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Khanra S, Das S, Sarraf NR, Datta S, Das AK, Manna M, Roy S. Antimony resistance mechanism in genetically different clinical isolates of Indian Kala-azar patients. Front Cell Infect Microbiol 2022; 12:1021464. [PMID: 36405965 PMCID: PMC9667115 DOI: 10.3389/fcimb.2022.1021464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/06/2022] [Indexed: 01/04/2024] Open
Abstract
The central theme of this enterprise is to find common features, if any, displayed by genetically different antimony (Sb)-resistant viscerotropic Leishmania parasites to impart Sb resistance. In a limited number of clinical isolates (n = 3), we studied the breadth of variation in the following dimensions: (a) intracellular thiol content, (b) cell surface expression of glycan having N-acetyl-D-galactosaminyl residue as the terminal sugar, and (c) gene expression of thiol-synthesizing enzymes (CBS, MST, gamma-GCS, ODC, and TR), antimony-reducing enzymes (TDR and ACR2), and antimonial transporter genes (AQP1, MRPA, and PRP1). One of the isolates, T5, that was genotypically characterized as Leishmania tropica, caused Indian Kala-azar and was phenotypically Sb resistant (T5-LT-SSG-R), while the other two were Leishmania donovani, out of which one isolate, AG83, is antimony sensitive (AG83-LD-SSG-S) and the other isolate, T8, is Sb resistant (T8-LD-SSG-R). Our study showed that the Sb-resistant parasites, regardless of their genotype, showed significantly higher intracellular thiol compared with Sb-sensitive AG83-LD-SSG-S. Seemingly, T5-LT-SSG-R showed about 1.9-fold higher thiol content compared with T8-LD-SSG-R which essentially mirrored cell surface N-acetyl-D-galactosaminyl expression. Except TR, the expression of the remaining thiol-synthesizing genes was significantly higher in T8-LD-SSG-R and T5-LT-SSG-R than the sensitive one, and between the Sb-resistant parasites, the latter showed a significantly higher expression. Furthermore, the genes for Sb-reducing enzymes increased significantly in resistant parasites regardless of genotype compared with the sensitive one, and between two resistant parasites, there was hardly any difference in expression. Out of three antimony transporters, AQP1 was decreased with the concurrent increase in MRPA and PRP1 in resistant isolates when compared with the sensitive counterpart. Interestingly, no difference in expression of the above-mentioned transporters was noted between two Sb-resistant isolates. The enduring image that resonated from our study is that the genetically diverse Sb-resistant parasites showed enhanced thiol-synthesizing and antimony transporter gene expression than the sensitive counterpart to confer a resistant phenotype.
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Affiliation(s)
- Supriya Khanra
- Department of Zoology, Barasat Government College, Kolkata, India
| | - Shantanabha Das
- Department of Zoology, Diamond Harbour Women’s University, Sarisha, West Bengal, India
| | | | - Sanchita Datta
- Department of Zoology, Barasat Government College, Kolkata, India
| | - Anjan Kumar Das
- Department of Medicine, Calcutta National Medical College, Kolkata, India
| | - Madhumita Manna
- Department of Zoology, Barasat Government College, Kolkata, India
| | - Syamal Roy
- Department of Infectious Diseases and Immunology, Indian Institute of Chemical Biology, Kolkata, India
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Khanra S, Kumar YP, Dash J, Banerjee R. In vitro screening of known drugs identified by scaffold hopping techniques shows promising leishmanicidal activity for suramin and netilmicin. BMC Res Notes 2018; 11:319. [PMID: 29784022 PMCID: PMC5963029 DOI: 10.1186/s13104-018-3446-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/15/2018] [Indexed: 01/07/2023] Open
Abstract
