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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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da Costa CS, Marques EM, do Nascimento JR, Lima VAS, Santos-Oliveira R, Figueredo AS, de Jesus CM, de Souza Nunes GC, Brandão CM, de Jesus ET, Sa MC, Tanaka AA, Braga G, Santos ACF, de Lima RB, Silva LA, Alencar LMR, da Rocha CQ, Gonçalves RS. Design of Liquid Formulation Based on F127-Loaded Natural Dimeric Flavonoids as a New Perspective Treatment for Leishmaniasis. Pharmaceutics 2024; 16:252. [PMID: 38399306 PMCID: PMC10891960 DOI: 10.3390/pharmaceutics16020252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/04/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Infectious and Parasitic Diseases (IPD) remain a challenge for medicine due to several interconnected reasons, such as antimicrobial resistance (AMR). American tegumentary leishmaniasis (ATL) is an overlooked IPD causing persistent skin ulcers that are challenging to heal, resulting in disfiguring scars. Moreover, it has the potential to extend from the skin to the mucous membranes of the nose, mouth, and throat in both humans and various animals. Given the limited effectiveness and AMR of current drugs, the exploration of new substances has emerged as a promising alternative for ATL treatment. Arrabidaea brachypoda (DC). Bureau is a native Brazilian plant rich in dimeric flavonoids, including Brachydin (BRA), which displays antimicrobial activity, but still little has been explored regarding the development of therapeutic formulations. In this work, we present the design of a low-cost liquid formulation based on the use of Pluronic F127 for encapsulation of high BRA concentration (LF-B500). The characterization techniques revealed that BRA-loaded F127 micelles are well-stabilized in an unusual worm-like form. The in vitro cytotoxicity assay demonstrated that LF-B500 was non-toxic to macrophages but efficient in the inactivation of forms of Leishmania amazonensis promastigotes with IC50 of 16.06 µg/mL. The results demonstrated that LF-B500 opened a new perspective on the use of liquid formulation-based natural products for ATL treatment.
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Affiliation(s)
- Camila Silva da Costa
- Laboratory of Chemistry of Natural Products, Department of Chemistry, Federal University of Maranhão, São Luís 65080-805, Brazil; (C.S.d.C.); (E.M.M.); (J.R.d.N.); (V.A.S.L.); (C.Q.d.R.)
| | - Estela Mesquita Marques
- Laboratory of Chemistry of Natural Products, Department of Chemistry, Federal University of Maranhão, São Luís 65080-805, Brazil; (C.S.d.C.); (E.M.M.); (J.R.d.N.); (V.A.S.L.); (C.Q.d.R.)
| | - Jessyane Rodrigues do Nascimento
- Laboratory of Chemistry of Natural Products, Department of Chemistry, Federal University of Maranhão, São Luís 65080-805, Brazil; (C.S.d.C.); (E.M.M.); (J.R.d.N.); (V.A.S.L.); (C.Q.d.R.)
- Postgraduate Program in Chemistry, Institute of Chemistry, UNESP-Estadual University Paulista Júlio de Mesquita Filho, Araraquara 14800-060, Brazil
| | - Victor Antônio Silva Lima
- Laboratory of Chemistry of Natural Products, Department of Chemistry, Federal University of Maranhão, São Luís 65080-805, Brazil; (C.S.d.C.); (E.M.M.); (J.R.d.N.); (V.A.S.L.); (C.Q.d.R.)
| | - Ralph Santos-Oliveira
- Nuclear Engineering Institute, Brazilian Nuclear Energy Commission, Rio de Janeiro 21941-906, Brazil;
- Laboratory of Nanoradiopharmacy, Rio de Janeiro State University, Rio de Janeiro 23070-200, Brazil
| | - Aline Santana Figueredo
- Laboratory of Immunophysiology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (A.S.F.); (C.M.d.J.); (L.A.S.)
| | - Caroline Martins de Jesus
- Laboratory of Immunophysiology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (A.S.F.); (C.M.d.J.); (L.A.S.)
| | | | - Clenilma Marques Brandão
- Department of Chemistry, Federal Institute of Maranhão, São Luis 65075-441, Brazil; (C.M.B.); (E.T.d.J.); (M.C.S.)
| | - Edson Tobias de Jesus
- Department of Chemistry, Federal Institute of Maranhão, São Luis 65075-441, Brazil; (C.M.B.); (E.T.d.J.); (M.C.S.)
| | - Mayara Coelho Sa
- Department of Chemistry, Federal Institute of Maranhão, São Luis 65075-441, Brazil; (C.M.B.); (E.T.d.J.); (M.C.S.)
| | - Auro Atsushi Tanaka
- Department of Chemistry, Federal University of Maranhão, São Luís 65080-805, Brazil; (A.A.T.); (G.B.); (A.C.F.S.); (R.B.d.L.)
| | - Gustavo Braga
- Department of Chemistry, Federal University of Maranhão, São Luís 65080-805, Brazil; (A.A.T.); (G.B.); (A.C.F.S.); (R.B.d.L.)
| | - Ana Caroline Ferreira Santos
- Department of Chemistry, Federal University of Maranhão, São Luís 65080-805, Brazil; (A.A.T.); (G.B.); (A.C.F.S.); (R.B.d.L.)
| | - Roberto Batista de Lima
- Department of Chemistry, Federal University of Maranhão, São Luís 65080-805, Brazil; (A.A.T.); (G.B.); (A.C.F.S.); (R.B.d.L.)
| | - Lucilene Amorim Silva
- Laboratory of Immunophysiology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (A.S.F.); (C.M.d.J.); (L.A.S.)
| | | | - Cláudia Quintino da Rocha
- Laboratory of Chemistry of Natural Products, Department of Chemistry, Federal University of Maranhão, São Luís 65080-805, Brazil; (C.S.d.C.); (E.M.M.); (J.R.d.N.); (V.A.S.L.); (C.Q.d.R.)
| | - Renato Sonchini Gonçalves
- Laboratory of Chemistry of Natural Products, Department of Chemistry, Federal University of Maranhão, São Luís 65080-805, Brazil; (C.S.d.C.); (E.M.M.); (J.R.d.N.); (V.A.S.L.); (C.Q.d.R.)
