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Alves LL, Freire ML, Troian IL, de Morais-Teixeira E, Cota G. Local amphotericin B therapy for Cutaneous Leishmaniasis: A systematic review. PLoS Negl Trop Dis 2024; 18:e0012127. [PMID: 38626196 PMCID: PMC11051593 DOI: 10.1371/journal.pntd.0012127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 04/26/2024] [Accepted: 04/01/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is characterized by potentially disfiguring skin ulcers carrying significant social stigma. To mitigate systemic drug exposure and reduce the toxicity from available treatments, studies addressing new local therapeutic strategies using available medications are coming up. This review systematically compiles preclinical and clinical data on the efficacy of amphotericin B (AmB) administered locally for cutaneous leishmaniasis. METHODOLOGY Structured searches were conducted in major databases. Clinical studies reporting cure rates and preclinical studies presenting any efficacy outcome were included. Exclusion criteria comprised nonoriginal studies, in vitro investigations, studies with fewer than 10 treated patients, and those evaluating AmB in combination with other antileishmanial drug components. PRINCIPAL FINDINGS A total of 21 studies were identified, encompassing 16 preclinical and five clinical studies. Preclinical assessments generally involved the topical use of commercial AmB formulations, often in conjunction with carriers or controlled release systems. However, the variation in the treatment schedules hindered direct comparisons. In clinical studies, topical AmB achieved a pooled cure rate of 45.6% [CI: 27.5-64.8%; I2 = 79.7; p = 0.002), while intralesional (IL) administration resulted in a 69.8% cure rate [CI: 52.3-82.9%; I2 = 63.9; p = 0.06). In the direct comparison available, no significant difference was noted between AmB-IL and meglumine antimoniate-IL administration (OR:1.7; CI:0.34-9.15, I2 = 79.1; p = 0.00), however a very low certainty of evidence was verified. CONCLUSIONS Different AmB formulations and administration routes have been explored in preclinical and clinical studies. Developing therapeutic technologies is evident. Current findings might be interpreted as a favorable proof of concept for the local AmB administration which makes this intervention eligible to be explored in future well-designed studies towards less toxic treatments for leishmaniasis.
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Affiliation(s)
- Líndicy Leidicy Alves
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana Lourenço Freire
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Isadora Lana Troian
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Eliane de Morais-Teixeira
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Cota
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
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Aronson NE, Billick K. Intralesional Antimonial Drug Treatment for Leishmania braziliensis Cutaneous Leishmaniasis: The Knowns and the Unknowns. Clin Infect Dis 2023; 77:583-588. [PMID: 37185765 DOI: 10.1093/cid/ciad248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/28/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- Naomi E Aronson
- Infectious Diseases Division, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kendall Billick
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
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Tan Y, El-Kersh K, Watson SE, Wintergerst KA, Huang J, Cai L. Cardiovascular Effects of Environmental Metal Antimony: Redox Dyshomeostasis as the Key Pathogenic Driver. Antioxid Redox Signal 2023; 38:803-823. [PMID: 36424825 PMCID: PMC10402706 DOI: 10.1089/ars.2022.0185] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
Significance: Cardiovascular diseases (CVDs) are the leading cause of death worldwide, which may be due to sedentary lifestyles with less physical activity and over nutrition as well as an increase in the aging population; however, the contribution of pollutants, environmental chemicals, and nonessential metals to the increased and persistent CVDs needs more attention and investigation. Among environmental contaminant nonessential metals, antimony has been less addressed. Recent Advances: Among environmental contaminant nonessential metals, several metals such as lead, arsenic, and cadmium have been associated with the increased risk of CVDs. Antimony has been less addressed, but its potential link to CVDs is being gradually recognized. Critical Issues: Several epidemiological studies have revealed the significant deleterious effects of antimony on the cardiovascular system in the absence or presence of other nonessential metals. There has been less focus on whether antimony alone can contribute to the pathogenesis of CVDs and the proposed mechanisms of such possible effects. This review addresses this gap in knowledge by presenting the current available evidence that highlights the potential role of antimony in the pathogenesis of CVDs, most likely via antimony-mediated redox dyshomeostasis. Future Directions: More direct evidence from preclinical and mechanistic studies is urgently needed to evaluate the possible roles of antimony in mitochondrial dysfunction and epigenetic regulation in CVDs. Antioxid. Redox Signal. 38, 803-823.
