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Peixoto JF, Gonçalves-Oliveira LF, Souza-Silva F, de Castro Côrtes LM, Finkelstein LC, Dias-Lopes G, Patricio BFDC, Lima CGDS, Rocha HVA, da Silva FDC, Ferreira VF, Pereira BAS, Alves CR. Efficacy of the treatment using a microemulsion loaded with epoxy-α-lapachone in combination with meglumine antimoniate against murine infection by Leishmania (Leishmania) amazonensis. Int J Parasitol Drugs Drug Resist 2024; 24:100525. [PMID: 38359731 PMCID: PMC10875245 DOI: 10.1016/j.ijpddr.2024.100525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
Leishmaniasis is a disease caused by Leishmania spp., affecting millions of people around the world. For decades, its treatment has been based on pentavalent antimonials, which notoriously cause toxic side effects in patients. In this study, epoxy-α-lapachone incorporated into an oil-in-water-type microemulsion (ELAP-ME) and meglumine antimoniate (MA) were assayed in monotherapy and in combination (ELAP-ME/MA) in BALB/c mice infected with Leishmania (Leishmania) amazonensis. In general, there was a reduction in paw lesion size (up to 37% reduction) and decreases of parasite loads in the footpad (∼40%) and lymph nodes (∼31%) of animals treated with ELAP-ME/MA, when compared to the non-treated control groups. Analyses of serum biochemical parameters revealed that the ELAP-ME/MA showed lower renal and hepatic toxicity when compared to MA 2-doses/week monotherapy. These findings indicate that the ELAP-ME/MA combination may be a promising approach for the treatment of cutaneous leishmaniasis.
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Affiliation(s)
- Juliana Figueiredo Peixoto
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas - Avenida Brasil 4365, CEP 21040-900, Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Luiz Filipe Gonçalves-Oliveira
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas - Avenida Brasil 4365, CEP 21040-900, Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Franklin Souza-Silva
- Centro de Desenvolvimento Tecnológico em Saúde, Fundação Oswaldo Cruz - Avenida Brasil, 4365, CEP 21040-900, Manguinhos, Rio de Janeiro, RJ, Brazil; Universidade Iguaçu - Avenida Abílio Augusto Távora 2134, CEP 26260-045, Dom Rodrigo, Nova Iguaçu, RJ, Brazil
| | - Luzia Monteiro de Castro Côrtes
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas - Avenida Brasil 4365, CEP 21040-900, Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Léa Cysne Finkelstein
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Imunoparasitologia - Avenida Brasil 4365, CEP 21040-900, Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Geovane Dias-Lopes
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas - Avenida Brasil 4365, CEP 21040-900, Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Beatriz Ferreira de Carvalho Patricio
- Fundação Oswaldo Cruz, Farmanguinhos, Laboratório de Micro e Nanotecnologia - Avenida Brasil 4036, CEP 21040361, Bonsucesso, Rio de Janeiro, RJ, Brazil; Universidade Federal do Estado do Rio de Janeiro, Instituto Biomédico, Laboratório de Farmacologia - Rua Frei Caneca 94, CEP 20211040, Centro, Rio de Janeiro, RJ, Brazil
| | - Carolina Guimarães de Souza Lima
- Universidade Federal Fluminense, Instituto de Química, Departamento de Química Orgânica - Outeiro de São João Batista s/n, CEP 24020-141, Niterói, RJ, Brazil
| | - Helvécio Vinícius Antunes Rocha
- Universidade Federal do Estado do Rio de Janeiro, Instituto Biomédico, Laboratório de Farmacologia - Rua Frei Caneca 94, CEP 20211040, Centro, Rio de Janeiro, RJ, Brazil
| | - Fernando de Carvalho da Silva
- Universidade Federal Fluminense, Instituto de Química, Departamento de Química Orgânica - Outeiro de São João Batista s/n, CEP 24020-141, Niterói, RJ, Brazil
| | - Vitor Francisco Ferreira
- Universidade Federal Fluminense, Instituto de Química, Departamento de Química Orgânica - Outeiro de São João Batista s/n, CEP 24020-141, Niterói, RJ, Brazil; Universidade Federal Fluminense, Faculdade de Farmácia, Departamento de Tecnologia Farmacêutica - Rua Dr. Mario Vianna 523, Santa Rosa, CEP 24241-002, Niterói, RJ, Brazil
| | - Bernardo Acácio Santini Pereira
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas - Avenida Brasil 4365, CEP 21040-900, Manguinhos, Rio de Janeiro, RJ, Brazil; Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Patologia - Avenida Marquês do Paraná, 303, CEP 24033-900, Centro, Niterói, RJ, Brazil
| | - Carlos Roberto Alves
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas - Avenida Brasil 4365, CEP 21040-900, Manguinhos, Rio de Janeiro, RJ, Brazil.
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2
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Mullis DM, Shegog E, Studemeister L, Hwang M. Successful Treatment of Rapidly Evolving Cutaneous Leishmaniasis With Amphotericin B and Miltefosine in an Immigrant From Venezuela. Open Forum Infect Dis 2024; 11:ofad683. [PMID: 38328492 PMCID: PMC10849113 DOI: 10.1093/ofid/ofad683] [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: 09/11/2023] [Accepted: 12/26/2023] [Indexed: 02/09/2024] Open
Abstract
Leishmaniasis is a vector-borne disease uncommonly encountered in the United States. This case report describes a 54-year-old man presenting with rapidly progressing, pruritic, painful ulcerative lesions after recently immigrating from Venezuela. A punch biopsy confirmed infection with Leishmaniasis braziliensis. He was successfully treated with amphotericin B and miltefosine.
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Affiliation(s)
- Danielle M Mullis
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Evan Shegog
- Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Lucy Studemeister
- Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Michael Hwang
- Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
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3
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de Morais RCS, de Melo MGN, de Goes TC, Pessoa e Silva R, de Morais RF, Guerra JADO, de Brito MEF, Brandão-Filho SP, de Paiva Cavalcanti M. Clinical-therapeutic follow-up of patients with American cutaneous leishmaniasis caused by different Leishmania spp. in Brazil. Exp Parasitol 2022; 240:108338. [DOI: 10.1016/j.exppara.2022.108338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 11/04/2022]
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Alcântara IS, Martins AOBPB, de Oliveira MRC, Coronel C, Gomez MCV, Rolón M, Wanderley AG, Júnior LJQ, de Souza Araújo AA, de Araújo ACJ, Freitas PR, Coutinho HDM, de Menezes IRA. Cytotoxic potential and antiparasitic activity of the Croton rhamnifolioides Pax leaves. & K. Hoffm essential oil and its inclusion complex (EOCr/β-CD). Polym Bull (Berl) 2022. [DOI: 10.1007/s00289-021-03556-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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5
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Leishmaniasis in Cameroon and neighboring countries: An overview of current status and control challenges. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2022; 2:100077. [PMID: 36589871 PMCID: PMC9795355 DOI: 10.1016/j.crpvbd.2022.100077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 01/04/2023]
Abstract
Leishmaniasis causes the ninth largest disease burden among infectious diseases but remains a very neglected tropical disease. Although the disease is endemic in Cameroon and some neighboring countries, data on its epidemiology are very scanty. The present review summarizes the available information on leishmaniasis in the central region of Africa. According to available records, Cameroon, Chad and Nigeria have been identified as endemic foci of both cutaneous (CL) and visceral leishmaniasis (VL). In addition, the phlebotomine vectors of leishmaniasis have been reported in these three countries and also in Congo and the Central African Republic. Although Gabon, Central African Republic, Equatorial Guinea and Congo are all situated next to the above leishmaniasis-endemic countries and are characterized by similar landscapes and vegetation, they lack published reports of autochthonous cases of leishmaniasis. Considering that many cases of the disease might remain unreported, it might not be an overstatement to recommend that research should be carried out in Gabon, Equatorial Guinea, Central African Republic and Congo to identify cases of leishmaniasis (CL and/or VL), the parasite and vector species, and the mammalian reservoir host. This review updates data on leishmaniasis and its insect vector in the geographical region of Central Africa. Such updates are basic requirement for the development of successful control programmes in individual countries and the whole region. In order to address the shortcomings identified in the present review, the authors recommend training of more scientists in leishmaniasis epidemiology in the region that should be accompanied by necessary funding. This training must be multidisciplinary and include development of laboratory and field skills for studies of the parasite, the vector, the reservoir, the vegetation and the soil in potential endemic foci. In addition, prospective studies involving geographers and other experts should develop a disease risk map of the Central Africa region.