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3
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Hughes K, Le TB, Van Der Smissen P, Tyteca D, Mingeot-Leclercq MP, Quetin-Leclercq J. The Antileishmanial Activity of Eugenol Associated with Lipid Storage Reduction Rather Than Membrane Properties Alterations. Molecules 2023; 28:molecules28093871. [PMID: 37175277 PMCID: PMC10179746 DOI: 10.3390/molecules28093871] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Leishmaniasis is a neglected tropical disease that still infects thousands of people per year throughout the world. The occurrence of resistance against major treatments for this disease causes a healthcare burden in low-income countries. Eugenol is a phenylpropanoid that has shown in vitro antileishmanial activity against Leishmania mexicana mexicana (Lmm) promastigotes with an IC50 of 2.72 µg/mL and a high selectivity index. Its specific mechanism of action has yet to be studied. We prepared large unilamellar vesicles (LUVs), mimicking Lmm membranes, and observed that eugenol induced an increase in membrane permeability and a decrease in membrane fluidity at concentrations much higher than IC50. The effect of eugenol was similar to the current therapeutic antibiotic, amphotericin B, although the latter was effective at lower concentrations than eugenol. However, unlike amphotericin B, eugenol also affected the permeability of LUVs without sterol. Its effect on the membrane fluidity of Lmm showed that at high concentrations (≥22.5× IC50), eugenol increased membrane fluidity by 20-30%, while no effect was observed at lower concentrations. Furthermore, at concentrations below 10× IC50, a decrease in metabolic activity associated with the maintenance of membrane integrity revealed a leishmaniostatic effect after 24 h of incubation with Lmm promastigotes. While acidocalcisomes distribution and abundance revealed by Trypanosoma brucei vacuolar H+ pyrophosphatase (TbVP1) immunolabeling was not modified by eugenol, a dose-dependent decrease of lipid droplets assessed by the Nile Red assay was observed. We hereby demonstrate that the antileishmanial activity of eugenol might not directly involve plasma membrane sterols such as ergosterol, but rather target the lipid storage of Lmm.
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Affiliation(s)
- Kristelle Hughes
- Pharmacognosy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Avenue E. Mounier 72, B1.72.03, B-1200 Brussels, Belgium
| | - Thanh Binh Le
- Pharmacognosy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Avenue E. Mounier 72, B1.72.03, B-1200 Brussels, Belgium
| | - Patrick Van Der Smissen
- CELL Unit and PICT Imaging Platform, de Duve Institute, Université Catholique de Louvain, Avenue Hippocrate 75, B1.75.05, B-1200 Brussels, Belgium
| | - Donatienne Tyteca
- CELL Unit and PICT Imaging Platform, de Duve Institute, Université Catholique de Louvain, Avenue Hippocrate 75, B1.75.05, B-1200 Brussels, Belgium
| | - Marie-Paule Mingeot-Leclercq
- Cellular and Molecular Pharmacology Unit (FACM), Louvain Drug Research Institute, Université Catholique de Louvain, Avenue E. Mounier 73, B1.73.05, B-1200 Brussels, Belgium
| | - Joëlle Quetin-Leclercq
- Pharmacognosy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Avenue E. Mounier 72, B1.72.03, B-1200 Brussels, Belgium
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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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Barba P, Morgado-Carrasco D, Quera A. [Translated article] Miltefosine to Treat Childhood Cutaneous Leishmaniasis. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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6
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Barba P, Morgado-Carrasco D, Quera A. Tratamiento de leishmaniasis cutánea infantil con miltefosina. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:827-831. [DOI: 10.1016/j.ad.2020.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/15/2020] [Accepted: 11/22/2020] [Indexed: 11/27/2022] Open
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Vital-Fujii DG, Baptista MS. Progress in the photodynamic therapy treatment of Leishmaniasis. ACTA ACUST UNITED AC 2021; 54:e11570. [PMID: 34730683 PMCID: PMC8555448 DOI: 10.1590/1414-431x2021e11570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/26/2021] [Indexed: 11/21/2022]
Abstract
Leishmaniasis is a serious and endemic infectious disease that has been reported in more than 90 countries and territories. The classical treatment presents a series of problems ranging from difficulty in administration, development of resistance, and a series of side effects. Photodynamic therapy (PDT) has already shown great potential for use as a treatment for leishmaniasis that is effective and non-invasive, with very minor side effects. PDT can also be inexpensive and easy to administer. In this review, we will report the most recent developments in the field, starting with the chemical diversity of photosensitizers, highlighting important mechanistic aspects, and noting information that may assist in designing and developing new and promising photosensitizer molecules.
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Affiliation(s)
- D G Vital-Fujii
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M S Baptista
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, SP, Brasil
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Cheng X, Gao J, Ding Y, Lu Y, Wei Q, Cui D, Fan J, Li X, Zhu E, Lu Y, Wu Q, Li L, Huang W. Multi-Functional Liposome: A Powerful Theranostic Nano-Platform Enhancing Photodynamic Therapy. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2100876. [PMID: 34085415 PMCID: PMC8373168 DOI: 10.1002/advs.202100876] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/11/2021] [Indexed: 05/05/2023]
Abstract
Although photodynamic therapy (PDT) has promising advantages in almost non-invasion, low drug resistance, and low dark toxicity, it still suffers from limitations in the lipophilic nature of most photosensitizers (PSs), short half-life of PS in plasma, poor tissue penetration, and low tumor specificity. To overcome these limitations and enhance PDT, liposomes, as excellent multi-functional nano-carriers for drug delivery, have been extensively studied in multi-functional theranostics, including liposomal PS, targeted drug delivery, controllable drug release, image-guided therapy, and combined therapy. This review provides researchers with a useful reference in liposome-based drug delivery.