Objective The rapid emergence of drug resistant Leishmanial strains makes it imperative to continue the development of cheap and effective drugs against the parasite. Due to the absence of effective vaccines against leishmaniasis, current therapeutic measures exclusively rely on chemotherapy. Here we attempt, to identify novel antileishmanial from a list of known drugs determined from a previous bioinformatics study. Synergism between various drug combinations (involving netilmicin, suramin, paromomycin and curcumin) have been estimated to identify potent multidrug therapies to combat the disease. Results The drugs were screened against Leishmania promastigotes by utilizing the MTT assay and against intracellular amastigotes using murine Macrophage like tumor cell, RAW 264.7 as a host. In vitro drug interactions were tested for several drug combinations with a modified fixed ratio isobologram method against both Leishmania major and Leishmania donovani. This work reports the in vitro antileishmanial activity for the aminoglycoside netilmicin (for some Leishmania parasites) and the anti-trypanosomatid suramin. Synergism was also observed between paromomycin–suramin and netilmicin–curcumin. Electronic supplementary material The online version of this article (10.1186/s13104-018-3446-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Supriya Khanra
- Crystallography and Molecular Biology Division, Saha Institute of Nuclear Physics, Sector 1, Block AF, Bidhannagar, Kolkata, 700064, India
| | - Y Pavan Kumar
- Department of Organic Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata, 700032, India
| | - Jyotirmayee Dash
- Department of Organic Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata, 700032, India
| | - Rahul Banerjee
- Crystallography and Molecular Biology Division, Saha Institute of Nuclear Physics, Sector 1, Block AF, Bidhannagar, Kolkata, 700064, India. .,Homi Bhabha National Institute, Anushakti Nagar, Mumbai, 400094, India.
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Kansal S, Chakravarty J, Kumar A, Malaviya P, Boelaert M, Hasker E, Ostyn B, Sundar S. Risk Factors associated with defaulting from visceral leishmaniasis treatment: analysis under routine programme conditions in Bihar, India. Trop Med Int Health 2017; 22:1037-1042. [PMID: 28594453 DOI: 10.1111/tmi.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the rate of default from treatment in the visceral leishmaniasis (VL) elimination programme and to identify risk factors and its underlying causes. METHODS Case-control study conducted between December 2009 and June 2012 in three primary health centres (PHCs) of Muzaffarpur district, India. Patients who defaulted from treatment from the PHCs were considered as 'cases' and those who completed their treatment as 'controls'. Two controls were included in the study for each case. Respondents' opinion and satisfaction with the services provided at the PHCs were also elicited. Logistic regression was performed to assess the contribution of sociodemographic variables on patient status, and a discriminant analysis was used (after decomposing the original data) to identify factors that can predict the patient status as defaulter or not, based on factor scores of the components as predictor variables. RESULTS During the study period, 16.3% (89/544) of patients defaulted; 87 cases and 188 controls were interviewed through a semistructured questionnaire. Women tended to be more at risk for default (OR, 1.6, 95% CI (0.9 -2.9). Treatment received was miltefosine in 55.6% and sodium stibogluconate (SSG) in 44.4%. Most (86%) defaulters completed their treatment at other healthcare facilities; 70% of them preferred non-governmental institutions. Most cited reasons for default were seeking a second opinion for VL treatment and preferring to be treated in specialised VL centres. Discriminant analysis showed only one significant predictor: dissatisfaction with the medical care received in PHCs. CONCLUSION Efforts are needed to enhance the quality of VL care at PHC level, which will be beneficial in increasing treatment completion rates.