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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: 6] [Impact Index Per Article: 2.0] [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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Pinto JG, Marcolino LM, Ferreira-Strixino J. Photodynamic activity of Photogem ® in Leishmania promastigotes and infected macrophages. Future Microbiol 2021; 16:95-106. [PMID: 33459574 DOI: 10.2217/fmb-2020-0019] [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] [Indexed: 12/16/2022] Open
Abstract
Objectives: This study aimed to evaluate the effect of photodynamic therapy (PDT) with Photogem® in promastigotes of Leishmania braziliensis and Leishmania major, and in infected macrophages. Materials & methods: The following parameters were analyzed: Photogem® internalization, mitochondrial activity, viability, tubulin marking and morphological alterations in promastigotes and viability in infected macrophages. Results: Photogem® accumulated in the cytosol and adhered to the flagellum. Changes were observed in the mitochondrial activity in groups maintained in the dark, with no viability alteration. After PDT, viability decreased up to 80%, and morphology was affected. Conclusion: The results point out that PDT with Photogem® can reduce parasite and macrophage viability.
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Affiliation(s)
- Juliana G Pinto
- Photobiology Applied to Health, Research & Development Institute, Univap Universidade do Vale do Paraíba, São José dos Campos, São Paulo, Brazil
| | - Luciana Mc Marcolino
- Photobiology Applied to Health, Research & Development Institute, Univap Universidade do Vale do Paraíba, São José dos Campos, São Paulo, Brazil
| | - Juliana Ferreira-Strixino
- Photobiology Applied to Health, Research & Development Institute, Univap Universidade do Vale do Paraíba, São José dos Campos, São Paulo, Brazil
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Lima FR, Ferreira LDM, Malta TA, Bonyek-Silva I, Santos RL, Tavares NM, Carvalho Filho EMD, Arruda S. Metformin promotes susceptibility to experimental Leishmania braziliensis infection. Mem Inst Oswaldo Cruz 2020; 115:e200272. [PMID: 33206822 PMCID: PMC7668079 DOI: 10.1590/0074-02760200272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/03/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Metformin (MET) is a hypoglycemic drug used for the treatment of diabetes, despite interference in host immunity against microorganisms. Cutaneous infection caused by pathogens such as Leishmania braziliensis (Lb), the agent responsible for cutaneous leishmaniasis (CL) in Brazil, represents an interesting model in which to evaluate the effects associated with MET. OBJECTIVE To evaluate the modulatory effect of MET in Lb infection. MATERIAL AND METHODS Experimental study of Lb infection and MET treatment in BALB/c mice and Raw 264.7 macrophages. FINDINGS MET treatment interfered with lesion kinetics, increased parasite load and reduced macrophage proliferation. Low concentrations of MET in Lb culture allow for the maintenance of stationary parasite growth phase. Lb-infected cells treated with MET exhibited increased parasite load. While both MET and Lb infection alone promoted the production of intracellular reactive oxygen species (ROS), reduced levels of ROS were seen in MET-treated Lb-infected macrophages. MAIN CONCLUSION Experimental treatment with MET interfered with the kinetics of cutaneous ulceration, increased Lb parasite load, altered ROS production and modulated cellular proliferation. Our experimental results indicate that MET interfere with the evolution of CL.
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Affiliation(s)
- Filipe Rocha Lima
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Salvador, BA, Brasil.,Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Lais de Melo Ferreira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Salvador, BA, Brasil.,Universidade Estadual da Bahia, Departamento de Ciências da Vida, Salvador, BA, Brasil
| | - Tainá Alves Malta
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Salvador, BA, Brasil.,Universidade Estadual da Bahia, Departamento de Ciências da Vida, Salvador, BA, Brasil
| | - Icaro Bonyek-Silva
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Laboratório de Interação Parasito-Hospedeiro e Epidemiologia, Salvador, BA, Brasil.,Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Reinan Lima Santos
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Laboratório de Interação Parasito-Hospedeiro e Epidemiologia, Salvador, BA, Brasil.,Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Natália Machado Tavares
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Laboratório de Interação Parasito-Hospedeiro e Epidemiologia, Salvador, BA, Brasil
| | - Edgar Marcelino de Carvalho Filho
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Laboratório de Pesquisa Clínica, Salvador, BA, Brasil.,Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Sérgio Arruda
- Fundação Oswaldo Cruz-Fiocruz, Instituto Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Salvador, BA, Brasil.,Universidade Estadual da Bahia, Departamento de Ciências da Vida, Salvador, BA, Brasil
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9
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Astronium fraxinifolium Schott Exerts Leishmanicidal Activity by Providing a Classically Polarized Profile in Infected Macrophages. Acta Parasitol 2020; 65:686-695. [PMID: 32347532 DOI: 10.2478/s11686-020-00200-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/18/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Leishmania braziliensis is prevalent in Latin American countries, including Brazil. It causes cutaneous and mucocutaneous leishmaniasis, leading to high morbidity, and has a low cure rate. Treatment is based on pentavalent antimonials; nonetheless, there are problems related to high toxicity, high cost, and parasitic resistance. Discovery of new leishmanicidal drugs without these limitations and that stimulate the cellular immune response is necessary. PURPOSE The present work evaluates whether Astronium fraxinifolium Schott exerts leishmanicidal activity against L. braziliensis by providing a classically polarized profile in infected macrophages. METHODS For the evaluation of the A. fraxinifolium Schott leishmanicidal activity, amastigote cell death was demonstrated in infected RAW 267.4 macrophages treated with an ethanolic extract from the plant sapwood (EEAF). For the evaluation of the EEAF capacity in providing a classically polarized profile in infected macrophages, the following analyses were done: detection of LAMP-1 protein by the baculovirus technology, measurement of superoxide anion by the NBT testing, quantification of TNF-α, IL-12p40, IL-10, IL-4, and TGF-β by sandwich-type enzyme immune assays, and iNOS and COX-2 expression by RT-PCR technique. RESULTS The EEAF significantly reduced amastigote counts inside the cells. Vacuoles were visualized in infected and treated cells before and after May-Grünwald-Giemsa staining. A strong LAMP-1 protein fluorescence revealed phagosome maturation in infected cells treated with the EEAF. No production of superoxide was visualized in infected cells treated with the plant material. Nonetheless, high levels of TNF-α, IL-12p40, and IL-10 were found in cell supernatants, but reduced levels of TGF-β and no IL-4 production. We identified augmented mRNA expression for COX-2, but no expression of iNOS mRNA. CONCLUSION Our results demonstrated that A. fraxinifolium induced a classically polarized profile in infected macrophages but also provided a less harmful environment by stimulating the production of certain anti-inflammatory mediators, such as IL-10.
