caused by parasites of the genus Leishmania. Although pentavalent antimony compounds are the treatment of choice, their use is limited by high cost, poor compliance, and systemic toxicity. Paromomycin was developed to overcome such limitations. However, there is no consensus on its efficacy. This meta-analysis assessed the efficacy and safety of paromomycin compared with placebo and pentavalent antimony compounds. Fourteen randomized controlled trials, including 1,221 patients, met our selection criteria. Topical paromomycin appeared to have therapeutic activity against the old world and new world cutaneous leishmaniasis, with increased local reactions, when combined with methylbenzethonium chloride. Topical paromomycin was not significantly different from intralesional pentavalent antimony compounds in treating the old world form, whereas it was inferior to parenteral pentavalent antimony compounds in treating the new world form. However, a similar efficacy was found between parenteral paromomycin and pentavalent antimony compounds in treating the new world form. Fewer systemic side effects were observed with topical and parenteral paromomycin than pentavalent antimony compounds. These results suggest that topical paromomycin with methylbenzethonium chloride could be a therapeutic alternative to pentavalent antimony compounds for selected cases of the old world cutaneous leishmaniasis.
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Affiliation(s)
- Dae Hyun Kim
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Hye Jin Chung
- Department of Dermatology and Cutaneous Biology, Jefferson Medical College, Philadelphia, Pennsylvania, United States of America
| | - Joachim Bleys
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - Reza F. Ghohestani
- Division of Dermatology and Cutaneous Surgery, Department of Medicine, University of Texas Medical School at San Antonio, Texas, United States of America
- Texas Dermatology Institute, San Antonio, Texas, United States of America
- * E-mail:
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In vitro and in vivo antileishmanial activities of a Brazilian green propolis extract. Parasitol Res 2008; 103:487-92. [PMID: 18491139 DOI: 10.1007/s00436-008-0970-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Accepted: 03/20/2008] [Indexed: 10/22/2022]
Abstract
The in vitro antileishmanial activity of Brazilian green propolis hydroalcoholic extract (BPE) were carried out on Leishmania (Viannia) braziliensis against both promastigote (doses ranging from 1 to 750 microg mL(-1)) and amastigote (10, 100, and 250 microg mL(-1)) assays in comparison with the positive (amphotericin B) and negative (dimethyl sulfoxide at 1% in physiologic solution) control groups. BPE displayed in vitro antileishmanial activities against promastigote forms of the parasite (p < 0.05). However, it was inactive against its amastigote ones. In the in vitro cytotoxicity assay against Vero cells, BPE showed no cytotoxicity in the maximum doses tested. The high-performance liquid chromatography analysis allowed the identification of caffeic acid, p-coumaric acid, aromadendrine-4'-methyl-ether, 3-prenyl-p-coumaric acid (drupanin), and 3,5-diprenil-p-cumárico acid (artepillin C) as major compounds of BPE. In the in vivo assay, using a Balb/C lineage of Mus musculus male mice, groups of ten animals each were treated (1.5 mg kg day(-1)) with BPE orally (group 1), BPE topically (group 2), BPE orally and topically (group 3), and glucantime (group 4), using NaCl 0.9% (group 5) as the negative control group. Groups 1, 2, and 3 displayed a decrease on lesion development, after 90 days of treatment, by 78.6%, 84.3%, and 90.0%, respectively, while the glucantime-treated group showed 57.7% of decrease, all in comparison with the negative control group. It is the first time that the in vivo antileishmanial activity has been reported for Brazilian green propolis.
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Osorio EJ, Robledo SM, Bastida J. Alkaloids with antiprotozoal activity. THE ALKALOIDS. CHEMISTRY AND BIOLOGY 2008; 66:113-90. [PMID: 19025098 DOI: 10.1016/s1099-4831(08)00202-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Edison J Osorio
- Grupo de Investigación en Sustancias Bioactivas, Facultad de Química-Farmacéutica, Universidad de Antioquia, A. A. 1226, Medellín, Colombia.
