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Dhulipalla M, Chouhan G. The Nexus between Leishmania & HIV: Debilitating Host Immunity and Hastening Comorbid Disease Burden. Exp Parasitol 2024:108826. [PMID: 39147120 DOI: 10.1016/j.exppara.2024.108826] [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: 04/17/2024] [Revised: 07/28/2024] [Accepted: 08/12/2024] [Indexed: 08/17/2024]
Abstract
The scintillating association between Leishmania and HIV has contributed exceptionally towards expansion of Visceral Leishmaniasis (VL) with Acquired Immunodeficiency Syndrome (AIDS). The co-infection poses a grievous threat to elimination of VL and containment of Human Immunodeficiency Virus (HIV). When coinfected, Leishmania and HIV complement each other's proliferation and survival by inducing immunesenescence, T cell fatigue and exhaustion. Antigen presentation is lost, co-stimulatory molecules are diminished whereas co-inhibitory molecules such as CTLA-4, TIGIT, LAG-3 etc. are upregulated to ensure a Th2-baised immune environment. As a consequence, Leishmania-HIV coinfection causes poor outcomes, inflates the spread of Leishmania parasites, enhances the severity of side-effects to drugs, as well as escalate the probability of treatment failure and mortality. What makes control extremely strenuous is that there are frequent episodes of VL relapse with no prognostic markers, no standard immunophenotype(s) and appearance of atypical clinical symptoms that further complicate diagnosis and treatment of coinfection cases. Thus, a standard therapeutic regimen has been difficult to develop and treatment is majorly dependent upon a combination of liposomal Amphotericin B and Miltefosine, a therapy that is expensive and capable of causing drastic side-effects in recipients. As World Health Organization is committed to eliminate both VL and HIV in due course of future, the existing therapeutic interventions require advancements to grapple and overcome this hazardous co-infection. In this context, an overview of HIV-VL co-infection, immunopathology of HIV and Leishmania co-inhabitance, available therapeutic options and their limitations in the treatment of co-infection are discussed in-depth.
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Affiliation(s)
- Manasvi Dhulipalla
- Department of Biotechnology, Sharda School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh, India 201306
| | - Garima Chouhan
- Department of Biotechnology, Sharda School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh, India 201306.
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2
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de Vrij N, Pollmann J, Rezende AM, Ibarra-Meneses AV, Pham TT, Hailemichael W, Kassa M, Bogale T, Melkamu R, Yeshanew A, Mohammed R, Diro E, Maes I, Domagalska MA, Landuyt H, Vogt F, van Henten S, Laukens K, Cuypers B, Meysman P, Beyene H, Sisay K, Kibret A, Mersha D, Ritmeijer K, van Griensven J, Adriaensen W. Persistent T cell unresponsiveness associated with chronic visceral leishmaniasis in HIV-coinfected patients. Commun Biol 2024; 7:524. [PMID: 38702419 PMCID: PMC11068874 DOI: 10.1038/s42003-024-06225-2] [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: 01/05/2023] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
A large proportion of HIV-coinfected visceral leishmaniasis (VL-HIV) patients exhibit chronic disease with frequent VL recurrence. However, knowledge on immunological determinants underlying the disease course is scarce. We longitudinally profiled the circulatory cellular immunity of an Ethiopian HIV cohort that included VL developers. We show that chronic VL-HIV patients exhibit high and persistent levels of TIGIT and PD-1 on CD8+/CD8- T cells, in addition to a lower frequency of IFN-γ+ TIGIT- CD8+/CD8- T cells, suggestive of impaired T cell functionality. At single T cell transcriptome and clonal resolution, the patients show CD4+ T cell anergy, characterised by a lack of T cell activation and lymphoproliferative response. These findings suggest that PD-1 and TIGIT play a pivotal role in VL-HIV chronicity, and may be further explored for patient risk stratification. Our findings provide a strong rationale for adjunctive immunotherapy for the treatment of chronic VL-HIV patients to break the recurrent disease cycle.
