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Arteaga-Livias K, Santos-Huerta M, Dámaso-Mata B, Panduro-Correa V, Gonzales-Zamora JA, Rodriguez-Morales AJ. Disseminated Cutaneous Leishmaniasis in a Pediatric Patient from Peru. J Trop Pediatr 2021; 67:5896074. [PMID: 32830256 DOI: 10.1093/tropej/fmaa051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Leishmaniasis is a disease predominantly prevalent in the tropics, considered as one of the primary neglected diseases, preferably affects individuals of low socioeconomic status. Although this condition is well described in children, disseminated cutaneous leishmaniasis is a rare form of increasing importance and multiple cases observed in the adult population; however, still little described in children. CASE We present the case of a 12-year-old male, who has multiple ulcerative and nodular lesions distributed throughout the body, of ∼1 year of evolution that did not respond to antimicrobial treatment. After the diagnostic process, positive serological tests were found for leishmaniasis, with improvement in the picture after the use of sodium stibogluconate. DISCUSSION Disseminated cutaneous leishmaniasis is a clinical form that is described with increasing frequency and should be recognized and treated appropriately, mainly in the pediatric population, avoiding complications and sequelae.
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Affiliation(s)
- Kovy Arteaga-Livias
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Perú.,Infectious Diseases, Hospital II EsSalud, Huànuco, Perú
| | - Mijael Santos-Huerta
- Facultad de Medicina, Universidad Nacional Hermilio Valdizán, Huánuco, Perú.,Sociedad Científica de Estudiantes de Medicina (SOCIEM-HCO), Huánuco, Perú
| | - Bernardo Dámaso-Mata
- Infectious Diseases, Hospital II EsSalud, Huànuco, Perú.,Facultad de Medicina, Universidad Nacional Hermilio Valdizán, Huánuco, Perú
| | - Vicky Panduro-Correa
- Facultad de Medicina, Universidad Nacional Hermilio Valdizán, Huánuco, Perú.,Hospital Regional Hermilio Valdizán, Huánuco, Perú
| | | | - Alfonso J Rodriguez-Morales
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Perú.,Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia.,Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Sede Pereira, Pereira, Risaralda, Colombia
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Abstract
Aim: Cysteine proteases are important molecular targets involved in the replication, virulence and survival of parasitic organisms, including Trypanosoma and Leishmania species. Methodology & results: Analogs of the 7-chloro-N-[3-(morpholin-4-yl)propyl]quinolin-4-amine were synthesized and their inhibitory activity against the enzymes cruzain and rhodesain as well as against promastigotes forms of Leishmania species and epimastigotes forms of Trypanosoma cruzi were evaluated. Five compounds showed activity against both enzymes with half maximal inhibitory concentration (IC50) values ranging from 23 to 123 μM. Among these, compounds 3 and 4 displayed leishmanicidal activity; compound 4 was the most promising with IC50 values <10 μM and no cytotoxicity for uninfected cells. Conclusion: The results obtained indicate that cysteine proteases are likely to be the molecular target of compounds 3 and 4.
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Lepesheva GI, Friggeri L, Waterman MR. CYP51 as drug targets for fungi and protozoan parasites: past, present and future. Parasitology 2018; 145:1820-1836. [PMID: 29642960 PMCID: PMC6185833 DOI: 10.1017/s0031182018000562] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The efficiency of treatment of human infections with the unicellular eukaryotic pathogens such as fungi and protozoa remains deeply unsatisfactory. For example, the mortality rates from nosocomial fungemia in critically ill, immunosuppressed or post-cancer patients often exceed 50%. A set of six systemic clinical azoles [sterol 14α-demethylase (CYP51) inhibitors] represents the first-line antifungal treatment. All these drugs were discovered empirically, by monitoring their effects on fungal cell growth, though it had been proven that they kill fungal cells by blocking the biosynthesis of ergosterol in fungi at the stage of 14α-demethylation of the sterol nucleus. This review briefs the history of antifungal azoles, outlines the situation with the current clinical azole-based drugs, describes the attempts of their repurposing for treatment of human infections with the protozoan parasites that, similar to fungi, also produce endogenous sterols, and discusses the most recently acquired knowledge on the CYP51 structure/function and inhibition. It is our belief that this information should be helpful in shifting from the traditional phenotypic screening to the actual target-driven drug discovery paradigm, which will rationalize and substantially accelerate the development of new, more efficient and pathogen-oriented CYP51 inhibitors.