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Affiliation(s)
- Xiamin Cheng
- Institute of Advanced SynthesisSchool of Chemistry and Molecular EngineeringNanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Jing Gao
- Institute of Advanced SynthesisSchool of Chemistry and Molecular EngineeringNanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Yang Ding
- Key Laboratory of Flexible Electronics (KLOFE) & Institute of Advanced Materials (IAM)Nanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Yao Lu
- Key Laboratory of Flexible Electronics (KLOFE) & Institute of Advanced Materials (IAM)Nanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Qiancheng Wei
- Institute of Advanced SynthesisSchool of Chemistry and Molecular EngineeringNanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Dezhi Cui
- Institute of Advanced SynthesisSchool of Chemistry and Molecular EngineeringNanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Jiali Fan
- Institute of Advanced SynthesisSchool of Chemistry and Molecular EngineeringNanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Xiaoman Li
- Institute of Advanced SynthesisSchool of Chemistry and Molecular EngineeringNanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Ershu Zhu
- Institute of Advanced SynthesisSchool of Chemistry and Molecular EngineeringNanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Yongna Lu
- Institute of Advanced SynthesisSchool of Chemistry and Molecular EngineeringNanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Qiong Wu
- Key Laboratory of Flexible Electronics (KLOFE) & Institute of Advanced Materials (IAM)Nanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Lin Li
- Key Laboratory of Flexible Electronics (KLOFE) & Institute of Advanced Materials (IAM)Nanjing Tech University (NanjingTech)Nanjing211816P. R. China
| | - Wei Huang
- Key Laboratory of Flexible Electronics (KLOFE) & Institute of Advanced Materials (IAM)Nanjing Tech University (NanjingTech)Nanjing211816P. R. China
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Chazapi E, Magoulas GE, Prousis KC, Calogeropoulou T. Phospholipid Analogues as Chemotherapeutic Agents Against Trypanosomatids. Curr Pharm Des 2021; 27:1790-1806. [PMID: 33302850 DOI: 10.2174/1381612826666201210115340] [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: 08/10/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neglected tropical diseases (NTDs) represent a serious problem in a number of countries around the world and especially in Africa and South America, affecting mostly the poor population which has limited access to the healthcare system. The drugs currently used for the treatment of NTDs are dated many decades ago and consequently, present in some cases very low efficacy, high toxicity and development of drug resistance. In the search for more efficient chemotherapeutic agents for NTDs, a large number of different compound classes have been synthesized and tested. Among them, ether phospholipids, with their prominent member miltefosine, are considered one of the most promising. OBJECTIVE This review summarizes the literature concerning the development of antiparasitic phospholipid derivatives, describing the efforts towards more efficient and less toxic analogues while providing an overview of the mechanism of action of this compound class against trypanosomatids. CONCLUSION Phospholipid analogues are already known for their antiprotozoal activity. Several studies have been conducted in order to synthesize novel derivatives with the aim to improve current treatments such as miltefosine, with promising results. Photolabeling and fluorescent alkyl phospholipid analogues have contributed to the clarification of the mode of action of this drug family.
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Affiliation(s)
- Evanthia Chazapi
- Institute of Chemical Biology, National Hellenic Research Foundation, 48 Vas, Constantinou Av., 11635, Athens, Greece
| | - George E Magoulas
- Institute of Chemical Biology, National Hellenic Research Foundation, 48 Vas, Constantinou Av., 11635, Athens, Greece
| | - Kyriakos C Prousis
- Institute of Chemical Biology, National Hellenic Research Foundation, 48 Vas, Constantinou Av., 11635, Athens, Greece
| | - Theodora Calogeropoulou
- Institute of Chemical Biology, National Hellenic Research Foundation, 48 Vas, Constantinou Av., 11635, Athens, Greece
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10
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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: 5] [Impact Index Per Article: 1.3] [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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11
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Hirabayashi KE, Lin CC, Ta CN. Oral miltefosine for refractory Acanthamoeba keratitis. Am J Ophthalmol Case Rep 2019; 16:100555. [PMID: 31650083 PMCID: PMC6804782 DOI: 10.1016/j.ajoc.2019.100555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 07/24/2019] [Accepted: 09/16/2019] [Indexed: 11/03/2022] Open
Abstract
Purpose To report the first case of Acanthamoeba keratitis treated with oral miltefosine in the United States. Observations A 17-year-old female with a history of orthokeratology contact lens wear presented after five months of left eye pain, redness, and photophobia. She was previously treated with antivirals and topical corticosteroids for presumed herpetic disease. She was found to have a large central ring infiltrate and corneal cultures were positive for Acanthamoeba. The infection progressed despite hourly PHMB 0.02% and chlorhexidine 0.02%, and oral vorizonazole. The patient was started on oral miltefosine 50 mg 3 times per day. Following one week of treatment, repeat cultures were positive for Acanthamoeba and therefore, the concentration of chlorhexidine was increased from 0.02% to 0.06% and PHMB was changed to propamidine isetionate (Brolene 0.1%). There was definite clinical improvement after five weeks of treatment with oral miltefosine, topical chlorhexidine 0.06% and propamidine isetionate 0.1%. Conclusions and importance Acanthamoeba keratitis is a challenging entity to treat and often associated with a poor prognosis. Oral miltefosine may offer additional therapeutic benefit in cases of refractory Acanthamoeba keratitis.
