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Tandon S, Puri M, Bharath Y, Choudhury UM, Mohapatra DK, Muthuswami R, Madhubala R. In vitro screening of natural product-based compounds for leishmanicidal activity. J Parasit Dis 2023; 47:644-658. [PMID: 37520198 PMCID: PMC10382454 DOI: 10.1007/s12639-023-01605-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/26/2023] [Indexed: 08/01/2023] Open
Abstract
Leishmaniasis is one of the major parasitic diseases, caused by obligate intracellular protozoa Leishmania, having high mortality as well as morbidity rate. As there is no human licensed vaccine available against leishmaniasis, chemotherapy remains the major way of combating this disease. Many disadvantages are known to be associated with the current drug regime including severe side effects and toxicity, long duration and expensive treatment, and the emergence of resistance. An alternative approach is being utilized to search for active molecules using natural sources, rather than relying on synthetic drugs. Many plant-derived secondary metabolites like phenolic compounds, steroids, quinones, etc. are being extensively investigated for their anti-leishmanial potential. One such group of complex phenolic compounds are diarylheptanoids. These compounds have been shown to exhibit anti-inflammatory, anti-parasitic, anti-fungal, and other pharmacological activities. In the present study, a set of sixteen tetrahydropyran derivatives including three natural products were obtained in lyophilized form. These compounds with trans-2,6-disubstituted tetrahydropyrans, Diospongin A, Diospongin B (isolated from Dioscorea spongiosa) and Centrolobine (Centrolobium sclerophyllum) as parent compounds were synthesized by the reaction of 1-phenyl-1-triemthylsiloxyethylene with six-membered cyclic hemiacetals in the presence of iodine as a catalyst. All the sixteen synthesized tetrahydropyran derivatives were used for toxicity analysis against L. donovani promastigotes, amastigotes and THP-1-derived human macrophages. IC50 values and selectivity index were calculated for all the compounds. Out of these sixteen, five compounds showed the best effect in vitro in terms of both leishmanicidal activity and non-toxicity to human macrophages.
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Affiliation(s)
- Smriti Tandon
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
- CCRAS-Central Ayurveda Research Institute, Jhansi, India
| | - Madhu Puri
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Yada Bharath
- CSIR-Indian Institute of Chemical Technology, Hyderabad, India
| | | | | | - Rohini Muthuswami
- Chromatin Remodelling Laboratory, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Rentala Madhubala
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
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Vallières C, Golinelli-Cohen MP, Guittet O, Lepoivre M, Huang ME, Vernis L. Redox-Based Strategies against Infections by Eukaryotic Pathogens. Genes (Basel) 2023; 14:genes14040778. [PMID: 37107536 PMCID: PMC10138290 DOI: 10.3390/genes14040778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Redox homeostasis is an equilibrium between reducing and oxidizing reactions within cells. It is an essential, dynamic process, which allows proper cellular reactions and regulates biological responses. Unbalanced redox homeostasis is the hallmark of many diseases, including cancer or inflammatory responses, and can eventually lead to cell death. Specifically, disrupting redox balance, essentially by increasing pro-oxidative molecules and favouring hyperoxidation, is a smart strategy to eliminate cells and has been used for cancer treatment, for example. Selectivity between cancer and normal cells thus appears crucial to avoid toxicity as much as possible. Redox-based approaches are also employed in the case of infectious diseases to tackle the pathogens specifically, with limited impacts on host cells. In this review, we focus on recent advances in redox-based strategies to fight eukaryotic pathogens, especially fungi and eukaryotic parasites. We report molecules recently described for causing or being associated with compromising redox homeostasis in pathogens and discuss therapeutic possibilities.
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Affiliation(s)
- Cindy Vallières
- Institut de Chimie des Substances Naturelles, CNRS UPR 2301, Université Paris-Saclay, 91198 Gif-sur-Yvette, France
| | - Marie-Pierre Golinelli-Cohen
- Institut de Chimie des Substances Naturelles, CNRS UPR 2301, Université Paris-Saclay, 91198 Gif-sur-Yvette, France
| | - Olivier Guittet
- Institut de Chimie des Substances Naturelles, CNRS UPR 2301, Université Paris-Saclay, 91198 Gif-sur-Yvette, France
| | - Michel Lepoivre
- Institut de Chimie des Substances Naturelles, CNRS UPR 2301, Université Paris-Saclay, 91198 Gif-sur-Yvette, France
| | - Meng-Er Huang
- Institut de Chimie des Substances Naturelles, CNRS UPR 2301, Université Paris-Saclay, 91198 Gif-sur-Yvette, France
| | - Laurence Vernis
- Institut de Chimie des Substances Naturelles, CNRS UPR 2301, Université Paris-Saclay, 91198 Gif-sur-Yvette, France
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3
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Amphotericin B-PEG Conjugates of ZnO Nanoparticles: Enhancement Antifungal Activity with Minimal Toxicity. Pharmaceutics 2022; 14:pharmaceutics14081646. [PMID: 36015271 PMCID: PMC9415822 DOI: 10.3390/pharmaceutics14081646] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 12/17/2022] Open
Abstract
Amphotericin B (AMB) is commonly used to treat life-threatening systemic fungal infections. AMB formulations that are more efficient and less nephrotoxic are currently unmet needs. In the current study, new ZnO-PEGylated AMB (ZnO-AMB-PEG) nanoparticles (NPs) were synthesized and their antifungal effects on the Candida spp. were investigated. The size and zeta potential values of AMB-PEG and ZnO-AMB-PEG NPs were 216.2 ± 26.9 to 662.3 ± 24.7 nm and −11.8 ± 2.02 to −14.2 ± 0.94 mV, respectively. The FTIR, XRD, and EDX spectra indicated that the PEG-enclosed AMB was capped by ZnO, and SEM images revealed the ZnO distribution on the surface NPs. In comparison to ZnO-AMB NPs and free AMB against C.albicans and C.neoformans, ZnO-AMB-PEG NPs significantly reduced the MIC and MFC. After a week of single and multiple dosage, the toxicity was investigated utilizing in vitro blood hemolysis, in vivo nephrotoxicity, and hepatic functions. ZnO-AMB-PEG significantly lowered WBC count and hematocrit concentrations when compared to AMB and ZnO-AMB. RBC count and hemoglobulin content, on the other hand, were unaltered. ZnO-AMB-PEG considerably lowered creatinine and blood urea nitrogen (BUN) levels when compared to AMB and ZnO-AMB. The difference in liver function indicators was determined to be minor by all formulae. These findings imply that ZnO-AMB-PEG could be utilized in the clinic with little nephrotoxicity, although more research is needed to determine the formulation’s in vivo efficacy.
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Ansari I, Basak R, Mukhopadhyay A. Hemoglobin Endocytosis and Intracellular Trafficking: A Novel Way of Heme Acquisition by Leishmania. Pathogens 2022; 11:585. [PMID: 35631106 PMCID: PMC9143042 DOI: 10.3390/pathogens11050585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 02/01/2023] Open
Abstract
Leishmania species are causative agents of human leishmaniasis, affecting 12 million people annually. Drugs available for leishmaniasis are toxic, and no vaccine is available. Thus, the major thrust is to identify new therapeutic targets. Leishmania is an auxotroph for heme and must acquire heme from the host for its survival. Thus, the major focus has been to understand the heme acquisition process by the parasites in the last few decades. It is conceivable that the parasite is possibly obtaining heme from host hemoprotein, as free heme is not available in the host. Current understanding indicates that Leishmania internalizes hemoglobin (Hb) through a specific receptor by a clathrin-mediated endocytic process and targets it to the parasite lysosomes via the Rab5 and Rab7 regulated endocytic pathway, where it is degraded to generate intracellular heme that is used by the parasite. Subsequently, intra-lysosomal heme is initially transported to the cytosol and is finally delivered to the mitochondria via different heme transporters. Studies using different null mutant parasites showed that these receptors and transporters are essential for the survival of the parasite. Thus, the heme acquisition process in Leishmania may be exploited for the development of novel therapeutics.