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Abstract
BACKGROUND Cutaneous leishmaniasis occurs worldwide in both old and new world countries with their own endemic foci. Many of those infected often experience a delay in diagnosis and inappropriate treatment. OBJECTIVES To review the literature in terms of the various treatment options described for cutaneous leishmaniasis. METHODS Literature on the treatment of cutaneous leishmaniasis retrieved by searching Index Medicus, PubMed and IndMed were reviewed. RESULTS AND CONCLUSION Review reveals no uniform pattern or definite guidelines for its therapy. The varied and contradictory experience of different workers further confounds the clinicians involved in the care of these patients. Selection of an appropriate and customized treatment schedule is a discretion the treating clinician has to make.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology & Leprosy, Indira Gandhi Medical College, Shimla, India
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15
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Mussi SV, Fernandes AP, Ferreira LAM. Comparative study of the efficacy of formulations containing fluconazole or paromomycin for topical treatment of infections by Leishmania (Leishmania) major and Leishmania (Leishmania) amazonensis. Parasitol Res 2007; 100:1221-6. [PMID: 17206508 DOI: 10.1007/s00436-006-0394-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 11/14/2006] [Indexed: 11/28/2022]
Abstract
The development of alternative therapeutic approaches for cutaneous leishmaniasis (CL) has received considerable attention in recent research, including the identification of formulations for topical treatment. In the present study, the activity of two formulations was evaluated in BALB/c mice experimentally infected with either Leishmania (Leishmania) major or L. (L.) amazonensis, a hydrophilic gel containing 10% paromomycin (PAHG) and a cream containing 1% fluconazole (FLUC). After development of ulcerated lesions, infected mice were divided into three groups of five animals each: (1) PA group: Lesions were covered with 50 microl of PAHG; (2) FLUC group: Lesions were covered with 50 microl of FLUC, and (3) placebo group: treated with gel without paromomycin. During and after treatment, the size of lesions was determined weekly using a caliper. The efficacy of PAHG was significantly higher than that observed for FLUC for both Leishmania species. The PAHG formulation was effective in promoting the healing of ulcers in all animals 28 days after the beginning of treatment, whereas none of the animals was cured by FLUC. These results suggest that the PAHG formulation could be suitable for clinical studies and may represent an alternative formulation for the topical treatment of CL.
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Affiliation(s)
- Samuel Vidal Mussi
- Department of Pharmaceuticals, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Antônio Carlos, 6627, CEP 31270-901, Belo Horizonte, Minas Gerais, Brazil
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16
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El-On J, Bazarsky E, Sneir R. Leishmania major: in vitro and in vivo anti-leishmanial activity of paromomycin ointment (Leshcutan) combined with the immunomodulator Imiquimod. Exp Parasitol 2006; 116:156-62. [PMID: 17306255 DOI: 10.1016/j.exppara.2006.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Revised: 11/01/2006] [Accepted: 12/15/2006] [Indexed: 10/23/2022]
Abstract
Paromomycin at 25, 50 and 100 microg/ml, inhibited the growth of Leishmania major amastigotes by 34.5%, 61.2%, 74.9% and 85.4%, 89.9%, 95.7% on the 2nd and the 4th day of treatment in culture, respectively. Methylbenzethonium chloride at 0.1 and 0.5 microg/ml and Imiquimod at 5 and 10 microg/ml, administered separately, inhibited the parasite development by 39.5% and 65.2% and 31.5% and 47.7%, respectively. Imiquimod (5-10 microg/ml) combined with either paromomycin (25, 50 and 100 microg/ml) or methylbenzethonium chloride (0.1 and 0.5 microg/ml) showed an anti-leishmanial additive effect. A 10 day topical treatment, twice daily, with an ointment containing 15% paromomycin and 12% methylbenzethonium chloride (Leshcutan), either undiluted or diluted 1:5 in soft white paraffin combined with 5% Imiquimod cream (Aldara), was as effective as Leshcutan given alone. The present study suggests that a combination of Aldara and Leshcutan is as effective as Leshcutan given alone in the topical treatment of CL caused by L. major.