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Affiliation(s)
- Kristin E Hirabayashi
- Department of Ophthalmology, Stanford University, Byers Eye Institute, 2452 Watson Ct, Palo Alto, CA, 94303, USA
| | - Charles C Lin
- Department of Ophthalmology, Stanford University, Byers Eye Institute, 2452 Watson Ct, Palo Alto, CA, 94303, USA
| | - Christopher N Ta
- Department of Ophthalmology, Stanford University, Byers Eye Institute, 2452 Watson Ct, Palo Alto, CA, 94303, USA
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12
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Cargnin ST, Staudt AF, Menezes C, Azevedo APD, Fialho SN, Tasca T, Teles CBG, Gnoatto SB. Evaluation of triterpenes derivatives in the viability of Leishmania amazonensis and Trichomonas vaginalis. BRAZ J PHARM SCI 2019. [DOI: 10.1590/s2175-97902019000317481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | | | - Tiana Tasca
- Federal University of Rio Grande do Sul (UFRGS), Brazil
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13
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Rugani JN, Quaresma PF, Gontijo CF, Soares RP, Monte-Neto RL. Intraspecies susceptibility of Leishmania (Viannia) braziliensis to antileishmanial drugs: Antimony resistance in human isolates from atypical lesions. Biomed Pharmacother 2018; 108:1170-1180. [PMID: 30372818 DOI: 10.1016/j.biopha.2018.09.149] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/21/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
Leishmania (Viannia) braziliensis is the most common etiological agent of cutaneous and mucocutaneous leishmaniasis (MCL) in Latin America. An interesting aspect of the disease outcome caused by this species is the appearance of non-ulcerated atypical cutaneous leishmaniasis. Atypical (AT) lesions are often associated with therapeutic failure when treated with antimony(Sb)-based drugs. Refractory cases are not necessarily due to intrinsic parasite drug resistance. The status of in vitro drug susceptibility from L. braziliensis field isolates is less assessed than patient treatment outcome. In this work, L. braziliensis isolated from typical CL (6), MCL (1) and AT (3) lesions and vector (1) were tested for their susceptibility to amphotericin B (AmB), miltefosine (MIL), glucantime (GLU) and non-comercial meglumine antimoniate (MA). Overall, intracellular amastigotes of all isolates were sensitive to the tested antileishmanial drugs except AT lesions-derived strains 316, 330 and 340 that presented in vitro resistance against SbV-based drugs. Although susceptible to miltefosine - based on phenotypic screening - intramacrophagic quiescent amastigotes could restore infection. L. braziliensis promastigotes isolated from AT lesions also displayed 29% reduced capacity to infect human monocyte-derived macrophages when compared with parasites obtained from patients with typical lesions, MCL or from sand-fly. These data indicate differences in drug susceptibility and infectiveness among L. braziliensis isolated from patients exhibiting different types of lesions and highlight the importance of its characterization for drug response prediction outcome in clinical practice.
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Affiliation(s)
- Jeronimo N Rugani
- Instituto René Rachou - Fiocruz Minas, Av. Augusto de Lima, 1715, 30190-009, Belo Horizonte, MG, Brazil.
| | - Patrícia F Quaresma
- Instituto René Rachou - Fiocruz Minas, Av. Augusto de Lima, 1715, 30190-009, Belo Horizonte, MG, Brazil.
| | - Célia F Gontijo
- Instituto René Rachou - Fiocruz Minas, Av. Augusto de Lima, 1715, 30190-009, Belo Horizonte, MG, Brazil.
| | - Rodrigo P Soares
- Instituto René Rachou - Fiocruz Minas, Av. Augusto de Lima, 1715, 30190-009, Belo Horizonte, MG, Brazil.
| | - Rubens L Monte-Neto
- Instituto René Rachou - Fiocruz Minas, Av. Augusto de Lima, 1715, 30190-009, Belo Horizonte, MG, Brazil.
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14
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Ventin F, Cincurá C, Machado PRL. Safety and efficacy of miltefosine monotherapy and pentoxifylline associated with pentavalent antimony in treating mucosal leishmaniasis. Expert Rev Anti Infect Ther 2018; 16:219-225. [PMID: 29411659 DOI: 10.1080/14787210.2018.1436967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Mucosal Leishmaniasis (ML) is a difficult to treat and severe form of Leishmaniasis. In general, more than 40% of subjects with ML have therapeutic failure upon the use of pentavalent antimony (Sbv) at 20mg/kg/day during 30 days. Additionally, Sbv is a toxic drug that requires parenteral administration, and many patients will need several courses to be cured. In cases that cannot be treated or cured by Sbv, the alternative is amphotericin B, another toxic and parenteral drug. As a consequence, many ML patients will be cured only after years of disease and may present several morbidities due to the aggressiveness of the disease or toxicity related to the treatment. Areas covered: We aimed to review clinical trials with Miltefosine or Sbv associated with pentoxifylline in the treatment of ML. Expert commentary: There are few studies to define more effective and safer therapy in mucosal disease caused by Leishmania, with an urgent need to supporting and funding well designed trials. Miltefosine monotherapy, as well as pentoxifylline combined with Sbv are promising therapeutic approaches to increase the cure rate of this neglected disease.