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Pinart M, Rueda JR, Romero GA, Pinzón-Flórez CE, Osorio-Arango K, Silveira Maia-Elkhoury AN, Reveiz L, Elias VM, Tweed JA. Interventions for American cutaneous and mucocutaneous leishmaniasis. Cochrane Database Syst Rev 2020; 8:CD004834. [PMID: 32853410 PMCID: PMC8094931 DOI: 10.1002/14651858.cd004834.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND On the American continent, cutaneous and mucocutaneous leishmaniasis (CL and MCL) are diseases associated with infection by several species of Leishmania parasites. Pentavalent antimonials remain the first-choice treatment. There are alternative interventions, but reviewing their effectiveness and safety is important as availability is limited. This is an update of a Cochrane Review first published in 2009. OBJECTIVES To assess the effects of interventions for all immuno-competent people who have American cutaneous and mucocutaneous leishmaniasis (ACML). SEARCH METHODS We updated our database searches of the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, LILACS and CINAHL to August 2019. We searched five trials registers. SELECTION CRITERIA Randomised controlled trials (RCTs) assessing either single or combination treatments for ACML in immuno-competent people, diagnosed by clinical presentation and Leishmania infection confirmed by smear, culture, histology, or polymerase chain reaction on a biopsy specimen. The comparators were either no treatment, placebo only, or another active compound. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our key outcomes were the percentage of participants 'cured' at least three months after the end of treatment, adverse effects, and recurrence. We used GRADE to assess evidence certainty for each outcome. MAIN RESULTS We included 75 studies (37 were new), totalling 6533 randomised participants with ATL. The studies were mainly conducted in Central and South America at regional hospitals, local healthcare clinics, and research centres. More male participants were included (mean age: roughly 28.9 years (SD: 7.0)). The most common confirmed species were L. braziliensis, L. panamensis, and L. mexicana. The most assessed interventions and comparators were non-antimonial systemics (particularly oral miltefosine) and antimonials (particularly meglumine antimoniate (MA), which was also a common intervention), respectively. Three studies included moderate-to-severe cases of mucosal leishmaniasis but none included cases with diffuse cutaneous or disseminated CL, considered the severe cutaneous form. Lesions were mainly ulcerative and located in the extremities and limbs. The follow-up (FU) period ranged from 28 days to 7 years. All studies had high or unclear risk of bias in at least one domain (especially performance bias). None of the studies reported the degree of functional or aesthetic impairment, scarring, or quality of life. Compared to placebo, at one-year FU, intramuscular (IM) MA given for 20 days to treat L. braziliensis and L. panamensis infections in ACML may increase the likelihood of complete cure (risk ratio (RR) 4.23, 95% confidence interval (CI) 0.84 to 21.38; 2 RCTs, 157 participants; moderate-certainty evidence), but may also make little to no difference, since the 95% CI includes the possibility of both increased and reduced healing (cure rates), and IMMA probably increases severe adverse effects such as myalgias and arthralgias (RR 1.51, 95% CI 1.17 to 1.96; 1 RCT, 134 participants; moderate-certainty evidence). IMMA may make little to no difference to the recurrence risk, but the 95% CI includes the possibility of both increased and reduced risk (RR 1.79, 95% CI 0.17 to 19.26; 1 RCT, 127 participants; low-certainty evidence). Compared to placebo, at six-month FU, oral miltefosine given for 28 days to treat L. mexicana, L. panamensis and L. braziliensis infections in American cutaneous leishmaniasis (ACL) probably improves the likelihood of complete cure (RR 2.25, 95% CI 1.42 to 3.38), and probably increases nausea rates (RR 3.96, 95% CI 1.49 to 10.48) and vomiting (RR 6.92, 95% CI 2.68 to 17.86) (moderate-certainty evidence). Oral miltefosine may make little to no difference to the recurrence risk (RR 2.97, 95% CI 0.37 to 23.89; low-certainty evidence), but the 95% CI includes the possibility of both increased and reduced risk (all based on 1 RCT, 133 participants). Compared to IMMA, at 6 to 12 months FU, oral miltefosine given for 28 days to treat L. braziliensis, L. panamensis, L. guyanensis and L. amazonensis infections in ACML may make little to no difference to the likelihood of complete cure (RR 1.05, 95% CI 0.90 to 1.23; 7 RCTs, 676 participants; low-certainty evidence). Based on moderate-certainty evidence (3 RCTs, 464 participants), miltefosine probably increases nausea rates (RR 2.45, 95% CI 1.72 to 3.49) and vomiting (RR 4.76, 95% CI 1.82 to 12.46) compared to IMMA. Recurrence risk was not reported. For the rest of the key comparisons, recurrence risk was not reported, and risk of adverse events could not be estimated. Compared to IMMA, at 6 to 12 months FU, oral azithromycin given for 20 to 28 days to treat L. braziliensis infections in ACML probably reduces the likelihood of complete cure (RR 0.51, 95% CI 0.34 to 0.76; 2 RCTs, 93 participants; moderate-certainty evidence). Compared to intravenous MA (IVMA) and placebo, at 12 month FU, adding topical imiquimod to IVMA, given for 20 days to treat L. braziliensis, L. guyanensis and L. peruviana infections in ACL probably makes little to no difference to the likelihood of complete cure (RR 1.30, 95% CI 0.95 to 1.80; 1 RCT, 80 participants; moderate-certainty evidence). Compared to MA, at 6 months FU, one session of local thermotherapy to treat L. panamensis and L. braziliensis infections in ACL reduces the likelihood of complete cure (RR 0.80, 95% CI 0.68 to 0.95; 1 RCT, 292 participants; high-certainty evidence). Compared to IMMA and placebo, at 26 weeks FU, adding oral pentoxifylline to IMMA to treat CL (species not stated) probably makes little to no difference to the likelihood of complete cure (RR 0.86, 95% CI 0.63 to 1.18; 1 RCT, 70 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS Evidence certainty was mostly moderate or low, due to methodological shortcomings, which precluded conclusive results. Overall, both IMMA and oral miltefosine probably result in an increase in cure rates, and nausea and vomiting are probably more common with miltefosine than with IMMA. Future trials should investigate interventions for mucosal leishmaniasis and evaluate recurrence rates of cutaneous leishmaniasis and its progression to mucosal disease.