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Affiliation(s)
- Joseph El-On
- Department of Microbiology and Immunology, Faculty of Health Sciences, Ben-Gurion University of the Negev and Soroka University Medical Center, Beer Sheva 84105, Israel.
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17
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Gonçalves GS, Fernandes AP, Souza RCC, Cardoso JE, de Oliveira-Silva F, Maciel FC, Rabello A, Ferreira LAM. Activity of a paromomycin hydrophilic formulation for topical treatment of infections by Leishmania (Leishmania) amazonensis and Leishmania (Viannia) braziliensis. Acta Trop 2005; 93:161-7. [PMID: 15652330 DOI: 10.1016/j.actatropica.2004.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Revised: 10/04/2004] [Accepted: 10/29/2004] [Indexed: 11/26/2022]
Abstract
Studies on in vitro skin permeation and in vivo anti-leishmanial activity in mice experimentally infected with Leishmania (Leishmania) major pointed out to the potential of a new paromomycin (PA) formulation (hydrophilic gel) for treatment of cutaneous leishmaniasis (CL). In this study, the activity of this formulation was evaluated in animals experimentally infected by Leishmania species that prevail in the New World. PA gel activity was compared to antimony treatment, since it is still the first choice treatment to the different clinical forms of leishmaniasis. The topical treatment activity with 10% PA gel in BALB/c mice infected by Leishmania (Leishmania) amazonensis was higher than that observed for parenteral antimony treatment, while the efficacy of these two regimes in hamsters infected by Leishmania (Viannia) braziliensis was similar. These results suggest that this formulation could be suitable for clinical studies and may represent an alternative novel formulation for topical treatment of CL.
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Affiliation(s)
- Gisele Santos Gonçalves
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av Antônio Carlos, 6627, CEP 31270-901, Belo Horizonte, Minas Gerais, Brazil
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18
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Ferreira LS, Ramaldes GA, Nunan EA, Ferreira LAM. In Vitro Skin Permeation and Retention of Paromomycin from Liposomes for Topical Treatment of the Cutaneous Leishmaniasis. Drug Dev Ind Pharm 2004; 30:289-96. [PMID: 15109028 DOI: 10.1081/ddc-120030423] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Paromomycin (PA), a very hydrophilic antibiotic, has been tested as an alternative topical treatment against cutaneous leishmaniasis (CL). Although this treatment has shown promising results, it has not been successful in accelerating the recovery in most cases. This could be attributed to the low skin penetration of PA. Liposomal formulations usually provide sustained and enhanced drug levels in skin. The aim of this study was to prepare liposomal formulations containing PA and to investigate their potential as topical delivery systems of this antileishmanial. Large multilamellar vesicles (MLVs) were prepared by conventional solvent evaporation method. Large unilamellar vesicles (LUVs) were prepared by reverse-phase evaporation method. The lipids used were soybean phosphatidylcholine (PC) and PC:cholesterol (CH) (molar ratio 1:1). The skin permeation experiments across stripped and normal hairless mice skin were performed in modified Franz diffusion cells. The PA entrapment in LUV liposomes (20.4 +/- 2.2%) was higher than that observed for MLV liposomes (7.5 +/- 0.9%). Drug entrapment was 41.9 +/- 6.2% and 27.2 +/- 2.4% for PC and PC:CH LUV, respectively. The skin permeation was 1.55 +/- 0.31%, 1.29 +/- 0.40%, 0.20 +/- 0.08%, and 0.50 +/- 0.19% for PC LUV, PC:CH LUV, empty LUV +/- PA and aqueous solution, respectively. Controlled topical delivery, across stripped skin, was observed for PA entrapped in LUV liposomes.