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Affiliation(s)
- S Kansal
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - J Chakravarty
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - A Kumar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - P Malaviya
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - M Boelaert
- Institute Tropical Medicine, Antwerp, Belgium
| | - E Hasker
- Institute Tropical Medicine, Antwerp, Belgium
| | - B Ostyn
- Institute Tropical Medicine, Antwerp, Belgium
| | - S Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Boettcher JP, Siwakoti Y, Milojkovic A, Siddiqui NA, Gurung CK, Rijal S, Das P, Kroeger A, Banjara MR. Visceral leishmaniasis diagnosis and reporting delays as an obstacle to timely response actions in Nepal and India. BMC Infect Dis 2015; 15:43. [PMID: 25656298 PMCID: PMC4335691 DOI: 10.1186/s12879-015-0767-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background To eliminate visceral leishmaniasis (VL) in India and Nepal, challenges of VL diagnosis, treatment and reporting need to be identified. Recent data indicate that VL is underreported and patients face delays when seeking treatment. Moreover, VL surveillance data might not reach health authorities on time. This study quantifies delays for VL diagnosis and treatment, and analyses the duration of VL reporting from district to central health authorities in India and Nepal. Methods A cross-sectional study conducted in 12 districts of Terai region, Nepal, and 9 districts of Bihar State, India, in 2012. Patients were interviewed in hospitals or at home using a structured questionnaire, health managers were interviewed at their work place using a semi-structured questionnaire and in-depth interviews were conducted with central level health managers. Reporting formats were evaluated. Data was analyzed using two-tailed Mann-Whitney U or Fisher’s exact test. Results 92 VL patients having experienced 103 VL episodes and 49 district health managers were interviewed. Patients waited in Nepal 30 days (CI 18-42) before seeking health care, 3.75 times longer than in Bihar (8d; CI 4-12). Conversely, the lag time from seeking health care to receiving a VL diagnosis was 3.6x longer in Bihar (90d; CI 68-113) compared to Nepal (25d; CI 13-38). The time span between diagnosis and treatment was short in both countries. VL reporting time was in Nepal 19 days for sentinel sites and 76 days for “District Public Health Offices (DPHOs)”. In Bihar it was 28 days for “District Malaria Offices”. In Nepal, 73% of health managers entered data into computers compared to 16% in Bihar. In both countries reporting was mainly paper based and standardized formats were rarely used. Conclusions To decrease the delay between onset of symptoms and getting a proper diagnosis and treatment the approaches in the two countries vary: In Nepal health education for seeking early treatment are needed while in Bihar the use of private and non-formal practitioners has to be discouraged. Reinforcement of VL sentinel reporting in Bihar, reorganization of DPHOs in Nepal, introduction of standardized reporting formats and electronic reporting should be conducted in both countries. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0767-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan P Boettcher
- Centre for Biological Threats and Special Pathogens, Robert Koch-Institute, Nordufer 20, Berlin, 13353, Germany.
| | - Yubaraj Siwakoti
- Valley College of Technical Sciences, Purbanchal University, Maharajgunj, Kathmandu, 44600, Nepal.
| | - Ana Milojkovic
- Clinical and Molecular Oncology, Max Delbrück Centrum für Molekulare Medizin, Berlin-Buch, Germany.
| | - Niyamat A Siddiqui
- Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India.
| | - Chitra K Gurung
- Public Health and Infectious Disease Research Center, New Baneshwor, Kathmandu, Nepal.
| | - Suman Rijal
- BP Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India.
| | - Axel Kroeger
- Special Programme for Research and Training in Tropical Diseases WHO-TDR, Geneva, Switzerland. .,Freiburg University Medical Centre, Zentrum für Medizin und Gesundheit, Freiburg, Germany.
| | - Megha R Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
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Malaviya P, Picado A, Hasker E, Ostyn B, Kansal S, Singh RP, Shankar R, Boelaert M, Sundar S. Health & Demographic Surveillance System profile: the Muzaffarpur-TMRC Health and Demographic Surveillance System. Int J Epidemiol 2014; 43:1450-7. [PMID: 25186307 DOI: 10.1093/ije/dyu178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Muzaffarpur-TMRC Health and Demographic Surveillance System (HDSS), established in 2007, was developed as an enlargement of the scope of a research collaboration on the project Visceral Leishmaniasis in Bihar, which had been ongoing since 2005. The HDSS is located in a visceral leishmaniasis (VL)-endemic area in the Muzaffarpur district of Bihar state in India. It is the only HDSS conducting research on VL, which is a vector-borne infectious disease transmitted by female phlebotomine sandflies and is fatal if left untreated. Currently the HDSS serves a population of over 105,000 in 66 villages. The HDSS collects data on vital events including pregnancies, births, deaths, migration and marriages, as well as other socio-economic indicators, at regular intervals. Incident VL cases are identified. The HDSS team is experienced in conducting both qualitative and quantitative studies, sample collection and rapid diagnostic tests in the field. In each village, volunteers connect the HDSS team with the community members. The Muzaffarpur-TMRC HDSS provides opportunities for studies on VL and other neglected tropical diseases (NTDs) and their interaction with demographic events such as migration. Queries related to research collaborations and data sharing can be sent to Dr Shyam Sundar at [drshyamsundar@hotmail.com].
