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Borba PB, Lago J, Lago T, Araújo-Pereira M, Queiroz ATL, Barud HS, Carvalho LP, Machado PRL, Carvalho EM, de Oliveira CI. Improved Treatment Outcome Following the Use of a Wound Dressings in Cutaneous Leishmaniasis Lesions. Pathogens 2024; 13:416. [PMID: 38787268 PMCID: PMC11124396 DOI: 10.3390/pathogens13050416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/24/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Leishmaniasis, caused by Leishmania parasites, is a neglected tropical disease and Cutaneous Leishmaniasis (CL) is the most common form. Despite the associated toxicity and adverse effects, Meglumine antimoniate (MA) remains the first-choice treatment for CL in Brazil, pressing the need for the development of better alternatives. Bacterial NanoCellulose (BNC), a biocompatible nanomaterial, has unique properties regarding wound healing. In a previous study, we showed that use of topical BNC + systemic MA significantly increased the cure rate of CL patients, compared to treatment with MA alone. Herein, we performed a study comparing the combination of a wound dressing (BNC or placebo) plus systemic MA versus systemic MA alone, in CL caused by Leishmania braziliensis. We show that patients treated with the combination treatment (BNC or placebo) + MA showed improved cure rates and decreased need for rescue treatment, although differences compared to controls (systemic MA alone) were not significant. However, the overall time-to-cure was significantly lower in groups treated with the combination treatment (BNC+ systemic MA or placebo + systemic MA) in comparison to controls (MA alone), indicating that the use of a wound dressing improves CL treatment outcome. Assessment of the immune response in peripheral blood showed an overall downmodulation in the inflammatory landscape and a significant decrease in the production of IL-1a (p < 0.05) in patients treated with topical BNC + systemic MA. Our results show that the application of wound dressings to CL lesions can improve chemotherapy outcome in CL caused by L. braziliensis.
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Affiliation(s)
- Pedro B. Borba
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador 40296-710, BA, Brazil
| | - Jamile Lago
- Serviço de Imunologia, HUPES-UFBA, Salvador 40110-060, BA, Brazil
| | - Tainã Lago
- Serviço de Imunologia, HUPES-UFBA, Salvador 40110-060, BA, Brazil
| | - Mariana Araújo-Pereira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER Initiative), Salvador 41720-200, BA, Brazil
- Instituto de Pesquisa Clínica e Translacional (IPCT), UniFTC, Salvador 41720-200, BA, Brazil
| | - Artur T. L. Queiroz
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador 40296-710, BA, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER Initiative), Salvador 41720-200, BA, Brazil
- Instituto de Pesquisa Clínica e Translacional (IPCT), UniFTC, Salvador 41720-200, BA, Brazil
| | - Hernane S. Barud
- Laboratório de BioPolímeros e Biomateriais, Uniara, Araraquara 14801-340, SP, Brazil
| | - Lucas P. Carvalho
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador 40296-710, BA, Brazil
- Serviço de Imunologia, HUPES-UFBA, Salvador 40110-060, BA, Brazil
- INCT—Instituto de Investigação em Doenças Tropicais, Salvador 40110-040, BA, Brazil
| | - Paulo R. L. Machado
- Serviço de Imunologia, HUPES-UFBA, Salvador 40110-060, BA, Brazil
- INCT—Instituto de Investigação em Doenças Tropicais, Salvador 40110-040, BA, Brazil
| | - Edgar M. Carvalho
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador 40296-710, BA, Brazil
- Serviço de Imunologia, HUPES-UFBA, Salvador 40110-060, BA, Brazil
- INCT—Instituto de Investigação em Doenças Tropicais, Salvador 40110-040, BA, Brazil
| | - Camila I. de Oliveira
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador 40296-710, BA, Brazil
- INCT—Instituto de Investigação em Doenças Tropicais, Salvador 40110-040, BA, Brazil
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Pereira IAG, Freitas CS, Câmara RSB, Jesus MM, Lage DP, Tavares GSV, Soyer TG, Ramos FF, Soares NP, Santiago SS, Martins VT, Vale DL, Pimenta BL, Ludolf F, Oliveira FM, Duarte MC, Chávez-Fumagalli MA, Costa AV, Gonçalves DU, Roatt BM, Teixeira RR, Coelho EAF. Treatment using vanillin-derived synthetic molecules incorporated into polymeric micelles is effective against infection caused by Leishmania amazonensis species. Exp Parasitol 2024; 260:108743. [PMID: 38513973 DOI: 10.1016/j.exppara.2024.108743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/26/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
Treatment against leishmaniasis presents problems, mainly due to the toxicity of the drugs, high cost, and the emergence of resistant strains. A previous study showed that two vanillin-derived synthetic molecules, 3s [4-(2-hydroxy-3-(4-octyl-1H-1,2,3-triazol-1-yl)propoxy)-3-methoxybenzaldehyde] and 3t [4-(3-(4-decyl-1H-1,2,3-triazol-1-yl)-2-hydroxypropoxy)-3-methoxybenzaldehyde], presented antileishmanial activity against Leishmania infantum, L. amazonensis, and L. braziliensis species. In the present work, 3s and 3t were evaluated to treat L. amazonensis-infected mice. Molecules were used pure or incorporated into Poloxamer 407-based micelles. In addition, amphotericin B (AmpB) and its liposomal formulation, Ambisome®, were used as control. Animals received the treatment and, one and 30 days after, they were euthanized to evaluate immunological, parasitological, and biochemical parameters. Results showed that the micellar compositions (3s/Mic and 3t/Mic) induced significant reductions in the lesion mean diameter and parasite load in the infected tissue and distinct organs, as well as a specific and significant antileishmanial Th1-type immune response, which was based on significantly higher levels of IFN-γ, IL-12, nitrite, and IgG2a isotype antibodies. Drug controls showed also antileishmanial action; although 3s/Mic and 3t/Mic have presented better and more significant parasitological and immunological data, which were based on significantly higher IFN-γ production and lower parasite burden in treated animals. In addition, significantly lower levels of urea, creatinine, alanine transaminase, and aspartate transaminase were found in mice treated with 3s/Mic and 3t/Mic, when compared to the others. In conclusion, results suggest that 3s/Mic and 3t/Mic could be considered as therapeutic candidates to treat against L. amazonensis infection.
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Affiliation(s)
- Isabela A G Pereira
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Camila S Freitas
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Raquel S B Câmara
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo M Jesus
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Daniela P Lage
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Grasiele S V Tavares
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Tauane G Soyer
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda F Ramos
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Nícia P Soares
- Laboratório de Imunopatologia, Núcleo de Pesquisas Em Ciências Biológicas, Departamento de Ciências Biológicas, Insituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Samira S Santiago
- Grupo de Síntese e Pesquisa de Compostos Bioativos, Departamento de Química, Universidade Federal de Viçosa, Avenida PH Rolfs, S/N, 36570-900, Viçosa, Minas Gerais, Brazil
| | - Vívian T Martins
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Danniele L Vale
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Breno L Pimenta
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Ludolf
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil; Programa de Pós-Graduação Em Ciências da Saúde, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, 30130-110, Minas Gerais, Brazil
| | - Fabrício M Oliveira
- Instituto Federal de Educação de Minas Gerais, Rua Afonso Sardinha, 90, Bairro Pioneiros, 36420-000, Ouro Branco, Minas Gerais, Brazil
| | - Mariana C Duarte
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil; Departamento de Patologia Clínica, COLTEC, Universidade Federal de Minas Gerais, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Miguel A Chávez-Fumagalli
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Urb. San José S/N, Umacollo, Arequipa, Peru
| | - Adilson V Costa
- Departamento de Química e Física, Universidade Federal Do Espírito Santo, Alto Universitário, S/n, Guararema, 29500-000, Alegre, Espírito Santo, Brazil
| | - Denise U Gonçalves
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Bruno M Roatt
- Laboratório de Imunopatologia, Núcleo de Pesquisas Em Ciências Biológicas, Departamento de Ciências Biológicas, Insituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Róbson R Teixeira
- Grupo de Síntese e Pesquisa de Compostos Bioativos, Departamento de Química, Universidade Federal de Viçosa, Avenida PH Rolfs, S/N, 36570-900, Viçosa, Minas Gerais, Brazil
| | - Eduardo A F Coelho
- Programa de Pós-Graduação Em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil; Departamento de Patologia Clínica, COLTEC, Universidade Federal de Minas Gerais, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
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Nepal B, McCormick-Baw C, Patel K, Firmani S, Wetzel DM. Cutaneous Leishmania mexicana infections in the United States: defining strains through endemic human pediatric cases in northern Texas. mSphere 2024; 9:e0081423. [PMID: 38421172 PMCID: PMC10964424 DOI: 10.1128/msphere.00814-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
Over a 6-month span, three patients under 5 years old with cutaneous leishmaniasis presented to the Pediatric Infectious Diseases Clinic at the University of Texas Southwestern Medical Center/Children's Health Dallas. None had traveled outside of northern Texas/southern Oklahoma; all had Leishmania mexicana infections confirmed by PCR. We provide case descriptions and images to increase the awareness of this disease among United States (US) physicians and scientists. Two patients responded to fluconazole, but the youngest required topical paromomycin. Combining these cases with guidelines and our literature review, we suggest that (i) higher doses (10-12 mg/kg/day) of fluconazole should be considered in young children to maximize likelihood and rapidity of response and (ii) patients should transition to alternate agents if they do not respond to high-dose fluconazole within 6 weeks. Furthermore, and of particular interest to the broad microbiology community, we used samples from these cases as a proof of concept to propose a mechanism to strain-type US-endemic L. mexicana. For our analysis, we sequenced three housekeeping genes and the internal transcribed sequence 2 of the ribosomal RNA gene. We identified genetic changes that not only allow us to distinguish US-based L. mexicana strains from strains found in other areas of the Americas but also establish polymorphisms that differ between US isolates. These techniques will allow documentation of genetic changes in this parasite as its range expands. Hence, our cases of cutaneous leishmaniasis provide significant evolutionary, treatment, and public health implications as climate change increases exposure to formerly tropical diseases in previously non-endemic areas. IMPORTANCE Leishmaniasis is a parasitic disease that typically affects tropical regions worldwide. However, the vector that carries Leishmania is spreading northward into the United States (US). Within a 6-month period, three young cutaneous leishmaniasis patients were seen at the Pediatric Infectious Diseases Clinic at the University of Texas Southwestern Medical Center/Children's Health Dallas. None had traveled outside of northern Texas and southern Oklahoma. We document their presentations, treatments, and outcomes and compare their management to clinical practice guidelines for leishmaniasis. We also analyzed the sequences of three critical genes in Leishmania mexicana isolated from these patients. We found changes that not only distinguish US-based strains from strains found elsewhere but also differ between US isolates. Monitoring these sequences will allow tracking of genetic changes in parasites over time. Our findings have significant US public health implications as people are increasingly likely to be exposed to what were once tropical diseases.
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Affiliation(s)
- Binita Nepal
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Clare McCormick-Baw
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karisma Patel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah Firmani
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dawn M. Wetzel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Parhizkar AR, Sharafi M, Mansuri S, Hadibarhaghtalab M, Afrashteh S, Fatemian H, Chijan MR. Comparing the efficacy of fluconazole and cryotherapy Versus cryotherapy alone on treating cutaneous leishmaniasis: a triple-blind randomized clinical trial. BMC Infect Dis 2024; 24:332. [PMID: 38509490 PMCID: PMC10953173 DOI: 10.1186/s12879-024-09211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Cutaneous Leishmaniasis (CL) is one of the highly prevalent endemic diseases in the Middle East. The disease is a complex skin infection imposing a heavy burden on many developing countries. This study aimed to evaluate the impact of adding oral fluconazole to topical cryotherapy on the treatment efficacy and time to achieve complete recovery of CL lesions. METHOD This triple-blind randomized clinical trial included 52 participants with CL. Participants were allocated to receive either weekly cryotherapy with liquid nitrogen and oral fluconazole at a dose of 6 mg/kg daily at a maximum of 400 mg for 6 weeks as the interventional arm or weekly cryotherapy with liquid nitrogen plus the placebo for the same period of 6 weeks as the control arm. RESULTS Fifty-two eligible participants enrolled the study, with a CL lesion count of 1 to 8 (mean 1.96), and served as the interventional (n = 28) and control (n = 24) arms. The trend of the mean surface area of the lesions was significantly decreasing in both arms (P < 0.001), with no statistically significant difference between arms (P = 0.133) or all assessed time point pairwise comparisons (P > 0.05). There was no significant difference between the treatment arms in terms of the end-point recovery status (P = 0.491) or the frequency of post-treatment secretion (P = 0.437). No adverse effect was observed. CONCLUSION Despite a slightly higher reduction in the lesion surface in the cryotherapy and fluconazole treatment arm, the addition of fluconazole did not provide statistically significant therapeutic value to cryotherapy in the treatment of CL. However, with adjustment for the initial lesion size, the efficacy of the regimen in the interventional arm was more pronounced, though it was still insignificant.
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Affiliation(s)
- Ahmad Reza Parhizkar
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Mehdi Sharafi
- Infectious and Tropical Diseases Research Center,Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Susan Mansuri
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Sima Afrashteh
- Department of Biostatistics and Epidemiology, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Hossein Fatemian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Machado PRL, Lago A, Cardoso TM, Magalhaes A, Carvalho LP, Lago T, Carvalho AM, Costa R, Carvalho EM. Disseminated Leishmaniasis, a Severe Form of Leishmania braziliensis Infection. Emerg Infect Dis 2024; 30:510-518. [PMID: 38407142 PMCID: PMC10902519 DOI: 10.3201/eid3003.230786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Disseminated leishmaniasis (DL) is an emergent severe disease manifesting with multiple lesions. To determine the relationship between immune response and clinical and therapeutic outcomes, we studied 101 DL and 101 cutaneous leishmaniasis (CL) cases and determined cytokines and chemokines in supernatants of mononuclear cells stimulated with leishmania antigen. Patients were treated with meglumine antimoniate (20 mg/kg) for 20 days (CL) or 30 days (DL); 19 DL patients were instead treated with amphotericin B, miltefosine, or miltefosine and meglumine antimoniate. High levels of chemokine ligand 9 were associated with more severe DL. The cure rate for meglumine antimoniate was low for both DL (44%) and CL (60%), but healing time was longer in DL (p = 0.003). The lowest cure rate (22%) was found in DL patients with >100 lesions. However, meglumine antimoniate/miltefosine treatment cured all DL patients who received it; therefore, that combination should be considered as first choice therapy.
