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Bashir S, Shabbir K, Din FU, Khan SU, Ali Z, Khan BA, Kim DW, Khan GM. Nitazoxanide and quercetin co-loaded nanotransfersomal gel for topical treatment of cutaneous leishmaniasis with macrophage targeting and enhanced anti-leishmanial effect. Heliyon 2023; 9:e21939. [PMID: 38027656 PMCID: PMC10661431 DOI: 10.1016/j.heliyon.2023.e21939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Anti-leishmanial medications administered by oral and parenteral routes are less effective for treatment of cutaneous leishmaniasis (CL) and cause toxicity, hence targeted drug delivery is an efficient way to improve drug availability for CL with reduced toxicity. This study aimed to develop, characterize and evaluate nitazoxanide and quercetin co-loaded nanotransfersomal gel (NTZ-QUR-NTG) for the treatment of CL. Methods NTZ-QUR-NT were prepared by thin film hydration method and were statistically optimized using Box-Behnken design. To ease the topical delivery and enhance the retention time, the NTZ-QUR-NT were dispersed in 2 % chitosan gel. Moreover, in-vitro drug release, ex-vivo permeation, macrophage uptake, cytotoxicity and anti-leishmanial assays were performed. Results The optimized formulation indicated mean particle size 210 nm, poly dispersity index (PDI) 0.16, zeta potential (ZP) -15.1 mV and entrapment efficiency (EE) of NTZ and QUR was 88 % and 85 %, respectively. NTZ-QUR-NT and NTZ-QUR-NTG showed sustained release of the incorporated drugs as compared to the drug dispersions. Skin permeation of NTZ and QUR in NTZ-QUR-NTG was 4 times higher in comparison to the plain gels. The NTZ-QUR-NT cell internalization was almost 10-folds higher than NTZ-QUR dispersion. The cytotoxicity potential (CC50) of NTZ-QUR-NT (71.95 ± 3.32 μg/mL) was reduced as compared to NTZ-QUR dispersion (49.77 ± 2.15 μg/mL. A synergistic interaction was found between NTZ and QUR. Moreover, in-vitro anti-leishmanial assay presented a lower IC50 value of NTZ-QUR-NT as compared to NTZ-QUR dispersion. Additionally, a significantly reduced lesion size was observed in NTZ-QUR-NTG treated BALB/c mice, indicating its antileishmanial potential. Conclusion It can be concluded that nanotransfersomal gel has the capability to retain and permeate the incorporated drugs through stratum corneum and induce synergetic anti-leishmanial effect of NTZ and QUR against cutaneous leishmaniasis.
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Affiliation(s)
- Sidra Bashir
- Nanomedicine Research Group, Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University Islamabad, Pakistan
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University Islamabad, Pakistan
| | - Kanwal Shabbir
- Nanomedicine Research Group, Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University Islamabad, Pakistan
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University Islamabad, Pakistan
| | - Fakhar ud Din
- Nanomedicine Research Group, Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University Islamabad, Pakistan
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University Islamabad, Pakistan
| | - Saif Ullah Khan
- Institute of Biotechnology and Microbiology, Bacha Khan University, Charsada, KPK, Pakistan
| | - Zakir Ali
- Nanomedicine Research Group, Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University Islamabad, Pakistan
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University Islamabad, Pakistan
| | - Barkat Ali Khan
- Drugs Design and Cosmetics Lab (DDCL), Faculty of Pharmacy Gomal University, Dera Ismail Khan, Pakistan
| | - Dong Wuk Kim
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, 41566, South Korea
| | - Gul Majid Khan
- Nanomedicine Research Group, Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University Islamabad, Pakistan
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University Islamabad, Pakistan
- Islamia College University, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Khalid H, Batool S, Din FU, Khan S, Khan GM. Macrophage targeting of nitazoxanide-loaded transethosomal gel in cutaneous leishmaniasis. ROYAL SOCIETY OPEN SCIENCE 2022. [PMID: 36249328 DOI: 10.5061/dryad.cfxpnvx7d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Topical delivery is preferable over systemic delivery for cutaneous leishmaniasis, because of its easy administration, reduced systemic adverse effects and low cost. Nitazoxanide (NTZ) has broad-spectrum activity against various parasites and has the potential to avoid drug resistance developed by enzymatic mutations. NTZ oral formulation is associated with severe dyspepsia and stomach pain. Herein, NTZ-transethosomes (NTZ-TES) were prepared and loaded into chitosan gel (NTZ-TEG) for topical delivery. NTZ-TES were prepared by the thin-film hydration method and optimized statistically via the Box-Behnken method. The optimized formulation indicated excellent particle size (176 nm), polydispersity index (0.093), zeta potential (-26.4 mV) and entrapment efficiency (86%). The transmission electron microscopy analysis showed spherical-sized particles and Fourier-transform infrared spectroscopy analysis indicated no interaction among the excipients. Similarly, NTZ-TEG showed optimal pH, desirable viscosity and good spreadability. NTZ-TES and NTZ-TEG showed prolonged release behaviour and higher skin penetration and deposition in the epidermal/dermal layer of skin in comparison with the NTZ-dispersion. Moreover, NTZ-TES showed higher percentage inhibition, lower half-maximal inhibitory concentration (IC50) against promastigotes and higher macrophage uptake. Additionally, skin irritation and histopathology studies indicated the safe and non-irritant behaviour of the NTZ-TEG. The obtained findings suggested the enhanced skin permeation and improved anti-leishmanial effect of NTZ when administered as NTZ-TEG.
