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Ferrante M, Leite BMM, Fontes LBC, Santos Moreira A, Nascimento de Almeida ÉM, Brodskyn CI, Lima IDS, dos Santos WLC, Pacheco LV, Cardoso da Silva V, dos Anjos JP, Guarieiro LLN, Landoni F, de Menezes JPB, Fraga DBM, Santos Júnior ADF, Veras PST. Pharmacokinetics, Dose-Proportionality, and Tolerability of Intravenous Tanespimycin (17-AAG) in Single and Multiple Doses in Dogs: A Potential Novel Treatment for Canine Visceral Leishmaniasis. Pharmaceuticals (Basel) 2024; 17:767. [PMID: 38931434 PMCID: PMC11206245 DOI: 10.3390/ph17060767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024] Open
Abstract
In the New World, dogs are considered the main reservoir of visceral leishmaniasis (VL). Due to inefficacies in existing treatments and the lack of an efficient vaccine, dog culling is one of the main strategies used to control disease, making the development of new therapeutic interventions mandatory. We previously showed that Tanespimycin (17-AAG), a Hsp90 inhibitor, demonstrated potential for use in leishmaniasis treatment. The present study aimed to test the safety of 17-AAG in dogs by evaluating plasma pharmacokinetics, dose-proportionality, and the tolerability of 17-AAG in response to a dose-escalation protocol and multiple administrations at a single dose in healthy dogs. Two protocols were used: Study A: four dogs received variable intravenous (IV) doses (50, 100, 150, 200, or 250 mg/m2) of 17-AAG or a placebo (n = 4/dose level), using a cross-over design with a 7-day "wash-out" period; Study B: nine dogs received three IV doses of 150 mg/m2 of 17-AAG administered at 48 h intervals. 17-AAG concentrations were determined by a validated high-performance liquid chromatographic (HPLC) method: linearity (R2 = 0.9964), intra-day precision with a coefficient of variation (CV) ≤ 8%, inter-day precision (CV ≤ 20%), and detection and quantification limits of 12.5 and 25 ng/mL, respectively. In Study A, 17-AAG was generally well tolerated. However, increased levels of liver enzymes-alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT)-and bloody diarrhea were observed in all four dogs receiving the highest dosage of 250 mg/m2. After single doses of 17-AAG (50-250 mg/m2), maximum plasma concentrations (Cmax) ranged between 1405 ± 686 and 9439 ± 991 ng/mL, and the area under the curve (AUC) plotting plasma concentration against time ranged between 1483 ± 694 and 11,902 ± 1962 AUC 0-8 h μg/mL × h, respectively. Cmax and AUC parameters were dose-proportionate between the 50 and 200 mg/m2 doses. Regarding Study B, 17-AAG was found to be well tolerated at multiple doses of 150 mg/m2. Increased levels of liver enzymes-ALT (28.57 ± 4.29 to 173.33 ± 49.56 U/L), AST (27.85 ± 3.80 to 248.20 ± 85.80 U/L), and GGT (1.60 ± 0.06 to 12.70 ± 0.50 U/L)-and bloody diarrhea were observed in only 3/9 of these dogs. After the administration of multiple doses, Cmax and AUC 0-48 h were 5254 ± 2784 μg/mL and 6850 ± 469 μg/mL × h in plasma and 736 ± 294 μg/mL and 7382 ± 1357 μg/mL × h in tissue transudate, respectively. In conclusion, our results demonstrate the potential of 17-AAG in the treatment of CVL, using a regimen of three doses at 150 mg/m2, since it presents the maintenance of high concentrations in subcutaneous interstitial fluid, low toxicity, and reversible hepatotoxicity.
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Affiliation(s)
- Marcos Ferrante
- Laboratory of Physiology and Pharmacology, Department of Veterinary Medicine, Federal University of Lavras, Lavras 37200-000, Minas Gerais, Brazil;
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Bruna Martins Macedo Leite
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Lívia Brito Coelho Fontes
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Alice Santos Moreira
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Élder Muller Nascimento de Almeida
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Claudia Ida Brodskyn
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Isadora dos Santos Lima
- Laboratory of Structural and Molecular Pathology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (I.d.S.L.); (W.L.C.d.S.)
| | - Washington Luís Conrado dos Santos
- Laboratory of Structural and Molecular Pathology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (I.d.S.L.); (W.L.C.d.S.)