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Affiliation(s)
| | | | - Amitabha Mukhopadhyay
- Kusuma School of Biological Sciences, Indian Institute of Technology, Hauz Khas, New Delhi 110016, India; (I.A.); (R.B.)
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5
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Bernatchez JA, Kil YS, Barbosa da Silva E, Thomas D, McCall LI, Wendt KL, Souza JM, Ackermann J, McKerrow JH, Cichewicz RH, Siqueira-Neto JL. Identification of Leucinostatins from Ophiocordyceps sp. as Antiparasitic Agents against Trypanosoma cruzi. ACS OMEGA 2022; 7:7675-7682. [PMID: 35284725 PMCID: PMC8908367 DOI: 10.1021/acsomega.1c06347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Safe and effective treatments for Chagas disease, a potentially fatal parasitic infection associated with cardiac and gastrointestinal pathology and caused by the kinetoplastid parasite Trypanosoma cruzi, have yet to be developed. Benznidazole and nifurtimox, which are currently the only available drugs against T. cruzi, are associated with severe adverse effects and questionable efficacy in the late stage of the disease. Natural products have proven to be a rich source of new chemotypes for other infectious agents. We utilized a microscopy-based high-throughput phenotypic screen to identify inhibitors of T. cruzi from a library of natural product samples obtained from fungi procured through a Citizen Science Soil Collection Program (https://whatsinyourbackyard.org/) and the Great Lakes (USA) benthic environment. We identified five leucinostatins (A, B, F, NPDG C, and NPDG D) as potent inhibitors of the intracellular amastigote form of T. cruzi. Leucinostatin B also showed in vivo suppression of T. cruzi in a mouse model of Chagas disease. Given prior reports that leucinostatins A and B have antiparasitic activity against the related kinetoplastid Trypanosoma brucei, our findings suggest a potential cross-trypanocidal compound class and provide a platform for the further chemical derivatization of a potent chemical scaffold against T. cruzi.
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Affiliation(s)
- Jean A. Bernatchez
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
- Center
for Discovery and Innovation in Parasitic Diseases, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Yun-Seo Kil
- Department
of Chemistry and Biochemistry, University
of Oklahoma, 101 Stephenson Parkway, Norman, Oklahoma 73019, United
States
- Natural
Products Discovery Group, University of
Oklahoma, 101 Stephenson
Parkway, Norman, Oklahoma 73019, United States
- Institute
for Natural Products Applications and Research Technologies, University of Oklahoma, 101 Stephenson Parkway, Norman, Oklahoma 73019, United States
| | - Elany Barbosa da Silva
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
- Center
for Discovery and Innovation in Parasitic Diseases, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Diane Thomas
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
- Center
for Discovery and Innovation in Parasitic Diseases, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Laura-Isobel McCall
- Department
of Chemistry and Biochemistry, University
of Oklahoma, 101 Stephenson Parkway, Norman, Oklahoma 73019, United
States
- Department
of Microbiology and Plant Biology, University
of Oklahoma, 101 Stephenson
Parkway, Norman, Oklahoma 73019, United States
- Laboratories
of Molecular Anthropology and Microbiome Research, University of Oklahoma, 101 Stephenson Parkway, Norman, Oklahoma 73019, United
States
| | - Karen L. Wendt
- Department
of Chemistry and Biochemistry, University
of Oklahoma, 101 Stephenson Parkway, Norman, Oklahoma 73019, United
States
- Natural
Products Discovery Group, University of
Oklahoma, 101 Stephenson
Parkway, Norman, Oklahoma 73019, United States
- Institute
for Natural Products Applications and Research Technologies, University of Oklahoma, 101 Stephenson Parkway, Norman, Oklahoma 73019, United States
| | - Julia M. Souza
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
- Center
for Discovery and Innovation in Parasitic Diseases, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
- Research
Group on Natural Products, Center for Research in Sciences and Technology, University of Franca, Avenida Dr. Armando Salles de Oliveira 201, Franca, São Paulo CEP 14404-600, Brazil
| | - Jasmin Ackermann
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
- Center
for Discovery and Innovation in Parasitic Diseases, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
- Athena
Institute, VU University Amsterdam, De Boelelaan 1085, HV Amsterdam 1081, The Netherlands
| | - James H. McKerrow
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
- Center
for Discovery and Innovation in Parasitic Diseases, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - Robert H. Cichewicz
- Department
of Chemistry and Biochemistry, University
of Oklahoma, 101 Stephenson Parkway, Norman, Oklahoma 73019, United
States
- Natural
Products Discovery Group, University of
Oklahoma, 101 Stephenson
Parkway, Norman, Oklahoma 73019, United States
- Institute
for Natural Products Applications and Research Technologies, University of Oklahoma, 101 Stephenson Parkway, Norman, Oklahoma 73019, United States
| | - Jair L. Siqueira-Neto
- Skaggs
School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
- Center
for Discovery and Innovation in Parasitic Diseases, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
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Lekic N, Tadic B, Djordjevic V, Basaric D, Micev M, Vucelic D, Mitrovic M, Grubor N. Splenectomy for Visceral Leishmaniasis Out of an Endemic Region: A Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58020184. [PMID: 35208507 PMCID: PMC8875283 DOI: 10.3390/medicina58020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
Visceral leishmaniasis (also known as kala-azar) is characterized by fever, weight loss, swelling of the spleen and liver, and pancytopenia. If it is not treated, the fatality rate in developing countries can be as high as 100% within 2 years. In a high risk situation for perioperative bleeding due to severe thrombocytopenia/coagulopathy, we present a rare challenge for urgent splenectomy in a patient with previously undiagnosed visceral leishmaniasis. A histologic examination of the spleen revealed a visceral leishmaniasis, and the patient was successfully treated with amphotericin B.
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Affiliation(s)
- Nebojsa Lekic
- Department for HBP Surgery, University Clinical Centre of Serbia, Clinic for Digestive Surgery, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (N.L.); (V.D.); (D.B.); (N.G.)
- Department for Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, Subotica No. 8, 11000 Belgrade, Serbia
| | - Boris Tadic
- Department for HBP Surgery, University Clinical Centre of Serbia, Clinic for Digestive Surgery, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (N.L.); (V.D.); (D.B.); (N.G.)
- Department for Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, Subotica No. 8, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-62-388-288
| | - Vladimir Djordjevic
- Department for HBP Surgery, University Clinical Centre of Serbia, Clinic for Digestive Surgery, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (N.L.); (V.D.); (D.B.); (N.G.)
| | - Dragan Basaric
- Department for HBP Surgery, University Clinical Centre of Serbia, Clinic for Digestive Surgery, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (N.L.); (V.D.); (D.B.); (N.G.)
- Department for Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, Subotica No. 8, 11000 Belgrade, Serbia
| | - Marjan Micev
- Department for Pathology, University Clinical Centre of Serbia, Clinic for Digestive Surgery, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia;
| | - Dragica Vucelic
- Department of Transfusion Medicine, Faculty of Medicine, University of Belgrade, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia;
| | - Milica Mitrovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia;
| | - Nikola Grubor
- Department for HBP Surgery, University Clinical Centre of Serbia, Clinic for Digestive Surgery, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (N.L.); (V.D.); (D.B.); (N.G.)