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Affiliation(s)
- Fernanda Ventin
- a Serviço de Imunologia , Complexo Hospitalar Universitário Professor Edgard Santos , Salvador , Brazil
| | - Carolina Cincurá
- a Serviço de Imunologia , Complexo Hospitalar Universitário Professor Edgard Santos , Salvador , Brazil
| | - Paulo Roberto Lima Machado
- a Serviço de Imunologia , Complexo Hospitalar Universitário Professor Edgard Santos , Salvador , Brazil.,b Serviço de Imunologia , National Institute of Science and Technology in Tropical Diseases (INCT-DT), CNPq/MCT , Salvador , Brazil
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15
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Amorim CF, Galina L, Carvalho NB, Sperotto NDM, Pissinate K, Machado P, Campos MM, Basso LA, Rodrigues-Junior VS, Carvalho EM, Santos DS. Inhibitory activity of pentacyano(isoniazid)ferrate(II), IQG-607, against promastigotes and amastigotes forms of Leishmania braziliensis. PLoS One 2017; 12:e0190294. [PMID: 29281707 PMCID: PMC5745003 DOI: 10.1371/journal.pone.0190294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/12/2017] [Indexed: 12/21/2022] Open
Abstract
M. tuberculosis and parasites of the genus Leishmania present the type II fatty acid biosynthesis system (FASII). The pentacyano(isoniazid)ferrate(II) compound, named IQG-607, inhibits the enzyme 2-trans-enoyl-ACP(CoA) reductase from M. tuberculosis, a key component in the FASII system. Here, we aimed to evaluate the inhibitory activity of IQG-607 against promastigote and amastigote forms of Leishmania (Viannia) braziliensis isolated from patients with different clinical forms of L. braziliensis infection, including cutaneous, mucosal and disseminated leishmaniasis. Importantly, IQG-607 inhibited the proliferation of three different isolates of L. braziliensis promastigotes associated with cutaneous, mucosal and disseminated leishmaniasis. The IC50 values for IQG-607 ranged from 32 to 75 μM, for these forms. Additionally, IQG-607 treatment decreased the proliferation of intracellular amastigotes in infected macrophages, after an analysis of the percentage of infected cells and the number of intracellular parasites/100 cells. IQG-607 reduced from 58% to 98% the proliferation of L. braziliensis from cutaneous, mucosal and disseminated strains. Moreover, IQG-607 was also evaluated regarding its potential toxic profile, by using different cell lines. Cell viability of the lineages Vero, HaCat and HepG2 was significantly reduced after incubation with concentrations of IQG-607 higher than 2 mM. Importantly, IQG-607, in a concentration of 1 mM, did not induce DNA damage in HepG2 cells, when compared to the untreated control group. Future studies will confirm the mechanism of action of IQG-607 against L. braziliensis.
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Affiliation(s)
- Camila F. Amorim
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Luiza Galina
- Centro de Pesquisas em Biologia Molecular e Funcional, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, PUCRS, Porto Alegre, Brazil
| | - Natália B. Carvalho
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Nathalia D. M. Sperotto
- Centro de Pesquisas em Biologia Molecular e Funcional, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Programa de Pós-Graduação em Medicina e Ciências da Saúde, PUCRS, Porto Alegre, Brazil
| | - Kenia Pissinate
- Centro de Pesquisas em Biologia Molecular e Funcional, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Pablo Machado
- Centro de Pesquisas em Biologia Molecular e Funcional, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, PUCRS, Porto Alegre, Brazil
| | - Maria M. Campos
- Programa de Pós-Graduação em Medicina e Ciências da Saúde, PUCRS, Porto Alegre, Brazil
- Instituto de Toxicologia e Farmacologia, PUCRS, Porto Alegre, Brazil
| | - Luiz A. Basso
- Centro de Pesquisas em Biologia Molecular e Funcional, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, PUCRS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Medicina e Ciências da Saúde, PUCRS, Porto Alegre, Brazil
| | - Valnês S. Rodrigues-Junior
- Centro de Pesquisas em Biologia Molecular e Funcional, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Programa de Pós-Graduação em Medicina e Ciências da Saúde, PUCRS, Porto Alegre, Brazil
- * E-mail: (EMC); (VSRJ)
| | - Edgar M. Carvalho
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Salvador, Bahia, Brazil
- Instituto de Pesquisa Gonçalo Muniz – Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- * E-mail: (EMC); (VSRJ)
| | - Diógenes Santiago Santos
- Centro de Pesquisas em Biologia Molecular e Funcional, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, PUCRS, Porto Alegre, Brazil
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16
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Handler MZ, Patel PA, Kapila R, Al-Qubati Y, Schwartz RA. Cutaneous and mucocutaneous leishmaniasis: Differential diagnosis, diagnosis, histopathology, and management. J Am Acad Dermatol 2016; 73:911-26; 927-8. [PMID: 26568336 DOI: 10.1016/j.jaad.2014.09.014] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/03/2014] [Accepted: 09/05/2014] [Indexed: 12/25/2022]
Abstract
The diagnosis of leishmaniasis can be challenging because it mimics both infectious and malignant conditions. A misdiagnosis may lead to an unfavorable outcome. Using culture, histologic, and/or polymerase chain reaction study results, a diagnosis of leishmaniasis can be established and treatment initiated. Appropriate management requires an accurate diagnosis, which often includes identification of the specific etiologic species. Different endemic areas have varying sensitivities to the same medication, even within individual species. Species identification may be of practical value, because infections with select species have a substantial risk of visceral involvement. In addition, HIV and otherwise immunocompromised patients with leishmaniasis have a propensity for diffuse cutaneous leishmaniasis. For most New World Leishmania species, parenteral antimonial drugs remain the first line of therapy, while Old World species are easily treated with physical modalities. Historically, live organism vaccination has been used and is effective in preventing leishmaniasis, but results in an inoculation scar and an incubation period that may last for years. A more effective method of vaccination would be welcome.
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Affiliation(s)
- Marc Z Handler
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Parimal A Patel
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Rajendra Kapila
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey; Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Robert A Schwartz
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey; Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, New Jersey; Rutgers School of Public Affairs and Administration, Newark, New Jersey.