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Affiliation(s)
- Mariona Pinart
- Free time independent Cochrane reviewer, Berlin, Germany
| | - José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Gustavo As Romero
- Center for Tropical Medicine, University of Brasilia, Brasilia, Brazil
| | | | - Karime Osorio-Arango
- Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Ana Nilce Silveira Maia-Elkhoury
- Communicable Diseases and Environmental Determinants of Health (CDE), Neglected, Tropical and Vector Borne Diseases (VT), Pan American Health Organization/ World Health Organization (PAHO/WHO), Rio de Janeiro, Brazil
| | - Ludovic Reveiz
- Evidence and Intelligence for Action in Health Department, Pan American Health Organization (PAHO), Washington DC, USA
| | - Vanessa M Elias
- Evidence and Intelligence for Action in Health Department, Pan American Health Organization (PAHO), Washington DC, USA
| | - John A Tweed
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
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11
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Calvopina M, Jijon S, Serrano E, Kato H. Case Report: Successful Treatment with Miltefosine of Severe New World Mucosal Leishmaniasis Caused by Leishmania guyanensis. Am J Trop Med Hyg 2020; 103:752-755. [PMID: 32524951 DOI: 10.4269/ajtmh.19-0867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
An 88-year-old man with mutilating mucosal leishmaniasis (ML) involving septal perforation, with granulomas in the pharynx and larynx, was treated with oral miltefosine, 50 mg three times/day for 28 days. Miltefosine, an antineoplastic agent, is considered an alternative option for the treatment of ML, showing efficacies of 75-92% in Bolivia, Brazil, and Argentina. The patient denied having previous cutaneous (CL) leishmaniasis, and no CL lesions were recognized by physical examination. Parasites obtained from mucosal lesions were identified by cytochrome b gene sequencing as Leishmania guyanensis. Clinical cure was observed 2 months posttreatment, and no evidence of reactivation was observed in the 3-year follow-up. Adverse effects such as nausea, loss of appetite, and epigastric pain were experienced during treatment with miltefosine. There is a need for improved access to miltefosine in leishmaniasis-endemic areas of Latin America and a greater awareness of ML and its treatment among physicians working in endemic countries.
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Affiliation(s)
- Manuel Calvopina
- OneHealth Research Group, Carrera de Medicina, Facultad de Ciencias de la Salud, Universidad De Las Américas (UDLA), Quito, Ecuador
| | - Sara Jijon
- OneHealth Research Group, Carrera de Medicina, Facultad de Ciencias de la Salud, Universidad De Las Américas (UDLA), Quito, Ecuador
| | - Esteban Serrano
- Servicio de Otorrinolaringología, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Hirotomo Kato
- Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Tochigi, Japan
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12
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Khan K, Khan AU, Ghufran, Khan A, Khan M, Ahmad I. Fractionated illumination improves the treatment outcomes of photodynamic therapy for high grade cutaneous leishmaniasis. Photodiagnosis Photodyn Ther 2020; 29:101622. [DOI: 10.1016/j.pdpdt.2019.101622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
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13
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Evaluation of MDR1 and MRPA genes expression in different types of dry cutaneous leishmaniasis. BMC Res Notes 2019; 12:803. [PMID: 31831065 PMCID: PMC6909633 DOI: 10.1186/s13104-019-4784-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/04/2019] [Indexed: 11/23/2022] Open
Abstract
Objective The resistance to antimony-containing glucantime is a major obstacle to successful treatment, especially in endemic areas. Looking the molecular mechanisms involved in this drug resistance will help in choosing the best treatment. The aim of this study was to evaluate the expression of multidrug-resistance 1 (MDR1) and multidrug-resistance protein A (MRPA) genes in acute, chronic non-lupoid, and chronic lupoid forms of dry type cutaneous leishmaniasis (DTCL). Results MDR1 gene was over-expressed as 14.4- and 1.56-folds in the chronic lupoid and acute forms compared with the chronic non-lupoid form, respectively. Results comparison showed P < 0.05 between the chronic non-lupoid and acute groups, P < 0.01 between acute and chronic lupoid groups, and P < 0.001 between the chronic non-lupoid and chronic lupoid groups. MRPA gene was over-expressed as 266 and 17.7-fold in the chronic lupoid and chronic non-lupoid forms compared with the acute form, respectively. Statistical analysis showed P < 0.01 between the chronic non-lupoid and chronic lupoid groups, P < 0.05 between acute and chronic non-lupoid groups, and P < 0.001 between the acute and chronic lupoid groups.
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Aragão Macedo SR, Ferreira AS, Biguinati de Barros N, Ulisses de Oliveira Meneguetti D, Facundo VA, Shibayama TY, Nicolete R. Evaluation of the antileishmanial activity of biodegradable microparticles containing a hexanic eluate subfraction of Maytenus guianensis bark. Exp Parasitol 2019; 205:107738. [DOI: 10.1016/j.exppara.2019.107738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/22/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
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Marques SA, Merlotto MR, Ramos PM, Marques MEA. American tegumentary leishmaniasis: severe side effects of pentavalent antimonial in a patient with chronic renal failure. An Bras Dermatol 2019; 94:355-357. [PMID: 31365669 PMCID: PMC6668951 DOI: 10.1590/abd1806-4841.20198388] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/09/2018] [Indexed: 01/12/2023] Open
Abstract
Pentavalent antimonials are the first-line drug treatment for American tegumentary leishmaniasis. We report on a patient with chronic renal failure on hemodialysis who presented with cutaneous lesions of leishmaniasis for four months. The patient was treated with intravenous meglumine under strict nephrological surveillance, but cardiotoxicity, acute pancreatitis, pancytopenia, and cardiogenic shock developed rapidly. Deficient renal clearance of meglumine antimoniate can result in severe toxicity, as observed in this case. These side effects are related to cumulative plasma levels of the drug. Therefore, second-line drugs like amphotericin B are a better choice for patients on dialysis.
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Affiliation(s)
- Sílvio Alencar Marques
- Department of Dermatology, Faculdade de Medicina de Botucatu,
Universidade Estadual Paulista, Botucatu (SP), Brazil
| | - Maira Renata Merlotto
- Department of Dermatology, Faculdade de Medicina de Botucatu,
Universidade Estadual Paulista, Botucatu (SP), Brazil
| | - Paulo Müller Ramos
- Department of Dermatology, Faculdade de Medicina de Botucatu,
Universidade Estadual Paulista, Botucatu (SP), Brazil
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Castelo-Branco PV, Alves HJ, Pontes RL, Maciel-Silva VL, Ferreira Pereira SR. Ascorbic acid reduces the genetic damage caused by miltefosine (hexadecylphosphocholine) in animals infected by Leishmania (Leishamnia) infantum without decreasing its antileishmanial activity. Int J Parasitol Drugs Drug Resist 2019; 9:8-15. [PMID: 30578864 PMCID: PMC6304451 DOI: 10.1016/j.ijpddr.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/06/2018] [Accepted: 12/12/2018] [Indexed: 02/06/2023]
Abstract
Leishamaniasis is a neglected disease caused by over 20 Leishmania species, occurring in more than a hundred countries. Miltefosine (hexadecylphosphocholine) is the single oral drug used in treatment for leshmaniases, including cases of infections resistant to pentavalent antimony. Our group has recently demonstrated the ability of miltefosine to cause genomic lesions by DNA oxidation. Acknowledging that antioxidant compounds can potentially modulate Reactive Oxygen Species (ROS), our study verified whether ascorbic acid reduces the genotoxic and mutagenic effects caused by miltefosine, and whether it interferes with drug efficacy. For this purpose, uninfected Swiss mice received simultaneous (single dose treatment) miltefosine and ascorbic acid (gavage and intraperitoneally), besides pre and post treatments (ascorbic acid 24 h before and after drug administration); furthermore, Balb/c mice infected with Leishmania infantum received miltefosine plus ascorbic acid (repeated doses treatment). We conducted comet assays, micronucleus tests, dosages of superoxide dismutase enzyme and parasitic burden by the limiting dilution assay. We observed that ascorbic acid administered intraperitoneally displayed a protective effect over damage caused by miltefosine. However, this effect was not not observed when the same doses were administered via gavage, possibly due to low serum levels of this antioxidant. Ascorbic acid's protective effect reinforces that miltefosine damages DNA by oxidizing its nitrogenous bases, which is reduced by ascorbic acid due to its ability of protecting genetic material from the action of ROS. Therefore, our results show that this drug is efficient in reducing parasitic burden of L. infantum.