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Lago T, Cardoso TM, Rocha A, Carvalho EM, Castellucci LC. Short communication: The miR-155a-5p is correlated with increased ROS and impaired apoptosis in macrophages infected by Leishmania braziliensis. PLoS One 2024; 19:e0298458. [PMID: 38381750 PMCID: PMC10880991 DOI: 10.1371/journal.pone.0298458] [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: 11/14/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Cutaneous leishmaniasis (CL) caused by Leishmania braziliensis, is a disease characterized by well-limited ulcerated lesions with raised borders in exposed parts of the body. miRNAs are recognized for their role in the complex and plastic interaction between host and pathogens, either as part of the host's strategy to neutralize infection or as a molecular mechanism employed by the pathogen to modulate host inflammatory pathways to remain undetected. The mir155 targets a broad range of inflammatory mediators, following toll-like receptors (TLRs) signaling. In this work, we evaluated the effects of the expression of miR155a-5p in human macrophages infected with L. braziliensis. Our results show that miR155a-5p is inversely correlated with early apoptosis and conversely, seems to influence an increment in the oxidative burst in these cells. Altogether, we spotted a functional role of the miR155a-5p in CL pathogenesis, raising the hypothesis that an increased miR-155 expression by TLR ligands influences cellular mechanisms settled to promote both killing and control of parasite density after infection.
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Affiliation(s)
- Tainã Lago
- Serviço de Imunologia da Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Ciências da Saúde da Universidade Federal da Bahia, Salvador, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
| | - Thyago Marconi Cardoso
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
- Laboratório de Pesquisas Clínicas—LAPEC—Instituto Gonçalo Moniz-FIOCRUZ, Salvador, Bahia, Brazil
| | - Alan Rocha
- Laboratório de Pesquisas Clínicas—LAPEC—Instituto Gonçalo Moniz-FIOCRUZ, Salvador, Bahia, Brazil
| | - Edgar M. Carvalho
- Serviço de Imunologia da Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Ciências da Saúde da Universidade Federal da Bahia, Salvador, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
- Laboratório de Pesquisas Clínicas—LAPEC—Instituto Gonçalo Moniz-FIOCRUZ, Salvador, Bahia, Brazil
| | - Léa Cristina Castellucci
- Serviço de Imunologia da Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Ciências da Saúde da Universidade Federal da Bahia, Salvador, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Brazil
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7
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Nepal B, McCormick-Baw C, Patel K, Firmani S, Wetzel DM. Cutaneous Leishmania mexicana Infections in the United States: Defining Strains Through Endemic Human Pediatric Cases in Northern Texas. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.11.23300611. [PMID: 38260515 PMCID: PMC10802665 DOI: 10.1101/2024.01.11.23300611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Over a six-month span, three patients under five years old with cutaneous leishmaniasis presented to the Pediatric Infectious Diseases Clinic at the University of Texas Southwestern Medical Center/Children's Health Dallas. None had traveled outside of the United States (US); all had confirmed L. mexicana infections by PCR. We provide case descriptions and images to increase the awareness of this disease among US physicians and scientists. Two patients responded to fluconazole, but one required topical paromomycin. Combining these cases with guidelines and our literature review, we suggest that: 1) higher doses (ten-twelve mg/kg/day) of fluconazole should be considered in young children to maximize likelihood and rapidity of response and 2) patients should transition to alternate agents if they do not respond to high-dose fluconazole within six weeks. Furthermore, and of particular interest to the broad microbiology community, we used samples from these cases as a proof-of-concept to propose a mechanism to strain-type US-endemic L. mexicana. For our analysis, we sequenced three housekeeping genes and the internal transcribed sequence 2 of the ribosomal RNA gene. We identified genetic changes that not only allow us to distinguish US-based L. mexicana strains from strains found in other areas of the Americas, but also establish polymorphisms that differ between US isolates. These techniques will allow documentation of genetic changes in this parasite as its range expands. Hence, our cases of cutaneous leishmaniasis provide significant evolutionary, treatment and public health implications as climate change increases exposure to formerly tropical diseases in previously non-endemic areas.
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Affiliation(s)
- Binita Nepal
- Department of Pediatrics, University of Texas Southwestern Medical Center
- Department of Biochemistry, University of Texas Southwestern Medical Center
| | | | - Karisma Patel
- Department of Pediatrics, University of Texas Southwestern Medical Center
| | - Sarah Firmani
- Department of Pediatrics, University of Texas Southwestern Medical Center
| | - Dawn M. Wetzel
- Department of Pediatrics, University of Texas Southwestern Medical Center
- Department of Biochemistry, University of Texas Southwestern Medical Center
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8
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Arruda S, Agra-Duarte G, Lago J, Oliveira L, Zacarias E, Carvalho LP, Machado PRL, de Oliveira CI, Carvalho EM. Clinical Profile and Diagnosis of Recurrent Cutaneous Leishmaniasis. Open Forum Infect Dis 2023; 10:ofad387. [PMID: 37564745 PMCID: PMC10411034 DOI: 10.1093/ofid/ofad387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
This case-control study compared the clinical profile, parasite load, polymerase chain reaction positivity, and response to therapy in patients with recurrent cutaneous leishmaniasis (RCL) with primary cutaneous leishmaniasis (CL). The RCL patients had milder diseases with lower parasite loads, a lower number of lesions, and more self-healing diseases than primary CL patients.
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Affiliation(s)
- Sérgio Arruda
- Instituto Gonçalo Moniz, Fiocruz, Salvador, Brasil
- Department of Pathology, Universidade Estadual da Bahia, Salvador, Brasil
| | | | - Jamile Lago
- Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brasil
| | - Lívia Oliveira
- Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Lucas P Carvalho
- Instituto Gonçalo Moniz, Fiocruz, Salvador, Brasil
- Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brasil
- Department of Medicine, Programa de Pós-graduação em Ciências da Saúde (PPGCS) da Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Brasil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil
| | - Paulo R L Machado
- Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brasil
- Department of Medicine, Programa de Pós-graduação em Ciências da Saúde (PPGCS) da Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Brasil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil
| | - Camila I de Oliveira
- Instituto Gonçalo Moniz, Fiocruz, Salvador, Brasil
- Department of Medicine, Programa de Pós-graduação em Ciências da Saúde (PPGCS) da Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Brasil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil
| | - Edgar M Carvalho
- Instituto Gonçalo Moniz, Fiocruz, Salvador, Brasil
- Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brasil
- Department of Medicine, Programa de Pós-graduação em Ciências da Saúde (PPGCS) da Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Brasil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil
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9
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Lago J, Fraga D, Guimarães LH, Lago T, Santos Y, Lago E, Werneck GL, Bacellar O, Carvalho EM. Efficacy of intralesional meglumine antimoniate in the treatment of canine tegumentary leishmaniasis: A Randomized controlled trial. PLoS Negl Trop Dis 2023; 17:e0011064. [PMID: 36791065 PMCID: PMC9931096 DOI: 10.1371/journal.pntd.0011064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/01/2023] [Indexed: 02/16/2023] Open
Abstract
Dogs living in areas of Leishmania (Viannia) braziliensis transmission may present canine tegumentary leishmaniasis (CTL) characterized by cutaneous or muzzle ulcers as well as asymptomatic L. braziliensis infection. It is not clear if dogs participate in the transmission chain of L. braziliensis to humans. However, dogs may remain with chronic ulcers for a long time, and as there are no public policies about CTL, these animals die or are sacrificed. Here we compare the efficacy of intralesional meglumine antimoniate with intralesional 0.9% NaCl solution in CTL treatment. This randomized control study included 32 dogs with cutaneous or muzzle lesions who had L. braziliensis DNA detected by PCR in tissue biopsied. Group one received 5ml of intralesional Glucantime, and group two received 5ml 0.9% NaCl solution, both applied in the four cardinal points on days 0, 15, and 30. Cure was defined as complete healing of the ulcers in the absence of raised borders on day 90. There was no difference in animals' demographic and clinical features in the two groups (p >.05). While at the endpoint, the cure rate was 87.5% in the group test, and in those who received 0.9 NaCl the cure rate was only 12.5%. As important as the high cure rate, the healing time was faster in dogs treated with antimony than in those treated with saline (p < .001). Intralesional meglumine antimoniate is effective in the treatment of dogs with L. braziliensis infection and accelerates the healing time of CTL.
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Affiliation(s)
- Jamile Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
- Post-Graduate Course in Health Sciences, Federal University of Bahia Medical School. Salvador, Bahia, Brazil
| | - Deborah Fraga
- Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Bahia, Brazil
| | | | - Tainã Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
- Post-Graduate Course in Health Sciences, Federal University of Bahia Medical School. Salvador, Bahia, Brazil
| | - Yuri Santos
- Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Bahia, Brazil
| | - Ednaldo Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência e Tecnologia e Inovação (MCTI), CNPq, Salvador, Bahia, Brazil
| | - Guilherme L. Werneck
- Department of Epidemiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute for Public Health Studies, Federal University of Rio de Janeiro. Federal
| | - Olívia Bacellar
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
- Post-Graduate Course in Health Sciences, Federal University of Bahia Medical School. Salvador, Bahia, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência e Tecnologia e Inovação (MCTI), CNPq, Salvador, Bahia, Brazil
| | - Edgar M. Carvalho
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil
- Post-Graduate Course in Health Sciences, Federal University of Bahia Medical School. Salvador, Bahia, Brazil
- Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Bahia, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência e Tecnologia e Inovação (MCTI), CNPq, Salvador, Bahia, Brazil
- * E-mail:
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10
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dos Santos RF, Da Silva T, Brito ACDS, Inácio JD, Ventura BD, Mendes MAP, Azevedo BF, Siqueira LM, Almeida-Amaral EE, Dutra PML, Da-Silva SAG. Therapeutic effect of oral quercetin in hamsters infected with Leishmania Viannia braziliensis. Front Cell Infect Microbiol 2023; 12:1059168. [PMID: 36710981 PMCID: PMC9880276 DOI: 10.3389/fcimb.2022.1059168] [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: 10/01/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023] Open
Abstract
Leishmaniasis is a parasitic disease caused by several species of intracellular protozoa of the genus Leishmania that present manifestations ranging from cutaneous ulcers to the fatal visceral form. Leishmania Viannia braziliensis is an important species associated with American tegumentary leishmaniasis and the main agent in Brazil, with variable sensitivity to available drugs. The search for new therapeutic alternatives to treat leishmaniasis is an urgent need, especially for endemic countries. Not only is quercetin well known for its antioxidant activity in radical scavenging but also several other biological effects are described, including anti-inflammatory, antimicrobial, and pro-oxidant activities. This study aimed to investigate the flavonoid quercetin's therapeutic potential in L. (V.) braziliensis infection. Quercetin showed antiamastigote (IC50 of 21 ± 2.5 µM) and antipromastigote (25 ± 0.7 µM) activities and a selectivity index of 22. The treatment of uninfected or L. (V.) braziliensis-infected macrophages with quercetin increased reactive oxygen species (ROS)/H202 generation without altering Nitric Oxide (NO) production. Oral treatment with quercetin of infected hamsters, starting at 1 week of infection for 8 weeks, reduced the lesion thickness (p > 0.01) and parasite load (p > 0.001). The results of this study suggest that the antiamastigote activity of the flavonoid quercetin in vitro is associated, at least in part, with the modulation of ROS production by macrophages. The efficacy of oral quercetin treatment in hamsters infected with L. (V.) braziliensis was presented for the first time and shows its promising therapeutic potential.
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Affiliation(s)
- Rosiane Freire dos Santos
- Laboratório de Imunofarmacologia Parasitária, Disciplina de Parasitologia/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thayssa Da Silva
- Laboratório de Imunofarmacologia Parasitária, Disciplina de Parasitologia/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andréia Carolinne de Souza Brito
- Laboratório de Imunofarmacologia Parasitária, Disciplina de Parasitologia/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Job Domingos Inácio
- Laboratório de Bioquímica de Tripanossomatídeos, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Bianca Domingues Ventura
- Laboratório de Imunofarmacologia Parasitária, Disciplina de Parasitologia/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michely Aparecida Polido Mendes
- Laboratório de Imunofarmacologia Parasitária, Disciplina de Parasitologia/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Fonseca Azevedo
- Laboratório de Imunofarmacologia Parasitária, Disciplina de Parasitologia/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Larissa Moreira Siqueira
- Laboratório de Imunofarmacologia Parasitária, Disciplina de Parasitologia/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Patrícia Maria Lourenço Dutra
- Laboratório de Imunofisiologia do Exercício, Disciplina de Parasitologia/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Silvia Amaral Gonçalves Da-Silva
- Laboratório de Imunofarmacologia Parasitária, Disciplina de Parasitologia/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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11
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Pinheiro AC, de Souza MVN. Current leishmaniasis drug discovery. RSC Med Chem 2022; 13:1029-1043. [PMID: 36324493 PMCID: PMC9491386 DOI: 10.1039/d1md00362c] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 08/12/2022] [Indexed: 01/09/2023] Open
Abstract
Leishmaniasis is a complex protozoan infectious disease and, associated with malnutrition, poor health services and unavailability of prophylactic control measures, neglected populations are particularly affected. Current drug regimens are outdated and associated with some drawbacks, such as cytotoxicity and resistance, and the development of novel, efficacious and less toxic drug regimens is urgently required. In addition, leishmanial pathogenesis is not well established or understood, and a prophylactic vaccine is an unfulfilled goal. Human kinetoplastid protozoan infections, including leishmaniasis, have been neglected for many years, and in an attempt to overcome this situation, some new drug targets were recently identified, enabling the development of new drugs and vaccines. Compounds from new drug classes have also shown excellent antileishmanial activities, some of the most promising ones included in clinical trials, and could be a hope to control the disease burden of this endemic disease in the near future. In this review, we discuss the limitations of current control methods, explore the wide range of compounds that are being screened and identified as antileishmanial drug prototypes, summarize the advances in identifying new drug targets aiming at innovative treatments and explore the state-of-art vaccine development field, including immunomodulation strategies.