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Affiliation(s)
- Yi Tan
- Department of Pediatrics, Pediatric Research Institute, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Wendy Novak Diabetes Institute, Norton Children's Hospital, Louisville, Kentucky, USA
| | - Karim El-Kersh
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sara E. Watson
- Wendy Novak Diabetes Institute, Norton Children's Hospital, Louisville, Kentucky, USA
- Division of Endocrinology, Department of Pediatrics, Norton Children's Hospital, University of Louisville, Louisville, Kentucky, USA
| | - Kupper A. Wintergerst
- Wendy Novak Diabetes Institute, Norton Children's Hospital, Louisville, Kentucky, USA
- Division of Endocrinology, Department of Pediatrics, Norton Children's Hospital, University of Louisville, Louisville, Kentucky, USA
- The Center for Integrative Environmental Health Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Jiapeng Huang
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, Kentucky, USA
- The Center for Integrative Environmental Health Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Innovation Institute, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Lu Cai
- Department of Pediatrics, Pediatric Research Institute, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Wendy Novak Diabetes Institute, Norton Children's Hospital, Louisville, Kentucky, USA
- The Center for Integrative Environmental Health Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Department of Radiation Oncology; University of Louisville School of Medicine, Louisville, Kentucky, USA
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García Bracamonte B, Burillo Martínez S, Morales Raya C, Ortiz Romero P. Alteraciones electrocardiográficas por Glucantime® intralesional, un evento adverso potencialmente grave. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:742-744. [DOI: 10.1016/j.ad.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/03/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022] Open
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Abadías-Granado I, Diago A, Cerro PA, Palma-Ruiz AM, Gilaberte Y. Cutaneous and Mucocutaneous Leishmaniasis. ACTAS DERMO-SIFILIOGRAFICAS 2021:S1578-2190(21)00171-2. [PMID: 34045157 DOI: 10.1016/j.adengl.2021.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/13/2021] [Indexed: 02/07/2023] Open
Abstract
Leishmaniasis is a chronic disease caused by flagellate protozoa of the genus Leishmania. It is a global disease, but most cases are seen in South America, the Mediterranean, and some areas of Asia and Africa. The 3 main types of leishmaniasis are cutaneous (the most common), mucocutaneous, and visceral (the most severe). Visceral leishmaniasis is also known as kala-azar. Leishmaniasis is diagnosed by demonstrating the presence of Leishmania amastigotes in clinical specimens using direct microscopic examination or molecular analysis. Various treatments exist, although the evidence supporting the options available for cutaneous leishmaniasis is weak. Both the classical presentation of leishmaniasis and our management of the disease have changed in recent decades because of acquired immune deficiency caused by conditions such as human immunodeficiency infection or the use of tumor necrosis factor inhibitors.
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Affiliation(s)
- I Abadías-Granado
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - P A Cerro
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A M Palma-Ruiz
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Y Gilaberte
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Abadías-Granado I, Diago A, Cerro PA, Palma-Ruiz AM, Gilaberte Y. Cutaneous and Mucocutaneous Leishmaniasis. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00108-3. [PMID: 33652011 DOI: 10.1016/j.ad.2021.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 01/10/2023] Open
Abstract
Leishmaniasis is a chronic disease caused by flagellate protozoa of the genus Leishmania. It is a global disease, but most cases are seen in South America, the Mediterranean, and some areas of Asia and Africa. The 3 main types of leishmaniasis are cutaneous (the most common), mucocutaneous, and visceral (the most severe). Visceral leishmaniasis is also known as kala-azar. Leishmaniasis is diagnosed by demonstrating the presence of Leishmania amastigotes in clinical specimens using direct microscopic examination or molecular analysis. Various treatments exist, although the evidence supporting the options available for cutaneous leishmaniasis is weak. Both the classical presentation of leishmaniasis and our management of the disease have changed in recent decades because of acquired immune deficiency caused by conditions such as HIV infection or the use of TNF inhibitors.
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Affiliation(s)
- I Abadías-Granado
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - P A Cerro
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A M Palma-Ruiz
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Y Gilaberte
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
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