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Affiliation(s)
- Nicky de Vrij
- Clinical Immunology Unit, Department of Clinical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium
- Adrem Data Lab, Department of Computer Science, University of Antwerp, 2020, Antwerp, Belgium
| | - Julia Pollmann
- Department of Medical Oncology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT) Heidelberg, 69120, Heidelberg, Germany
| | - Antonio M Rezende
- Department of Microbiology, Aggeu Magalhães Institute-FIOCRUZ/PE, Recife, Brazil
| | - Ana V Ibarra-Meneses
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Thao-Thy Pham
- Clinical Immunology Unit, Department of Clinical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium
| | - Wasihun Hailemichael
- Department of Immunology and Molecular Biology, Faculty of Biomedical Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekibib Kassa
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Tadfe Bogale
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Roma Melkamu
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Arega Yeshanew
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Rezika Mohammed
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Ermias Diro
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | - Ilse Maes
- Molecular Parasitology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium
| | - Malgorzata A Domagalska
- Molecular Parasitology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium
| | - Hanne Landuyt
- Clinical Trial Unit, Department of Clinical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium
| | - Florian Vogt
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, 2601, Australia
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
- Unit of Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium
| | - Saskia van Henten
- Unit of Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium
| | - Kris Laukens
- Adrem Data Lab, Department of Computer Science, University of Antwerp, 2020, Antwerp, Belgium
| | - Bart Cuypers
- Adrem Data Lab, Department of Computer Science, University of Antwerp, 2020, Antwerp, Belgium
| | - Pieter Meysman
- Adrem Data Lab, Department of Computer Science, University of Antwerp, 2020, Antwerp, Belgium
| | | | | | | | | | | | - Johan van Griensven
- Unit of Neglected Tropical Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium
| | - Wim Adriaensen
- Clinical Immunology Unit, Department of Clinical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium.
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3
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Santos GDA, Sousa JM, de Aguiar AHBM, Torres KCS, Coelho AJS, Ferreira AL, Lima MIS. Systematic Review of Treatment Failure and Clinical Relapses in Leishmaniasis from a Multifactorial Perspective: Clinical Aspects, Factors Associated with the Parasite and Host. Trop Med Infect Dis 2023; 8:430. [PMID: 37755891 PMCID: PMC10534360 DOI: 10.3390/tropicalmed8090430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/28/2023] Open
Abstract
Leishmaniasis is a disease caused by protozoa of the genus Leishmania. Treatment options are limited, and there are frequent cases of treatment failure and clinical relapse. To understand these phenomena better, a systematic review was conducted, considering studies published between 1990 and 2021 in Portuguese, English, and Spanish. The review included 64 articles divided into three categories. Case reports (26 articles) focused on treatment failure and clinical relapse in cutaneous leishmaniasis patients (47.6%), primarily affecting males (74%) and children (67%), regardless of the clinical manifestation. Experimental studies on the parasite (19 articles), particularly with L. major (25%), indicated that alterations in DNA and genic expression (44.82%) played a significant role in treatment failure and clinical relapse. Population data on the human host (19 articles) identified immunological characteristics as the most associated factor (36%) with treatment failure and clinical relapse. Each clinical manifestation of the disease presented specificities in these phenomena, suggesting a multifactorial nature. Additionally, the parasites were found to adapt to the drugs used in treatment. In summary, the systematic review revealed that treatment failure and clinical relapse in leishmaniasis are complex processes influenced by various factors, including host immunology and parasite adaptation.
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Affiliation(s)
- Gustavo de Almeida Santos
- Postgraduate Program in Health and Environment, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil;
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
| | - Juliana Mendes Sousa
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
| | - Antônio Henrique Braga Martins de Aguiar
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
| | - Karina Cristina Silva Torres
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
- Postgraduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil
| | - Ana Jessica Sousa Coelho
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
- Postgraduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil
| | - André Leite Ferreira
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
| | - Mayara Ingrid Sousa Lima
- Postgraduate Program in Health and Environment, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil;
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
- Postgraduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil
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Domagalska MA, Barrett MP, Dujardin JC. Drug resistance in Leishmania: does it really matter? Trends Parasitol 2023; 39:251-259. [PMID: 36803859 DOI: 10.1016/j.pt.2023.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
Treatment failure (TF) jeopardizes the management of parasitic diseases, including leishmaniasis. From the parasite's point of view, drug resistance (DR) is generally considered as central to TF. However, the link between TF and DR, as measured by in vitro drug susceptibility assays, is unclear, some studies revealing an association between treatment outcome and drug susceptibility, others not. Here we address three fundamental questions aiming to shed light on these ambiguities. First, are the right assays being used to measure DR? Second, are the parasites studied, which are generally those that adapt to in vitro culture, actually appropriate? Finally, are other parasite factors - such as the development of quiescent forms that are recalcitrant to drugs - responsible for TF without DR?