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17
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de Morais-Teixeira E, Aguiar MG, Soares de Souza Lima B, Ferreira LAM, Rabello A. Combined suboptimal schedules of topical paromomycin, meglumine antimoniate and miltefosine to treat experimental infection caused by Leishmania (Viannia) braziliensis. J Antimicrob Chemother 2015; 70:3283-90. [PMID: 26346991 DOI: 10.1093/jac/dkv254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 07/21/2015] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the efficacy of binary combinations of suboptimal schedules of drugs with different administration routes (topical paromomycin, intramuscular meglumine antimoniate and oral miltefosine) to treat animals infected with Leishmania (Viannia) braziliensis. METHODS Hamsters were inoculated with L. (V.) braziliensis and after ulceration of lesions, divided into seven groups: untreated control, paromomycin, miltefosine, meglumine antimoniate, meglumine antimoniate + paromomycin, miltefosine + paromomycin and meglumine antimoniate + miltefosine. Meglumine antimoniate and miltefosine were administered at low doses and topical paromomycin at a single daily application regimen. The animals were treated for 20 consecutive days (meglumine antimoniate and/or paromomycin) and/or 10 alternate days (miltefosine). Lesion sizes were determined weekly. Upon completion of treatment, parasites were recovered from skin lesions and spleens and evaluated by limiting dilution assay. RESULTS The combinations of a once daily application of paromomycin with low doses of miltefosine or meglumine antimoniate yielded higher efficacies in reducing the parasite load as well as lesion size when compared with any of these drugs administered as monotherapy regimens at the same suboptimal schedules. CONCLUSIONS Considering the parameters evaluated, the combinations of a systemic therapy with topical treatment were more effective than monotherapy with each of these drugs. These combinations may represent an alternative combination strategy for the treatment of leishmaniasis caused by L. (V.) braziliensis.
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Affiliation(s)
- Eliane de Morais-Teixeira
- Laboratório de Pesquisas Clínicas-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Marta Gontijo Aguiar
- Laboratório de Pesquisas Clínicas-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil Department of Pharmaceutics, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Soares de Souza Lima
- Laboratório de Pesquisas Clínicas-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Antônio Miranda Ferreira
- Department of Pharmaceutics, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Rabello
- Laboratório de Pesquisas Clínicas-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz-FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
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18
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Ribeiro JBP, Miranda-Vilela AL, Graziani D, Gomes MRDA, Amorim AAS, Garcia RD, de Souza Filho J, Tedesco AC, Primo FL, Moreira JR, Lima AV, Sampaio RNR. Evaluation of the efficacy of systemic miltefosine associated with photodynamic therapy with liposomal chloroaluminium phthalocyanine in the treatment of cutaneous leishmaniasis caused by Leishmania (L.) amazonensis in C57BL/6 mice. Photodiagnosis Photodyn Ther 2015; 13:282-290. [PMID: 26306406 DOI: 10.1016/j.pdpdt.2015.08.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 08/16/2015] [Accepted: 08/19/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND The shortage of drugs is a concern and has become the object of studies to discover effective alternatives for cutaneous leishmaniasis (CL) treatment. A topical formulation has been sought due to its low toxicity. Development of alternative therapies, such as multimodal ones, is important in confronting drug resistance. This study aims to compare the in vivo efficacy of topical photodynamic therapy (PDT) using liposomal chloroaluminium phthalocyanine (AlClPC) in the treatment of CL, isolated and associated with systemic therapy with miltefosine. METHODS Five groups were adopted, each one with six isogenic adult female mice C57BL/6: (1) Negative Control-non-infected and non-treated; (2) Positive Control (PBS)-infected and non-treated; (3) Miltefosine-infected and treated with oral miltefosine 200 mg/kg/day; (4) Infected and treated with PDT with topical AlClPC (500 μL) on alternate days; (5) Oral Miltefosine 200 mg/kg/day and PDT with topical AlClPC (500 μL) on alternate days. Therapeutic schemes lasted 20 days. Infection was confirmed by culture in Nove-McNeal-Nicolle medium (NNN) of lymph collected from the animal paw, and animals were evaluated by paw measurement and parasitological criteria. RESULTS Miltefosine associated with PDT with AlClPC promoted a significant reduction in parasite number and viability when compared to the other infected groups, also returning the paw diameter to a size similar to the negative control group after 20 days of treatment. CONCLUSIONS Association of miltefosine with PDT mediated by topical AlClPC represents hopes for CL treatment, an increasing dermatological disease in some countries.
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Affiliation(s)
- Jefferson Bruno Pereira Ribeiro
- Faculdade de Medicina, Laboratório de Dermatomicologia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, 70910-900 Brasília/DF, Brazil
| | - Ana Luisa Miranda-Vilela
- Instituto de Ciências Biológicas, Departamento de Genética e Morfologia, Universidade de Brasília, Campus Darcy Ribeiro, 70910-900 Brasília/DF, Brazil; Faculdades Integradas da União Educacional do Planalto Central (Faciplac), Curso de Medicina, Campus Gama, 72460-000 Gama/DF, Brazil.