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Affiliation(s)
- Husna Khalid
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Sibgha Batool
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Fakhar Ud Din
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Salman Khan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Gul Majid Khan
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Islamia College University, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Khalid H, Batool S, Din FU, Khan S, Khan GM. Macrophage targeting of nitazoxanide-loaded transethosomal gel in cutaneous leishmaniasis. ROYAL SOCIETY OPEN SCIENCE 2022. [PMID: 36249328 DOI: 10.6084/m9.figshare.c.6214720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Topical delivery is preferable over systemic delivery for cutaneous leishmaniasis, because of its easy administration, reduced systemic adverse effects and low cost. Nitazoxanide (NTZ) has broad-spectrum activity against various parasites and has the potential to avoid drug resistance developed by enzymatic mutations. NTZ oral formulation is associated with severe dyspepsia and stomach pain. Herein, NTZ-transethosomes (NTZ-TES) were prepared and loaded into chitosan gel (NTZ-TEG) for topical delivery. NTZ-TES were prepared by the thin-film hydration method and optimized statistically via the Box-Behnken method. The optimized formulation indicated excellent particle size (176 nm), polydispersity index (0.093), zeta potential (-26.4 mV) and entrapment efficiency (86%). The transmission electron microscopy analysis showed spherical-sized particles and Fourier-transform infrared spectroscopy analysis indicated no interaction among the excipients. Similarly, NTZ-TEG showed optimal pH, desirable viscosity and good spreadability. NTZ-TES and NTZ-TEG showed prolonged release behaviour and higher skin penetration and deposition in the epidermal/dermal layer of skin in comparison with the NTZ-dispersion. Moreover, NTZ-TES showed higher percentage inhibition, lower half-maximal inhibitory concentration (IC50) against promastigotes and higher macrophage uptake. Additionally, skin irritation and histopathology studies indicated the safe and non-irritant behaviour of the NTZ-TEG. The obtained findings suggested the enhanced skin permeation and improved anti-leishmanial effect of NTZ when administered as NTZ-TEG.
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Affiliation(s)
- Husna Khalid
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Sibgha Batool
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Fakhar Ud Din
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Salman Khan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Gul Majid Khan
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Islamia College University, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Khalid H, Batool S, Din FU, Khan S, Khan GM. Macrophage targeting of nitazoxanide-loaded transethosomal gel in cutaneous leishmaniasis. ROYAL SOCIETY OPEN SCIENCE 2022; 9:220428. [PMID: 36249328 PMCID: PMC9532992 DOI: 10.1098/rsos.220428] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/12/2022] [Indexed: 05/03/2023]
Abstract
Topical delivery is preferable over systemic delivery for cutaneous leishmaniasis, because of its easy administration, reduced systemic adverse effects and low cost. Nitazoxanide (NTZ) has broad-spectrum activity against various parasites and has the potential to avoid drug resistance developed by enzymatic mutations. NTZ oral formulation is associated with severe dyspepsia and stomach pain. Herein, NTZ-transethosomes (NTZ-TES) were prepared and loaded into chitosan gel (NTZ-TEG) for topical delivery. NTZ-TES were prepared by the thin-film hydration method and optimized statistically via the Box-Behnken method. The optimized formulation indicated excellent particle size (176 nm), polydispersity index (0.093), zeta potential (-26.4 mV) and entrapment efficiency (86%). The transmission electron microscopy analysis showed spherical-sized particles and Fourier-transform infrared spectroscopy analysis indicated no interaction among the excipients. Similarly, NTZ-TEG showed optimal pH, desirable viscosity and good spreadability. NTZ-TES and NTZ-TEG showed prolonged release behaviour and higher skin penetration and deposition in the epidermal/dermal layer of skin in comparison with the NTZ-dispersion. Moreover, NTZ-TES showed higher percentage inhibition, lower half-maximal inhibitory concentration (IC50) against promastigotes and higher macrophage uptake. Additionally, skin irritation and histopathology studies indicated the safe and non-irritant behaviour of the NTZ-TEG. The obtained findings suggested the enhanced skin permeation and improved anti-leishmanial effect of NTZ when administered as NTZ-TEG.