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Affiliation(s)
- Luciana S Ferreira
- Department of Pharmaceutics, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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19
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Abstract
Natural products are not only the basis for traditional or ethnic medicine. Only recently, they have provided highly successful new drugs such as Artemisinin. Furthermore, screening natural products found in all sorts of environments such as the deep sea, rain forests and hot springs, and produced by all sorts of organisms ranging from bacteria, fungi and plants to protozoa, sponges and invertebrates, is a highly competitive field where all of the major pharmaceutical companies are encountered. Already, many new natural product groups have revealed antiparasitic properties of surprising efficacy and selectivity, as will be shown in this review for plant-derived alkaloids, terpenes and phenolics. Many novel lead structures, however, have severe chemico-physical drawbacks such as poor solubility. Here, innovative drug formulations and carrier systems might help, as discussed by the authors in another article of this series.
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Affiliation(s)
- O Kayser
- Freie Universität Berlin, Institut für Pharmazie, Pharmazeutische Biotechnologie, Kelchstrasse 31, 12169 Berlin, Germany.
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20
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Natural products as potential antiparasitic drugs. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1572-5995(02)80019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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21
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Sharquie KE, Najim RA, Farjou IB, Al-Timimi DJ. Oral zinc sulphate in the treatment of acute cutaneous leishmaniasis. Clin Exp Dermatol 2001; 26:21-6. [PMID: 11260171 DOI: 10.1046/j.1365-2230.2001.00752.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A clinical trial to evaluate the efficiency of oral zinc sulphate in the treatment of cutaneous leishmaniasis was conducted. One-hundred and four patients with parasitologically proven cutaneous leishmaniasis were included in the trial. Patients were assigned randomly to receive 2.5, 5 or 10 mg/kg of zinc sulphate orally, and a control group of patients did not receive any treatment. All patients were followed up for 45 days. At the end of the follow-up period, lesions were assessed and parasitological proof of cure or otherwise was sought. Results showed that the cure rate for the 2.5 mg/kg group was 83.9%, for the 5 mg/kg treatment group it was 93.1% and for the 10 mg/kg treatment group it was 96.9%. No lesions in the control group showed any sign of healing during the follow-up period. Therefore, oral zinc sulphate can be recommended as a very safe therapy for cutaneous leishmaniasis.
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Affiliation(s)
- K E Sharquie
- Department of Dermatology, College of Medicine, University of Baghdad, Baghdad, Iraq
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22
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Najim RA, Sharquie KE, Farjou IB. Zinc sulphate in the treatment of cutaneous leishmaniasis: an in vitro and animal study. Mem Inst Oswaldo Cruz 1998; 93:831-7. [PMID: 9921312 DOI: 10.1590/s0074-02761998000600025] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study was designed to evaluate the effectiveness of zinc sulphate both in vitro and in an animal model against both strains of old world cutaneous leishmaniasis. The in vitro sensitivities of promastigotes and axenic amastigotes of both Leishmania major and L. tropica to zinc sulphate was determined, the LD50 calculated and compared to the standard treatment for cutaneous leishmaniasis pentavalent antimony compounds. The results show that the two forms of both strains were sensitive to zinc sulphate and their respective LD50 were lower compared to the pentavalent antimony compound. Furthermore the sensitivities of the forms of both strains were tested using a simple slide method and compared to results of the standard method. To confirm this result, zinc sulphate was administered orally to mice infected with cutaneous leishmaniasis both therapeutically and prophylactically. Results showed that oral zinc sulphate was effective in both treatment and prophylaxis for cutaneous leishmaniasis. These results encourage the use of oral zinc sulphate in the treatment of cutaneous leishmaniasis clinically.