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Affiliation(s)
- Patrícia Valéria Castelo-Branco
- Laboratory of Genetics and Molecular Biology, Department of Biology, Federal University of Maranhão, Cidade Universitária do Bacanga, São Luís, Maranhão, Brazil
| | - Hugo José Alves
- Laboratory of Genetics and Molecular Biology, Department of Biology, Federal University of Maranhão, Cidade Universitária do Bacanga, São Luís, Maranhão, Brazil
| | - Raissa Lacerda Pontes
- Laboratory of Genetics and Molecular Biology, Department of Biology, Federal University of Maranhão, Cidade Universitária do Bacanga, São Luís, Maranhão, Brazil
| | - Vera Lucia Maciel-Silva
- Laboratory of Genetics and Molecular Biology, Department of Biology, Federal University of Maranhão, Cidade Universitária do Bacanga, São Luís, Maranhão, Brazil; Department of Chemistry and Biology, University of State of Maranhão, São Luís, Maranhão, Brazil
| | - Silma Regina Ferreira Pereira
- Laboratory of Genetics and Molecular Biology, Department of Biology, Federal University of Maranhão, Cidade Universitária do Bacanga, São Luís, Maranhão, Brazil.
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Visceral and Cutaneous Leishmaniasis Recommendations for Solid Organ Transplant Recipients and Donors. Transplantation 2018; 102:S8-S15. [PMID: 29381573 DOI: 10.1097/tp.0000000000002018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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18
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Genistein and Ascorbic Acid Reduce Oxidative Stress-Derived DNA Damage Induced by the Antileishmanial Meglumine Antimoniate. Antimicrob Agents Chemother 2018; 62:AAC.00456-18. [PMID: 29941649 DOI: 10.1128/aac.00456-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/15/2018] [Indexed: 12/15/2022] Open
Abstract
Meglumine antimoniate (Glucantime) is a pentavalent antimonial used to treat leishmaniasis, despite its acknowledged toxic effects, such as its ability to cause oxidative damage to lipids and proteins. Recently, our group demonstrated that meglumine antimoniate causes oxidative stress-derived DNA damage. Knowing that antioxidants modulate reactive oxygen species, we evaluated the capacity of genistein and ascorbic acid for preventing genotoxicity caused by meglumine antimoniate. For that, mice (n = 5/group) received genistein (via gavage) in doses of 5, 10, and 20 mg/kg for three consecutive days. After this period, they were treated with 810 mg/kg meglumine antimoniate via intraperitoneal (i.p.) route. Furthermore, mice (n = 5/group) simultaneously received ascorbic acid (i.p.) in doses of 30, 60, and 120 mg/kg and 810 mg/kg meglumine antimoniate. We also conducted post- and pretreatment assays, in which animals received ascorbic acid (60 mg/kg) 24 h prior to or after receiving meglumine antimoniate. Genomic instability and mutagenicity were analyzed through conventional comet assay and enzymatic assay using formamide pyrimidine DNA glycosylase (Fpg) enzyme, as well as the micronucleus test, respectively. Meglumine antimoniate induced an increase in the DNA damage after digestion with Fpg, reinforcing its mutagenic potential by oxidizing DNA bases, which was prevented by genistein. Similarly, ascorbic acid was capable of reducing mutagenic effects in simultaneous treatment as well as in posttreatment. Therefore, our results demonstrate that both compounds are efficient in preventing mutations in mammalian cells treated with meglumine antimoniate.
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Gonçalves SVCB, Costa CHN. Treatment of cutaneous leishmaniasis with thermotherapy in Brazil: an efficacy and safety study. An Bras Dermatol 2018; 93:347-355. [PMID: 29924242 PMCID: PMC6001097 DOI: 10.1590/abd1806-4841.20186415] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/19/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pentavalent antimonials remain as the standard drugs in the treatment of cutaneous leishmaniosis. The high cost, difficult administration, long treatment time, toxicity and increasing morbidity are factors that limit the use of these drugs. OBJECTIVES To describe the response to radiofrequency thermotherapy in the treatment of localized cutaneous leishmaniasis in Brazil, and to evaluate its safety and tolerability. METHODS We conducted a non-comparative open trial with a total of 15 patients confirmed to have cutaneous leishmaniasis on parasitological examination. A single radiofrequency thermotherapy session at 50ºC for 30 seconds was applied to the lesion and its edges. In patients with more than one lesion, only the largest one was treated initially. If after 30 days there was no evidence of healing, the smaller lesion was also treated with thermotherapy. Clinical cure was defined as visible healing for three months after treatment. The patients were followed-up for six months and there was no follow-up loss. RESULTS Of all 23 lesions, only two evolved to complete healing without the need of treatment. Of 21 lesions, 18 (85.7%) achieved full healing. The main observed side effects were itching, burning sensation, pain and blisters. STUDY LIMITATIONS Sample with a small number of patients and short follow-up. CONCLUSION Thermotherapy can be considered a therapeutic alternative in localized cutaneous leishmaniasis, especially in cases of single cutaneous lesions and with formal contraindications to conventional treatment with pentavalent antimonials.
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Tajuddeen N, Isah MB, Suleiman MA, van Heerden FR, Ibrahim MA. The chemotherapeutic potential of chalcones against leishmaniases: a review. Int J Antimicrob Agents 2017; 51:311-318. [PMID: 28668673 DOI: 10.1016/j.ijantimicag.2017.06.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/06/2017] [Accepted: 06/17/2017] [Indexed: 02/07/2023]
Abstract
Leishmaniases are endemic diseases in tropical and sub-tropical regions of the world and are considered by the World Health Organization (WHO) to be among the six most important neglected tropical diseases. The current therapeutic arsenal against the disease is associated with a series of chemotherapeutic setbacks. However, since the early 1990s, naturally occurring chalcones with promising antileishmanial effects have been reported, and several other synthetic chalcones and chalcone-hybrid molecules have been confirmed to possess potent activity against various Leishmania species. This paper is a comprehensive review covering the antileishmanial activity of 34 naturally occurring chalcones, 224 synthetic/semisynthetic chalcones and 54 chalcone-hybrid molecules. Several chalcones in the synthetic/semisynthetic category had IC50 values < 5 µM, with very good selectivity against parasites, and the structure-activity relationships as well as the proposed mechanism of action are discussed. We identified knowledge-gaps with the hope of providing future direction for the discovery of novel antileishmanial drugs from chalcones.
