Leishmania major: histopathological responses before and after topical treatment in experimental animals

Local Skin Inflammation in Cutaneous Leishmaniasis as a Source of Variable Pharmacokinetics and Therapeutic Efficacy of Liposomal Amphotericin B

Disfiguring skin lesions caused by several species of the Leishmania parasite characterize cutaneous leishmaniasis (CL). Successful treatment of CL with intravenous (i.v.) liposomal amphotericin B (LAmB) relies on the presence of adequate antibiotic concentrations at the dermal site of infection within the inflamed skin.

Disfiguring skin lesions caused by several species of the Leishmania parasite characterize cutaneous leishmaniasis (CL). Successful treatment of CL with intravenous (i.v.) liposomal amphotericin B (LAmB) relies on the presence of adequate antibiotic concentrations at the dermal site of infection within the inflamed skin. Here, we have investigated the impact of the local skin inflammation on the pharmacokinetics (PK) and efficacy of LAmB in two murine models of localized CL (Leishmania major and Leishmania mexicana) at three different stages of disease (papule, initial nodule, and established nodule). Twenty-four hours after the administration of one 25 mg/kg of body weight LAmB (i.v.) dose to infected BALB/c mice (n = 5), drug accumulation in the skin was found to be dependent on the causative parasite species (L. major > L. mexicana) and the disease stage (papule > initial nodule > established nodule > healthy skin). Elevated tissue drug levels were associated with increased vascular permeability (Evans blue assay) and macrophage infiltration (histomorphometry) in the infected skin, two pathophysiological parameters linked to tissue inflammation. After identical treatment of CL in the two models with 5 × 25 mg/kg LAmB (i.v.), intralesional drug concentrations and reductions in lesion size and parasite load (quantitative PCR [qPCR]) were all ≥2-fold higher for L. major than for L. mexicana. In conclusion, drug penetration of LAmB into CL skin lesions could depend on the disease stage and the causative Leishmania species due to the influence of local tissue inflammation.

Efficacy of Paromomycin-Chloroquine Combination Therapy in Experimental Cutaneous Leishmaniasis

The 4-aminoquinoline chloroquine (CQ) is clinically used in combination with doxycycline to cure chronic Q fever, as it enhances the activity of the antibiotic against the causative bacterium Coxiella burnetii residing within macrophage phagolysosomes. As there is a similar cellular host-pathogen biology for Leishmania parasites, this study aimed to determine whether such an approach could also be the basis for a new, improved treatment for cutaneous leishmaniasis (CL). We have evaluated the in vitro and in vivo activities of combinations of CQ with the standard drugs paromomycin (PM), miltefosine, and amphotericin B against Leishmania major and Leishmania mexicana In 72-h intracellular antileishmanial assays, outcomes were variable for different drugs. Significantly, the addition of 10 μM CQ to PM reduced 50% effective concentrations (EC50s) by over 5-fold against L. major and against normally insensitive L. mexicana parasites. In murine models of L. major and L. mexicana CL, daily coadministration of 50 mg/kg of body weight PM and 25 mg/kg CQ for 10 days resulted in a significant reduction in lesion size but not in parasite load compared to those for mice given the same doses of PM alone. Overall, our data indicate that PM-CQ combination therapy is unlikely to be a potential candidate for further preclinical development.

Leishmanicidal activity of amino acid and peptide esters

Amino acid and dipeptide esters kill intracellular and isolated L. amazonensis amastigotes. Several o f the compounds also restrict the growth o f mouse lesions after intralesional administration. However, the esters are known to be toxic in vitro for monocytes and certain lymphoid cells. Michel Rabinovitch surveys the mechanisms o f the leishmanicidal activity, describes some structure--activity relationships, and discusses strategies for the design of compounds more selective for the parasite.

Leishmania major: inhibition of the chemiluminescent response of human polymorphonuclear leukocytes by promastigotes and their excreted factors

The effect of various leishmanial preparations on the chemiluminescent response (CR) of human polymorphonuclear leukocytes (PMN) was studied. Almost no CR was observed with PMN stimulated with either Leishmania promastigotes or their excreted factors (EFs). Promastigotes added to PMN stimulated with phorbol myristate acetate (PMA), at a proportion of 20 to 1, respectively inhibited approximately 80-83% of the CR activity. Leishmanial promastigotes, whether live or dead, infective or non-infective as well as whole parasite homogenates, soluble and insoluble fractions, all decreased the CR of the PMN (PMN-CR). A similar effect was also observed with leishmanial EFs. The degree of inhibition was dose dependent and increasing the amount of EFs in the reaction mixture resulted in decrease of the PMN-CR. More than 80% of the total activity of the PMN-CR was inhibited by 500 micrograms EFs added at zero time to the reaction mixture. The inhibition of PMN-CR obtained from a patient suffering from a chronic infection caused by L. major was not significantly different from that observed with PMN from normal donors. The present study suggests that the PMN-CR is impaired by the Leishmania parasites and their EFs and thus may allow a greater survival of the parasites within these cells.