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Affiliation(s)
- R A Najim
- Department of Pharmacology, University of Baghdad, Iraq
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23
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Balaña-Fouce R, Reguera RM, Cubría JC, Ordóñez D. The pharmacology of leishmaniasis. GENERAL PHARMACOLOGY 1998; 30:435-43. [PMID: 9580315 DOI: 10.1016/s0306-3623(97)00268-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The development of new strategies on chemotherapy of parasitic protozoan diseases is one of the most exciting research fields of recent years. World Health Organization (WHO) reports have recognized that the physiology and biochemistry of protozoan parasites and the host-parasite relation are the main targets for the design of new drugs that can be used in the future against these diseases.
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Affiliation(s)
- R Balaña-Fouce
- Department of Physiology, Pharmacology and Toxicology (INTOXCAL), University of León, Spain
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24
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Affiliation(s)
- A Alkhawajah
- Department of Pharmacology, College of Medicine, King Faisal University, Dammam, Saudi Arabia
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25
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Neva FA, Ponce C, Ponce E, Kreutzer R, Modabber F, Olliaro P. Non-ulcerative cutaneous leishmaniasis in Honduras fails to respond to topical paromomycin. Trans R Soc Trop Med Hyg 1997; 91:473-5. [PMID: 9373659 DOI: 10.1016/s0035-9203(97)90290-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A double-'blind', placebo-controlled trial of topical therapy with 15% paromomycin (aminosidine) and 10% urea in white paraffin was carried out on 53 patients with non-ulcerating cutaneous leishmaniasis in Honduras. Although the treatment was not effective, several unexpected findings emerged from the trial. Leishmania mexicana was found to be the cause of many of the skin lesions in one of the 2 study sites. These lesions were clinically indistinguishable from those caused by L. chagasi, the aetiologic agent previously found for this form of leishmaniasis. This is the first documented report of L. mexicana in Honduras.
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Affiliation(s)
- F A Neva
- Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, Maryland, USA
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26
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Affiliation(s)
- S A Bell
- Department of Dermatology, Ludwig-Maximillians-University München, Germany
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27
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Maarouf M, Lawrence F, Croft SL, Robert-Gero M. Ribosomes of Leishmania are a target for the aminoglycosides. Parasitol Res 1995; 81:421-5. [PMID: 7501642 DOI: 10.1007/bf00931504] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ribosomes of Leishmania, a parasitic protozoan (member of the order of Kinetoplastidae), were purified on a sucrose density gradient. Two different types of ribosomes were isolated from the promastigotes: cytoplasmic (88S and 91S from L. tropica and L. donovani, respectively) and mitochondrial (75S in both species). Both types of ribosome dissociated into their subunits at low Mg2+ concentration (1-2 mM) as follows: 67S and 49S for the 91S cytoplasmic ribosomes of L. donovani and 61S and 43S for the 88S cytoplasmic ribosome of L. tropica; 55S and 34S for L. tropica and 60S and 39S for L. donovani mitochondrial ribosomes, respectively. Paromomycin (aminosidine), an aminoglycoside aminocyclitol antibiotic, interacted with the ribosomes to promote the association of the subunits. Under similar experimental conditions, spermidine and pentamidine were inactive.
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Affiliation(s)
- M Maarouf
- Institut de Chimie des Substances Naturelles, C.N.R.S., Gif-Yvette, France
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28
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Guberman D, Vardy DA, Klapholz L, Klaus SN. Vector-borne infections: a hazard for adventure visitors to Israel. ACTA ACUST UNITED AC 1994. [DOI: 10.1580/0953-9859-5.3.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Neal RA, Murphy AG, Olliaro P, Croft SL. Aminosidine ointments for the treatment of experimental cutaneous leishmaniasis. Trans R Soc Trop Med Hyg 1994; 88:223-5. [PMID: 8036682 DOI: 10.1016/0035-9203(94)90307-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A 15% aminosidine sulphate (AS)/10% urea/white soft paraffin (WSP) ointment cured all Leishmania major lesions on Balb/C mice following topical application for 10 d. Some relapses were observed 10 weeks after treatment. AS alone in WSP ointment was also highly effective. The ointment containing urea was non-irritant to mice, whereas ointments containing quaternary ammonium compounds were irritant. The 15% AS/10% urea/WSP ointment was not effective in the treatment of L. mexicana or L. panamensis lesions on Balb/C mice, no cure being observed.