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Affiliation(s)
- Nasir Tajuddeen
- Department of Chemistry, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Fanie R van Heerden
- School of Chemistry and Physics, University of KwaZulu-Natal, Private Bag X01, Scottsville 3209, South Africa
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21
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Monzote L, Jiménez J, Cuesta-Rubio O, Márquez I, Gutiérrez Y, da Rocha CQ, Marchi M, Setzer WN, Vilegas W. In Vitro
Assessment of Plants Growing in Cuba Belonging to Solanaceae Family Against Leishmania amazonensis. Phytother Res 2016; 30:1785-1793. [DOI: 10.1002/ptr.5681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Lianet Monzote
- Departmento de Parasitología; Instituto de Medicina Tropical ‘Pedro Kouri’; Habana Cuba
| | - Jenny Jiménez
- Laboratorio de Producciones Biofarmacéuticas (LABIOFAM); Matanzas Cuba
| | - Osmany Cuesta-Rubio
- Unidad Académica de Ciencias Químicas y de la Salud; Universidad Técnica de Machala; Machala Ecuador
| | - Ingrid Márquez
- Unidad Académica de Ciencias Químicas y de la Salud; Universidad Técnica de Machala; Machala Ecuador
| | - Yamile Gutiérrez
- Departmento de Química, Instituto de Farmacia y Alimentos (IFAL); Universidad de la Habana; Habana Cuba
| | - Cláudia Quintino da Rocha
- Laboratorio de Biodiversidad; Universidad Estatal Paulista Julio de Mesquita Filho; São Paulo Brazil
| | - Mary Marchi
- Departmento de Química, Instituto de Química; Universidad Estatal Paulista Julio de Mesquita Filho; São Paulo Brazil
| | - William N. Setzer
- Department of Chemistry; University of Alabama in Huntsville; Huntsville AL USA
| | - Wagner Vilegas
- Laboratorio de Biodiversidad; Universidad Estatal Paulista Julio de Mesquita Filho; São Paulo Brazil
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22
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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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The pentavalent antimonial therapy against experimental Leishmania amazonensis infection is more effective under the inhibition of the NF-κB pathway. Int Immunopharmacol 2015. [DOI: 10.1016/j.intimp.2015.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Montoya A, Daza A, Muñoz D, Ríos K, Taylor V, Cedeño D, Vélez ID, Echeverri F, Robledo SM. Development of a novel formulation with hypericin to treat cutaneous leishmaniasis based on photodynamic therapy in in vitro and in vivo studies. Antimicrob Agents Chemother 2015; 59:5804-13. [PMID: 26169411 PMCID: PMC4538502 DOI: 10.1128/aac.00545-15] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/30/2015] [Indexed: 12/12/2022] Open
Abstract
An evaluation of the leishmanicidal activity in vitro and in vivo of hypericin, an expanded-spectrum photosensitizer found in Hypericum perforatum, is presented. Hypericin was evaluated against intracellular amastigotes in vitro of Leishmania (Viannia) panamensis. A topical formulation containing 0.5% hypericin was developed and assayed in vivo in a hamster model of cutaneous leishmaniasis. Results demonstrate that hypericin induces a significant antiamastigote effect in vitro against L. panamensis by decreasing the number of parasites inside infected cells. The topical formulation of 0.5% hypericin allows healing of L. panamensis-induced lesions upon a topical application of 40 mg/day plus visible-light irradiation (5 J/cm(2), 15 min), twice a week for 3 weeks.
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Affiliation(s)
- Andrés Montoya
- PECET-Medical Research institute, School of Medicine, University of Antioquia, Medellín, Colombia
| | - Alejandro Daza
- PECET-Medical Research institute, School of Medicine, University of Antioquia, Medellín, Colombia
| | - Diana Muñoz
- PECET-Medical Research institute, School of Medicine, University of Antioquia, Medellín, Colombia
| | - Karina Ríos
- PECET-Medical Research institute, School of Medicine, University of Antioquia, Medellín, Colombia
| | - Viviana Taylor
- PECET-Medical Research institute, School of Medicine, University of Antioquia, Medellín, Colombia
| | - David Cedeño
- Department of Chemistry, Illinois State University, Normal, Illinois, USA
| | - Iván D Vélez
- PECET-Medical Research institute, School of Medicine, University of Antioquia, Medellín, Colombia
| | - Fernando Echeverri
- QOPN-Institute of Chemistry, School of Exact and Natural Sciences, University of Antioquia, Medellín, Colombia
| | - Sara M Robledo
- PECET-Medical Research institute, School of Medicine, University of Antioquia, Medellín, Colombia
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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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Activity of synthetic chalcones in hamsters experimentally infected with Leishmania (Viannia) braziliensis. Parasitol Res 2015; 114:3587-600. [DOI: 10.1007/s00436-015-4581-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/11/2015] [Indexed: 11/26/2022]
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Macedo SRA, de Barros NB, Ferreira AS, Moreira-Dill LS, Calderon LA, Soares AM, Nicolete R. Biodegradable microparticles containing crotamine isolated from Crotalus durissus terrificus display antileishmanial activity in vitro. Pharmacology 2015; 95:78-86. [PMID: 25633844 DOI: 10.1159/000371391] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 12/03/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To evaluate antileishmanial activity of crotamine, a toxin isolated from Crotalus durissus terrificus, in solution form and encapsulated in biodegradable microparticles in vitro. METHODS Particles were analyzed on-chip by surface plasmon resonance and characterized by testing their diameters, zeta potential and encapsulation rate. The viability of promastigotes as well as murine macrophages was assessed. Furthermore, the phagocytic index was determined for macrophages, and cell supernatants were collected for the determination of TNF-α levels. An infection assay using Leishmania amazonensis-infected macrophages was also conducted. RESULTS The diameters and zeta potential of control particles (1.35 μm; -12.3 mV) and of those containing crotamine (3.09 μm; -20.9 mV) were adequate for the assays conducted. Crotamine-loaded particles were better captured by macrophages than control particles (increase of 12% in the phagocytic index), leading to increased TNF-α levels (196 pg/ml), and they also induced a significant decrease in the numbers of amastigotes compared to infected macrophages only. CONCLUSION The approach presented here opens the possibility of working with safe concentrations of encapsulated toxins to reach antileishmanial effects.
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Affiliation(s)
- Sharon Rose A Macedo
- Laboratório de Biotecnologia Aplicada à Saúde, Fundação Oswaldo Cruz, Fiocruz Rondônia, Porto Velho, RO, Brazil
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Gomes CM, Damasco FDS, Morais OOD, Paula CDRD, Sampaio RNR. Recurrent cutaneous leishmaniasis. An Bras Dermatol 2014; 88:462-4. [PMID: 23793208 PMCID: PMC3754387 DOI: 10.1590/abd1806-4841.20131885] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 10/16/2012] [Indexed: 12/03/2022] Open
Abstract
We present a case of an 18-year-old male patient who, after two years of inappropriate treatment for cutaneous leishmaniasis, began to show nodules arising at the edges of the former healing scar. He was immune competent and denied any trauma. The diagnosis of recurrent cutaneous leishmaniasis was made following positive culture of aspirate samples. The patient was treated with N-methylglucamine associated with pentoxifylline for 30 days. Similar cases require special attention mainly because of the challenges imposed by treatment.
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Affiliation(s)
- Ciro Martins Gomes
- Dermatology Department, Brasilia University Hospital, UnB, Brasilia, DF, Brazil.