| | - Daniel Graziani
- Faculdade de Medicina, Laboratório de Dermatomicologia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, 70910-900 Brasília/DF, Brazil
| | | | - Ana Angélica Santarem Amorim
- Faculdade de Medicina, Laboratório de Dermatomicologia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, 70910-900 Brasília/DF, Brazil
| | - Rafaela Debastiani Garcia
- Faculdade de Medicina, Laboratório de Dermatomicologia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, 70910-900 Brasília/DF, Brazil
| | - José de Souza Filho
- Instituto de Ciências Biológicas, Departamento de Genética e Morfologia, Universidade de Brasília, Campus Darcy Ribeiro, 70910-900 Brasília/DF, Brazil
| | - Antônio Cláudio Tedesco
- Departamento de Química, Laboratório de Fotobiologia e Fotomedicina, Centro de Nanotecnologia e Engenharia Tecidual, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, 14040-901 Ribeirão Preto-SP, Brazil
| | - Fernando Lucas Primo
- Departamento de Química, Laboratório de Fotobiologia e Fotomedicina, Centro de Nanotecnologia e Engenharia Tecidual, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, 14040-901 Ribeirão Preto-SP, Brazil
| | - Jonathan Rosa Moreira
- Faculdades Projeção, Núcleo de Desenvolvimento Científico (NDC), 72115-700 Taguatinga/DF, Brazil
| | - Alexandre Vasconcelos Lima
- Instituto Brasileiro de Segurança no Trânsito, SRTVS Quadra 701 Bloco 3, Cobertura, Edificio Palácio do Rádio I, Asa Sul, 70340-901 Brasília/DF, Brazil
| | - Raimunda Nonata Ribeiro Sampaio
- Faculdade de Medicina, Laboratório de Dermatomicologia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, 70910-900 Brasília/DF, Brazil
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19
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Toledo Junior A, Daher AB, Amaral TA, Carvalho SFG, Romero GAS, Rabello A. Poor response to azithromycin in cutaneous leishmaniasis leading to a premature interruption of a multicentric phase III clinical trial in Brazil. Rev Soc Bras Med Trop 2015; 47:756-62. [PMID: 25626655 DOI: 10.1590/0037-8682-0266-2014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/08/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction Parenteral antimony-based compounds are still the standard of care for cutaneous leishmaniasis (CL) treatment in many countries, despite their high toxicity. Previous studies showed that oral azithromycin could be an option for CL treatment. The aim of this study was to evaluate efficacy and safety of oral azithromycin (AZ) for CL treatment compared with injectable meglumine antimoniate (MA). Methods This was a randomized, open-label, 2-arm, non-inferiority clinical trial. Treatment-naïve patients with localized CL were treated with MA (15mg/kg/day up to 1,215mg) or AZ (500mg/day) during 20 consecutive days. The primary efficacy end point was a CL cure 90 days after treatment completion. The analysis was performed with intention-to-treat (ITT) and per protocol (PP) analyses. After an anticipated interim analysis, the study was interrupted due to the high failure rate in the azithromycin group. Results Twenty-four volunteers were included in each group. The MA group had a higher cure rate than the AZ group with the ITT and PP analyses, which were 54.2% versus 20.8% [relative risk (RR) 1.97; 95% confidence intervals (95%CI) 1.13-3.42] and 72.2% versus 23.8% (RR 3.03; 95%CI 1.34-6.87), respectively. No unexpected adverse events were observed. Conclusions Azithromycin is ineffective for CL treatment and does not seem to have a role in the therapeutic arsenal for CL.
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Affiliation(s)
- Antonio Toledo Junior
- Serviço Multiprofissional de Infectologia, Universidade José do Rosário Vellano, Belo Horizonte, MG, BRAZIL
| | - André Bastos Daher
- Plataforma de Pesquisa Clínica, Vice-Presidência de Pesquisa e Laboratórios de Referência, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Thaís Alves Amaral
- Plataforma de Pesquisa Clínica, Vice-Presidência de Pesquisa e Laboratórios de Referência, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Sílvio Fernando Guimarães Carvalho
- Departamento de Doenças Infecciosas, Hospital Universitário Clemente de Faria, Universidade Estadual de Montes Claros, Montes Claros, MG, Brasil
| | | | - Ana Rabello
- Laboratório de Pesquisa Clínica, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, BRAZIL
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20
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Teles CBG, Moreira-Dill LS, Silva ADA, Facundo VA, de Azevedo WF, da Silva LHP, Motta MCM, Stábeli RG, Silva-Jardim I. A lupane-triterpene isolated from Combretum leprosum Mart. fruit extracts that interferes with the intracellular development of Leishmania (L.) amazonensis in vitro. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:165. [PMID: 26048712 PMCID: PMC4457080 DOI: 10.1186/s12906-015-0681-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 05/20/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND 3beta,6beta,16beta-trihydroxylup-20(29)-ene is a lupane triterpene isolated from Combretum leprosum fruit. The lupane group has been extensively used in studies on anticancer effects; however, its possible activity against protozoa parasites is yet poorly known. The high toxicity of the compounds currently used in leishmaniasis chemotherapy stimulates the investigation of new molecules and drug targets for antileishmanial therapy. METHODS The activity of 3beta,6beta,16beta-trihydroxylup-20(29)-ene was evaluated against Leishmania (L.) amazonensis by determining the cytotoxicity of the compound on murine peritoneal macrophages, as well as its effects on parasite survival inside host cells. To evaluate the effect of this compound on intracellular amastigotes, cultures of infected macrophages were treated for 24, 48 and 96 h and the percentage of infected macrophages and the number of intracellular parasites was scored using light microscopy. RESULTS Lupane showed significant activity against the intracellular amastigotes of L. (L.) amazonensis. The treatment with 109 μM for 96 h reduced in 80 % the survival index of parasites in BALB/c peritoneal macrophages. At this concentration, the triterpene caused no cytotoxic effects against mouse peritoneal macrophages. Ultrastructural analyses of L. (L.) amazonensis intracellular amastigotes showed that lupane induced some morphological changes in parasites, such as cytosolic vacuolization, lipid body formation and mitochondrial swelling. Bioinformatic analyses through molecular docking suggest that this lupane has high-affinity binding with DNA topoisomerase. CONCLUSION Taken together, our results have showed that the lupane triterpene from C. leprosum interferes with L. (L.) amazonensis amastigote replication and survival inside vertebrate host cells and bioinformatics analyses strongly indicate that this molecule may be a potential inhibitor of topoisomerase IB. Moreover, this study opens major prospects for the development of novel chemotherapeutic agents with leishmanicidal activity.