- Department of Pathology and Forensic Medicine, Bahia Medical School, Federal University of Bahia, Salvador 40110-906, Bahia, Brazil
| | - Luciano Vasconcellos Pacheco
- Department of Life Sciences, State University of Bahia, Salvador 41150-000, Bahia, Brazil; (L.V.P.); (V.C.d.S.); (A.d.F.S.J.)
| | - Vagner Cardoso da Silva
- Department of Life Sciences, State University of Bahia, Salvador 41150-000, Bahia, Brazil; (L.V.P.); (V.C.d.S.); (A.d.F.S.J.)
| | - Jeancarlo Pereira dos Anjos
- Integrated Campus of Manufacturing and Technology, SENAI CIMATEC University Center, Salvador 41650-010, Bahia, Brazil; (J.P.d.A.); (L.L.N.G.)
| | - Lílian Lefol Nani Guarieiro
- Integrated Campus of Manufacturing and Technology, SENAI CIMATEC University Center, Salvador 41650-010, Bahia, Brazil; (J.P.d.A.); (L.L.N.G.)
| | - Fabiana Landoni
- Department of Pharmacology, Faculty of Veterinary Science, National University of La Plata, Buenos Aires 1900, Argentina;
| | - Juliana P. B. de Menezes
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Deborah Bittencourt Mothé Fraga
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
- Department of Preventive Veterinary Medicine and Animal Production, School of Veterinary Medicine and Animal Science, Federal University of Bahia, Salvador 40170-110, Bahia, Brazil
- National Institute of Science and Technology of Tropical Diseases (INCT-DT), National Council for Scientific Research and Development (CNPq)
| | - Aníbal de Freitas Santos Júnior
- Department of Life Sciences, State University of Bahia, Salvador 41150-000, Bahia, Brazil; (L.V.P.); (V.C.d.S.); (A.d.F.S.J.)
| | - Patrícia Sampaio Tavares Veras
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
- National Institute of Science and Technology of Tropical Diseases (INCT-DT), National Council for Scientific Research and Development (CNPq)
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Ruchman SG, Fitzgerald B, Roda G, Van Ochten N, Castillo AY, Kaplan SR. A 52-Year-Old Man with a Chronic Nasal Wound. NEJM EVIDENCE 2024; 3:EVIDmr2400089. [PMID: 38804788 DOI: 10.1056/evidmr2400089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
AbstractMorning Report is a time-honored tradition where physicians-in-training present cases to their colleagues and clinical experts to collaboratively examine an interesting patient presentation. The Morning Report section seeks to carry on this tradition by presenting a patient's chief concern and story, inviting the reader to develop a differential diagnosis and discover the diagnosis alongside the authors of the case. This report examines the story of a 52-year-old man who sought evaluation for a chronic nasal lesion that had eroded into his nasal septum. Using questions, physical examination, and testing, an illness script for the presentation emerges. As the clinical course progresses, the differential is refined until a diagnosis is made.
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Affiliation(s)
- Samuel G Ruchman
- from the Internal Medicine and Internal Medicine-Pediatrics Residency Programs and Division of Infectious Diseases, University of Colorado School of Medicine
| | - Beret Fitzgerald
- from the Internal Medicine and Internal Medicine-Pediatrics Residency Programs and Division of Infectious Diseases, University of Colorado School of Medicine
| | - Gavriel Roda
- from the Internal Medicine and Internal Medicine-Pediatrics Residency Programs and Division of Infectious Diseases, University of Colorado School of Medicine
| | - Natalie Van Ochten
- from the Internal Medicine and Internal Medicine-Pediatrics Residency Programs and Division of Infectious Diseases, University of Colorado School of Medicine
| | - Alyssa Y Castillo
- from the Internal Medicine and Internal Medicine-Pediatrics Residency Programs and Division of Infectious Diseases, University of Colorado School of Medicine
| | - Samantha R Kaplan
- from the Internal Medicine and Internal Medicine-Pediatrics Residency Programs and Division of Infectious Diseases, University of Colorado School of Medicine
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Bharadava K, Upadhyay TK, Kaushal RS, Ahmad I, Alraey Y, Siddiqui S, Saeed M. Genomic Insight of Leishmania Parasite: In-Depth Review of Drug Resistance Mechanisms and Genetic Mutations. ACS OMEGA 2024; 9:12500-12514. [PMID: 38524425 PMCID: PMC10955595 DOI: 10.1021/acsomega.3c09400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 03/26/2024]
Abstract
Leishmaniasis, which is caused by a parasitic protozoan of the genus Leishmania, is still a major threat to global health, impacting millions of individuals worldwide in endemic areas. Chemotherapy has been the principal method for managing leishmaniasis; nevertheless, the evolution of drug resistance offers a significant obstacle to therapeutic success. Drug-resistant behavior in these parasites is a complex phenomenon including both innate and acquired mechanisms. Resistance is frequently related to changes in drug transportation, drug target alterations, and enhanced efflux of the drug from the pathogen. This review has revealed specific genetic mutations in Leishmania parasites that are associated with resistance to commonly used antileishmanial drugs such as pentavalent antimonials, miltefosine, amphotericin B, and paromomycin, resulting in changes in gene expression along with the functioning of various proteins involved in drug uptake, metabolism, and efflux. Understanding the genetic changes linked to drug resistance in Leishmania parasites is essential for creating approaches for tackling and avoiding the spread of drug-resistant variants. Based on which specific treatments focus on mutations and pathways could potentially improve treatment efficacy and help long-term leishmaniasis control. More study is needed to uncover the complete range of genetic changes generating medication resistance and to develop new therapies based on available information.