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Affiliation(s)
- Paritosh Malaviya
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, Institute of Tropical Medicine, Antwerp, Belgium and Barcelona Centre for International Health Research, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, Institute of Tropical Medicine, Antwerp, Belgium and Barcelona Centre for International Health Research, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Albert Picado
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, Institute of Tropical Medicine, Antwerp, Belgium and Barcelona Centre for International Health Research, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Epco Hasker
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, Institute of Tropical Medicine, Antwerp, Belgium and Barcelona Centre for International Health Research, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Bart Ostyn
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, Institute of Tropical Medicine, Antwerp, Belgium and Barcelona Centre for International Health Research, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Sangeeta Kansal
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, Institute of Tropical Medicine, Antwerp, Belgium and Barcelona Centre for International Health Research, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Rudra Pratap Singh
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, Institute of Tropical Medicine, Antwerp, Belgium and Barcelona Centre for International Health Research, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Ravi Shankar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, Institute of Tropical Medicine, Antwerp, Belgium and Barcelona Centre for International Health Research, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Marleen Boelaert
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, Institute of Tropical Medicine, Antwerp, Belgium and Barcelona Centre for International Health Research, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, Institute of Tropical Medicine, Antwerp, Belgium and Barcelona Centre for International Health Research, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
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Ostyn B, Hasker E, Dorlo TPC, Rijal S, Sundar S, Dujardin JC, Boelaert M. Failure of miltefosine treatment for visceral leishmaniasis in children and men in South-East Asia. PLoS One 2014; 9:e100220. [PMID: 24941345 PMCID: PMC4062493 DOI: 10.1371/journal.pone.0100220] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 05/25/2014] [Indexed: 12/22/2022] Open
Abstract
Background High frequency of relapse in miltefosine-treated visceral leishmaniasis (VL) patients in India and Nepal followed up for twelve months. Objective To identify epidemiological and clinical risk factors for relapse of VL in patients recently treated with standard dosing of miltefosine in India and Nepal. Design Prospective observational study in three Primary Health Centers and one reference center in Muzaffarpur district, Bihar, India; and two zonal hospitals and a university hospital in South-east Nepal; records of all consenting patients diagnosed with VL and treated with miltefosine according to the current treatment guidelines of the Kala azar elimination program between 2009 and 2011. Results We compared the clinical records of 78 cases of relapse with those of 775 patients who had no record of subsequent relapse. Relapse was 2 times more common amongst male patients (IRR 2.14, 95% CI 1.27–3.61), and 2 to 3 times more frequent in the age groups below 15 compared to the over 25 year olds (age 10 to 14: IRR 2.53; 95% CI 1.37–4.65 and Age 2 to 9: IRR 3.19; 95% CI 1.77–5.77). History of earlier VL episodes, or specific clinical features at time of diagnosis such as duration of symptoms or spleen size were no predictors of relapse. Conclusions Young age and male gender were associated with increased risk of VL relapse after miltefosine, suggesting that the mechanism of relapse is mainly host-related i.e. immunological factors and/or drug exposure (pharmacokinetics). The observed decrease in efficacy of miltefosine may be explained by the inclusion of younger patients compared to the earlier clinical trials, rather than by a decreased susceptibility of the parasite to miltefosine. Our findings highlight the importance of proper clinical trials in children, including pharmacokinetics, to determine the safety, efficacy, drug exposure and therapeutic response of new drugs in this age group.
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Affiliation(s)
- Bart Ostyn
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thomas P. C. Dorlo
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Suman Rijal
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Jean-Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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