- Department for Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, Subotica No. 8, 11000 Belgrade, Serbia
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7
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Detection of biosynthetic genes of microbially-synthesized secondary metabolites in a contaminated tropical agricultural soil. Biologia (Bratisl) 2021. [DOI: 10.1007/s11756-021-00851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Ortalli M, Varani S, Cimato G, Veronesi R, Quintavalla A, Lombardo M, Monari M, Trombini C. Evaluation of the Pharmacophoric Role of the O-O Bond in Synthetic Antileishmanial Compounds: Comparison between 1,2-Dioxanes and Tetrahydropyrans. J Med Chem 2020; 63:13140-13158. [PMID: 33091297 PMCID: PMC8018184 DOI: 10.1021/acs.jmedchem.0c01589] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Indexed: 12/17/2022]
Abstract
Leishmaniases are neglected diseases that can be treated with a limited drug arsenal; the development of new molecules is therefore a priority. Recent evidence indicates that endoperoxides, including artemisinin and its derivatives, possess antileishmanial activity. Here, 1,2-dioxanes were synthesized with their corresponding tetrahydropyrans lacking the peroxide bridge, to ascertain if this group is a key pharmacophoric requirement for the antileishmanial bioactivity. Newly synthesized compounds were examined in vitro, and their mechanism of action was preliminarily investigated. Three endoperoxides and their corresponding tetrahydropyrans effectively inhibited the growth of Leishmania donovani promastigotes and amastigotes, and iron did not play a significant role in their activation. Further, reactive oxygen species were produced in both endoperoxide- and tetrahydropyran-treated promastigotes. In conclusion, the peroxide group proved not to be crucial for the antileishmanial bioactivity of endoperoxides, under the tested conditions. Our findings reveal the potential of both 1,2-dioxanes and tetrahydropyrans as lead compounds for novel therapies against Leishmania.
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Affiliation(s)
- Margherita Ortalli
- Unit of Clinical Microbiology, Regional Reference
Centre for Microbiological Emergencies (CRREM), St. Orsola-Malpighi
University Hospital, Via Massarenti 9, 40138 Bologna,
Italy
| | - Stefania Varani
- Unit of Clinical Microbiology, Regional Reference
Centre for Microbiological Emergencies (CRREM), St. Orsola-Malpighi
University Hospital, Via Massarenti 9, 40138 Bologna,
Italy
- Department of Experimental, Diagnostic and Specialty
Medicine, Alma Mater Studiorum - University of Bologna, Via
Massarenti 9, 40138 Bologna, Italy
| | - Giorgia Cimato
- Unit of Clinical Microbiology, Regional Reference
Centre for Microbiological Emergencies (CRREM), St. Orsola-Malpighi
University Hospital, Via Massarenti 9, 40138 Bologna,
Italy
| | - Ruben Veronesi
- Department of Chemistry “G. Ciamician”,
Alma Mater Studiorum - University of Bologna Via Selmi 2,
40126 Bologna, Italy
| | - Arianna Quintavalla
- Department of Chemistry “G. Ciamician”,
Alma Mater Studiorum - University of Bologna Via Selmi 2,
40126 Bologna, Italy
- Centro Interuniversitario di Ricerca sulla Malaria
(CIRM) - Italian Malaria Network (IMN), University of Milan,
20100 Milan, Italy
| | - Marco Lombardo
- Department of Chemistry “G. Ciamician”,
Alma Mater Studiorum - University of Bologna Via Selmi 2,
40126 Bologna, Italy
- Centro Interuniversitario di Ricerca sulla Malaria
(CIRM) - Italian Malaria Network (IMN), University of Milan,
20100 Milan, Italy
| | - Magda Monari
- Department of Chemistry “G. Ciamician”,
Alma Mater Studiorum - University of Bologna Via Selmi 2,
40126 Bologna, Italy
| | - Claudio Trombini
- Department of Chemistry “G. Ciamician”,
Alma Mater Studiorum - University of Bologna Via Selmi 2,
40126 Bologna, Italy
- Centro Interuniversitario di Ricerca sulla Malaria
(CIRM) - Italian Malaria Network (IMN), University of Milan,
20100 Milan, Italy
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9
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Rapid Clinical Management of Leishmaniasis in Emergency Department: A Case Report with Clinical Review of Recent Literature. BIOLOGY 2020; 9:biology9110351. [PMID: 33113951 PMCID: PMC7690715 DOI: 10.3390/biology9110351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
Simple Summary In this article, we have briefly described the various forms of leishmania infection occur in emergency settings as well as the principal differential diagnoses, and we propose a decision algorithm to facilitate its early recognition in the emergency department (ED). Regarding the last point, the costs and validity of the most common modern diagnostic technologies have been examined, with particular attention to their sensibility and specificity; particularly, rk39-based RTD has been examined. To reinforce the importance of a quick diagnosis performed in the emergency room, we introduce a rather paradigmatic case report of a 19-year-old patient presenting with suspected lymphoproliferative disease and subsequently addressed to the incorrect hospital ward. As often happens, signs and symptoms tended toward the diagnosis of a hematologic disease rather than an infectious one: therefore, it is crucial to include a variety of diagnostic possibilities when a patient presents with fever and associated lympho-adenomegaly with minor symptoms: Leishmaniasis always needs to be considered among them. Abstract Systemic or localized lympho-adenomegaly is a common cause of access to the emergency department (ED), and differential diagnosis is often complicated. The combination of anamnesis, physical examination, laboratory tests, and instrumental diagnosis are extremely important to orientate toward a rapid and correct therapy, even if a prompt discrimination of the etiology of this lymphadenomegaly is not often possible. Our aim with this review is to improve the management of a differential diagnosis between hematological and infective diseases as leishmaniasis in ED and suggest quick diagnostic techniques that might be useful for early identification. Together in the review, we describe a case report of a young man affected from visceral leishmaniasis who presented to our ED and was incorrectly addressed to the wrong ward for the study of his condition. Subsequently, we focus on the clinical presentation of visceral leishmaniasis and compare it to the most common differential diagnoses that are usually taken into account in the management of such patients.
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Medrán NS, Sayé M, Pereira CA, Tekwani BL, La-Venia A, Labadie GR. Expanding the scope of synthetic 1,2,4-trioxanes towards Trypanosoma cruzi and Leishmania donovani. Bioorg Med Chem Lett 2020; 30:127491. [PMID: 32795626 DOI: 10.1016/j.bmcl.2020.127491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 01/29/2023]
Abstract
A series of synthetic 1,2,4-trioxanes related to artemisinin was tested against L. donovani and T. cruzi parasites. This screening identified some active compounds, with key common structural features. Interestingly, these selected trioxanes were efficient against both parasites, and achieved antiparasitic activities comparable or superior than those presented by the corresponding reference drugs, artemisinin and artesunate. This study represents the first example of synthetic trioxanes evaluated on T. cruzi and provides possible candidates for developing new drugs for the treatment of leishmaniasis and Chagas disease.
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Affiliation(s)
- Noelia S Medrán
- Instituto de Química Rosario (IQUIR-CONICET), Universidad Nacional de Rosario-CONICET, Suipacha 531, S2002LRK Rosario, Argentina; Departamento de Química Orgánica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Melisa Sayé
- Universidad de Buenos Aires, Facultad de Medicina, Instituto de Investigaciones Médicas A. Lanari, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad de Buenos Aires, Instituto de Investigaciones Médicas (IDIM), Laboratorio de Parasitología Molecular, Buenos Aires, Argentina
| | - Claudio A Pereira
- Universidad de Buenos Aires, Facultad de Medicina, Instituto de Investigaciones Médicas A. Lanari, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad de Buenos Aires, Instituto de Investigaciones Médicas (IDIM), Laboratorio de Parasitología Molecular, Buenos Aires, Argentina
| | - Babu L Tekwani
- National Center for Natural Products Research & Department of Pharmacology, School of Pharmacy, University of Mississippi, University, MS 38677, USA
| | - Agustina La-Venia
- Instituto de Química Rosario (IQUIR-CONICET), Universidad Nacional de Rosario-CONICET, Suipacha 531, S2002LRK Rosario, Argentina; Departamento de Química Orgánica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina.
| | - Guillermo R Labadie
- Instituto de Química Rosario (IQUIR-CONICET), Universidad Nacional de Rosario-CONICET, Suipacha 531, S2002LRK Rosario, Argentina; Departamento de Química Orgánica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina.