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12
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Cutaneous Leishmaniasis: A 2022 Updated Narrative Review into Diagnosis and Management Developments. Am J Clin Dermatol 2022; 23:823-840. [PMID: 36103050 PMCID: PMC9472198 DOI: 10.1007/s40257-022-00726-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 01/10/2023]
Abstract
This review is an update of an earlier narrative review published in 2015 on developments in the clinical management of cutaneous leishmaniasis (CL) including diagnosis, treatment, prevention and control measurements. CL is a vector-borne infection caused by the protozoan parasite Leishmania. The vector is the female sandfly. Globally, CL affects 12 million cases and annually 2 million new cases occur. CL is endemic in almost 100 countries and the total risk population is approximately 350 million people. WHO lists CL an emerging and uncontrolled disease and a neglected tropical disease. Local experience-based evidence remains the mainstay for the management of CL. Whereas intralesional therapeutic options are the first treatment option for most CL patients, those with mucocutaneous and disseminated involvement require a systemic therapeutic approach. Moreover, different Leishmania species can vary in their treatment outcomes. Therefore, species determination is critical for optimal CL clinical management. New DNA techniques allow for relatively easy Leishmania species determination, yet they are not easily implemented in resource-limited settings. There is a desperate need for novel, less toxic, and less painful treatment options, especially for children with CL. Yet, the large and well conducted studies required to provide the necessary evidence are lacking. To further control and potentially eliminate CL, we urgently need to improve vector control, and diagnostics, and we require efficient and safe vaccines. Alas, since CL primarily affects poor people, biotechnical companies dedicate little investment into the research programs that could lead to diagnostic, pharmaceutical, and vaccine innovations.
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13
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de Mesquita TGR, Junior JDES, da Silva LDO, Silva GAV, de Araújo FJ, Pinheiro SK, Kerr HKA, da Silva LS, de Souza LM, de Almeida SA, Queiroz KLGD, de Souza JL, da Silva CC, Sequera HDG, de Souza MLG, Barbosa AN, Pontes GS, Guerra MVDF, Ramasawmy R. Distinct plasma chemokines and cytokines signatures in Leishmania guyanensis-infected patients with cutaneous leishmaniasis. Front Immunol 2022; 13:974051. [PMID: 36091007 PMCID: PMC9453042 DOI: 10.3389/fimmu.2022.974051] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
The immunopathology associated with Leishmaniasis is a consequence of inflammation. Upon infection with Leishmania, the type of host-immune response is determinant for the clinical manifestations that can lead to either self-healing or chronic disease. Multiple pathways may determine disease severity. A comparison of systemic immune profiles in patients with cutaneous leishmaniasis caused by L. guyanensis and healthy individuals with the same socio-epidemiological characteristics coming from the same endemic areas as the patients is performed to identify particular immune profile and pathways associated with the progression of disease development. Twenty-seven plasma soluble circulating factors were evaluated between the groups by univariate and multivariate analysis. The following biomarkers pairs IL-17/IL-9 (ρ=0,829), IL-17/IL-12 (ρ=0,786), IL-6/IL-1ra (ρ=0,785), IL-6/IL-12 (ρ=0,780), IL-1β/G-CSF (ρ=0,758) and IL-17/MIP-1β (ρ=0,754) showed the highest correlation mean among the patient while only INF-γ/IL-4 (ρ=0.740), 17/MIP-1β (ρ=0,712) and IL-17/IL-9 (ρ=0,707) exhibited positive correlation among the control group. The cytokine IL-17 and IL1β presented the greater number of positive pair correlation among the patients. The linear combinations of biomarkers displayed IP-10, IL-2 and RANTES as the variables with the higher discriminatory activity in the patient group compared to PDGF, IL-1ra and eotaxin among the control subjects. IP-10, IL-2, IL-1β, RANTES and IL-17 seem to be predictive value of progression to the development of disease among the Lg-infected individuals.
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Affiliation(s)
- Tirza Gabrielle Ramos de Mesquita
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Molecular Biology, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - José do Espírito Santo Junior
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
- Faculdade de Medicina Nilton Lins, Universidade Nilton Lins, Manaus, Brazil
| | | | - George Allan Villarouco Silva
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
| | - Felipe Jules de Araújo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Faculdade de Medicina Nilton Lins, Universidade Nilton Lins, Manaus, Brazil
| | - Suzana Kanawati Pinheiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Molecular Biology, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | | | - Lener Santos da Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Molecular Biology, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Luciane Macedo de Souza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | | | - Josué Lacerda de Souza
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
- Faculdade de Medicina Nilton Lins, Universidade Nilton Lins, Manaus, Brazil
| | - Cilana Chagas da Silva
- Department of Molecular Biology, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Héctor David Graterol Sequera
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Molecular Biology, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Mara Lúcia Gomes de Souza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Molecular Biology, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | | | - Gemilson Soares Pontes
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
- Department of Virology, Instituto Nacional de Pesquisas da Amazônia, Manaus, Brazil
- Genomic Health Surveillance Network: Optimization of Assistance and Research in The State of Amazonas – REGESAM, Manaus, Amazonas, Brazil
| | - Marcus Vinitius de Farias Guerra
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Molecular Biology, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Rajendranath Ramasawmy
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Department of Molecular Biology, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Faculdade de Medicina Nilton Lins, Universidade Nilton Lins, Manaus, Brazil
- Genomic Health Surveillance Network: Optimization of Assistance and Research in The State of Amazonas – REGESAM, Manaus, Amazonas, Brazil
- *Correspondence: Rajendranath Ramasawmy,
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14
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Madusanka RK, Silva H, Karunaweera ND. Treatment of Cutaneous Leishmaniasis and Insights into Species-Specific Responses: A Narrative Review. Infect Dis Ther 2022; 11:695-711. [PMID: 35192172 PMCID: PMC8960542 DOI: 10.1007/s40121-022-00602-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/31/2022] [Indexed: 12/16/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is a complex skin infection that has imposed a heavy burden on many developing countries and is caused by more than 20 Leishmania species. This disease is predominantly associated with disfiguring scars and major social stigma upon infection. The severity of the disease seemingly depends on many factors including the species of parasite, the host, region of endemicity, socio-economic status and the accessibility to health facilities. Despite myriad studies that have been performed on current and novel therapies, the treatment outcomes of CL remain contentious, possibly because of the knowledge gaps that still exist. The differential responses to the current CL therapies have become a major drawback in disease control, and the dearth of information on critical analyses of outcomes of such studies is a hindrance to the overall understanding. On the basis of currently available literature on treatment outcomes, we discuss the most effective doses, drug susceptibilities/resistance and treatment failures of the Leishmania genus for both monotherapy and combination therapy. This review focuses on the available treatment modalities for CL caused by different Leishmania species, with insights into their species-specific efficacies, which would inform the selection of appropriate drugs for the treatment and control of leishmaniasis.
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Affiliation(s)
| | - Hermali Silva
- Department of Parasitology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo 8, Sri Lanka
| | - Nadira D Karunaweera
- Department of Parasitology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo 8, Sri Lanka.
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15
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A pilot and open trial to evaluate topical Bacterial Cellulose bio-curatives in the treatment of cutaneous leishmaniasis caused by L. braziliensis. Acta Trop 2022; 225:106192. [PMID: 34662548 DOI: 10.1016/j.actatropica.2021.106192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/27/2021] [Accepted: 10/04/2021] [Indexed: 01/16/2023]
Abstract
The treatment of cutaneous leishmaniasis (CL) in Brazil using pentavalent antimony (Sbv) is associated with a high failure rate and long time to heal. Moreover, standard Sbv treatment cures only 50-60% of the cases. In this pilot clinical trial, we evaluated the topical use of bacterial cellulose (BC) bio-curatives + Sbv in the treatment of CL caused by L. braziliensis, in Bahia, Brazil. A total of 20 patients were randomized in two groups assigned to receive either parenteral Sbv alone or parenteral Sbv plus topically applied BC bio-curatives. CL patients treated with Sbv + topical BC bio-curatives had a significantly higher cure rate at 60 days post initiation of treatment compared to CL patients treated with Sbv alone (P=0.01). At day 90 post initiation of treatment, cure rate was similar in the two groups as was overall healing time. Adverse effects or local reactions to topical BC application were not observed. This pilot trial shows that the potential use of a combined therapy consisting of topical BC bio-curatives and parenteral Sbv in favoring healing of CL lesions caused by L. braziliensis, at an early time point.
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16
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Lago T, Carvalho LP, Nascimento M, Guimarães LH, Lago J, Castellucci L, Carvalho AM, Lago A, Carvalho EM. Influence of Obesity on Clinical Manifestations and Response to Therapy in Cutaneous Leishmaniasis Caused by Leishmania braziliensis. Clin Infect Dis 2021; 73:1020-1026. [PMID: 33725723 DOI: 10.1093/cid/ciab236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) caused by Leishmania braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates <60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. METHODS A total of 90 age-matched patients with CL were included (30 obese, 30 overweight, and 30 with normal body mass index [BMI]). CL was diagnosed through documentation of L. braziliensis DNA by polymerase chain reaction or identification of amastigotes in biopsied skin-lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (Sanofi-Aventis; 20 mg/kg/day) was administered for 20 days. RESULTS Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After 1 course of antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (P < .01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (P < .05). CONCLUSIONS Obesity modifies the clinical presentation of CL and host immune response and is associated with greater failure to therapy.
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Affiliation(s)
- Tainã Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | - Lucas P Carvalho
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil.,Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Brazil
| | - Mauricio Nascimento
- Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil.,Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Brazil
| | - Luiz H Guimarães
- Federal University of Southern Bahia, Teixeira de Freitas, Brazil
| | - Jamile Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | - Léa Castellucci
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | | | - Alex Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | - Edgar M Carvalho
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil.,Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Brazil
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17
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de Souza ML, Dos Santos WM, de Sousa ALMD, Ferraz LRDM, da Costa LAG, Silva EO, Rolim Neto PJ. Cutaneous leishmaniasis: new oral therapeutic approaches under development. Int J Dermatol 2021; 61:89-98. [PMID: 34510406 DOI: 10.1111/ijd.15902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/14/2021] [Accepted: 08/19/2021] [Indexed: 12/19/2022]
Abstract
The World Health Organization (WHO) classifies leishmaniasis as a disease for which the development of new treatments is a priority. Available drugs are not fully effective in all cases; they have parenteral administration and exhibit serious and common adverse effects. The only oral drug available (miltefosine) has shown resistance, is expensive, and is not available in many endemic countries. Thus, the development of an oral medicine may solve many of these issues. Based on that, this review aimed to investigate which therapeutic alternatives have been studied for the development of oral drugs for the treatment of cutaneous leishmaniasis. A literature search for keywords "leishmania and oral" was performed in PubMed and ScienceDirect, considering articles published in the last 5 years. The articles were selected based on the objective of the review. The main problem in the current treatment of leishmaniasis is the administration of injectables, since it requires patients to travel to health centers, hospitalization, and professional administration, conditions that are not adapted to the socioeconomic reality of patients. Therefore, many research studies have evaluated oral alternatives for the treatment of cutaneous leishmaniasis. The main tested approaches were obtaining new molecules, repositioning drugs, and new formulations of old drugs. The prospects are encouraging but still require more in vivo bioavailability and clinical trials.
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Affiliation(s)
- Myla Lôbo de Souza
- Laboratory of Drug Technology, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Av. Prof Artur de Sá, S/N, Recife - Pernambuco, Brazil
| | - Widson Michael Dos Santos
- Laboratory of Drug Technology, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Av. Prof Artur de Sá, S/N, Recife - Pernambuco, Brazil
| | - André Luiz Moreira Domingues de Sousa
- Laboratory of Drug Technology, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Av. Prof Artur de Sá, S/N, Recife - Pernambuco, Brazil
| | - Leslie Raphael de Moura Ferraz
- Laboratory of Drug Technology, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Av. Prof Artur de Sá, S/N, Recife - Pernambuco, Brazil
| | - Lucas Amadeu Gonzaga da Costa
- Laboratory of Drug Technology, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Av. Prof Artur de Sá, S/N, Recife - Pernambuco, Brazil
| | - Emerson Oliveira Silva
- Laboratory of Drug Technology, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Av. Prof Artur de Sá, S/N, Recife - Pernambuco, Brazil
| | - Pedro José Rolim Neto
- Laboratory of Drug Technology, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Av. Prof Artur de Sá, S/N, Recife - Pernambuco, Brazil
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18
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Briones Nieva CA, Cid AG, Romero AI, García-Bustos MF, Villegas M, Bermúdez JM. An appraisal of the scientific current situation and new perspectives in the treatment of cutaneous leishmaniasis. Acta Trop 2021; 221:105988. [PMID: 34058160 DOI: 10.1016/j.actatropica.2021.105988] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/18/2022]
Abstract
Leishmaniasis is a Neglected Tropical Diseases caused by protozoan parasites of the genus Leishmania. It is a major health problem in many tropical and subtropical regions of the world and can produce three different clinical manifestations, among which cutaneous leishmaniasis has a higher incidence in the world than the other clinical forms. There are no recognized and reliable means of chemoprophylaxis or vaccination against infections with different forms of leishmaniasis. In addition, chemotherapy, unfortunately, remains, in many respects, unsatisfactory. Therefore, there is a continuing and urgent need for new therapies against leishmaniasis that are safe and effective in inducing a long-term cure. This review summarizes the latest advances in currently available treatments and improvements in the development of drug administration. In addition, an analysis of the in vivo assays was performed and the challenges facing promising strategies to treat CL are discussed. The treatment of leishmaniasis will most likely evolve into an approach that uses multiple therapies simultaneously to reduce the possibility of developing drug resistance. There is a continuous effort to discover new drugs to improve the treatment of leishmaniasis, but this is mainly at the level of individual researchers. Undoubtedly, more funding is needed in this area, as well as greater participation of the pharmaceutical industry to focus efforts on the development of chemotherapeutic agents and vaccines for this and other neglected tropical diseases.