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Affiliation(s)
- Galina I. Lepesheva
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
| | - Laura Friggeri
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
| | - Michael R. Waterman
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
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Paniz-Mondolfi AE, Talhari C, García Bustos MF, Rosales T, Villamil-Gomez WE, Marquez M, Pérez Alvarez AM, Tálamo Sánchez AI, Rodriguez-Morales AJ. American cutaneous leishmaniasis in infancy and childhood. Int J Dermatol 2017; 56:1328-1341. [PMID: 28741648 DOI: 10.1111/ijd.13664] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/12/2017] [Accepted: 04/25/2017] [Indexed: 12/26/2022]
Abstract
Infant and young child skin diseases are among the most common features of morbidity throughout the tropics. Because the skin is directly exposed to the environment, it is considerably affected by climatic and local conditions such as vectors and microorganisms, as in the case of leishmaniasis. In America the observed magnitude of cutaneous leishmaniasis in children has led to the study of increased risk of exposure of this group due to the possibility of peri- and intradomiciliary transmission. The present review pretends to make a concrete approach all through the broad and main figures of this parasitic disease, including the clinical, physiopathological, epidemiological, diagnostic, and therapeutic aspects, in order to be used as a practical source of reference for pediatricians leading with tropical cutaneous pathology in the region.
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Affiliation(s)
- Alberto E Paniz-Mondolfi
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela.,Laboratory of Biochemistry, Instituto de Biomedicina/IVSS, Caracas, Venezuela
| | - Carolina Talhari
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Universidade Nilton Lins, Manaus, Amazonas, Brasil
| | - María F García Bustos
- Instituto de Patología Experimental, Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Salta, Argentina
| | | | - Wilmer E Villamil-Gomez
- Infectious Diseases and Infection Control Reserch Group, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia
| | - Marilianna Marquez
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela.,Universidad Centroccidental Lisandro Alvarado (UCLA), Barquisimeto, Venezuela
| | - Alexandra M Pérez Alvarez
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela
| | - Alejandra I Tálamo Sánchez
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela.,Universidad Centroccidental Lisandro Alvarado (UCLA), Barquisimeto, Venezuela
| | - Alfonso J Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
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Emami S, Tavangar P, Keighobadi M. An overview of azoles targeting sterol 14α-demethylase for antileishmanial therapy. Eur J Med Chem 2017; 135:241-259. [PMID: 28456033 DOI: 10.1016/j.ejmech.2017.04.044] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/11/2017] [Accepted: 04/18/2017] [Indexed: 02/07/2023]
Abstract
The azole antifungal drugs are an important class of chemotherapeutic agents with broad-spectrum of activity against yeasts and filamentous fungi, act in the ergosterol biosynthetic pathway through inhibition of the cytochrome P450-dependent enzyme sterol 14α-demethylase. Azole antifungals have also been repurposed for treatment of tropical protozoan infections including human leishmaniasis. Recent advances in molecular biology and computational chemistry areas have increased our knowledge about sterol biochemical pathway in Leishmania parasites. Based on the importance of sterol biosynthetic pathway in Leishmania parasites, we reviewed all studies reported on azoles for potential antileishmanial therapy along their structural and biological aspects. This review may help medicinal chemists for design of new azole-derived antileishmanial drugs.