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Affiliation(s)
- R A Neal
- Department of Medical Parasitology, London School of Hygiene and Tropical Medicine, UK
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30
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Iwu MM, Jackson JE, Schuster BG. Medicinal plants in the fight against leishmaniasis. ACTA ACUST UNITED AC 1994; 10:65-8. [PMID: 15275504 DOI: 10.1016/0169-4758(94)90398-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the tremendous progress mode in the understanding o f the molecular biology of Leishmania and the clinical possibilities presented by some experimental chemotherapeutic agents, no new drugs have been developed for the treatment of leishmaniasis since the introduction of the pentovalent antimoniols more than 50 years ago. As reviewed here by Maurice M. Iwu, Joan E. Jackson and Brion G. Schuster, recognition of the current extensive use of herbal therapy in Leishmania-endemic regions has renewed interest in evaluation of plant remedies used in traditional medicine as sources of potential antileishmanials.
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Affiliation(s)
- M M Iwu
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Washington, DC 20307-5100, USA
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31
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Abstract
Attempts to suppress a harmful genetic trait by antisense means, or to restore a normal phenotype by gene transfer, attract much publicity. This is especially the case where clinical trials incorporating such methodologies have been initiated, such as antisense oligonucleotide therapies for some types of leukaemia, antisense gene-transfer therapy for a form of lung cancer, and gene-transfer therapies for adenosine deaminase deficiency, severe combined immunodeficiency disease, and various forms of cancer including brain tumours and melanoma. However, translation of laboratory success into treatment or control of disease is unlikely to be straightforward. Here, Nick Miller and Richard Vile summarize the rationale, problems and potential of such techniques as applied to parasitic disease.
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Affiliation(s)
- N Miller
- Imperial Cancer Research Fund, 44 Lincoln's Inn Fields, London, UK WC2 3PX
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32
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Krause G, Kroeger A. Topical treatment of American cutaneous leishmaniasis with paramomycin and methylbenzethonium chloride: a clinical study under field conditions in Ecuador. Trans R Soc Trop Med Hyg 1994; 88:92-4. [PMID: 8154018 DOI: 10.1016/0035-9203(94)90517-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Fifty-two patients with American cutaneous leishmaniasis (ACL) from the Pacific coast of Ecuador were treated topically with an ointment containing 15% paramomycin (PR) and 12% methylbenzethonium chloride (MBCL) in vaselinum album (white soft paraffin; white petrolatum). After 20 applications (over 10 or 20 d) all lesions showed complete epithelialization within the first 100 d. Five patients developed new lesions during the one year observation period; 2 of these were probably reinfections. Considering all 5 cases as treatment failures, the healing rates were: 72% after 50 d, 90% after 100 d, and 85% after 360 d. In a separate study in the same area, a group of 23 patients was left without treatment for 3 months. Only 9% of the untreated patients healed spontaneously after 50 d. Growth of the lesion, inflammation and pain were observed at the beginning of treatment. After treatment, most lesions healed rapidly without scars. The drug was well accepted by the patients and was easy to administer under tropical field conditions.
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Affiliation(s)
- G Krause
- Institute of Tropical Hygiene and Public Health, University of Heidelberg, Germany
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33
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Weinrauch L, Cawich F, Craig P, Sosa JX, el-On J. Topical treatment of New World cutaneous leishmaniasis in Belize: a clinical study. J Am Acad Dermatol 1993; 29:443-6. [PMID: 8349861 DOI: 10.1016/0190-9622(93)70209-c] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Many studies have been performed during the past decade to find an effective topical therapy for cutaneous leishmaniasis (CL). OBJECTIVE Our purpose was to evaluate the effect of paromomycin ointment (P-ointment) containing 15% paromomycin sulfate and 12% methylbenzethonium chloride on Belizean patients with New World CL. METHODS Fifty-three patients were treated twice daily for 14 to 21 days with P-ointment. RESULTS Sixty-eight percent of the patients healed, 6% had a delayed cure, and 26% did not respond. No toxic effects from the ointment were observed. CONCLUSION Topical paromomycin is as efficacious in the treatment of New World CL as other currently accepted modalities that are potentially more toxic.