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Affiliation(s)
- C A Briones Nieva
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta - Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, (4400) Salta, Argentina
| | - Alicia Graciela Cid
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta - Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, (4400) Salta, Argentina
| | - Analía Irma Romero
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta - Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, (4400) Salta, Argentina
| | - María Fernanda García-Bustos
- Instituto de Patología Experimental, Universidad Nacional de Salta - Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Mercedes Villegas
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta - Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, (4400) Salta, Argentina
| | - José María Bermúdez
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta - Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, (4400) Salta, Argentina.
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Sridharan K, Sivaramakrishnan G. Comparative assessment of interventions for treating cutaneous leishmaniasis: A network meta-analysis of randomized clinical trials. Acta Trop 2021; 220:105944. [PMID: 33957088 DOI: 10.1016/j.actatropica.2021.105944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/28/2021] [Accepted: 04/26/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Various interventions including laser therapy, heat therapy, and several drugs have been trialed in patients with cutaneous leishmaniasis. Due to the lack of an evidence-based comparison of all these interventions, we carried out the present network meta-analysis. METHODS Electronic databases were searched for randomized clinical trials evaluating the efficacy and safety of any interventions in patients with cutaneous leishmaniasis. The proportion of patients with complete cure was the primary outcome. The proportion of lesions cured at the end of treatment, the proportion of lesions with minimal/no response to treatment, and proportion of wounds with minimal/no change were the secondary outcomes. Random-effects modeling was used for generating pooled estimates. Rankogram plot was used for identifying the 'best intervention'. For interventions containing a combination of treatments, backslash (/) has been used for depicting the same. RESULTS One-hundred and thirty-one studies were included. Intralesional meglumine, topical paromomycin/gentamicin, topical paromomycin, parenteral sodium stibogluconate, topical honey/intralesional meglumine, topical liposomal amphotericin B, oral zinc sulphate, oral miltefosine, parenteral meglumine, heat therapy, topical liposomal azithromycin, intralesional meglumine/silver dressing, intralesional sodium stibogluconate, parenteral meglumine/intralesional meglumine, oral allopurinol/parenteral meglumine, topical trichloroacetic acid/heat therapy, oral zinc sulphate/oral ketoconazole, topical imiquimod/cryotherapy, intralesional meglumine/cryotherapy, topical herbal extract of Z-HE, parenteral pentamidine, topical trichloroacetic acid/intralesional meglumine, carbon-dioxide laser, topical recombinant granulocyte-macrophage colony-stimulating factor/parenteral meglumine, intralesional dapsone, carbon-dioxide laser/intralesional meglumine, moist wet dressing with sodium hypochlorite, parenteral sodium stibogluconate/intralesional recombinant granulocyte-macrophage colony-stimulating factor, oral dapsone, intralesional sodium stibogluconate/oral ketoconazole, intralesional sodium stibogluconate/parenteral sodium stibogluconate and electrocautery/moist wet dressing with sodium hypochlorite were observed with significantly greater proportion of patients with complete cure compared to placebo/untreated controls. Rankogram analysis revealed that parenteral pentamidine has the highest statistical probability of being the best in the pool. CONCLUSION We observed several interventions to be effective for treating cutaneous leishmaniasis. However, greater caution is required in interpreting the results as the estimates are likely to change with the advent of results from future studies.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
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20
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Veraldi S, Romagnuolo M, Cusini M, Maronese CA. Therapy of cutaneous leishmaniasis caused by Leishmania braziliensis with fluconazole. Dermatol Ther 2021; 34:e15060. [PMID: 34250686 PMCID: PMC8596449 DOI: 10.1111/dth.15060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Stefano Veraldi
- Department of Pathophysiology and Transplantation, Università degli Studi, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Romagnuolo
- Department of Pathophysiology and Transplantation, Università degli Studi, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Cusini
- Department of Pathophysiology and Transplantation, Università degli Studi, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Alberto Maronese
- Department of Pathophysiology and Transplantation, Università degli Studi, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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21
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Farias Amorim C, O. Novais F, Nguyen BT, Nascimento MT, Lago J, Lago AS, Carvalho LP, Beiting DP, Scott P. Localized skin inflammation during cutaneous leishmaniasis drives a chronic, systemic IFN-γ signature. PLoS Negl Trop Dis 2021; 15:e0009321. [PMID: 33793565 PMCID: PMC8043375 DOI: 10.1371/journal.pntd.0009321] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/13/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
Cutaneous leishmaniasis is a localized infection controlled by CD4+ T cells that produce IFN-γ within lesions. Phagocytic cells recruited to lesions, such as monocytes, are then exposed to IFN-γ which triggers their ability to kill the intracellular parasites. Consistent with this, transcriptional analysis of patient lesions identified an interferon stimulated gene (ISG) signature. To determine whether localized L. braziliensis infection triggers a systemic immune response that may influence the disease, we performed RNA sequencing (RNA-seq) on the blood of L. braziliensis-infected patients and healthy controls. Functional enrichment analysis identified an ISG signature as the dominant transcriptional response in the blood of patients. This ISG signature was associated with an increase in monocyte- and macrophage-specific marker genes in the blood and elevated serum levels IFN-γ. A cytotoxicity signature, which is a dominant feature in the lesions, was also observed in the blood and correlated with an increased abundance of cytolytic cells. Thus, two transcriptional signatures present in lesions were found systemically, although with a substantially reduced number of differentially expressed genes (DEGs). Finally, we found that the number of DEGs and ISGs in leishmaniasis was similar to tuberculosis-another localized infection-but significantly less than observed in malaria. In contrast, the cytolytic signature and increased cytolytic cell abundance was not found in tuberculosis or malaria. Our results indicate that systemic signatures can reflect what is occurring in leishmanial lesions. Furthermore, the presence of an ISG signature in blood monocytes and macrophages suggests a mechanism to limit systemic spread of the parasite, as well as enhance parasite control by pre-activating cells prior to lesion entry.
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Affiliation(s)
- Camila Farias Amorim
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, United States of America
| | - Fernanda O. Novais
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, United States of America
| | - Ba T. Nguyen
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, United States of America
| | - Mauricio T. Nascimento
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisas Clínicas do Instituto de Pesquisas Gonçalo Moniz–Fiocruz, Salvador, Brazil
| | - Jamile Lago
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisas Clínicas do Instituto de Pesquisas Gonçalo Moniz–Fiocruz, Salvador, Brazil
| | - Alexsandro S. Lago
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisas Clínicas do Instituto de Pesquisas Gonçalo Moniz–Fiocruz, Salvador, Brazil
| | - Lucas P. Carvalho
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisas Clínicas do Instituto de Pesquisas Gonçalo Moniz–Fiocruz, Salvador, Brazil
| | - Daniel P. Beiting
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, United States of America
| | - Phillip Scott
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, United States of America
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22
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J B, M BM, Chanda K. An Overview on the Therapeutics of Neglected Infectious Diseases-Leishmaniasis and Chagas Diseases. Front Chem 2021; 9:622286. [PMID: 33777895 PMCID: PMC7994601 DOI: 10.3389/fchem.2021.622286] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/14/2021] [Indexed: 12/20/2022] Open
Abstract
Neglected tropical diseases (NTDs) as termed by WHO include twenty different infectious diseases that are caused by bacteria, viruses, and parasites. Among these NTDs, Chagas disease and leishmaniasis are reported to cause high mortality in humans and are further associated with the limitations of existing drugs like severe toxicity and drug resistance. The above hitches have rendered researchers to focus on developing alternatives and novel therapeutics for the treatment of these diseases. In the past decade, several target-based drugs have emerged, which focus on specific biochemical pathways of the causative parasites. For leishmaniasis, the targets such as nucleoside analogs, inhibitors targeting nucleoside phosphate kinases of the parasite’s purine salvage pathway, 20S proteasome of Leishmania, mitochondria, and the associated proteins are reviewed along with the chemical structures of potential drug candidates. Similarly, in case of therapeutics for Chagas disease, several target-based drug candidates targeting sterol biosynthetic pathway (C14-ademethylase), L-cysteine protease, heme peroxidation, mitochondria, farnesyl pyrophosphate, etc., which are vital and unique to the causative parasite are discussed. Moreover, the use of nano-based formulations towards the therapeutics of the above diseases is also discussed.
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Affiliation(s)
- Brindha J
- Division of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Chennai, India
| | - Balamurali M M
- Division of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Chennai, India
| | - Kaushik Chanda
- Department of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Vellore, India
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23
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Anti-Leishmania IgG is a marker of disseminated leishmaniasis caused by Leishmania braziliensis. Int J Infect Dis 2021; 106:83-90. [PMID: 33578011 DOI: 10.1016/j.ijid.2021.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In this study, we determined the accuracy of anti-Leishmania IgG and IgG subclasses to distinguish clinical forms of American tegumentary leishmaniasis (ATL) and and determined the relationship between antibodies levels with cytokine production and severity of ATL. METHODS Participants were 40 patients with cutaneous leishmaniasis (CL), 20 patients with mucosal leishmaniasis (ML), 20 patients with disseminated leishmaniasis (DL), and 20 individuals with subclinical Leishmania braziliensis infection (SC). Diagnosis was performed by DNA of L. braziliensis or IFN-γ production in SC. IgG and subclasses of IgG to soluble Leishmania antigen and cytokine levels in supernatants of mononuclear cells were detected by ELISA. RESULTS IgG was detected in 95%, 95%, and 100% of patients with CL, ML, and DL, respectively. Higher levels of anti-Leishmania IgG and IgG2 were seen in DL compared to CL, ML, and SC. ROC analysis confirmed the ability of IgG to distinguish DL from the other clinical forms. A direct correlation was observed between IgG titers and levels of IFN-γ and CXCL10 in CL and DL, and IgG2 antibodies were correlated with the number of lesions in DL. CONCLUSIONS High anti-Leishmania IgG and IgG2 levels are characteristic of DL, and while IgG was correlated with pro-inflammatory cytokines, IgG2 was direct correlated with the number of lesions.
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24
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Mendes L, Guerra JO, Costa B, Silva ASD, Guerra MDGB, Ortiz J, Doria SS, Silva GVD, de Jesus DV, Barral-Netto M, Penna G, Carvalho EM, Machado PRL. Association of miltefosine with granulocyte and macrophage colony-stimulating factor (GM-CSF) in the treatment of cutaneous leishmaniasis in the Amazon region: A randomized and controlled trial. Int J Infect Dis 2020; 103:358-363. [PMID: 33253864 DOI: 10.1016/j.ijid.2020.11.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To compare topical granulocyte and macrophage colony-stimulating factor (GM-CSF) and miltefosine (G + M) versus placebo and miltefosine (P + M) or parenteral meglumine antimoniate (MA) in the treatment of 150 patients with cutaneous leishmaniasis (CL) caused by Leishmania guyanensis in the Amazon. DESIGN A randomized and double-blinded clinical trial. RESULTS At 90 days after the initiation of therapy, the cure rates were 66%, 58%, and 52% for the groups P + M, G + M, and MA, respectively (p > 0.05). Cure rates at 180 days did not differ. Healing time was similar in the 3 groups, but faster in the MA group as compared to the G + M group (p = 0.04). Mild and transitory systemic adverse events were frequent in all groups (above 85%). Nausea (85%) and vomiting (39%) predominated in the miltefosine groups and arthralgia (51%) and myalgia (48%) in the MA group. One patient (group MA) stopped treatment after presenting with fever, exanthema, and severe arthralgia. CONCLUSIONS Miltefosine did not present a higher cure rate than MA, and the association of GM-CSF did not improve the therapeutic response. Nevertheless, because of its less toxicity, easier administration, and a similar cure rate when compared with MA, miltefosine should remain as one of the main drugs for treating CL due to L. guyanensis. (Clinicaltrials.gov Identifier NCT03023111).
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Affiliation(s)
- Luciana Mendes
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil; Universidade Federal do Amazonas, Brazil
| | - Jorge Oliveira Guerra
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | | | - Aríneia Soares da Silva
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Maria das Graças Barbosa Guerra
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Jéssica Ortiz
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Susan Smith Doria
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - George Villarouco da Silva
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | - Denison Vital de Jesus
- Programa de Pós graduação em Medicina Tropical da Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado-UEA/FMTHVD, Manaus, Amazonas, Brazil
| | | | - Gerson Penna
- Núcleo de Medicina Tropical, Universidade de Brasília (UnB), Brasília-DF, e Escola Fiocruz de Governo, Fundação Oswaldo Cruz Brasília, Brazil
| | - Edgar M Carvalho
- Instituto Gonçalo Moniz (IGM), FIOCRUZ, Bahia, Brazil; Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil
| | - Paulo R L Machado
- Instituto Gonçalo Moniz (IGM), FIOCRUZ, Bahia, Brazil; Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil.