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Affiliation(s)
- Saeed Emami
- Department of Medicinal Chemistry and Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Pegah Tavangar
- Department of Medicinal Chemistry and Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoud Keighobadi
- Student Research Committee, Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
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Prates FVDO, Dourado MEF, Silva SC, Schriefer A, Guimarães LH, Brito MDGO, Almeida J, Carvalho EM, Machado PRL. Fluconazole in the Treatment of Cutaneous Leishmaniasis Caused by Leishmania braziliensis: A Randomized Controlled Trial. Clin Infect Dis 2016; 64:67-71. [PMID: 27803094 DOI: 10.1093/cid/ciw662] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/16/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The treatment of cutaneous leishmaniasis (CL) caused by Leishmania braziliensis in Brazil with pentavalent antimony (Sbv) is associated with a high rate of failure, up to 45% of cases. In addition, Sbv can only administered parenterally and has important toxic effect. An effective, safe, and oral treatment for CL is required. METHODS A randomized controlled clinical trial was conducted to compare the efficacy and safety of high-dosage oral fluconazole (6.5-8.0 mg/kg/d for 28 days) versus a standard Sbv protocol (20 mg/kg/d for 20 days) for the treatment of CL in Bahia, Brazil. RESULTS A total of 53 subjects were included in the trial; 26 were treated with Sbv, and 27 with fluconazole. Intention-to-treat analysis showed initial cure rates (2 months after treatment) of 22.2% (6 of 27) in the fluconazole and 53.8% (14 of 26) in the Sbv group (P = .04). Six months after treatment, the final cure rate remained the same in both groups, without any relapses. The frequencies of adverse effects in the Sbv and fluconazole groups were similar, 34.6% versus 37% respectively. One patient treated with fluconazole discontinued treatment owing to malaise, headache, and moderate dizziness (Common Terminology Criteria for Adverse Events grade 2). CONCLUSIONS Oral fluconazole at a dosage of 6.5-8 mg/kg/d for 28 days should not be considered an effective treatment for CL caused by L. braziliensisClinical Trials Registration. NCT01953744.
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Affiliation(s)
- Fernanda V de O Prates
- Serviço de Imunologia, Hospital Universitário Prof Edgard Santos, Universidade Federal da Bahia
| | - Mayra E F Dourado
- Serviço de Imunologia, Hospital Universitário Prof Edgard Santos, Universidade Federal da Bahia
| | - Silvana C Silva
- Serviço de Imunologia, Hospital Universitário Prof Edgard Santos, Universidade Federal da Bahia
| | - Albert Schriefer
- Serviço de Imunologia, Hospital Universitário Prof Edgard Santos, Universidade Federal da Bahia.,Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais
| | - Luiz H Guimarães
- Serviço de Imunologia, Hospital Universitário Prof Edgard Santos, Universidade Federal da Bahia.,Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais
| | | | - Juliana Almeida
- Serviço de Imunologia, Hospital Universitário Prof Edgard Santos, Universidade Federal da Bahia
| | - Edgar M Carvalho
- Serviço de Imunologia, Hospital Universitário Prof Edgard Santos, Universidade Federal da Bahia.,Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais.,Centro de Pesquisa Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
| | - Paulo R L Machado
- Serviço de Imunologia, Hospital Universitário Prof Edgard Santos, Universidade Federal da Bahia.,Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais
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Antileishmanial Activity of Ezetimibe: Inhibition of Sterol Biosynthesis, In Vitro Synergy with Azoles, and Efficacy in Experimental Cutaneous Leishmaniasis. Antimicrob Agents Chemother 2016; 60:6844-6852. [PMID: 27600041 DOI: 10.1128/aac.01545-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/28/2016] [Indexed: 12/11/2022] Open
Abstract
Leishmaniasis affects mainly low-income populations in tropical regions. Radical innovation in drug discovery is time-consuming and expensive, imposing severe restrictions on the ability to launch new chemical entities for the treatment of neglected diseases. Drug repositioning is an attractive strategy for addressing a specific demand more easily. In this project, we have evaluated the antileishmanial activities of 30 drugs currently in clinical use for various morbidities. Ezetimibe, clinically used to reduce intestinal cholesterol absorption in dyslipidemic patients, killed Leishmania amazonensis promastigotes with a 50% inhibitory concentration (IC50) of 30 μM. Morphological analysis revealed that ezetimibe caused the parasites to become rounded, with multiple nuclei and flagella. Analysis by gas chromatography (GC)-mass spectrometry (MS) showed that promastigotes treated with ezetimibe had smaller amounts of C-14-demethylated sterols, and accumulated more cholesterol and lanosterol, than untreated promastigotes. We then evaluated the combination of ezetimibe with well-known antileishmanial azoles. The fractional inhibitory concentration index (FICI) indicated synergy when ezetimibe was combined with ketoconazole or miconazole. The activity of ezetimibe against intracellular amastigotes was confirmed, with an IC50 of 20 μM, and ezetimibe reduced the IC90s of ketoconazole and miconazole from 11.3 and 11.5 μM to 4.14 and 8.25 μM, respectively. Subsequently, we confirmed the activity of ezetimibe in vivo, showing that it decreased lesion development and parasite loads in murine cutaneous leishmaniasis. We concluded that ezetimibe has promising antileishmanial activity and should be considered in combination with azoles in further preclinical and clinical studies.