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de Lima SCG, Teixeira MJ, Lopes Júnior JEG, de Morais SM, Torres AF, Braga MA, Rodrigues RO, Santiago GMP, Martins AC, Nagao-Dias AT. In vitro and in vivo leishmanicidal activity of Astronium fraxinifolium (Schott) and Plectranthus amboinicus (Lour.) Spreng against Leishmania (Viannia) braziliensis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:848293. [PMID: 24829921 PMCID: PMC4009211 DOI: 10.1155/2014/848293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/20/2014] [Indexed: 11/29/2022]
Abstract
The aim of the present work was to evaluate antileishmanial activity of Astronium fraxinifolium and Plectranthus amboinicus. For the in vitro tests, essential oil of P. amboinicus (OEPA) and ethanolic extracts from A. fraxinifolium (EEAF) were incubated with 10(6) promastigotes of L. (Viannia) braziliensis. The OEPA was able to reduce the parasite growth after 48 h; nonetheless, all the EEAFs could totally abolish the parasite growth. For the in vivo studies, BALB/c mice were infected subcutaneously (s.c.) with 10(7) L. braziliensis promastigotes. Treatment was done by administering OEPA intralesionally (i.l.) for 14 days. No difference was found in lesion thickness when those animals were compared with the untreated animals. Further, golden hamsters were infected s.c. with 10(6) L. braziliensis promastigotes. The first protocol of treatment consisted of ethanolic leaf extract from A. fraxinifolium (ELEAF) administered i.l. for 4 days and a booster dose at the 7th day. The animals showed a significant reduction of lesion thickness in the 6th week, but it was not comparable to the animals treated with Glucantime. The second protocol consisted of 15 daily intralesional injections. The profiles of lesion thickness were similar to the standard treatment. In conclusion, in vivo studies showed a high efficacy when the infected animals were intralesionally treated with leaf ethanolic extract from A. fraxinifolium.
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Affiliation(s)
- Silvio César Gomes de Lima
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará (UFC), Rua Capitão Francisco Pedro 1210, 60430-370 Fortaleza, CE, Brazil
| | - Maria Jania Teixeira
- Departamento de Patologia e Medicina Legal, Faculdade de Medicina, UFC, Rua Monsenhor Furtado S/N, 60430-350 Fortaleza, CE, Brazil
| | - José Evaldo Gonçalves Lopes Júnior
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará (UFC), Rua Capitão Francisco Pedro 1210, 60430-370 Fortaleza, CE, Brazil
| | - Selene Maia de Morais
- Departamento de Química, Universidade Estadual do Ceará, Avenida Paranjana 1700, 60000-001 Fortaleza, CE, Brazil
| | - Alba Fabiola Torres
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará (UFC), Rua Capitão Francisco Pedro 1210, 60430-370 Fortaleza, CE, Brazil
| | - Milena Aguiar Braga
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará (UFC), Rua Capitão Francisco Pedro 1210, 60430-370 Fortaleza, CE, Brazil
| | - Raphael Oliveira Rodrigues
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará (UFC), Rua Capitão Francisco Pedro 1210, 60430-370 Fortaleza, CE, Brazil
| | | | - Alice Costa Martins
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará (UFC), Rua Capitão Francisco Pedro 1210, 60430-370 Fortaleza, CE, Brazil
| | - Aparecida Tiemi Nagao-Dias
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará (UFC), Rua Capitão Francisco Pedro 1210, 60430-370 Fortaleza, CE, Brazil
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van Griensven J, Carrillo E, López-Vélez R, Lynen L, Moreno J. Leishmaniasis in immunosuppressed individuals. Clin Microbiol Infect 2014; 20:286-99. [DOI: 10.1111/1469-0691.12556] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Adriano AL, Leal PAB, Breckenfeld MP, Costa IDS, Almeida C, Sousa ARDD. American tegumentary leishmaniasis: an uncommon clinical and histopathological presentation. An Bras Dermatol 2014; 88:260-2. [PMID: 23739691 PMCID: PMC3750893 DOI: 10.1590/s0365-05962013000200015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 03/27/2012] [Indexed: 11/21/2022] Open
Abstract
We report a case of an unusual presentation of American Tegumentary Leishmaniasis
involving a male patient with a solitary lesion on the ear lobe, persisting with
minimal increase for at least six months without ulceration or related symptoms. The
histological sections showed epithelial atrophy and a large number of structures
consistent with Leishmania sp. amastigotes within macrophages. Treatment commenced
with meglumine antimoniate resulting in regression of the condition. This report is
of importance given the unusual clinical manifestation and histopathological findings
in this case and the fact that there was low correlation with the extended duration
of the disease.
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de Mello TFP, Bitencourt HR, Pedroso RB, Aristides SMA, Lonardoni MVC, Silveira TGV. Leishmanicidal activity of synthetic chalcones in Leishmania (Viannia) braziliensis. Exp Parasitol 2013; 136:27-34. [PMID: 24269198 DOI: 10.1016/j.exppara.2013.11.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 10/30/2013] [Accepted: 11/11/2013] [Indexed: 01/16/2023]
Abstract
The treatment of American cutaneous leishmaniasis (ACL) is based on a small group of compounds that were developed decades ago, all of which are highly toxic and have a high rate of treatment failure. The chalcones show leishmanicidal activity, yet few studies have evaluated this activity against Leishmania (Viannia) braziliensis, one of the most important species of Leishmania across Latin America. Four new synthetic chalcones (1-4) were evaluated for inhibitory activity in vitro against promastigotes and intracellular parasites 24h post infection of L. (V.) braziliensis, cytotoxicity for macrophages J774.A1 and red blood cells, and the ability to stimulate nitric oxide production. The results for the inhibitory concentration for 50% of the promastigotes (IC50) (1.38±1.09-6.36±2.04μM), cytotoxic concentration for 50% of the macrophages (CC50) (13.49±3.13-199.43±4.11μM), and selectivity index (SI) (3.76 to 33.94) indicate that all chalcones (1-4) showed an effect on promastigotes of L. (V.) braziliensis; chalcone 2 had the highest SI. The haemolytic assay with chalcones 1 (301.93μM), 2 (534.18μM), 3 (419.46μM) and 4 (381.11μM) showed 0.00%, 2.33%, 0.57% and 1.74% haemolysis, respectively. All chalcones significantly reduced the infection index of macrophages by parasites; for chalcones (1-3) this effect may be dependent on nitric-oxide production by macrophages. The chalcones tested exhibited inhibitory activity for promastigotes and intracellular parasites of L. (V.) braziliensis, with low toxicity for macrophages and red blood cells. The anti-Leishmania activity of chalcones (1-3) may depend on the stimulation of nitric-oxide production in the initial stage of infection. These results show an initially encouraging potential for the use of chalcones (1-4) to treat ACL.
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Affiliation(s)
- Tatiane F P de Mello
- Post-Graduate Program in Health Sciences, Universidade Estadual de Maringá, Maringá, Brazil
| | | | - Raissa B Pedroso
- Post-Graduate Program in Health Sciences, Universidade Estadual de Maringá, Maringá, Brazil
| | - Sandra M A Aristides
- Department of Clinical Analysis and Biomedicine, Universidade Estadual de Maringá, Maringá, Brazil
| | - Maria V C Lonardoni
- Department of Clinical Analysis and Biomedicine, Universidade Estadual de Maringá, Maringá, Brazil
| | - Thais G V Silveira
- Department of Clinical Analysis and Biomedicine, Universidade Estadual de Maringá, Maringá, Brazil.