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Affiliation(s)
- Carolina Bioni Garcia Teles
- Malaria and Leishmaniasis Bioassays platform, Oswaldo Cruz Foundation (Fiocruz Rondônia), Porto Velho, Rondônia, Brazil.
| | - Leandro Soares Moreira-Dill
- Center of Studies for Biomolecules Applied to Health (CEBio), Oswaldo Cruz Foundation (Fiocruz Rondônia), Porto Velho, Rondônia, Brazil.
| | - Alexandre de Almeida Silva
- Laboratory of Insect Bioecology, Universidade Federal de Rondônia (UNIR), Porto Velho, Rondônia, Brazil.
- Laboratory of Medical Entomology, Oswaldo Cruz Foundation (Fiocruz Rondônia), Porto Velho, Rondônia, Brazil.
| | - Valdir Alves Facundo
- Research Laboratory of Chemistry of Natural Products, Universidade Federal de Rondônia (UNIR), Porto Velho, Rondônia, Brazil.
| | - Walter F de Azevedo
- Structural Biochemistry Laboratory, PUC, Rio Grande do Sul, Porto Alegre, Brazil.
| | - Luiz Hildebrando Pereira da Silva
- Laboratory of Molecular Epidemiology, Research Institute for Tropical Diseases in Rondônia (IPEPATRO), Porto Velho, Rondônia, Brazil.
| | - Maria Cristina M Motta
- Laboratory of Cellular Ultrastructure Hertha Meyer, Institute of Biophysics, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | - Rodrigo Guerino Stábeli
- Center of Studies for Biomolecules Applied to Health (CEBio), Oswaldo Cruz Foundation (Fiocruz Rondônia), Porto Velho, Rondônia, Brazil.
| | - Izaltina Silva-Jardim
- Department of Biological Sciences, Universidade Estadual de Santa Cruz (UESC), Ilheús, Bahia, Brazil.
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Eiras DP, Kirkman LA, Murray HW. Cutaneous Leishmaniasis: Current Treatment Practices in the USA for Returning Travelers. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2015; 7:52-62. [PMID: 25788870 DOI: 10.1007/s40506-015-0038-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Leishmaniasis, a protozoal infection transmitted by sandfly bite, produces a clinical spectrum of disease ranging from asymptomatic infection to ulcerative skin and mucosal lesions to visceral involvement. Leishmaniasis is endemic in regions of Africa, the Middle East, south Asia, southern Europe, northern South America, and Central America. There has been an increase in imported leishmaniasis into developed, non-endemic countries due to increasing global travel. While pentavalent antimonials have been the mainstay of antileishmanial treatment for decades, newer therapeutic options have become available for all forms of infection, including liposomal amphotericin B, miltefosine, fluconazole, and ketoconazole. For the returning traveler with cutaneous leishmaniasis in the USA, treatment approaches are determined based on infecting species, initial presentation, extent and progression of disease, the advantages and drawbacks of available parenteral and oral drugs, and clinician-consultant experience.
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Munoz C, Alzoubi K, Jacobi J, Abed M, Lang F. Effect of miltefosine on erythrocytes. Toxicol In Vitro 2013; 27:1913-9. [PMID: 23811261 DOI: 10.1016/j.tiv.2013.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 05/10/2013] [Accepted: 06/18/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND Miltefosine, an alkylphosphocholine drug with antiparasite, antibacterial, antifungal and antineoplastic potency, is the only oral drug that can be used to treat visceral and cutaneous leishmaniasis. The effect of miltefosine is at least partially due to triggering of apoptosis. Similar to apoptosis of nucleated cells, erythrocytes may enter suicidal death or eryptosis, which is characterized by cell shrinkage and by cell membrane scrambling with phosphatidylserine-exposure at the erythrocyte surface. Eryptosis may be triggered following increase of cytosolic Ca(2+)-level ([Ca(2+)]i). The present study explored, whether miltefosine elicits eryptosis. METHODS Cell volume has been estimated from forward scatter, phosphatidylserine-exposure from annexin-V-binding, hemolysis from hemoglobin release, [Ca(2+)]i from Fluo3-fluorescence. RESULTS A 48 h exposure to miltefosine (≥ 4.9 μM) was followed by significant decrease of forward scatter and significant increase of annexin-V-binding. The effect was paralleled by significant increase of [Ca(2+)]i. The annexin-V-binding following miltefosine treatment was significantly blunted in the nominal absence of extracellular Ca(2+). CONCLUSION Miltefosine stimulates eryptosis, an effect at least partially due to stimulation of Ca(2+) entry.
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Affiliation(s)
- Carlos Munoz
- Department of Physiology, University of Tuebingen, Gmelinstr. 5, 72076 Tuebingen, Germany
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Costa ISF, de Souza GFP, de Oliveira MG, Abrahamsohn IDA. S-nitrosoglutathione (GSNO) is cytotoxic to intracellular amastigotes and promotes healing of topically treated Leishmania major or Leishmania braziliensis skin lesions. J Antimicrob Chemother 2013; 68:2561-8. [DOI: 10.1093/jac/dkt210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Abstract
Malaria, diarrhea, respiratory infections, and cutaneous larva migrans are common travel-related infections observed in children and adolescents returning from trips to developing countries. Children visiting friends and relatives are at the highest risk because few visit travel clinics before travel, their stays are longer, and the sites they visit are more rural. Clinicians must be able to prepare their pediatric-age travelers before departure with preventive education, prophylactic and self-treating medications, and vaccinations. Familiarity with the clinical manifestations and treatment of travel-related infections will secure prompt and effective therapy.
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