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25
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Malta-Santos H, Fukutani KF, Sorgi CA, Queiroz ATL, Nardini V, Silva J, Lago A, Carvalho LP, Machado PLR, Bozza PT, França-Costa J, Faccioli LH, Carvalho EM, Andrade BB, Borges VM. Multi-omic Analyses of Plasma Cytokines, Lipidomics, and Transcriptomics Distinguish Treatment Outcomes in Cutaneous Leishmaniasis. iScience 2020; 23:101840. [PMID: 33313489 PMCID: PMC7721649 DOI: 10.1016/j.isci.2020.101840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/09/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
Leishmania braziliensis infection frequently results in cutaneous leishmaniasis (CL). An increase in incidence of drug-resistant CL leading to treatment failure has been reported. Identification of reliable predictors of treatment outcomes is necessary to optimize patient care. Here, we performed a prospective case-control study in which plasma levels of cytokines and lipid mediators were assessed at different time points during antileishmanial therapy in patients with CL from Brazil. Multidimensional analyses were employed to describe a combination of biomarkers able to predict and characterize treatment failure. We found a biosignature influenced mainly by plasma levels of lipid mediators that accurately predicted treatment failure. Furthermore, transcriptomic analysis of a publicly available data set revealed that expression levels of genes related to lipid metabolism measured in skin lesions could distinguish treatment outcomes in CL. Thus, activation of pathways linked to lipid biosynthesis predicts treatment failure in CL. The biomarkers identified may be further explored as therapeutic targets.
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Affiliation(s)
- Hayna Malta-Santos
- Faculdade de Medicina da Bahia (FAMED), Universidade Federal da Bahia, Salvador, Brazil.,Instituto Gonçalo Moniz (IGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Kiyoshi F Fukutani
- Instituto Gonçalo Moniz (IGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Salvador, Brazil
| | - Carlos A Sorgi
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto (FCFRP-USP), Universidade de São Paulo (USP), São Paulo, Brazil
| | - Artur T L Queiroz
- Instituto Gonçalo Moniz (IGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Salvador, Brazil
| | - Viviane Nardini
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto (FCFRP-USP), Universidade de São Paulo (USP), São Paulo, Brazil
| | - Juliana Silva
- Serviço de Imunologia, C-HUPES, Universidade Federal da Bahia, Salvador, Brazil
| | - Alex Lago
- Serviço de Imunologia, C-HUPES, Universidade Federal da Bahia, Salvador, Brazil
| | - Lucas P Carvalho
- Instituto Gonçalo Moniz (IGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Serviço de Imunologia, C-HUPES, Universidade Federal da Bahia, Salvador, Brazil
| | - Paulo L R Machado
- Serviço de Imunologia, C-HUPES, Universidade Federal da Bahia, Salvador, Brazil
| | - Patrícia T Bozza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jaqueline França-Costa
- Instituto Gonçalo Moniz (IGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Serviço de Imunologia, C-HUPES, Universidade Federal da Bahia, Salvador, Brazil
| | - Lucia H Faccioli
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto (FCFRP-USP), Universidade de São Paulo (USP), São Paulo, Brazil
| | - Edgar M Carvalho
- Faculdade de Medicina da Bahia (FAMED), Universidade Federal da Bahia, Salvador, Brazil.,Instituto Gonçalo Moniz (IGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Serviço de Imunologia, C-HUPES, Universidade Federal da Bahia, Salvador, Brazil
| | - Bruno B Andrade
- Faculdade de Medicina da Bahia (FAMED), Universidade Federal da Bahia, Salvador, Brazil.,Instituto Gonçalo Moniz (IGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER), Salvador, Brazil.,Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.,Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil
| | - Valéria M Borges
- Faculdade de Medicina da Bahia (FAMED), Universidade Federal da Bahia, Salvador, Brazil.,Instituto Gonçalo Moniz (IGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
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26
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Machado PRL, Prates FVO, Boaventura V, Lago T, Guimarães LH, Schriefer A, Corte TWF, Penna G, Barral A, Barral-Netto M, Carvalho EM. A double-bind and randomized trial to evaluate Miltefosine and topical GM-CSF in the treatment of cutaneous leishmaniasis caused by Leishmania braziliensis in Brazil. Clin Infect Dis 2020; 73:e2465-e2469. [PMID: 32894278 PMCID: PMC8492114 DOI: 10.1093/cid/ciaa1337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/11/2020] [Indexed: 11/14/2022] Open
Abstract
Background The treatment of cutaneous leishmaniasis (CL) in Brazil using pentavalent antimony (Sbv) is associated with a high rate of failure. Miltefosine has proven efficacy for CL caused by L. braziliensis, with a cure rate (CR) of 75%. A combined treatment with granulocyte macrophage colony-stimulating factor (GM-CSF) and miltefosine could increase CR and decrease healing time. Methods A randomized, double-blind clinical trial to evaluate the efficacy of miltefosine combined with topical GM-CSF (M + GM) vs miltefosine and placebo (M + P) vs Sbv in 133 patients with CL caused by L. braziliensis in Bahia, Brazil. Results The final CR at 180 days after the initiation of treatment was 44.4% in the Sbv group, 76.6% in the M + P group (P = .003 vs Sbv), and 75.6% in the M + GM group (P = .004 vs Sbv). The median healing time for cure was 102 days for the Sbv group and 60 days for both miltefosine groups (P = .0009). During the 6-month follow-up period, 4 relapses were documented: 1 in the Sbv group, 1 in the M + P group, and 2 in the M + GM group. Mild adverse events occurred in 65% of patients from the Sbv group, 76% and 79% from the M + P and M + GM groups respectively. Conclusions Miltefosine is more effective than Sbv for the treatment of CL caused by L. braziliensis in Brazil and accelerates the healing time. Association with GM-CSF does not improve therapeutic outcome. Clinical Trials Registration NCT03023111.
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Affiliation(s)
- Paulo R L Machado
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil
| | - Fernanda V O Prates
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil
| | | | - Tainã Lago
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Luiz H Guimarães
- Universidade Federal do Sul da Bahia, Teixeira de Freitas, Brazil
| | - Albert Schriefer
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil
| | - Temis W F Corte
- Quatro G Pesquisa & Desenvolvimento, LTDA, Av. Ipiranga, Prédio 92A, Porto Alegre, Brasil
| | - Gerson Penna
- Núcleo de Medicina Tropical, Universidade de Brasília (UnB), Brasília-DF, Brazil
| | - Aldina Barral
- Instituto Gonçalo Moniz (IGM), FIOCRUZ, Bahia, Brazil
| | | | - Edgar M Carvalho
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil.,Instituto Gonçalo Moniz (IGM), FIOCRUZ, Bahia, Brazil
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Roatt BM, de Oliveira Cardoso JM, De Brito RCF, Coura-Vital W, de Oliveira Aguiar-Soares RD, Reis AB. Recent advances and new strategies on leishmaniasis treatment. Appl Microbiol Biotechnol 2020; 104:8965-8977. [PMID: 32875362 DOI: 10.1007/s00253-020-10856-w] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/13/2020] [Accepted: 08/23/2020] [Indexed: 12/18/2022]
Abstract
Leishmaniasis is one of the most important tropical neglected diseases according to the World Health Organization. Even after more than a century, we still have few drugs for the disease therapy and their great toxicity and side effects put in check the treatment control program around the world. Moreover, the emergence of strains resistant to conventional drugs, co-infections such as HIV/Leishmania spp., the small therapeutic arsenal (pentavalent antimonials, amphotericin B and formulations, and miltefosine), and the low investment for the discovery/development of new drugs force researchers and world health agencies to seek new strategies to combat and control this important neglected disease. In this context, the aim of this review is to summarize new advances and new strategies used on leishmaniasis therapy addressing alternative and innovative treatment paths such as physical and local/topical therapies, combination or multi-drug uses, immunomodulation, drug repurposing, and the nanotechnology-based drug delivery systems.Key points• The treatment of leishmaniasis is a challenge for global health agencies.• Toxicity, side effects, reduced therapeutic arsenal, and drug resistance are the main problems.• New strategies and recent advances on leishmaniasis treatment are urgent.• Immunomodulators, nanotechnology, and drug repurposing are the future of leishmaniasis treatment.
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Affiliation(s)
- Bruno Mendes Roatt
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Morro do Cruzeiro, Ouro Preto, Minas Gerais, 35400-000, Brazil.,Departamento de Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Morro do Cruzeiro, Ouro Preto, Minas Gerais, 35400-000, Brazil.,Instituto de Ciência e Tecnologia de Doenças Tropicais (INCT-DT), Salvador, Bahia, Brazil
| | - Jamille Mirelle de Oliveira Cardoso
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Morro do Cruzeiro, Ouro Preto, Minas Gerais, 35400-000, Brazil
| | - Rory Cristiane Fortes De Brito
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Morro do Cruzeiro, Ouro Preto, Minas Gerais, 35400-000, Brazil
| | - Wendel Coura-Vital
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Morro do Cruzeiro, Ouro Preto, Minas Gerais, 35400-000, Brazil.,Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, 35400-00, Brazil
| | - Rodrigo Dian de Oliveira Aguiar-Soares
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Morro do Cruzeiro, Ouro Preto, Minas Gerais, 35400-000, Brazil.,Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, 35400-00, Brazil
| | - Alexandre Barbosa Reis
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas, Universidade Federal de Ouro Preto, Morro do Cruzeiro, Ouro Preto, Minas Gerais, 35400-000, Brazil. .,Instituto de Ciência e Tecnologia de Doenças Tropicais (INCT-DT), Salvador, Bahia, Brazil. .,Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, 35400-00, Brazil.
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In Vitro Anti-Leishmanial Assessment of Some Medicinal Plants Collected from Al Qassim, Saudi Arabia. Acta Parasitol 2020; 65:696-703. [PMID: 32347535 DOI: 10.2478/s11686-020-00205-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/19/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE In the present work, a group of nine medicinal plants (Sonchus oleraceus, Echinops spinosissimus, Trichodesma africana, Pergularia tomentosa, Teucrium oliverianum, Blepharis ciliaris, Citrllus colocynthis, Cleome amblyocarpa and Aerva javanica) from eight different families were investigated for their in vitro anti-leishmanial activity against the promastigote and amastigote stages of Leishmania major. L. major is the causative agent of cutaneous leishmaniasis (CL) which is one of the major health problems in Saudi Arabia and neighboring countries such as Iraq and Iran. However, the commonly available commercial therapeutics still come with multiple unwanted side effects in addition to parasite resistance, so medicinal plants have attracted attention due to their affordability and beneficial effects. METHODS The selected plants were collected from Al Qassim region in the middle of Saudi Arabia, and then extracts were prepared with methanol using overnight soaking for the whole plants. RPMI 1640 was used to culture L. major to obtain promastigotes and intramacrophage amastigotes, which were used later for evaluation of extract activity in vitro via spectrophotometric and microscopic techniques. The MTT assay was used for cytotoxic evaluation of plant extracts against macrophage cells. Data were expressed in mean ± SD. Linear regression was used for IC50 and CC50 calculation. T test was used for significant differences at P ≤ 0.05. RESULTS All the plants revealed anti-leishmanial activity against the L. major amastigote stage with IC50 values less than 91 µg/mL. The three most potent were T. oliverianum, P. tomentosa and C. amblyocarpa with IC50 values of 7.8, 13.7 and 21.5 µg/mL, respectively. The L. major promastigote stage was more tolerant, so only T. oliverianum extract showed an IC50 less than 30 (26.6 µg/mL). P. tomentosa is the most toxic plant with CC50 3.1 µg/mL followed by T. africana CC50 9.5 µg/mL, the other plants possess CC50 over 40 µg/mL. The best SI values were obtained from the C. amblyocarpa and T. oliverianum extracts against the L. major amastigote stages with 5.7 and 5.3, respectively. CONCLUSION We can conclude that T. oliverianum, P. tomentosa and C. amblyocarpa are the best anti-leishmanial plants, so further phytochemical studies for isolation of active ingredients are highly recommended.
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Evaluation of the Ability of Miltefosine Associated with Topical GM-CSF in Modulating the Immune Response of Patients with Cutaneous Leishmaniasis. J Immunol Res 2020; 2020:2789859. [PMID: 32851099 PMCID: PMC7439779 DOI: 10.1155/2020/2789859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/09/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022] Open
Abstract
Cutaneous leishmaniasis (CL) due to L. braziliensis is associated with an exaggerated inflammatory response and tissue damage. Miltefosine is more effective than pentavalent antimony (Sbv) in the treatment of CL, and here, we evaluate the ability of Sbv, miltefosine, and GM-CSF administered intravenously, orally, or topically, respectively, to modify the immune response. Patients were treated with miltefosine plus GM-CSF, miltefosine plus placebo, or Sbv. Mononuclear cells were stimulated with soluble Leishmania antigen (SLA) on day 0 and day 15 of therapy, and cytokine levels were determined in supernatants by ELISA. The lymphocyte proliferation and oxidative burst were evaluated by flow cytometry, and the degree of infection and Leishmania killing by optical microscopy. Proliferation of CD4+ T cells were enhanced in patients using miltefosine and in CD8+ T cells when GM-CSF was associated. Enhancement in the oxidative burst occurred in the miltefosine plus GM-CSF group on day 15 of therapy. Moreover, the number of L. braziliensis in infected monocytes on day 15 as well as the percentage of infected cells was lower after 48- and 72-hour culture in cells from patients treated with miltefosine plus GM-CSF. In addition to the ability of miltefosine to kill Leishmania, the changes in the immune response caused by miltefosine and GM-CSF may increase the cure rate of CL patients using these drugs.