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Coser EM, Ferreira BA, Branco N, Yamashiro-Kanashiro EH, Lindoso JAL, Coelho AC. Activity of paromomycin against Leishmania amazonensis: Direct correlation between susceptibility in vitro and the treatment outcome in vivo. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2020; 14:91-98. [PMID: 33011651 PMCID: PMC7548989 DOI: 10.1016/j.ijpddr.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022]
Abstract
Paromomycin is an aminoglycoside antibiotic approved in 2006 for the treatment of visceral leishmaniasis caused by Leishmania donovani in Southeast Asia. Although this drug is not approved for the treatment of visceral and cutaneous leishmaniasis in Brazil, it is urgent and necessary to evaluate the potential of this drug as alternative for the treatment against species responsible for these clinical forms of the disease. In Brazil, Leishmania amazonensis is responsible for cutaneous and diffuse cutaneous leishmaniasis. The diffuse cutaneous form of the disease is difficult to treat and frequent relapses are reported, mainly when the treatment is interrupted. Here, we evaluated paromomycin susceptibility in vitro of a L. amazonensis clinical isolate from a patient with cutaneous leishmaniasis and the reference strain L. amazonensis M2269, as well as its in vivo efficacy in a murine experimental model. Although never exposed to paromomycin, a significant differential susceptibility between these two lines was found. Paromomycin was highly active in vitro against the clinical isolate in both forms of the parasite, while its activity against the reference strain was less active. In vivo studies in mice infected with each one of these lines demonstrated that paromomycin reduces lesion size and parasite burden and a direct correlation between the susceptibility in vitro and the effectiveness of this drug in vivo was found. Our findings indicate that paromomycin efficacy in vivo is dependent on intrinsic susceptibility of the parasite. Beyond that, this study contributes for the evaluation of the potential use of paromomycin in chemotherapy of cutaneous leishmaniasis in Brazil caused by L. amazonensis.
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Affiliation(s)
- Elizabeth M Coser
- Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Bianca A Ferreira
- Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Nilson Branco
- Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Edite H Yamashiro-Kanashiro
- Laboratório de Soroepidemiologia e Imunobiologia, Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Laboratório de Imunologia (LIM 48), Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José Angelo L Lindoso
- Laboratório de Protozoologia, Instituto de Medicina Tropical de São Paulo, Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Instituto de Infectologia Emilio Ribas, São Paulo, Brazil
| | - Adriano C Coelho
- Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil.
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Visceral leishmaniasis in Northeast Brazil: What is the impact of HIV on this protozoan infection? PLoS One 2019; 14:e0225875. [PMID: 31805100 PMCID: PMC6894860 DOI: 10.1371/journal.pone.0225875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/14/2019] [Indexed: 02/06/2023] Open
Abstract
Background The aim of this study was to compare cases of Visceral Leishmaniasis (VL) with and without HIV in a state in northeastern Brazil. Methodology We performed a comparative study in the state’s referral hospital for infectious/parasitic diseases located in Northeast Brazil between January 2007 and July 2017. The data obtained using this protocol were analyzed with SPSS. Principal findings In total, 252 patients were evaluated, including 126 with coincident VL/HIV and 126 with VL alone. Both groups primarily consisted of male patients. The most commonly affected ages were 30–39 years in the coinfected group and 19–29 years in the VL group (p < 0.001). Fever and anorexia (p = 0.001), which were more common in those with VL alone, were frequently observed, while diarrhea, vomiting, bleeding and dyspnea were more common in patients with VL/HIV coinfection (p<0.005). According to the hemogram results, leukocyte levels were lower in the VL group (p < 0.0001). Additionally, AST (aspartate aminotransferase) and ALT (alanine aminotransferase) levels differed between the groups, with higher levels in patients with VL (p < 0.001). On average, HIV was diagnosed 2.6 years before VL (p < 0.001), and VL relapse was observed only in the coinfection group (36.5% of cases). Fever (β = +0.17; p = 0.032) in the first VL/HIV episode was identified as a risk factor for relapse (R2 = 0.18). More deaths occurred in the VL/HIV group (11.1%) than in the VL group (2.4%). Conclusion/Significance VL/HIV was found to be prevalent among young adults, although the median patient age was higher in the VL/HIV group. The classic symptomatology of VL was more common in patients not coinfected with HIV; therefore, attention is needed in patients with HIV who present with any symptoms that suggest the presence of VL, especially in endemic areas. No cases of VL relapse occurred in patients without HIV, and death was more common in the VL/HIV co-infected group.
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Ortalli M, Varani S, Rosso C, Quintavalla A, Lombardo M, Trombini C. Evaluation of synthetic substituted 1,2-dioxanes as novel agents against human leishmaniasis. Eur J Med Chem 2019; 170:126-140. [PMID: 30878827 DOI: 10.1016/j.ejmech.2019.02.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/29/2019] [Accepted: 02/25/2019] [Indexed: 01/28/2023]
Abstract
The treatment of human leishmaniasis is currently based on few compounds that are highly toxic, expensive and have a high rate of treatment failure. A number of recent studies on new drugs focuses on natural or semi-synthetic compounds. Among them, the endoperoxide artemisinin, extracted from Artemisia annua, and some of its derivatives have shown leishmanicidal activity. In the present work, a series of structurally simple, fully synthetic 1,2-dioxanes were evaluated for in vitro antileishmanial activity against promastigotes of Leishmania donovani; the cytotoxicity for mammalian cells was also assessed. The six most promising compounds in terms of activity and selectivity were further investigated for their antileishmanial activity on the promastigote forms of L. tropica, L. major and L. infantum and against L. donovani amastigotes. The good performance in terms of potency and selectivity makes these six hits promising candidates for a preliminary lead optimization as antileishmanial agents.
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Affiliation(s)
- M Ortalli
- Alma Mater Studiorum - University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine, Via Massarenti 9, 40138, Bologna, Italy
| | - S Varani
- Alma Mater Studiorum - University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine, Via Massarenti 9, 40138, Bologna, Italy; Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - C Rosso
- Alma Mater Studiorum - University of Bologna, Department of Chemistry "G. Ciamician", Via Selmi 2, 40126, Bologna, Italy
| | - A Quintavalla
- Alma Mater Studiorum - University of Bologna, Department of Chemistry "G. Ciamician", Via Selmi 2, 40126, Bologna, Italy.
| | - M Lombardo
- Alma Mater Studiorum - University of Bologna, Department of Chemistry "G. Ciamician", Via Selmi 2, 40126, Bologna, Italy
| | - C Trombini
- Alma Mater Studiorum - University of Bologna, Department of Chemistry "G. Ciamician", Via Selmi 2, 40126, Bologna, Italy
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Lindoso JAL, Moreira CHV, Cunha MA, Queiroz IT. Visceral leishmaniasis and HIV coinfection: current perspectives. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2018; 10:193-201. [PMID: 30410407 PMCID: PMC6197215 DOI: 10.2147/hiv.s143929] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Visceral leishmaniasis (VL) is caused by Leishmania donovani and Leishmania infantum. The burden of VL is concentrated in tropical and subtropical areas; however, HIV infection has spread VL over a hyperendemic area. Several outcomes are observed as a result of VL–HIV coinfection. Impacts are observed in immunopathogenesis, clinical manifestation, diagnosis, and therapeutic response. Concerning clinical manifestation, typical and unusual manifestation has been observed during active VL in HIV-infected patient, as well as alteration in immunoresponse, inducing greater immunosuppression by low CD4 T-lymphocyte count or even by induction of immunoactivation, with cell senescence. Serological diagnosis of VL in the HIV-infected is poor, due to low humoral response, characterized by antibody production, so parasitological methods are more recommended. Another important and even more challenging point is the definition of the best therapeutic regimen for VL in HIV-coinfected patients, because in this population there is greater failure and consequently higher mortality. The challenge of better understanding immunopathogenesis in order to obtain more effective therapies is one of the crucial points to be developed. The combination of drugs and the use of secondary prophylaxis associated with highly active antiretroviral therapy may be the best tool for treatment of HIV coinfection. Some derivatives from natural sources have action against Leishmania; however, studies have been limited to in vitro evaluation, without clinical trials.