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Affiliation(s)
- L Weinrauch
- Department of Dermatology, Hadassah University Hospital, Jerusalem, Israel
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34
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França F, Cuba CA, Moreira EA, Miguel O, Almeida M, das Virgens MDL, Marsden PD. [An evaluation of the effect of a bark extract from the cashew (Anacardium occidentale L.) on infection by Leishmania (Viannia) braziliensis]. Rev Soc Bras Med Trop 1993; 26:151-5. [PMID: 8146389 DOI: 10.1590/s0037-86821993000300004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This paper presents an evaluation of the therapeutic effect of an hydroalcoholic extract of A. occidentale L. bark against Leishmania (Viannia) brasiliensis. The extract showed high activity in the in vitro model against the promastigotes of this species. However in the in vivo model no curative activity was observed.
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Affiliation(s)
- F França
- Núcleo de Medicina Tropical e Nutrição, Universidade de Brasília, DF
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35
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Vardy DA, Frankenburg S, Goldenhersh M, Leibovici V, Klaus SN. Unusually extensive disease caused by Leishmania major parasites. Clin Exp Dermatol 1993; 18:36-40. [PMID: 8382568 DOI: 10.1111/j.1365-2230.1993.tb00963.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Simple cutaneous leishmaniasis (CL), which is endemic in several areas of Israel, is usually caused by Leishmania major. CL, which is caused by replication of parasites within dermal macrophages, is self-limited and almost always confined to the skin. We recently encountered two cases of CL in which skin defenses were breached and lesions appeared in subcutaneous locations. In one case, abnormal cell-mediated immune function was detected. The purpose of this article is to present these data and to comment on the immunological aspects of leishmaniasis.
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Affiliation(s)
- D A Vardy
- Department of Dermatology, Hadassah University Hospital, Jerusalem, Israel
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36
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el-On J, Halevy S, Grunwald MH, Weinrauch L. Topical treatment of Old World cutaneous leishmaniasis caused by Leishmania major: a double-blind control study. J Am Acad Dermatol 1992; 27:227-31. [PMID: 1430361 DOI: 10.1016/0190-9622(92)70175-f] [Citation(s) in RCA: 121] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND A controlled study of the efficacy of topical paromomycin sulfate (PR) and methylbenzethonium chloride (MBCl) in cutaneous leishmaniasis (CL) has not yet been performed. OBJECTIVE The therapeutic effect of an ointment containing 15% PR and either 12% or 5% MBCl (15/12 or 15/5 P-ointment) on patients suffering from Old World CL was examined in a randomized, double-blind, cross-over study. METHODS Thirty-nine patients with Old World CL caused by Leishmania major were treated topically, twice daily, for 10 to 20 days with 15/12 or 15/5 P-ointment and 10 to 20 days with a placebo ointment to achieve a total of 30 days of treatment in all groups. RESULTS In the P-ointment-treated groups, 74.2% (29 of 39 patients) of the patients were cured versus 26.6% (4 of 15 patients) in the placebo-treated group. Little difference was found between the 15/12 and 15/5 P-ointment groups. CONCLUSION In most of the patients treated with the active ingredients, total elimination of the parasites was achieved within the first 10 days of treatment.