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Pinart M, Rueda JR, Romero GA, Pinzón-Flórez CE, Osorio-Arango K, Silveira Maia-Elkhoury AN, Reveiz L, Elias VM, Tweed JA. Interventions for American cutaneous and mucocutaneous leishmaniasis. Cochrane Database Syst Rev 2020; 8:CD004834. [PMID: 32853410 PMCID: PMC8094931 DOI: 10.1002/14651858.cd004834.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND On the American continent, cutaneous and mucocutaneous leishmaniasis (CL and MCL) are diseases associated with infection by several species of Leishmania parasites. Pentavalent antimonials remain the first-choice treatment. There are alternative interventions, but reviewing their effectiveness and safety is important as availability is limited. This is an update of a Cochrane Review first published in 2009. OBJECTIVES To assess the effects of interventions for all immuno-competent people who have American cutaneous and mucocutaneous leishmaniasis (ACML). SEARCH METHODS We updated our database searches of the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, LILACS and CINAHL to August 2019. We searched five trials registers. SELECTION CRITERIA Randomised controlled trials (RCTs) assessing either single or combination treatments for ACML in immuno-competent people, diagnosed by clinical presentation and Leishmania infection confirmed by smear, culture, histology, or polymerase chain reaction on a biopsy specimen. The comparators were either no treatment, placebo only, or another active compound. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our key outcomes were the percentage of participants 'cured' at least three months after the end of treatment, adverse effects, and recurrence. We used GRADE to assess evidence certainty for each outcome. MAIN RESULTS We included 75 studies (37 were new), totalling 6533 randomised participants with ATL. The studies were mainly conducted in Central and South America at regional hospitals, local healthcare clinics, and research centres. More male participants were included (mean age: roughly 28.9 years (SD: 7.0)). The most common confirmed species were L. braziliensis, L. panamensis, and L. mexicana. The most assessed interventions and comparators were non-antimonial systemics (particularly oral miltefosine) and antimonials (particularly meglumine antimoniate (MA), which was also a common intervention), respectively. Three studies included moderate-to-severe cases of mucosal leishmaniasis but none included cases with diffuse cutaneous or disseminated CL, considered the severe cutaneous form. Lesions were mainly ulcerative and located in the extremities and limbs. The follow-up (FU) period ranged from 28 days to 7 years. All studies had high or unclear risk of bias in at least one domain (especially performance bias). None of the studies reported the degree of functional or aesthetic impairment, scarring, or quality of life. Compared to placebo, at one-year FU, intramuscular (IM) MA given for 20 days to treat L. braziliensis and L. panamensis infections in ACML may increase the likelihood of complete cure (risk ratio (RR) 4.23, 95% confidence interval (CI) 0.84 to 21.38; 2 RCTs, 157 participants; moderate-certainty evidence), but may also make little to no difference, since the 95% CI includes the possibility of both increased and reduced healing (cure rates), and IMMA probably increases severe adverse effects such as myalgias and arthralgias (RR 1.51, 95% CI 1.17 to 1.96; 1 RCT, 134 participants; moderate-certainty evidence). IMMA may make little to no difference to the recurrence risk, but the 95% CI includes the possibility of both increased and reduced risk (RR 1.79, 95% CI 0.17 to 19.26; 1 RCT, 127 participants; low-certainty evidence). Compared to placebo, at six-month FU, oral miltefosine given for 28 days to treat L. mexicana, L. panamensis and L. braziliensis infections in American cutaneous leishmaniasis (ACL) probably improves the likelihood of complete cure (RR 2.25, 95% CI 1.42 to 3.38), and probably increases nausea rates (RR 3.96, 95% CI 1.49 to 10.48) and vomiting (RR 6.92, 95% CI 2.68 to 17.86) (moderate-certainty evidence). Oral miltefosine may make little to no difference to the recurrence risk (RR 2.97, 95% CI 0.37 to 23.89; low-certainty evidence), but the 95% CI includes the possibility of both increased and reduced risk (all based on 1 RCT, 133 participants). Compared to IMMA, at 6 to 12 months FU, oral miltefosine given for 28 days to treat L. braziliensis, L. panamensis, L. guyanensis and L. amazonensis infections in ACML may make little to no difference to the likelihood of complete cure (RR 1.05, 95% CI 0.90 to 1.23; 7 RCTs, 676 participants; low-certainty evidence). Based on moderate-certainty evidence (3 RCTs, 464 participants), miltefosine probably increases nausea rates (RR 2.45, 95% CI 1.72 to 3.49) and vomiting (RR 4.76, 95% CI 1.82 to 12.46) compared to IMMA. Recurrence risk was not reported. For the rest of the key comparisons, recurrence risk was not reported, and risk of adverse events could not be estimated. Compared to IMMA, at 6 to 12 months FU, oral azithromycin given for 20 to 28 days to treat L. braziliensis infections in ACML probably reduces the likelihood of complete cure (RR 0.51, 95% CI 0.34 to 0.76; 2 RCTs, 93 participants; moderate-certainty evidence). Compared to intravenous MA (IVMA) and placebo, at 12 month FU, adding topical imiquimod to IVMA, given for 20 days to treat L. braziliensis, L. guyanensis and L. peruviana infections in ACL probably makes little to no difference to the likelihood of complete cure (RR 1.30, 95% CI 0.95 to 1.80; 1 RCT, 80 participants; moderate-certainty evidence). Compared to MA, at 6 months FU, one session of local thermotherapy to treat L. panamensis and L. braziliensis infections in ACL reduces the likelihood of complete cure (RR 0.80, 95% CI 0.68 to 0.95; 1 RCT, 292 participants; high-certainty evidence). Compared to IMMA and placebo, at 26 weeks FU, adding oral pentoxifylline to IMMA to treat CL (species not stated) probably makes little to no difference to the likelihood of complete cure (RR 0.86, 95% CI 0.63 to 1.18; 1 RCT, 70 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS Evidence certainty was mostly moderate or low, due to methodological shortcomings, which precluded conclusive results. Overall, both IMMA and oral miltefosine probably result in an increase in cure rates, and nausea and vomiting are probably more common with miltefosine than with IMMA. Future trials should investigate interventions for mucosal leishmaniasis and evaluate recurrence rates of cutaneous leishmaniasis and its progression to mucosal disease.
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Affiliation(s)
- Mariona Pinart
- Free time independent Cochrane reviewer, Berlin, Germany
| | - José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Gustavo As Romero
- Center for Tropical Medicine, University of Brasilia, Brasilia, Brazil
| | | | - Karime Osorio-Arango
- Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Ana Nilce Silveira Maia-Elkhoury
- Communicable Diseases and Environmental Determinants of Health (CDE), Neglected, Tropical and Vector Borne Diseases (VT), Pan American Health Organization/ World Health Organization (PAHO/WHO), Rio de Janeiro, Brazil
| | - Ludovic Reveiz
- Evidence and Intelligence for Action in Health Department, Pan American Health Organization (PAHO), Washington DC, USA
| | - Vanessa M Elias
- Evidence and Intelligence for Action in Health Department, Pan American Health Organization (PAHO), Washington DC, USA
| | - John A Tweed
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
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Raeisi M, Mirkarimi K, Jannat B, Rahimi Esboei B, Pagheh AS, Mehrbakhsh Z, Ghaffarifar F, Jorjani O, Foroutan M. In Vitro Effect of Some Medicinal Plants on Leishmania major Strain MRHO/IR/75/ER. MEDICAL LABORATORY JOURNAL 2020. [DOI: 10.29252/mlj.14.4.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Suprien C, Rocha PN, Teixeira M, Carvalho LP, Guimarães LH, Bonvoisin T, Machado PRL, Carvalho EM. Clinical Presentation and Response to Therapy in Children with Cutaneous Leishmaniasis. Am J Trop Med Hyg 2020; 102:777-781. [PMID: 32043440 DOI: 10.4269/ajtmh.19-0531] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cutaneous leishmaniasis (CL) caused by Leishmania braziliensis occurs predominantly in adult males. Herein, we compare the clinical presentation and the response to antimony therapy of CL in children versus adults. Participants included 571 patients with CL; of these, 129 were children (age ≤ 12 years). Cure was defined as the complete healing of ulcer in the absence of raised borders at day 90 after initiation of therapy. Failure was defined by the presence of an active ulcer or a scar with elevated borders at day 90. In comparison with adults, children had shorter duration of illness, more lesions in the head, and smaller ulcers. Risk factors for therapeutic failure were younger age, shorter duration of disease, higher number of lesions, and larger size of the biggest ulcer. When age was categorized in ≤ 12-year-olds (children versus adults), it predicted therapeutic failure with statistical significance at day 60 but not at day 90. In conclusion, our data indicate that there are significant differences in the clinical presentation of CL between children and adults. Physicians caring for children with CL should be aware that lesions may take longer to heal and remain alert for the possibility of higher odds of therapeutic failure in this group.
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Affiliation(s)
- Carvel Suprien
- Programa de Pós-Graduação em Ciências da Saúde da Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Brazil
| | - Paulo N Rocha
- Serviço de Imunologia do Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Ciências da Saúde da Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Brazil
| | | | - Lucas P Carvalho
- Instituto de Ciências da Saúde da Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Ciências da Saúde da Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Brazil.,Serviço de Imunologia do Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Instituto Gonçalo Moniz (IGM), FIOCRUZ-BA, Salvador, Brazil.,National Institutes of Science and Technology in Tropical Diseases, Ministry of Science and Technology, Salvador, Brazil
| | - Luiz H Guimarães
- Universidade Federal do Sul da Bahia, Ilhéus, Brazil.,National Institutes of Science and Technology in Tropical Diseases, Ministry of Science and Technology, Salvador, Brazil
| | | | - Paulo R L Machado
- National Institutes of Science and Technology in Tropical Diseases, Ministry of Science and Technology, Salvador, Brazil.,Serviço de Imunologia do Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Edgar M Carvalho
- Serviço de Imunologia do Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,National Institutes of Science and Technology in Tropical Diseases, Ministry of Science and Technology, Salvador, Brazil.,Instituto Gonçalo Moniz (IGM), FIOCRUZ-BA, Salvador, Brazil
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Abstract
Aim: Cysteine proteases are important molecular targets involved in the replication, virulence and survival of parasitic organisms, including Trypanosoma and Leishmania species. Methodology & results: Analogs of the 7-chloro-N-[3-(morpholin-4-yl)propyl]quinolin-4-amine were synthesized and their inhibitory activity against the enzymes cruzain and rhodesain as well as against promastigotes forms of Leishmania species and epimastigotes forms of Trypanosoma cruzi were evaluated. Five compounds showed activity against both enzymes with half maximal inhibitory concentration (IC50) values ranging from 23 to 123 μM. Among these, compounds 3 and 4 displayed leishmanicidal activity; compound 4 was the most promising with IC50 values <10 μM and no cytotoxicity for uninfected cells. Conclusion: The results obtained indicate that cysteine proteases are likely to be the molecular target of compounds 3 and 4.
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da Hora AS, de Almeida LF, do Lago TS, Machado PR, Castellucci LC. FLI1 gene influences lesion size and skin test may predict therapeutic response in cutaneous leishmaniasis. Mem Inst Oswaldo Cruz 2020; 115:e190361. [PMID: 32130370 PMCID: PMC7064323 DOI: 10.1590/0074-02760190361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/31/2020] [Indexed: 12/18/2022] Open
Abstract
Genes associated with wound healing have been shown to be risk factors for
cutaneous leishmaniasis (CL) which is caused by Leishmania
braziliensis. In this study, we examined whether the genes
previously associated with CL influenced the clinical outcome. Patients were
genotyped and retrospectively classified as responders, who were cured with a
single course of pentavalent antimony (Sbv), or as refractories, who did not
respond to Sbv. Patients characterised as responders showed a stronger response
to the leishmanin skin test (LST) when compared to the refractory subjects (p =
0.0003). Furthermore, we observed an association between the
FLI1 CC genotype and an increased size of ulcers (p =
0.0170). We suggest that the leishmanin skin test may be a predictive tool for
therapeutic outcome and reinforce FLI1 as a potential
influencer of susceptibility and lesion size in CL.
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Affiliation(s)
- Anadilton Santos da Hora
- Universidade Federal da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brasil.,Universidade Federal da Bahia, Serviço de Imunologia, Salvador, BA, Brasil
| | | | - Tainã Souza do Lago
- Universidade Federal da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brasil.,Universidade Federal da Bahia, Serviço de Imunologia, Salvador, BA, Brasil
| | - Paulo Roberto Machado
- Universidade Federal da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brasil.,Universidade Federal da Bahia, Serviço de Imunologia, Salvador, BA, Brasil.,Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, BA, Brasil
| | - Léa Cristina Castellucci
- Universidade Federal da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brasil.,Universidade Federal da Bahia, Serviço de Imunologia, Salvador, BA, Brasil.,Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, BA, Brasil
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Kosaka A, Sakamoto N, Hikone M, Imai K, Ota M, Washino T, Maeda T, Iwabuchi S. Failure of Liposomal-amphotericin B Treatment for New World Cutaneous Leishmaniasis due to Leishmania braziliensis. Intern Med 2020; 59:1227-1230. [PMID: 32378656 PMCID: PMC7270753 DOI: 10.2169/internalmedicine.4096-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Liposomal-amphotericin B (L-AmB) is used for cutaneous leishmaniasis (CL); however, its treatment failure has not yet been described in detail. A 58-year-old man returned from the Republic of Venezuela with a cutaneous ulcer on his left lower leg. The causative pathogen was Leishmania braziliensis. We started L-AmB 3 mg/kg/day for 6 days; however, the ulcer did not resolve. The patient was successfully retreated with a higher dose L-AmB 4 mg/kg/day 9 times (total, 36 mg/kg). If L-AmB fails to treat CL and other therapeutics cannot be used, increasing the L-AmB dose is a viable option.
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Affiliation(s)
- Atsushi Kosaka
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Naoya Sakamoto
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Mayu Hikone
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Kazuo Imai
- Department of Infectious Diseases and Infection Control, Saitama Medical University, Japan
- Center for Clinical Infectious Diseases and Research, Saitama Medical University, Japan
| | - Masayuki Ota
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Takuya Washino
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Takuya Maeda
- Department of Microbiology, Saitama Medical University, Japan
| | - Sentarou Iwabuchi
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
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Abstract
Cutaneous leishmaniasis (CL) is a diverse human disease caused by more than 20 Leishmania species transmitted by the bite of an infected sand fly. Diagnostic testing is recommended to confirm infection and determine the infecting species. Treatment decisions are complex and providers should consider infecting species, patient comorbidities, extent and location of lesions, and previous treatments. There is no single universal treatment for CL and some treatment can have toxicity. Treatment should be individualized and factors, such as self-healing nature of this infection, risk of metastatic complications (ie, mucosal leishmaniasis), and patient wishes, need to be included in individual risk-benefit treatment decisions.