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Affiliation(s)
- José Angelo Lauletta Lindoso
- Instituto de Infectologia Emilio Ribas, São Paulo, Brazil, .,Nucleo de Medicina Tropical, Universidade de Brasília, Brasília, Brazil, .,Laboratorio de Soroepidemiologia, Institutode Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil,
| | - Carlos Henrique Valente Moreira
- Instituto de Infectologia Emilio Ribas, São Paulo, Brazil, .,Laboratorio de Parasitologia, Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Mirella Alves Cunha
- Departamento de Infectologia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Igor Thiago Queiroz
- Universidade Potiguar (UnP), Laureate International Universities, Natal, Brazil.,Hospital Giselda Trigueiro (SESAP/RN), Natal, Brazil
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Sunyoto T, Potet J, Boelaert M. Why miltefosine-a life-saving drug for leishmaniasis-is unavailable to people who need it the most. BMJ Glob Health 2018; 3:e000709. [PMID: 29736277 PMCID: PMC5935166 DOI: 10.1136/bmjgh-2018-000709] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/13/2018] [Indexed: 11/08/2022] Open
Abstract
Miltefosine, the only oral drug approved for the treatment of leishmaniasis-a parasitic disease transmitted by sandflies-is considered as a success story of research and development (R&D) by a public-private partnership (PPP). It epitomises the multiple market failures faced by a neglected disease drug: patients with low ability to pay, neglect by authorities and uncertain market size. Originally developed as an anticancer agent in the 1990s, the drug was registered in India in 2002 to treat the fatal visceral leishmaniasis. At the time, miltefosine was considered a breakthrough in the treatment, making it feasible to eliminate a regional disease. Today, access to miltefosine remains far from secure. The initial PPP agreement which includes access to the public sector is not enforced. The reality on the ground has been challenging: shortages due to inefficient supply chains, and use of a substandard product which led to a high number of treatment failures and deaths. Miltefosine received orphan drug status in the USA; when it was registered there in 2014, a priority review voucher (PRV) was awarded. The PRV, meant to facilitate drug development for neglected disease, was subsequently sold to another company for US$125 million without, to date, any apparent impact on drug access. At the heart of these concerns are questions on how to protect societal benefit of a drug developed with public investment, while clinicians worldwide struggle with its lack of affordability, limited availability and sustainability of access. This article analyses the reasons behind the postregistration access failure of miltefosine and provides the lessons learnt.
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Affiliation(s)
- Temmy Sunyoto
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- Policy Department, Médecins Sans Frontières- Campaign for Access to Medicines, Geneva, Switzerland
| | - Julien Potet
- Policy Department, Médecins Sans Frontières- Campaign for Access to Medicines, Geneva, Switzerland
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
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A brief history of antibiotics and select advances in their synthesis. J Antibiot (Tokyo) 2017; 71:153-184. [DOI: 10.1038/ja.2017.62] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/17/2017] [Accepted: 04/23/2017] [Indexed: 12/20/2022]
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Artemisinin and its derivatives in treating protozoan infections beyond malaria. Pharmacol Res 2016; 117:192-217. [PMID: 27867026 DOI: 10.1016/j.phrs.2016.11.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 01/09/2023]
Abstract
Parasitic protozoan diseases continue to rank among the world's greatest global health problems, which are also common among poor populations. Currently available drugs for treatment present drawbacks, urging the need for more effective, safer, and cheaper drugs. Artemisinin (ART) and its derivatives are some of the most important classes of antimalarial agents originally derived from Artemisia annua L. However, besides the outstanding antimalarial and antischistosomal activities, ART and its derivatives also possess activities against other parasitic protozoa. In this paper we review the activities of ART and its derivatives against protozoan parasites in vitro and in vivo, including Leishmania spp., Trypanosoma spp., Toxoplasma gondii, Neospora caninum, Eimeria tenella, Acanthamoeba castellanii, Naegleria fowleri, Cryptosporidium parvum, Giardia lamblia, and Babesia spp. We conclude that ART and its derivatives may be good alternatives for treating other non-malarial protozoan infections in developing countries, although more studies are necessary before they can be applied clinically.
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Natural Products: Insights into Leishmaniasis Inflammatory Response. Mediators Inflamm 2015; 2015:835910. [PMID: 26538837 PMCID: PMC4619978 DOI: 10.1155/2015/835910] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/22/2015] [Indexed: 12/12/2022] Open
Abstract
Leishmaniasis is a vector-borne disease that affects several populations worldwide, against which there are no vaccines available and the chemotherapy is highly toxic. Depending on the species causing the infection, the disease is characterized by commitment of tissues, including the skin, mucous membranes, and internal organs. Despite the relevance of host inflammatory mediators on parasite burden control, Leishmania and host immune cells interaction may generate an exacerbated proinflammatory response that plays an important role in the development of leishmaniasis clinical manifestations. Plant-derived natural products have been recognized as bioactive agents with several properties, including anti-protozoal and anti-inflammatory activities. The present review focuses on the antileishmanial activity of plant-derived natural products that are able to modulate the inflammatory response in vitro and in vivo. The capability of crude extracts and some isolated substances in promoting an anti-inflammatory response during Leishmania infection may be used as part of an effective strategy to fight the disease.
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Georgiadou SP, Makaritsis KP, Dalekos GN. Leishmaniasis revisited: Current aspects on epidemiology, diagnosis and treatment. J Transl Int Med 2015; 3:43-50. [PMID: 27847886 PMCID: PMC4936444 DOI: 10.1515/jtim-2015-0002] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Leishmaniasis is a vector-borne disease caused by protozoan parasites of the genus Leishmania. It is transmitted by phlebotomine female sand flies of the genera Phlebotomus and Lutzomyia in the old and new world, respectively. More than 20 well-recognized Leishmania species are known to infect humans and cause visceral (VL), cutaneous (CL) and mucocutaneous (ML) forms of the disease. Approximately 350 million people are at risk of contracting the disease and an estimated 1.6 million new cases occur annually. The disease mainly affects poor people in Africa, Asia and Latin America, and is associated with malnutrition, population migration, poor residency conditions, frail immune system and lack of resources. Previously, diagnosis of leishmaniasis relied mainly on invasive techniques of detecting parasites in splenic and bone marrow aspirates. Nevertheless, serological tests using the recombinant kinesin antigen (rK39) and molecular methods (polymerase chain reaction) are considered the best options for diagnosis today, despite problems related to varying sensitivities and specificities and field adaptability. Therapy of leishmaniasis ranges from local treatment of cutaneous lesions to systemic often toxic, therapy for disseminated CL, ML and VL. Agents with efficacy against leishmaniasis include amphotericin B, pentavalent antimonial drugs, paromomycin and miltefosine. No single therapy of VL currently offers satisfactory efficacy along with safety. This article provides a brief and updated systematic review on the epidemiology, diagnosis and treatment of this neglected disease.