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Affiliation(s)
- J el-On
- Department of Microbiology and Immunology, Faculty of Health Sciences, Ben Gurion University of The Negev, Beer Sheva, Israel
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37
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Lezama-Davila CM, Williams DM, Gallagher G, Alexander J. Cytokine control of Leishmania infection in the BALB/c mouse: enhancement and inhibition of parasite growth by local administration of IL-2 or IL-4 is species and time dependent. Parasite Immunol 1992; 14:37-48. [PMID: 1557229 DOI: 10.1111/j.1365-3024.1992.tb00004.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The therapeutic potential of locally injected interleukin-2 (IL-2) or interleukin-4 (IL-4) was studied in the footpads of Leishmania mexicana or Leishmania major infected BALB/c mice. The disease state was measured both pathologically, by measuring lesion size, and parasitologically, by counting total parasite numbers from infected footpads. IL-2 (0.5 microgram/dose) or IL-4 (0.1 microgram/dose) was administered either early, 1 day and/or 15 days after infection, or late, after palpable lesions had developed. Results differed markedly depending on which Leishmania species was used and at what time during the course of disease that therapy commenced. Both L. major and L. mexicana infections, as measured by footpad thickness and parasite number, were exacerbated if IL-4 was injected into the infected footpads early, during the first two weeks of infection. Paradoxically, late intralesional injection (i.e. after measurable lesions had developed) of IL-4 markedly inhibited both lesion size and parasite growth in L. major, though not L. mexicana, infected mice. IL-2 had no measurable effect on the course of L. major infections no matter when or how often, the infected footpads of mice were treated. However, early administration of IL-2 did exacerbate L. mexicana lesion and parasite growth while late treatment had no effect. Generally, but not always, increases in footpad size correlated with increases in parasite number.
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Affiliation(s)
- C M Lezama-Davila
- Department of Immunology, University of Strathclyde, Todd Centre, Glasgow
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el-Safi SH, Murphy AG, Bryceson AD, Neal RA. A double-blind clinical trial of the treatment of cutaneous leishmaniasis with paromomycin ointment. Trans R Soc Trop Med Hyg 1990; 84:690-1. [PMID: 2278070 DOI: 10.1016/0035-9203(90)90146-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- S H el-Safi
- Department of Medical Parasitology, London School of Hygiene and Tropical Medicine, UK
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Wright CW, Phillipson JD. Natural products and the development of selective antiprotozoal drugs. Phytother Res 1990. [DOI: 10.1002/ptr.2650040402] [Citation(s) in RCA: 130] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Sharma S. Vector-borne diseases. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 1990; 35:365-485. [PMID: 2290983 DOI: 10.1007/978-3-0348-7133-4_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- S Sharma
- Medicinal Chemistry Division, Central Drug Research Institute, Lucknow, India
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Carter KC, Alexander J, Baillie AJ. Studies on the topical treatment of experimental cutaneous leishmaniasis: the therapeutic effect of methyl benzethonium chloride and the aminoglycosides, gentamicin and paromomycin. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1989; 83:233-9. [PMID: 2604461 DOI: 10.1080/00034983.1989.11812337] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BALB/c mice infected with either Leishmania major or Leishmania mexicana were treated twice a day for 10 days with an ointment containing 15% gentamicin or paromomycin, with or without 12% methylbenzethonium chloride (MBCl). It was found that topical application of either paromomycin or MBCl cured the parasite lesion, and that combined treatment with the two compounds had an additive effect. However, after four days' therapy there was a severe inflammatory response at the treatment site, and in most experiments mice relapsed and renewed lesion growth was observed. It is suggested that a non-specific inflammatory reaction may be an important component of the therapeutic response. In further experiments, L. major infected mice treated with paromomycin and MBCl which had cured but not relapsed 58 days after treatment were challenged with a similar dose of the homologous parasite. Lesions developed 16 days post-infection, and the number of parasites recovered from these lesions was similar to that recovered from lesions in control mice. Therefore no protective immunity had been induced by chemotherapy.
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Affiliation(s)
- K C Carter
- Immunology Division, Strathclyde University, Glasgow, U.K
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