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Affiliation(s)
- Naomi E Aronson
- Infectious Diseases Division, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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Kariyawasam R, Challa P, Lau R, Boggild AK. Susceptibility testing of Leishmania spp. against amphotericin B and fluconazole using the Sensititre™ YeastOne™ YO9 platform. BMC Infect Dis 2019; 19:593. [PMID: 31286895 PMCID: PMC6615197 DOI: 10.1186/s12879-019-4237-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current drug regimens for cutaneous leishmaniasis (CL) include toxic systemic therapies such as amphotericin B (AB) and pentavalent antimonials. Fluconazole (FZ) is a well-tolerated potential oral alternative for the management CL. To date, few objective data exist to guide clinical decision-making when selecting a therapeutic agent a priori, and standardized, clinically-approved drug susceptibility testing platforms for Leishmania spp. have yet to be established. The Sensititre™ YeastOne™ YO9 plate is a commercialized drug susceptibility plate including AB and FZ used for routine testing of non-fastidious yeast. Our objective was to adapt the readily available Sensititre™ YeastOne™ YO9 plate, to determine drug susceptibility profiles of AB and FZ in cultured isolates of Old World and New World Leishmania spp. for the treatment of CL. METHODS Promastigotes were cultured in Tobie's medium with Locke's overlay until log phase growth was achieved, inoculated into the Sensititre™ system, and incubated over 96 H. minimum inhibitory concentrations (MICs) were determined colorimetrically, and promastigote death was assessed by conventional microscopy out to 96- h. Colour change correlated to MIC values. RESULTS All strains tested exhibited MIC values for FZ that were ≥ 256 μg/mL. New World strains demonstrated reduced susceptibility to AB (0.25 μg/mL - 0.50 μg/mL AB) compared to Old World strains at 0.12 μg/mL AB (p = 0.02). Seventeen (61%) of 28 Viannia isolates versus 82% (27/33) of non-Viannia isolates were resistant at 0.12 μg/mL AB (p = 0.09). For L. V. braziliensis isolates, mean MIC for AB was 0.375 ± 0.14 μg/mL (range 0.25-0.50 μg/mL), while for isolates of L. V. panamensis it was 0.314 ± 0.26 μg/mL (range 0.12-1.0 μg/mL). CONCLUSIONS We adapted the Sensititre™ YeastOne™ YO9 plate for testing of Leishmania spp. susceptibility profiles for commonly used antifungals in the treatment of CL, including AB and FZ. Given its current utility in mycology, optimization of the system for potential clinical implementation in parasitology should be pursued. However evaluation of clinically relevant amastigote-stage stages, and higher concentrations of FZ beyond the upper limit concentration of the Sensititre™ YeastOne™ Y09 plate would be required.
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Affiliation(s)
- Ruwandi Kariyawasam
- Institute of Medical Sciences, University of Toronto, Address: 1 King’s College Circle, Toronto, Ontario M5S 1A8 Canada
| | - Priyanka Challa
- Faculty of Arts and Science, University of Toronto, Address: 100 St. George Street, Toronto, Ontario M5S 3G3 Canada
| | - Rachel Lau
- Public Health Ontario Laboratory, Address: 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Andrea K. Boggild
- Institute of Medical Sciences, University of Toronto, Address: 1 King’s College Circle, Toronto, Ontario M5S 1A8 Canada
- Public Health Ontario Laboratory, Address: 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
- Tropical Disease Unit, Toronto General Hospital, Toronto, Address: 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4 Canada
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Sundar S, Agrawal N, Singh B. Exploiting knowledge on pharmacodynamics-pharmacokinetics for accelerated anti-leishmanial drug discovery/development. Expert Opin Drug Metab Toxicol 2019; 15:595-612. [PMID: 31174439 DOI: 10.1080/17425255.2019.1629417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Being on the top list of neglected tropical diseases, leishmaniasis has been marked for elimination by 2020. In the light of small armamentarium of drugs and their associated drawbacks, the understanding of pharmacodynamics and/or pharmacokinetics becomes a priority to achieve and sustain disease elimination. Areas covered: The authors have looked into pharmacological aspects of existing and emerging drugs for treatment of leishmaniasis. An in-depth understanding of pharmacodynamics and pharmacokinetics (PKPD) provides a rationale for drug designing and optimizing the treatment strategies. It forms a key to prevent drug resistance and avoid drug-associated adverse effects. The authors have compiled the researches on the PKPD of different anti-leishmanial formulations that have the potential for improved and/or effective disease intervention. Expert opinion: Understanding the pharmacological aspects of drugs forms the basis for the clinical application of novel drugs. Tailoring drug dosage and individualized treatment can avoid the adverse events and bridge gap between the in vitro models and their clinical application. An integrated approach, with pragmatic use of technological advances can improve phenotypic screening and physiochemical properties of novel drugs. Concomitantly, this can serve to improve clinical efficacies, reduce the incidence of relapse and accelerate the drug discovery/development process for leishmaniasis elimination.
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Affiliation(s)
- Shyam Sundar
- a Department of Medicine , Institute of Medical Sciences, Banaras Hindu University , Varanasi , India
| | - Neha Agrawal
- b Hepatology , Temple University , Philadelphia , PA , USA
| | - Bhawana Singh
- a Department of Medicine , Institute of Medical Sciences, Banaras Hindu University , Varanasi , India.,c Department of Pathology , Wexner Medical Center, The Ohio State University , Columbus , OH , USA
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Chakravarty J, Sundar S. Current and emerging medications for the treatment of leishmaniasis. Expert Opin Pharmacother 2019; 20:1251-1265. [DOI: 10.1080/14656566.2019.1609940] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jaya Chakravarty
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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40
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Sampaio RNR, Silva JSFE, Paula CDRD, Porto C, Motta JDOCD, Pereira LIDA, Martins SS, Barroso DH, Freire GSM, Gomes CM. A randomized, open-label clinical trial comparing the long-term effects of miltefosine and meglumine antimoniate for mucosal leishmaniasis. Rev Soc Bras Med Trop 2019; 52:e20180292. [PMID: 30942258 DOI: 10.1590/0037-8682-0292-2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/18/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The treatment of mucosal leishmaniasis (ML) is difficult due to the toxicity and route of administration of standard drugs. Miltefosine is an oral agent used for leishmaniasis treatment; however, no data exist regarding its use for ML in Brazil. In this study, we aimed to evaluate the efficacy of miltefosine for ML treatment compared to that of pentavalent antimonial in a pilot study. METHODS We performed a randomized clinical trial with two parallel groups. The tested intervention consisted of miltefosine 1.3-2 mg/kg/day (two capsules) for 28 days or intravenous 20 mg SbV/kg/day of meglumine antimoniate (N-MA) for 30 days. The final endpoint was defined as complete healing of the lesion four years after treatment. We also analyzed an early endpoint at 90 days after treatment. RESULTS Forty patients were included in this study: each experimental group comprised 20 patients. Applying a multivariate model in an intention-to-treat analysis, we observed that patients treated with miltefosine had a cure probability 2.08 times greater (95% confidence interval [CI] = 1.03-4.18) than those treated with N-MA at 90 days after treatment. At the final endpoint, we observed no differences in cure probability between miltefosine and N-MA (relative risk = 0.66; 95% CI = 0.33-1.32). With respect to adverse reactions, significant differences between groups were related to gastrointestinal effects, which were more frequent in the miltefosine group. CONCLUSIONS Miltefosine may be an interesting alternative for treating ML because of its oral administration and cure rate after long-term follow-up.
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Affiliation(s)
- Raimunda Nonata Ribeiro Sampaio
- Laboratório de Dermatomicologia, Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil.,Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brasil.,Pós-graduação Stricto Sensu em ciências da saúde, Universidade de Brasília, Brasília, DF, Brasil
| | | | | | - Cláudia Porto
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brasil
| | | | | | - Sofia Sales Martins
- Pós-graduação Stricto Sensu em ciências da saúde, Universidade de Brasília, Brasília, DF, Brasil
| | - Daniel Holanda Barroso
- Pós-graduação Stricto Sensu em ciências da saúde, Universidade de Brasília, Brasília, DF, Brasil
| | | | - Ciro Martins Gomes
- Laboratório de Dermatomicologia, Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil.,Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brasil
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41
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Ortalli M, Varani S, Rosso C, Quintavalla A, Lombardo M, Trombini C. Evaluation of synthetic substituted 1,2-dioxanes as novel agents against human leishmaniasis. Eur J Med Chem 2019; 170:126-140. [PMID: 30878827 DOI: 10.1016/j.ejmech.2019.02.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/29/2019] [Accepted: 02/25/2019] [Indexed: 01/28/2023]
Abstract
The treatment of human leishmaniasis is currently based on few compounds that are highly toxic, expensive and have a high rate of treatment failure. A number of recent studies on new drugs focuses on natural or semi-synthetic compounds. Among them, the endoperoxide artemisinin, extracted from Artemisia annua, and some of its derivatives have shown leishmanicidal activity. In the present work, a series of structurally simple, fully synthetic 1,2-dioxanes were evaluated for in vitro antileishmanial activity against promastigotes of Leishmania donovani; the cytotoxicity for mammalian cells was also assessed. The six most promising compounds in terms of activity and selectivity were further investigated for their antileishmanial activity on the promastigote forms of L. tropica, L. major and L. infantum and against L. donovani amastigotes. The good performance in terms of potency and selectivity makes these six hits promising candidates for a preliminary lead optimization as antileishmanial agents.
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Affiliation(s)
- M Ortalli
- Alma Mater Studiorum - University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine, Via Massarenti 9, 40138, Bologna, Italy
| | - S Varani
- Alma Mater Studiorum - University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine, Via Massarenti 9, 40138, Bologna, Italy; Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - C Rosso
- Alma Mater Studiorum - University of Bologna, Department of Chemistry "G. Ciamician", Via Selmi 2, 40126, Bologna, Italy
| | - A Quintavalla
- Alma Mater Studiorum - University of Bologna, Department of Chemistry "G. Ciamician", Via Selmi 2, 40126, Bologna, Italy.
| | - M Lombardo
- Alma Mater Studiorum - University of Bologna, Department of Chemistry "G. Ciamician", Via Selmi 2, 40126, Bologna, Italy
| | - C Trombini
- Alma Mater Studiorum - University of Bologna, Department of Chemistry "G. Ciamician", Via Selmi 2, 40126, Bologna, Italy
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42
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Lago TS, Silva JA, Lago EL, Carvalho EM, Zanette DL, Castellucci LC. The miRNA 361-3p, a Regulator of GZMB and TNF Is Associated With Therapeutic Failure and Longer Time Healing of Cutaneous Leishmaniasis Caused by L. (viannia) braziliensis. Front Immunol 2018; 9:2621. [PMID: 30487794 PMCID: PMC6247993 DOI: 10.3389/fimmu.2018.02621] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/25/2018] [Indexed: 12/16/2022] Open
Abstract
L. (viannia) braziliensis infection causes American Tegumentary Leishmaniasis (ATL), with prolonged time to healing lesions. The potent inflammatory response developed by the host is important to control the parasite burden and infection however an unbalanced immunity may cooperate to the tissue damage observed. The range of mechanisms underlying the pathological responses associated with ATL still needs to be better understood. That includes epigenetic regulation by non-coding MicroRNAs (miRNAs), non-coding sequences around 22 nucleotides that act as post-transcriptional regulators of RNAs encoding proteins. The miRNAs have been associated with diverse parasitic diseases, including leishmaniasis. Here we evaluated miRNAs that targeted genes expressed in cutaneous leishmaniasis lesions (CL) by comparing its expression in both CL and normal skin obtained from the same individual. In addition, we evaluated if the miRNAs expression would be correlated with clinical parameters such as therapeutic failure, healing time as well as lesion size. The miR-361-3p and miR-140-3p were significantly more expressed in CL lesions compared to normal skin samples (p = 0.0001 and p < 0.0001, respectively). In addition, the miR-361-3p was correlated with both, therapeutic failure and healing time of disease (r = 0.6, p = 0.003 and r = 0.5, p = 0.007, respectively). In addition, complementary analysis shown that miR-361-3p is able to identify with good sensitivity (81.2%) and specificity (100%) patients who tend to fail initial treatment with pentavalent antimonial (Sbv). Finally, the survival analysis considering “cure” as the endpoint showed that the higher the expression of miR-361-3p, the longer the healing time of CL. Overall, our data suggest the potential of miR-361-3p as a prognostic biomarker in CL caused by L. braziliensis.
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Affiliation(s)
- Tainã S Lago
- Serviço de Imunologia, Universidade Federal da Bahia, Salvador, Brazil.,Laboratório de Investigação em Genética e Hematologia Tanslacional do Instituto Gonçalo Moniz-Fiocruz-Ba, Salvador, Brazil
| | | | - Ednaldo L Lago
- Serviço de Imunologia, Universidade Federal da Bahia, Salvador, Brazil
| | - Edgar M Carvalho
- Serviço de Imunologia, Universidade Federal da Bahia, Salvador, Brazil.,Laboratório de Pesquisa Clínica (LAPEC) do Instituto Gonçalo Moniz-Fiocruz-Ba, Salvador, Brazil.,Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil.,Programa de Pós-graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Dalila L Zanette
- Laboratório de Investigação em Genética e Hematologia Tanslacional do Instituto Gonçalo Moniz-Fiocruz-Ba, Salvador, Brazil
| | - Léa Cristina Castellucci
- Serviço de Imunologia, Universidade Federal da Bahia, Salvador, Brazil.,Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil.,Programa de Pós-graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
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43
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Michelerio A, Barruscotti S, Bossi G, Brazzelli V. Pediatric Old World cutaneous leishmaniasis treated with oral fluconazole: A case series. Pediatr Dermatol 2018; 35:384-387. [PMID: 29582455 DOI: 10.1111/pde.13493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis has an incidence of 0.7-1.2 million cases per year and represents a growing concern in the outpatient dermatologic practice in Europe because of imported cases due to increased travel to risk areas and to immigration phenomena. When dealing with children, the treatment can be challenging because of side effects and pain of classic antimonial therapy leading to poor rates of course completion and requirement of sedation for several children. METHODS We retrospectively studied three cases of cutaneous leishmaniasis in pediatric patients, between the ages of 3 and 6 years of age, treated with oral fluconazole. We examined the efficacy, the tolerability, the safety profile and the cosmetic result of fluconazole at a dose of 6 mg/kg/daily for 6 weeks. RESULTS The patients had a complete resolution of their lesions with minimal scarring. No adverse effect was reported. The leishmaniasis species identified were L. major or L. tropica. CONCLUSION Considering sides effects and the parents' and the clinician's concern for systemic treatment in the pediatric population, fluconazole represents a valid, safe and easily manageable option for Old World cutaneous leishmaniasis in pediatric outpatients caused by L. major or L. tropica.