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Affiliation(s)
- Sarah P Georgiadou
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Konstantinos P Makaritsis
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
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Boelaert M, Verdonck K, Menten J, Sunyoto T, van Griensven J, Chappuis F, Rijal S. Rapid tests for the diagnosis of visceral leishmaniasis in patients with suspected disease. Cochrane Database Syst Rev 2014; 2014:CD009135. [PMID: 24947503 PMCID: PMC4468926 DOI: 10.1002/14651858.cd009135.pub2] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The diagnosis of visceral leishmaniasis (VL) in patients with fever and a large spleen relies on showing Leishmania parasites in tissue samples and on serological tests. Parasitological techniques are invasive, require sophisticated laboratories, consume time, or lack accuracy. Recently, rapid diagnostic tests that are easy to perform have become available. OBJECTIVES To determine the diagnostic accuracy of rapid tests for diagnosing VL in patients with suspected disease presenting at health services in endemic areas. SEARCH METHODS We searched MEDLINE, EMBASE, LILACS, CIDG SR, CENTRAL, SCI-expanded, Medion, Arif, CCT, and the WHO trials register on 3 December 2013, without applying language or date limits. SELECTION CRITERIA This review includes original, phase III, diagnostic accuracy studies of rapid tests in patients clinically suspected to have VL. As reference standards, we accepted: (1) direct smear or culture of spleen aspirate; (2) composite reference standard based on one or more of the following: parasitology, serology, or response to treatment; and (3) latent class analysis. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed quality of included studies using the QUADAS-2 tool. Discrepancies were resolved by a third author. We carried out a meta-analysis to estimate sensitivity and specificity of rapid tests, using a bivariate normal model with a complementary log-log link function. We analysed each index test separately. As possible sources of heterogeneity, we explored: geographical area, commercial brand of index test, type of reference standard, disease prevalence, study size, and risk of bias (QUADAS-2). We also undertook a sensitivity analysis to assess the influence of imperfect reference standards. MAIN RESULTS Twenty-four studies containing information about five index tests (rK39 immunochromatographic test (ICT), KAtex latex agglutination test in urine, FAST agglutination test, rK26 ICT, and rKE16 ICT) recruiting 4271 participants (2605 with VL) were included. We carried out a meta-analysis for the rK39 ICT (including 18 studies; 3622 participants) and the latex agglutination test (six studies; 1374 participants). The results showed considerable heterogeneity. For the rK39 ICT, the overall sensitivity was 91.9% (95% confidence interval (95% CI) 84.8 to 96.5) and the specificity 92.4% (95% CI 85.6 to 96.8). The sensitivity was lower in East Africa (85.3%; 95% CI 74.5 to 93.2) than in the Indian subcontinent (97.0%; 95% CI 90.0 to 99.5). For the latex agglutination test, overall sensitivity was 63.6% (95% CI 40.9 to 85.6) and specificity 92.9% (95% CI 76.7 to 99.2). AUTHORS' CONCLUSIONS The rK39 ICT shows high sensitivity and specificity for the diagnosis of visceral leishmaniasis in patients with febrile splenomegaly and no previous history of the disease, but the sensitivity is notably lower in east Africa than in the Indian subcontinent. Other rapid tests lack accuracy, validation, or both.
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Affiliation(s)
| | | | | | | | | | - Francois Chappuis
- Geneva University HospitalsDivision of International and Humanitarian MedicineRue Gabrielle‐Perret‐Gentil, 61211GenevaSwitzerland14
| | - Suman Rijal
- BP Koirala Institute of Health SciencesDepartment of Internal MedicineGhopaDharanSunsariNepal056700
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Sangshetti JN, Shaikh RI, Khan FAK, Patil RH, Marathe SD, Gade WN, Shinde DB. Synthesis, antileishmanial activity and docking study of N′-substitutedbenzylidene-2-(6,7-dihydrothieno[3,2-c]pyridin-5(4H)-yl)acetohydrazides. Bioorg Med Chem Lett 2014; 24:1605-10. [DOI: 10.1016/j.bmcl.2014.01.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 12/28/2013] [Accepted: 01/16/2014] [Indexed: 11/26/2022]
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Anti-leishmanial activity of the antimicrobial peptide DRS 01 observed in Leishmania infantum (syn. Leishmania chagasi) cells. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2014; 10:483-90. [DOI: 10.1016/j.nano.2013.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/08/2013] [Accepted: 09/16/2013] [Indexed: 11/24/2022]
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Bottieau E, Vekemans M, Van Gompel A. Therapy of vector-borne protozoan infections in nonendemic settings. Expert Rev Anti Infect Ther 2014; 9:583-608. [DOI: 10.1586/eri.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cota GF, de Sousa MR, Fereguetti TO, Rabello A. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis 2013; 7:e2195. [PMID: 23658850 PMCID: PMC3642227 DOI: 10.1371/journal.pntd.0002195] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 03/25/2013] [Indexed: 12/27/2022] Open
Abstract
Objective We conducted a systematic literature review with indirect comparison of studies evaluating therapeutic efficacy and toxicity associated to visceral leishmaniasis (VL) therapy among HIV infected individuals. Main outcome measurements The outcomes of interest were clinical and parasitological cure, mortality, and adverse events. Methods PRISMA guidelines for systematic reviews and Cochrane manual were followed. Sources were MEDLINE, LILACS, EMBASE, Web of Knowledge databases and manual search of references from evaluated studies. We included all studies reporting outcomes after VL treatment, regardless of their design. Study quality was evaluated systematically by using the Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Comprehensive Meta-Analysis software v.2.2.048 was used to perform one-group meta-analysis of study arms with the same drug to estimate global rates of success and adverse events with each drug. These estimates were used, when possible, to indirectly compare treatment options, adjusted for CD4 count. Direct comparison was pooled when available. Results Seventeen studies reporting five treatment regimens and outcome of 920 VL episodes occurring in HIV infected individuals were included. The main outstanding difference in outcome among the treatment regimens was observed in mortality rate: it was around 3 times higher with high-dose antimony use (18.4%, CI 95% 13.3–25%), indirectly compared to lipid formulations of amphotericin B treatment (6.1%, CI 95% 3.9–9.4%). It was observed, also by indirect comparison, higher rates of clinical improvement in study arms using amphotericin B than in study arms using pentavalent antimonial therapy (Sbv). The parasitological cure, an outcome that presented some degree of risk of selection and verification bias, had rates that varied widely within the same treatment arm, with high heterogeneity, hampering any formal comparison among drugs. One direct comparison of amphotericin and antimoniate was possible combining results of two studies and confirming the superiority of amphotericin. Conclusions Available evidence suggests that amphotericin is superior to antimony treatment. Death rate using antimoniate high dose is unacceptably high. Randomized controlled trials are necessary to compare different formulations and doses of amphotericin, alternative therapies and drug combinations. In co-infection with HIV/AIDS, visceral leishmaniasis (VL) most often results in an unfavorable response to treatment, frequent relapses, and in premature deaths. Scarce data is available regarding the treatment of leishmaniasis in HIV-infected patients (VL-HIV). Despite this, clinical decisions must be made. To aid in this task we reviewed comprehensive and systematically the available literature about efficacy and toxicity of therapeutic options for VL-HIV. PRISMA guidelines and Cochrane manual for systematic reviews were followed. Direct and indirect comparisons of nonrandomized studies were used, adjusting for CD4 count. Seventeen studies reporting five treatment regimens and outcome of 920 VL episodes occurring in HIV infected individuals were included. Results suggest higher survival and clinical response rate with amphotericin B than with antimony treatment. Antimonial therapy carries a higher rate of drug discontinuation and a significantly higher mortality indirectly compared to treatment with amphotericin B. Randomized controlled trials are needed to compare doses and formulations of amphotericin and alternative treatments.
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Affiliation(s)
- Gláucia F Cota
- Laboratory of Clinical Research, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil.
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Abstract
OBJECTIVE To assess the quantity and distribution of evidence from randomised controlled trials for the treatment of the major neglected tropical diseases and to identify gaps in the evidence with network analysis. DESIGN Systematic review and network analysis. DATA SOURCES Cochrane Central Register of Controlled Trials and PubMed from inception to 31 August 2011. STUDY SELECTION Randomised controlled trials that examined treatment of 16 neglected tropical diseases or complications thereof published in English, French, Spanish, Portuguese, German, or Dutch. RESULTS We identified 971 eligible randomised trials. Leishmaniasis (184 trials, 23,039 participants) and geohelminth infections; 160 trials, 46,887 participants) were the most studied, while dracunculiasis (nine trials, 798 participants) and Buruli ulcer (five trials, 337 participants) were least studied. Relative to its global burden of disease, lymphatic filariasis had the fewest trials and participants. Only 11% of trials were industry funded. Either a single trial or trials with fewer than 100 participants comprised the randomised evidence for first or second line treatments for Buruli ulcer, human African trypanosomiasis, American trypanosomiasis, cysticercosis, rabies, echinococcosis, New World cutaneous leishmaniasis, and each of the foodborne trematode infections. Among the 10 disease categories with more than 40 trials, five lacked sufficient head to head comparisons between first or second line treatments. CONCLUSIONS There is considerable variation in the amount of evidence from randomised controlled trials for each of the 16 major neglected tropical diseases. Even in diseases with substantial evidence, such as leishmaniasis and geohelminth infections, some recommended treatments have limited supporting data and lack head to head comparisons.