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Affiliation(s)
| | - Michael P Barrett
- School of Infection & Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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El-Dirany R, Fernández-Rubio C, Peña-Guerrero J, Moreno E, Larrea E, Espuelas S, Abdel-Sater F, Brandenburg K, Martínez-de-Tejada G, Nguewa P. Repurposing the Antibacterial Agents Peptide 19-4LF and Peptide 19-2.5 for Treatment of Cutaneous Leishmaniasis. Pharmaceutics 2022; 14:pharmaceutics14112528. [PMID: 36432719 PMCID: PMC9697117 DOI: 10.3390/pharmaceutics14112528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
The lack of safe and cost-effective treatments against leishmaniasis highlights the urgent need to develop improved leishmanicidal agents. Antimicrobial peptides (AMPs) are an emerging category of therapeutics exerting a wide range of biological activities such as anti-bacterial, anti-fungal, anti-parasitic and anti-tumoral. In the present study, the approach of repurposing AMPs as antileishmanial drugs was applied. The leishmanicidal activity of two synthetic anti-lipopolysaccharide peptides (SALPs), so-called 19-2.5 and 19-4LF was characterized in Leishmania major. In vitro, both peptides were highly active against intracellular Leishmania major in mouse macrophages without exerting toxicity in host cells. Then, q-PCR-based gene profiling, revealed that this activity was related to the downregulation of several genes involved in drug resistance (yip1), virulence (gp63) and parasite proliferation (Cyclin 1 and Cyclin 6). Importantly, the treatment of BALB/c mice with any of the two AMPs caused a significant reduction in L. major infective burden. This effect was associated with an increase in Th1 cytokine levels (IL-12p35, TNF-α, and iNOS) in the skin lesion and spleen of the L. major infected mice while the Th2-associated genes were downregulated (IL-4 and IL-6). Lastly, we investigated the effect of both peptides in the gene expression profile of the P2X7 purinergic receptor, which has been reported as a therapeutic target in several diseases. The results showed significant repression of P2X7R by both peptides in the skin lesion of L. major infected mice to an extent comparable to that of a common anti-leishmanial drug, Paromomycin. Our in vitro and in vivo studies suggest that the synthetic AMPs 19-2.5 and 19-4LF are promising candidates for leishmaniasis treatment and present P2X7R as a potential therapeutic target in cutaneous leishmaniasis (CL).
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Affiliation(s)
- Rima El-Dirany
- ISTUN Institute of Tropical Health, Department of Microbiology and Parasitology, IdiSNA (Navarra Institute for Health Research), University of Navarra, c/Irunlarrea 1, 31008 Pamplona, Navarra, Spain
- Laboratory of Molecular Biology and Cancer Immunology, Faculty of Sciences I, Lebanese University, Hadath 1003, Lebanon
| | - Celia Fernández-Rubio
- ISTUN Institute of Tropical Health, Department of Microbiology and Parasitology, IdiSNA (Navarra Institute for Health Research), University of Navarra, c/Irunlarrea 1, 31008 Pamplona, Navarra, Spain
| | - José Peña-Guerrero
- ISTUN Institute of Tropical Health, Department of Microbiology and Parasitology, IdiSNA (Navarra Institute for Health Research), University of Navarra, c/Irunlarrea 1, 31008 Pamplona, Navarra, Spain
| | - Esther Moreno
- ISTUN Institute of Tropical Health, Department of Chemistry and Pharmaceutical Technology, IdiSNA (Navarra Institute for Health Research), University of Navarra, c/Irunlarrea 1, 31008 Pamplona, Navarra, Spain
| | - Esther Larrea
- ISTUN Institute of Tropical Health, IdiSNA (Navarra Institute for Health Research), University of Navarra, 31008 Pamplona, Navarra, Spain
| | - Socorro Espuelas
- ISTUN Institute of Tropical Health, Department of Chemistry and Pharmaceutical Technology, IdiSNA (Navarra Institute for Health Research), University of Navarra, c/Irunlarrea 1, 31008 Pamplona, Navarra, Spain
| | - Fadi Abdel-Sater
- Laboratory of Molecular Biology and Cancer Immunology, Faculty of Sciences I, Lebanese University, Hadath 1003, Lebanon
| | - Klaus Brandenburg
- Brandenburg Antiinfektiva GmbH, c/o Forschungszentrum Borstel, Leibniz Lungenzentrum, 23845 Borstel, Germany
| | - Guillermo Martínez-de-Tejada
- Department of Microbiology and Parasitology, IdiSNA (Navarra Institute for Health Research), University of Navarra, 31008 Pamplona, Navarra, Spain
| | - Paul Nguewa
- ISTUN Institute of Tropical Health, Department of Microbiology and Parasitology, IdiSNA (Navarra Institute for Health Research), University of Navarra, c/Irunlarrea 1, 31008 Pamplona, Navarra, Spain
- Correspondence:
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Takele Y, Adem E, Franssen SU, Womersley R, Kaforou M, Levin M, Müller I, Cotton JA, Kropf P. Impaired in vitro Interferon-γ production in patients with visceral leishmaniasis is improved by inhibition of PD1/PDL-1 ligation. PLoS Negl Trop Dis 2022; 16:e0010544. [PMID: 35749568 PMCID: PMC9262188 DOI: 10.1371/journal.pntd.0010544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 07/07/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
Visceral leishmaniasis (VL) is a neglected tropical disease that causes substantial morbidity and mortality and is a growing health problem in Ethiopia, where this study took place. Most individuals infected with Leishmania donovani parasites will stay asymptomatic, but some develop VL that, if left untreated, is almost always fatal. This stage of the disease is associated with a profound immunosuppression, characterised by impaired production of Interferonγ (IFNγ), a cytokine that plays a key role in the control of Leishmania parasites, and high expression levels of an inhibitory receptor, programmed cell death 1 (PD1) on CD4+ T cells. Here, we tested the contribution of the interaction between the immune checkpoint PD1 and its ligand PDL-1 on the impaired production of IFNγ in VL patients. Our results show that in the blood of VL patients, not only CD4+, but also CD8+ T cells express high levels of PD1 at the time of VL diagnosis. Next, we identified PDL-1 expression on different monocyte subsets and neutrophils and show that PDL-1 levels were significantly increased in VL patients. PD1/PDL-1 inhibition resulted in significantly increased production of IFNγ, suggesting that therapy using immune checkpoint inhibitors might improve disease control in these patients.