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Affiliation(s)
- Andrea Michelerio
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania Barruscotti
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Grazia Bossi
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Valeria Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Lago ASD, Nascimento M, Carvalho AM, Lago N, Silva J, Queiroz JR, Carvalho LP, Schriefer A, Wilson M, Machado P, Carvalho EM. The Elderly Respond to Antimony Therapy for Cutaneous Leishmaniasis Similarly to Young Patients but Have Severe Adverse Reactions. Am J Trop Med Hyg 2018; 98:1317-1324. [PMID: 29582733 DOI: 10.4269/ajtmh.17-0736] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
There is evidence that elderly patients with cutaneous leishmaniasis (CL) have more mucosal and disseminated diseases than young patients and their cells produce less antigen-induced interferon (IFN)-γ. Herein, we compared the roles of interleukin (IL)-10 and IL-15 as modulators of antigen-induced immune responses and the incidence of adverse reaction and response to therapy in young versus elderly patients with CL. Study participants included 35 senior (60-85 years) and 35 young (18-40 years) patients who had a diagnosis of CL documented by typical cutaneous lesions containing Leishmania braziliensis DNA. Elderly patients had less lymph node enlargement. Antigen-induced blood cell cytokine responses were studied in the absence or presence of IL-10 antibody or exogenously added recombinant IL-15. The ratio of IFN-γ/IL-10 was lower in elderly patients, and IFN-γ production was enhanced by either neutralization of IL-10 or exogenous recombinant IL-15 in blood cells from elderly but not young patients. Patients were treated three times weekly with antimony at 20 mg/kg/day for 20 doses. Although there was no difference in response to therapy between the two groups, two young patients needed rescue therapy with amphotericin B. Ventricular arrhythmias and ventricular overload were more frequent in elderly patients. We conclude that elderly patients have alterations in the immune response that may influence clinical manifestations, but we did not find that they had a higher failure rate than young subjects to antimony therapy. However, because of the high rate of electrocardiographic abnormalities during therapy, antimony should not be used in elderly patients with CL.
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Affiliation(s)
- Alexsandro Souza do Lago
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Maurício Nascimento
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Augusto M Carvalho
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Neuza Lago
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Juliana Silva
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - José Roberto Queiroz
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Lucas P Carvalho
- Laboratório de Pesquisas Clínicas do Instituto Gonçalo Moniz (IGM), Fiocruz, Salvador, Brazil.,CNPq/MCT, Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil.,Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Albert Schriefer
- CNPq/MCT, Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil.,Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Mary Wilson
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Paulo Machado
- CNPq/MCT, Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil.,Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Edgar M Carvalho
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Laboratório de Pesquisas Clínicas do Instituto Gonçalo Moniz (IGM), Fiocruz, Salvador, Brazil.,CNPq/MCT, Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Salvador, Brazil
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45
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Cota BB, Tunes LG, Maia DNB, Ramos JP, Oliveira DMD, Kohlhoff M, Alves TMDA, Souza-Fagundes EM, Campos FF, Zani CL. Leishmanicidal compounds of Nectria pseudotrichia, an endophytic fungus isolated from the plant Caesalpinia echinata (Brazilwood). Mem Inst Oswaldo Cruz 2018; 113:102-110. [PMID: 29236928 PMCID: PMC5722265 DOI: 10.1590/0074-02760170217] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/22/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In a screen of extracts from plants and fungi to detect antileishmanial activity, we found that the ethyl acetate extract of the fungus Nectria pseudotrichia, isolated from the tree Caesalpinia echinata (Brazilwood), is a promising source of bioactive compounds. OBJECTIVES The aims of this study were to isolate and determine the chemical structures of the compounds responsible for the antileishmanial activity of the organic extract from N. pseudotrichia. METHODS Compounds were isolated by chromatographic fractionation using semi-preparative high-performance liquid chromatography, and their chemical structures were determined by analytical and spectral data and by comparison with published data. The antileishmanial activity of the isolated compounds was evaluated in intracellular amastigote forms of Leishmania (Viannia) braziliensis expressing firefly luciferase as reporter gene, and cytotoxicity was determined in Vero and THP-1 mammalian cell lines by MTT assay. FINDINGS Fractionation of the extract yielded seven compounds: 10-acetyl trichoderonic acid A (1), 6'-acetoxy-piliformic acid (2), 5',6'-dehydropiliformic acid (3), piliformic acid (4), hydroheptelidic acid (5), xylaric acid D (6), and cytochalasin D (7). Compounds 1, 2 and 3 are reported here for the first time. Compounds 1, 2, and 5 were more active, with IC50 values of 21.4, 28.3, and 24.8 µM, respectively, and showed low toxicity to Vero and THP-1 cells. MAIN CONCLUSIONS N. pseudotrichia produces secondary metabolites that are more toxic to intracellular amastigote forms of L. (V.) braziliensis than to mammalian cells.
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Affiliation(s)
- Betania Barros Cota
- Laboratório de Química de Produtos Naturais Bioativos, Instituto René Rachou, Fundação Oswaldo Cruz-Fiocruz, Belo Horizonte, MG, Brasil
| | - Luiza Guimarães Tunes
- Laboratório de Genômica Funcional e Proteômica de Leishmania spp. e Trypanosoma cruzi, Instituto René Rachou, Fundação Oswaldo Cruz-Fiocruz, Belo Horizonte, MG, Brasil
| | - Daniela Nabak Bueno Maia
- Laboratório de Química de Produtos Naturais Bioativos, Instituto René Rachou, Fundação Oswaldo Cruz-Fiocruz, Belo Horizonte, MG, Brasil
| | - Jonas Pereira Ramos
- Departamento de Fisiologia e Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | - Markus Kohlhoff
- Laboratório de Química de Produtos Naturais Bioativos, Instituto René Rachou, Fundação Oswaldo Cruz-Fiocruz, Belo Horizonte, MG, Brasil
| | - Tânia Maria de Almeida Alves
- Laboratório de Química de Produtos Naturais Bioativos, Instituto René Rachou, Fundação Oswaldo Cruz-Fiocruz, Belo Horizonte, MG, Brasil
| | | | - Fernanda Fraga Campos
- Departamento de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brasil
| | - Carlos Leomar Zani
- Laboratório de Química de Produtos Naturais Bioativos, Instituto René Rachou, Fundação Oswaldo Cruz-Fiocruz, Belo Horizonte, MG, Brasil
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Francesconi VA, Francesconi F, Ramasawmy R, Romero GAS, Alecrim MDGC. Failure of fluconazole in treating cutaneous leishmaniasis caused by Leishmania guyanensis in the Brazilian Amazon: An open, nonrandomized phase 2 trial. PLoS Negl Trop Dis 2018; 12:e0006225. [PMID: 29481560 PMCID: PMC5854414 DOI: 10.1371/journal.pntd.0006225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 03/15/2018] [Accepted: 01/09/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The treatment of Leishmaniasis caused by Leishmania (Viannia) guyanensis is based on a weak strength of evidence from very few clinical trials and some case series reports. Current treatment guidelines recommend pentamidine isethionate or meglumine antimoniate (Glucantime) as the first-line choices. Both are parenteral drugs with a low therapeutic indexes leading to a high risk of undesired effects. Imidazole derivatives interfere with the production of leishmanial ergosterol, an essential component of their membrane structure. One drug that has been studied in different clinical presentations of Leishmania is fluconazole, a hydrophilic bis-triazole, which is easily absorbed through the oral route with a low toxicity profile and is considered safe for children. This drug is readily available in poor countries with a reasonable cost making it a potential option for treating leishmaniasis. METHODS AND FINDINGS An adaptive nonrandomized clinical trial with sequential groups with dose escalation of oral fluconazole was designed to treat adult men with localized cutaneous leishmaniasis (LCL) in Manaus, Brazil. Eligible participants were patients with LCL with confirmed Leishmania guyanensis infection. RESULTS Twenty adult male patients were treated with 450 mg of fluconazole daily for 30 days. One patient (5%) was cured within 30 days of treatment. Of the 19 failures (95%), 13 developed a worsening of ulcers and six evolved lymphatic spreading of the disease. Planned dose escalation was suspended after the disappointing failure rate during the first stage of the trial. CONCLUSION/SIGNIFICANCE Oral fluconazole, at the dose of 450mg per day, was not efficacious against LCL caused by Leishmania guyanensis in adult men. TRIAL REGISTRATION Brazilian Clinical Trial Registration (ReBec)-RBR-8w292w; UTN number-1158-2421.
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Affiliation(s)
- Valeska Albuquerque Francesconi
- Department of Dermatology, Academic and Research Division at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Fabio Francesconi
- Department of Dermatology, Academic and Research Division at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Rajendranath Ramasawmy
- Department of Molecular Biology, Division of Immunogenetics, at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado and Universidade Nilton Lins, Manaus, Amazonas, Brazil
| | | | - Maria das Graças Costa Alecrim
- Department of Infectology, Division of Malaria and Neglected Tropical Diseases at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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Galvão EL, Rabello A, Cota GF. Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis. PLoS One 2017; 12:e0186117. [PMID: 29016694 PMCID: PMC5633178 DOI: 10.1371/journal.pone.0186117] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background Several controlled and uncontrolled studies addressing azole antifungal drugs for cutaneous and mucosal leishmaniasis have been published with inconclusive results. We conducted a systematic literature review of studies evaluating the efficacy and toxicity associated with azole therapy for tegumentary leishmaniasis. Methodology PRISMA guidelines for systematic reviews and the Cochrane manual were followed, and the review methodology was registered (PROSPERO; CRD42016048668). Sources included the EMBASE, Web of Science, MEDLINE, LILACS, and IBECS databases along with a manual search of references from evaluated studies. Additional resources such as Google Scholar and clinicaltrials.gov were also searched. We included all studies reporting cure rate after cutaneous or mucosal leishmaniasis treatment with systemic azole drugs, regardless of their design. R software was used to estimate global rates of success and adverse events with each drug. The main outcome of interest was clinical cure, defined as complete re-epithelialization of all lesions. Results A total of 37 studies involving 1259 patients that reported outcomes after fluconazole (9), ketoconazole (14) and itraconazole (15) treatments were included. Only 14 (38%) were randomized controlled trials (RCT). The pooled azole final efficacy rate was 64% (CI95%: 57–70%) for all studies and 60% (CI95%: 50–70%) (p = 0.41) if only RCTs studies were considered. Twenty-four studies were conducted in the Old World and 13 studies in the Americas. The final efficacy rate according to New and Old World were 62% (CI95%: 43–77%) and 66% (CI95%: 58–73%), respectively. The final efficacy rate of azoles according to species were 89% (CI95%: 50–98%) for L. mexicana; 88% for L. infantum (CI95%: 27–99%); 80% for L. donovani; 53% (CI95%: 29–76%) for L. major; 49% for L. braziliensis (CI95%: 21–78%); and 15% (CI95%: 1–84%) for L. tropica. The cure rates were similar among the fluconazole, ketoconazole and itraconazole group arms (p = 0.89), specifically 61% (CI95%: 48–72%), 64% (CI95%: 44–80%) 65% (CI95%: 56–72%), respectively. Adverse events during fluconazole, itraconazole and ketoconazole therapy were reported in 7% (CI95%: 3–14%), 12% (CI95% 8–19%) and 13% (CI95%: 6–29%) of treated patients, respectively, without difference among them (p = 0.35). This systematic review included studies with small samples and both non-comparative and non-randomized studies and the main limitation was the low quality of the available studies. Conclusions Available evidence suggests that fluconazole, ketoconazole and itraconazole have similar and modest efficacy rates for tegumentary leishmaniasis treatment. There is insufficient evidence to support the exclusive use of azole therapy as a single agent for leishmaniasis treatment.
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Affiliation(s)
- Endi Lanza Galvão
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Ana Rabello
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Fernandes Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
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Abstract
Leishmaniasis is caused by an intracellular parasite transmitted to humans by the bite of a sand fly. It is endemic in Asia, Africa, the Americas, and the Mediterranean region. Worldwide, 1.5 to 2 million new cases occur each year, 350 million are at risk of acquiring the disease, and leishmaniasis causes 70,000 deaths per year. Clinical features depend on the species of
Leishmania involved and the immune response of the host. Manifestations range from the localized cutaneous to the visceral form with potentially fatal outcomes. Many drugs are used in its treatment, but the only effective treatment is achieved with current pentavalent antimonials.
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Affiliation(s)
- Edoardo Torres-Guerrero
- Sección de Micología, Hospital "Manuel Gea González" Secretaría de Salud, Calz. de Tlalpan 4800, Ciudad de México 14080, Mexico
| | | | - Julieta Ruiz-Esmenjaud
- Sección de Micología, Hospital "Manuel Gea González" Secretaría de Salud, Calz. de Tlalpan 4800, Ciudad de México 14080, Mexico
| | - Roberto Arenas
- Sección de Micología, Hospital "Manuel Gea González" Secretaría de Salud, Calz. de Tlalpan 4800, Ciudad de México 14080, Mexico
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