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Affiliation(s)
- Shanthi Kappagoda
- Center for Primary Care and Outcomes Research and Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Kumar D, Singh R, Bhandari V, Kulshrestha A, Negi NS, Salotra P. Biomarkers of antimony resistance: need for expression analysis of multiple genes to distinguish resistance phenotype in clinical isolates of Leishmania donovani. Parasitol Res 2012; 111:223-30. [PMID: 22302478 DOI: 10.1007/s00436-012-2823-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 01/10/2012] [Indexed: 10/14/2022]
Abstract
Resistance to antimony is a major cause of failure to therapy in a large proportion of visceral leishmaniasis cases. Methods to distinguish resistant and sensitive parasite are urgently needed as the standard in vitro intracellular drug susceptibility assays are cumbersome and time consuming. Differential expression profiling studies have led to the identification of several antimony resistance-associated genes; however, their efficacy as a potential biomarker for monitoring antimony resistance remains imprecise. We analysed the expression of eight genes [antimony metabolism-associated genes - multidrug resistance protein A (MRPA), γ-glutamylcysteine synthetase (γ-GCS) and aquaporin-1 (AQP1) - and genes identified by proteome/transcriptome profiling—heat shock protein 83, mitogen-activated protein kinase 1 and histones H1, H2A and H4) in antimony-resistant (n=10) and antimony-sensitive (n=4) clinical isolates of Leishmania donovani by quantitative real-time PCR, in comparison with a lab-generated resistant and a standard sensitive isolate. We observed a significant differential expression of MRPA, histone H1 (p<0.01), γ-GCS, HSP83 (p<0.005) and histone H2A and H4 (p<0.0001) in a group of sodium antimony gluconate-resistant isolates compared to sensitive isolates. Preferential AQP1 expression was observed in all the sensitive isolates (p<0.0001). Overall, expression profile in field isolates for all the genes studied showed altered expression in majority of isolates, while in some, the expression was static. All the isolates showed a mosaic of expression pattern of the genes analysed indicating constellation of genes contributes towards the drug susceptibility of parasite. As none of the genes exhibit an absolute correlation with phenotype, targeted expression analysis of a set of genes should be considered as biomarker for distinguishing the antimony-resistant and antimony-sensitive parasite.
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Affiliation(s)
- Dhiraj Kumar
- National Institute of Pathology, Indian Council of Medical Research, Safdarjung Hospital Campus, New Delhi, India
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Salavati R, Moshiri H, Kala S, Shateri Najafabadi H. Inhibitors of RNA editing as potential chemotherapeutics against trypanosomatid pathogens. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2011; 2:36-46. [PMID: 24533263 DOI: 10.1016/j.ijpddr.2011.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 10/17/2011] [Accepted: 10/21/2011] [Indexed: 01/14/2023]
Abstract
The related trypanosomatid pathogens, Trypanosoma brucei spp., Trypanosoma cruzi and Leishmania spp. cause devastating diseases in humans and animals and continue to pose a major challenge in drug development. Mitochondrial RNA editing, catalyzed by multi-protein complexes known as editosomes, has provided an opportunity for development of efficient and specific chemotherapeutic targets against trypanosomatid pathogens. This review will discuss both methods for discovery of RNA editing inhibitors, as well as inhibitors against the T. brucei editosome that were recently discovered through creative virtual and high throughput screening methods. In addition, the use of these inhibitors as agents that can block or perturb one or more steps of the RNA editing process will be discussed. These inhibitors can potentially be used to study the dynamic processing and assembly of the editosome proteins. A thorough understanding of the mechanisms and specificities of these new inhibitors is needed in order to contribute to both the functional studies of an essential gene expression mechanism and to the possibility of future drug development against the trypanosomatid pathogens.
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Affiliation(s)
- Reza Salavati
- Department of Biochemistry, McGill University, McIntyre Medical Building, 3655 Promenade Sir William Osler, Montreal, Quebec, Canada H3G1Y6 ; Institute of Parasitology, McGill University, 21111 Lakeshore Road, Ste. Anne de Bellevue, Quebec, Canada H9X3V9 ; McGill Centre for Bioinformatics, McGill University, Bellini Building, 3649 Promenade Sir William Osler, Montreal, Quebec, Canada H3G0B1
| | - Houtan Moshiri
- Department of Biochemistry, McGill University, McIntyre Medical Building, 3655 Promenade Sir William Osler, Montreal, Quebec, Canada H3G1Y6 ; Institute of Parasitology, McGill University, 21111 Lakeshore Road, Ste. Anne de Bellevue, Quebec, Canada H9X3V9
| | - Smriti Kala
- Institute of Parasitology, McGill University, 21111 Lakeshore Road, Ste. Anne de Bellevue, Quebec, Canada H9X3V9
| | - Hamed Shateri Najafabadi
- Institute of Parasitology, McGill University, 21111 Lakeshore Road, Ste. Anne de Bellevue, Quebec, Canada H9X3V9 ; McGill Centre for Bioinformatics, McGill University, Bellini Building, 3649 Promenade Sir William Osler, Montreal, Quebec, Canada H3G0B1
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Boelaert M, Chappuis F, Menten J, van Griensven J, Sunyoto T, Rijal S. Rapid diagnostic tests for visceral leishmaniasis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd009135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Antimony-resistant clinical isolates of Leishmania donovani are susceptible to paromomycin and sitamaquine. Antimicrob Agents Chemother 2011; 55:2916-21. [PMID: 21464251 DOI: 10.1128/aac.00812-10] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Widespread antimonial resistance in anthroponotic visceral leishmaniasis (VL) makes it critical to monitor the susceptibility of prevailing field isolates to upcoming antileishmanials in order to frame the right treatment policies to protect these drugs against development of resistance. We aimed to generate the baseline data on natural in vitro susceptibility to paromomycin and sitamaquine in Leishmania donovani field isolates from VL patients (n = 20) coming from zones of varying sodium antimony gluconate (SAG) resistance. We further monitored nitric oxide (NO) release in infected macrophages treated with these drugs. Field isolates exhibited variable sensitivity to paromomycin and sitamaquine with respective mean 50% effective dose (ED₅₀) values ± standard error of the mean (SEM) of 3.9 ± 0.3 μM and 2.1 ± 0.2 μM at the intracellular amastigote stage and 29.8 ± 2.5 μM and 17.7 ± 1.0 μM at the promastigote stage. Susceptibilities at the two parasite stages did not correlate for either drug. Isolates from high SAG resistance zones exhibited significantly lower susceptibility to sitamaquine than those from low SAG resistance zones, while isolates from different zones showed similar susceptibilities to paromomycin. NO release was promoted in L. donovani-infected macrophages upon treatment with paromomycin/sitamaquine. NO inhibitors significantly compromised amastigote killing by sitamaquine, but not by paromomycin. In conclusion, SAG-resistant/sensitive VL isolates were susceptible to both paromomycin and sitamaquine. Paromomycin, exhibiting higher efficacy against SAG-resistant parasites and having a distinct mechanism of action, appears to be a promising drug for combination therapy.
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Clementi A, Battaglia G, Floris M, Castellino P, Ronco C, Cruz DN. Renal involvement in leishmaniasis: a review of the literature. NDT Plus 2011; 4:147-52. [PMID: 25984144 PMCID: PMC4421603 DOI: 10.1093/ndtplus/sfr008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 01/18/2011] [Indexed: 11/13/2022] Open
Abstract
Leishmaniasis, an infectious disease endemic in tropical, Asian and southern European countries, is caused by obligate intramacrophage protozoa and is transmitted through the bite of infected female sandflies. More than 20 leishmanial species are responsible for four main clinical syndromes: cutaneous leishmaniasis; mucocutaneous leishmaniasis; visceral leishmaniasis, also known as kala-azar, and post-kala-azar dermal leishmaniasis. Visceral leishmaniasis can present with varying clinical features and the kidney can also be involved. Both glomerular and tubular function can be altered and patients can develop proteinuria, haematuria, abnormalities in urinary concentration and acidification and acute and chronic renal insufficiency. Not only the disease itself but also the therapy administered might be responsible for the renal involvement in kala-azar. Indeed, some of the agents with efficiency against visceral leishmaniasis, such as pentavalent antimonial drugs, amphotericin B, pentamidine, miltefosine, paromomycin and simataquine, may be associated with a high risk of renal toxicity. In this article, the literature on renal involvement in visceral leishmaniasis is reviewed.