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Rabelo VW, Santos TF, Terra L, Santana MV, Castro HC, Rodrigues CR, Abreu PA. Targeting CYP51 for drug design by the contributions of molecular modeling. Fundam Clin Pharmacol 2016; 31:37-53. [PMID: 27487199 DOI: 10.1111/fcp.12230] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/15/2016] [Accepted: 08/01/2016] [Indexed: 11/28/2022]
Abstract
CYP51 is an enzyme of sterol biosynthesis pathway present in animals, plants, protozoa and fungi. This enzyme is described as an important drug target that is still of interest. Therefore, in this work, we reviewed the structure and function of CYP51 and explored the molecular modeling approaches for the development of new antifungal and antiprotozoans that target this enzyme. Crystallographic structures of CYP51 of some organisms have already been described in the literature, which enable the construction of homology models of other organisms' enzymes and molecular docking studies of new ligands. The binding mode and interactions of some new series of azoles with antifungal or antiprotozoan activities has been studied and showed important residues of the active site. Molecular modeling is an important tool to be explored for the discovery and optimization of CYP51 inhibitors with better activities, pharmacokinetics, and toxicological profiles.
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Affiliation(s)
- Vitor W Rabelo
- Laboratório de Modelagem Molecular e Pesquisa em Ciências Farmacêuticas (LAMCIFAR), Universidade Federal do Rio de Janeiro, Campus Macaé Professor Aloísio Teixeira, Avenida São José do Barreto 767, CEP 27965-045, Macaé, RJ, Brazil
| | - Taísa F Santos
- Laboratório de Modelagem Molecular e Pesquisa em Ciências Farmacêuticas (LAMCIFAR), Universidade Federal do Rio de Janeiro, Campus Macaé Professor Aloísio Teixeira, Avenida São José do Barreto 767, CEP 27965-045, Macaé, RJ, Brazil
| | - Luciana Terra
- Laboratório de Antibióticos, Bioquímica, Ensino e Modelagem Molecular (LabiEMol), Instituto de Biologia, Universidade Federal Fluminense, Campus Valonguinho Outeiro de São João Baptista s/n, Centro, CEP 24210130, Niterói, RJ, Brazil
| | - Marcos V Santana
- Laboratório de Antibióticos, Bioquímica, Ensino e Modelagem Molecular (LabiEMol), Instituto de Biologia, Universidade Federal Fluminense, Campus Valonguinho Outeiro de São João Baptista s/n, Centro, CEP 24210130, Niterói, RJ, Brazil
| | - Helena C Castro
- Laboratório de Antibióticos, Bioquímica, Ensino e Modelagem Molecular (LabiEMol), Instituto de Biologia, Universidade Federal Fluminense, Campus Valonguinho Outeiro de São João Baptista s/n, Centro, CEP 24210130, Niterói, RJ, Brazil
| | - Carlos R Rodrigues
- Laboratório de Modelagem Molecular e QSAR (ModMolQSAR), Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373, Cidade Universitária, CEP 21941-599, Rio de Janeiro, RJ, Brazil
| | - Paula A Abreu
- Laboratório de Modelagem Molecular e Pesquisa em Ciências Farmacêuticas (LAMCIFAR), Universidade Federal do Rio de Janeiro, Campus Macaé Professor Aloísio Teixeira, Avenida São José do Barreto 767, CEP 27965-045, Macaé, RJ, Brazil
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