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Affiliation(s)
- Krupanshi Bharadava
- Biophysics
& Structural Biology, Research & Development Cell, Parul University, Vadodara, Gujarat 391760, India
| | - Tarun Kumar Upadhyay
- Department
of Life Sciences, Parul Institute of Applied Sciences & Research
and Development Cell, Parul University, Vadodara, Gujarat 391760, India
| | - Radhey Shyam Kaushal
- Biophysics
& Structural Biology, Research & Development Cell, Parul University, Vadodara, Gujarat 391760, India
- Department
of Life Sciences, Parul Institute of Applied Sciences & Research
and Development Cell, Parul University, Vadodara, Gujarat 391760, India
| | - Irfan Ahmad
- Department
of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Yasser Alraey
- Department
of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Samra Siddiqui
- Department
of Health Service Management, College of Public Health and Health
Informatics, University of Hail, Hail 55476, Saudi Arabia
| | - Mohd Saeed
- Department
of Biology, College of Science, University
of Hail, Hail 55476, Saudi Arabia
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Kontoghiorghes GJ. Drug Selection and Posology, Optimal Therapies and Risk/Benefit Assessment in Medicine: The Paradigm of Iron-Chelating Drugs. Int J Mol Sci 2023; 24:16749. [PMID: 38069073 PMCID: PMC10706143 DOI: 10.3390/ijms242316749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/19/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
The design of clinical protocols and the selection of drugs with appropriate posology are critical parameters for therapeutic outcomes. Optimal therapeutic protocols could ideally be designed in all diseases including for millions of patients affected by excess iron deposition (EID) toxicity based on personalised medicine parameters, as well as many variations and limitations. EID is an adverse prognostic factor for all diseases and especially for millions of chronically red-blood-cell-transfused patients. Differences in iron chelation therapy posology cause disappointing results in neurodegenerative diseases at low doses, but lifesaving outcomes in thalassemia major (TM) when using higher doses. In particular, the transformation of TM from a fatal to a chronic disease has been achieved using effective doses of oral deferiprone (L1), which improved compliance and cleared excess toxic iron from the heart associated with increased mortality in TM. Furthermore, effective L1 and L1/deferoxamine combination posology resulted in the complete elimination of EID and the maintenance of normal iron store levels in TM. The selection of effective chelation protocols has been monitored by MRI T2* diagnosis for EID levels in different organs. Millions of other iron-loaded patients with sickle cell anemia, myelodysplasia and haemopoietic stem cell transplantation, or non-iron-loaded categories with EID in different organs could also benefit from such chelation therapy advances. Drawbacks of chelation therapy include drug toxicity in some patients and also the wide use of suboptimal chelation protocols, resulting in ineffective therapies. Drug metabolic effects, and interactions with other metals, drugs and dietary molecules also affected iron chelation therapy. Drug selection and the identification of effective or optimal dose protocols are essential for positive therapeutic outcomes in the use of chelating drugs in TM and other iron-loaded and non-iron-loaded conditions, as well as general iron toxicity.
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Affiliation(s)
- George J Kontoghiorghes
- Postgraduate Research Institute of Science, Technology, Environment and Medicine, Limassol 3021, Cyprus
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