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Affiliation(s)
- Yegnasew Takele
- Department of Infectious Disease, Imperial College London, London, United Kingdom
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, United Kingdom
| | - Emebet Adem
- Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia
| | | | - Rebecca Womersley
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Michael Levin
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Ingrid Müller
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | | | - Pascale Kropf
- Department of Infectious Disease, Imperial College London, London, United Kingdom
- * E-mail:
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Franssen SU, Sanders MJ, Berriman M, Petersen CA, Cotton JA. Geographic Origin and Vertical Transmission of Leishmania infantum Parasites in Hunting Hounds, United States. Emerg Infect Dis 2022; 28:1211-1223. [PMID: 35608628 PMCID: PMC9155895 DOI: 10.3201/eid2806.211746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Vertical transmission of leishmaniasis is common but is difficult to study against the background of pervasive vector transmission. We present genomic data from dogs in the United States infected with Leishmania infantum parasites; these infections have persisted in the apparent absence of vector transmission. We demonstrate that these parasites were introduced from the Old World separately and more recently than L. infantum from South America. The parasite population shows unusual genetics consistent with a lack of meiosis: a high level of heterozygous sites shared across all isolates and no decrease in linkage with genomic distance between variants. Our data confirm that this parasite population has been evolving with little or no sexual reproduction. This demonstration of vertical transmission has profound implications for the population genetics of Leishmania parasites. When investigating transmission in complex natural settings, considering vertical transmission alongside vector transmission is vital.
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Takele Y, Mulaw T, Adem E, Shaw CJ, Franssen SU, Womersley R, Kaforou M, Taylor GP, Levin M, Müller I, Cotton JA, Kropf P. Immunological factors, but not clinical features, predict visceral leishmaniasis relapse in patients co-infected with HIV. Cell Rep Med 2022; 3:100487. [PMID: 35106507 PMCID: PMC8784791 DOI: 10.1016/j.xcrm.2021.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/11/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
Visceral leishmaniasis (VL) has emerged as a clinically important opportunistic infection in HIV patients, as VL/HIV co-infected patients suffer from frequent VL relapse. Here, we follow cohorts of VL patients with or without HIV in Ethiopia. By the end of the study, 78.1% of VL/HIV-but none of the VL patients-experience VL relapse. Despite a clinically defined cure, VL/HIV patients maintain higher parasite loads, lower BMI, hepatosplenomegaly, and pancytopenia. We identify three immunological markers associated with VL relapse in VL/HIV patients: (1) failure to restore antigen-specific production of IFN-γ, (2) persistently lower CD4+ T cell counts, and (3) higher expression of PD1 on CD4+ and CD8+ T cells. We show that these three markers, which can be measured in primary hospital settings in Ethiopia, combine well in predicting VL relapse. The use of our prediction model has the potential to improve disease management and patient care.
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Affiliation(s)
- Yegnasew Takele
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Leishmaniasis Research and Treatment Centre, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Tadele Mulaw
- Leishmaniasis Research and Treatment Centre, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Emebet Adem
- Leishmaniasis Research and Treatment Centre, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Caroline Jayne Shaw
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London SW7 2AZ, UK
| | | | - Rebecca Womersley
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
| | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
| | | | - Michael Levin
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
| | - Ingrid Müller
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
| | | | - Pascale Kropf
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
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