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Placa eritematodescamativa de lento crecimiento en la cara y el cuero cabelludo de una mujer anciana. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2013.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Torres Garcia Y, Escutia Muñoz B, Botella Estrada R. Slow-growing scaly erythematous plaque on the face and scalp of an elderly woman. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:715-6. [PMID: 24011741 DOI: 10.1016/j.adengl.2013.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 02/24/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- Y Torres Garcia
- Departamento de Dermatología, Hospital Universitario La Fe, Valencia, Spain
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Reveiz L, Maia-Elkhoury ANS, Nicholls RS, Romero GAS, Yadon ZE. Interventions for American cutaneous and mucocutaneous leishmaniasis: a systematic review update. PLoS One 2013; 8:e61843. [PMID: 23637917 PMCID: PMC3639260 DOI: 10.1371/journal.pone.0061843] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/14/2013] [Indexed: 12/22/2022] Open
Abstract
Introduction Leishmaniasis is an important public health problem in the Americas. A Cochrane review published in 2009 analyzed 38 randomized controlled trials (RCT). We conducted a systematic review to evaluate the effects of therapeutic interventions for American cutaneous and mucocutaneous leishmaniasis. Methods All studies were extracted from PubMed, Embase, Lilacs (2009 to July, 2012 respectively), the Cochrane Central Register of Controlled Trials (6-2012) and references of identified publications. RCTs’ risk of bias was assessed. Results We identified 1865 references of interest; we finally included 10 new RCTs. The risk of bias scored low or unclear for most domains. Miltefosine was not significantly different from meglumine antimoniate in the complete cure rate at 6 months (4 RCT; 584 participants; ITT; RR: 1.12; 95%CI: 0.85 to 1.47; I2 78%). However a significant difference in the rate of complete cure favoring miltefosine at 6 months was found in L. panamensis and L. guyanensis (2 RCTs, 206 participants; ITT; RR: 1.22; 95%CI: 1.02 to 1.46; I2 0%). One RCT found that meglumine antimoniate was superior to pentamidine in the rate of complete cure for L. braziliensis (80 participants, ITT; RR: 2.21; 95%CI: 1.41 to 3.49), while another RCT assessing L. guyanensis did not find any significant difference. Although meta-analysis of three studies found a significant difference in the rate of complete cure at 3 months favoring imiquimod versus placebo (134 participants; ITT; RR: 1.45; 95%CI: 1.12 to 1.88; I2 0%), no significant differences were found at 6 and 12 months. Thermotherapy and nitric oxide were not superior to meglumine antimoniate. Conclusion Therapeutic interventions for American cutaneous and mucocutaneous leishmaniasis are varied and should be decided according to the context. Since mucosal disease is the more neglected form of leishmaniasis a multicentric trial should be urgently considered.
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Affiliation(s)
- Ludovic Reveiz
- Health Systems Based on Primary Health Care, Pan American Health Organization (PAHO), Washington, DC, United States of America
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Demers E, Forrest DM, Weichert GE. Cutaneous leishmaniasis in a returning traveller. CMAJ 2013; 185:681-3. [PMID: 23529965 DOI: 10.1503/cmaj.120694] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Eric Demers
- Biology Department, Vancouver Island University, Nanaimo, BC.
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Ordaz-Farias A, Muñoz-Garza FZ, Sevilla-Gonzalez FK, Arana-Guajardo A, Ocampo-Candiani J, Treviño-Garza N, Becker I, Camacho-Ortiz A. Case report: Transient success using prolonged treatment with miltefosine for a patient with diffuse cutaneous leishmaniasis infected with Leishmania mexicana mexicana. Am J Trop Med Hyg 2012; 88:153-6. [PMID: 23243111 DOI: 10.4269/ajtmh.2012.11-0592] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Leishmania sp. is an intracellular parasite that causes a variable degree of clinical manifestations, especially in the skin. We present the case of a 38-year-old male with a chronic history of mucocutaneous disease present since childhood that generated deformity, loss of cartilage in the ears and nose, and scarring that limited his range of motion. The parasite was identified as L. mexicana mexicana. The patient was treated with a 3-month course of oral miltefosine with overwhelming results.
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Affiliation(s)
- Alejandro Ordaz-Farias
- Department of Medicine, University Hospital Dr. José Eleuterio González, Monterrey, Nuevo Leon, México.
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Bacon KM, Hotez PJ, Kruchten SD, Kamhawi S, Bottazzi ME, Valenzuela JG, Lee BY. The potential economic value of a cutaneous leishmaniasis vaccine in seven endemic countries in the Americas. Vaccine 2012. [PMID: 23176979 DOI: 10.1016/j.vaccine.2012.11.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cutaneous leishmaniasis (CL) and its associated complications, including mucocutaneous leishmaniasis (MCL) and diffuse CL (DCL) have emerged as important neglected tropical diseases in Latin America, especially in areas associated with human migration, conflict, and recent deforestation. Because of the limitations of current chemotherapeutic approaches to CL, MCL, and DCL, several prototype vaccines are in different states of product and clinical development. We constructed and utilized a Markov decision analytic computer model to evaluate the potential economic value of a preventative CL vaccine in seven countries in Latin America: Bolivia, Brazil, Colombia, Ecuador, Mexico, Peru, and Venezuela. The results indicated that even a vaccine with a relatively short duration of protection and modest efficacy could be recommended for use in targeted locations, as it could prevent a substantial number of cases at low-cost and potentially even result in cost savings. If the population in the seven countries were vaccinated using a vaccine that provides at least 10 years of protection, an estimated 41,000-144,784 CL cases could be averted, each at a cost less than the cost of current recommended treatments. Further, even a vaccine providing as little as five years duration of protection with as little as 50% efficacy remains cost-effective compared with chemotherapy; additional scenarios resembling epidemic settings such as the one that occurred in Chaparral, Colombia in 2004 demonstrate important economic benefits.
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Affiliation(s)
- Kristina M Bacon
- Public Health Computational and Operational Research, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Silva MDSD, Sousa RTD, Silva EBD, Guerra JADO, Gomes NM, Santana RFD, Mubarac RS. Primary lesion of mucocutaneous leishmaniasis simulating external otitis. Braz J Otorhinolaryngol 2012; 78:137. [PMID: 23108835 PMCID: PMC9450710 DOI: 10.5935/1808-8694.20120023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Peck GW, Kirkup BC. Biocompatibility of antimicrobials to maggot debridement therapy: medical maggots Lucilia sericata (Diptera: Calliphoridae) exhibit tolerance to clinical maximum doses of antimicrobials. JOURNAL OF MEDICAL ENTOMOLOGY 2012; 49:1137-1143. [PMID: 23025196 DOI: 10.1603/me12066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The larvae of calliphorid flies are used to debride wounds of patients with severe tissue destruction, often concurrently with antimicrobials. The current study evaluates the effects of ceftazidime, tobramycin, amikacin, gentamicin, polymyxin B, doxycycline, paromomycin, amphotericin B, sodium stibogluconate, and miltefosine at 1, 10, and 100 x the Maximum Clinical Concentration (mg/kg/d) in raw liver assays. Effects on larvae were small and depended on dose and antimicrobial formulation, with hours in assay (24 or 48 h) having a significant effect on larval survival. Sodium stibgluconate had the strongest effect on maggot survival (80.0% at 48 h). These results suggest that the antimicrobials tested here may be used simultaneously with maggot debridement therapy, and may actually increase the effectiveness of maggot debridement therapy in certain applications where >1 x Maximum Clinical Concentration is indicated, such as topical creams for cutaneous leishmaniasis.
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Affiliation(s)
- George W Peck
- Wound Infections Department, Bacterial Disease Branch, Walter Reed Army Institute of Research, 530 Robert Grant Ave., Silver Spring, MD 20910, USA.
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