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Affiliation(s)
- Husna Khalid
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Sibgha Batool
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Fakhar ud Din
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Salman Khan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Gul Majid Khan
- Nanomedicine Research Group, Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Department of Pharmacy, Quaid-i-Azam University, 45320 Islamabad, Pakistan
- Islamia College University, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Li J, Kuang H, Zhan X. Nitazoxanide in the Treatment of Intestinal Parasitic Infections in Children: A Systematic Review and Meta-Analysis. Indian J Pediatr 2020; 87:17-25. [PMID: 31833040 DOI: 10.1007/s12098-019-03098-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 10/11/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of nitazoxanide in intestinal parasitic infections in children. METHODS Four databases, PubMed, EMBASE, Web of Science and Cochrane Library, have been systematically searched from the inception of each database up to March 1st, 2019. The enrolled studies were limited to randomized clinical trials in children, comparing nitazoxanide with placebo or other antiparasitic drugs. The data extraction and quality assessment of pooled studies were conducted by two reviewers independently. For meta-analysis, Stata12.0 was used and a randomized effect model or a fixed effect model was selected according to the outcomes of heterogeneity test. RESULTS A total of 1645 subjects in 13 randomized controlled trials (RCTs) were enrolled, including 768 cases in the trial group and 877 cases in the control group. The effect of nitazoxanide vs. placebo and other antiparasitic drugs on the excretion rate of pathogens was uncertain (OR = 2.06, 95%CI [1.01,4.20], P = 0.047; I2 = 84.7%; very low quality evidence). Compared with placebo, subgroup analysis suggested that nitazoxanide could significantly improve the excretion rate of pathogens (OR = 7.01, 95%CI [1.82,26.94], P = 0.005; I2 = 79.1%; moderate quality evidence), while it made little or no difference compared with antiparasitic drugs (OR = 0.72, 95%CI [0.47,1.09], P = 0.124; I2 = 33.1%; low quality evidence). Meanwhile, nitazoxanide might increase the remission rate of diarrhea with OR = 5.12, 95%CI [2.00,13.08], P = 0.001; I2 = 72.3%; low quality evidence). However, it might also increase the rate of adverse events (OR = 1.47, 95%CI [1.05,2.07], P = 0.026; I2 = 44.7%; low quality evidence). CONCLUSIONS The authors are uncertain whether or not nitazoxanide could improve the excretion rate of pathogens. Based on low-certainty evidence, nitazoxanide may improve the remission rate of diarrhea in children with intestinal parasite infections, but it may be associated with an increased risk of adverse reactions. Hence, more RCTs with a low risk of bias are still needed to assess the efficacy and safety of nitazoxanide.
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Affiliation(s)
- Jinyi Li
- Department of Gastroenterology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongyu Kuang
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xue Zhan
- Department of Gastroenterology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China. .,Ministry of Education Key Laboratory of Child Development and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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Ranawaka RR, Weerakoon HS, de Silva SHP. Randomized, double-blind, controlled, comparative study on intralesional 10% and 15% hypertonic saline versus intralesional sodium stibogluconate inLeishmania donovanicutaneous leishmaniasis. Int J Dermatol 2015; 54:555-63. [DOI: 10.1111/ijd.12685] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Hema S. Weerakoon
- Department of Dermatology; Anuradhapura Teaching Hospital; Anuradhapura Sri Lanka
| | - S. H. Padmal de Silva
- Department of Evaluation and Research; National Institute of Health Sciences; Kalutara Sri Lanka
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