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Affiliation(s)
- Anna Clementi
- Department of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy ; International Renal Research Institute (IRRIV), Vicenza, Italy ; Department of Internal Medicine, Policlinico Universitario, Catania, Italy
| | - Giorgio Battaglia
- Department of Nephrology, Santa Marta e Santa Venera, Catania, Italy
| | - Matteo Floris
- Department of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy ; International Renal Research Institute (IRRIV), Vicenza, Italy ; Department of Nephrology San Michele Hospital, Cagliari, Italy
| | - Pietro Castellino
- Department of Internal Medicine, Policlinico Universitario, Catania, Italy
| | - Claudio Ronco
- Department of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy ; International Renal Research Institute (IRRIV), Vicenza, Italy
| | - Dinna N Cruz
- Department of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy ; International Renal Research Institute (IRRIV), Vicenza, Italy
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Mondal S, Bhattacharya P, Ali N. Current diagnosis and treatment of visceral leishmaniasis. Expert Rev Anti Infect Ther 2010; 8:919-44. [PMID: 20695748 DOI: 10.1586/eri.10.78] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Human visceral leishmaniasis (VL), a potentially fatal disease, is most prevalent in the Indian subcontinent, East Africa and South America. Definite diagnosis and effective treatment are the primary needs for the control of VL. Diagnosis of VL has typically relied on microscopic examination of bone marrow/splenic aspirate, but serology and molecular methods are now better alternatives. The conventional drugs for treatment of VL have limitations including unresponsiveness, relapse, specific toxicities and parenteral administration lasting for long durations. Moreover, they are less effective in HIV-VL-coinfected patients. Registration of miltefosine and paromomycin, and preferential pricing of AmBisome has offered more choices for monotherapy and combination therapy for VL. Combination therapy will increase treatment efficacy and prevent the development of resistance. In addition, active case finding and vector control strategies will also have a positive impact in the control of VL. This article critically addresses the currently available diagnostic and treatment regimens for the control of VL.
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Affiliation(s)
- Smriti Mondal
- Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, Kolkata, India
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van Griensven J, Balasegaram M, Meheus F, Alvar J, Lynen L, Boelaert M. Combination therapy for visceral leishmaniasis. THE LANCET. INFECTIOUS DISEASES 2010; 10:184-94. [DOI: 10.1016/s1473-3099(10)70011-6] [Citation(s) in RCA: 231] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Patel TA, Lockwood DN. Pentamidine as secondary prophylaxis for visceral leishmaniasis in the immunocompromised host: report of four cases. Trop Med Int Health 2009; 14:1064-70. [DOI: 10.1111/j.1365-3156.2009.02329.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tipparaju SK, Joyasawal S, Pieroni M, Kaiser M, Brun R, Kozikowski AP. In pursuit of natural product leads: synthesis and biological evaluation of 2-[3-hydroxy-2-[(3-hydroxypyridine-2-carbonyl)amino]phenyl]benzoxazole-4-carboxylic acid (A-33853) and its analogues: discovery of N-(2-benzoxazol-2-ylphenyl)benzamides as novel antileishmanial chemotypes. J Med Chem 2009; 51:7344-7. [PMID: 18989953 DOI: 10.1021/jm801241n] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The first synthesis and biological evaluation of antibiotic 31 (A-33853) and its analogues are reported. Initial screening for inhibition of L. donovani, T. b. rhodesiense, T. cruzi, and P. falciparum cultures followed by determination of IC(50) in L. donovani and cytotoxicity on L6 cells revealed 31 to be 3-fold more active than miltefosine, a known antileishmanial drug. Compounds 14, 15, and 25 selectively inhibited L. donovani at nanomolar concentrations and showed much lower cytotoxicity.
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Affiliation(s)
- Suresh K Tipparaju
- Drug Discovery Program, Department of Medicinal Chemistry and Pharmacognosy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, Illinois 60612, USA
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Gradoni L, Soteriadou K, Louzir H, Dakkak A, Toz SO, Jaffe C, Dedet JP, Campino L, Cañavate C, Dujardin JC. Drug regimens for visceral leishmaniasis in Mediterranean countries. Trop Med Int Health 2008; 13:1272-6. [DOI: 10.1111/j.1365-3156.2008.02144.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jochim RC, Teixeira CR, Laughinghouse A, Mu J, Oliveira F, Gomes RB, Elnaiem DE, Valenzuela JG. The midgut transcriptome of Lutzomyia longipalpis: comparative analysis of cDNA libraries from sugar-fed, blood-fed, post-digested and Leishmania infantum chagasi-infected sand flies. BMC Genomics 2008; 9:15. [PMID: 18194529 PMCID: PMC2249575 DOI: 10.1186/1471-2164-9-15] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 01/14/2008] [Indexed: 11/24/2022] Open
Abstract
Background In the life cycle of Leishmania within the alimentary canal of sand flies the parasites have to survive the hostile environment of blood meal digestion, escape the blood bolus and attach to the midgut epithelium before differentiating into the infective metacyclic stages. The molecular interactions between the Leishmania parasites and the gut of the sand fly are poorly understood. In the present work we sequenced five cDNA libraries constructed from midgut tissue from the sand fly Lutzomyia longipalpis and analyzed the transcripts present following sugar feeding, blood feeding and after the blood meal has been processed and excreted, both in the presence and absence of Leishmania infantum chagasi. Results Comparative analysis of the transcripts from sugar-fed and blood-fed cDNA libraries resulted in the identification of transcripts differentially expressed during blood feeding. This included upregulated transcripts such as four distinct microvillar-like proteins (LuloMVP1, 2, 4 and 5), two peritrophin like proteins, a trypsin like protein (Lltryp1), two chymotrypsin like proteins (LuloChym1A and 2) and an unknown protein. Downregulated transcripts by blood feeding were a microvillar-like protein (LuloMVP3), a trypsin like protein (Lltryp2) and an astacin-like metalloprotease (LuloAstacin). Furthermore, a comparative analysis between blood-fed and Leishmania infected midgut cDNA libraries resulted in the identification of the transcripts that were differentially expressed due to the presence of Leishmania in the gut of the sand fly. This included down regulated transcripts such as four microvillar-like proteins (LuloMVP1,2, 4 and 5), a Chymotrypsin (LuloChym1A) and a carboxypeptidase (LuloCpepA1), among others. Upregulated midgut transcripts in the presence of Leishmania were a peritrophin like protein (LuloPer1), a trypsin-like protein (Lltryp2) and an unknown protein. Conclusion This transcriptome analysis represents the largest set of sequence data reported from a specific sand fly tissue and provides further information of the transcripts present in the sand fly Lutzomyia longipalpis. This analysis provides the detailed information of molecules present in the midgut of this sand fly and the transcripts potentially modulated by blood feeding and by the presence of the Leishmania parasite. More importantly, this analysis suggests that Leishmania infantum chagasi alters the expression profile of certain midgut transcripts in the sand fly during blood meal digestion and that this modulation may be relevant for the survival and establishment of the parasite in the gut of the fly. Moreover, this analysis suggests that these changes may be occurring during the digestion of the blood meal and not afterwards.
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Affiliation(s)
- Ryan C Jochim
- Vector Molecular Biology Unit, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA.
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Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol 2007; 5:873-82. [PMID: 17938629 DOI: 10.1038/nrmicro1748] [Citation(s) in RCA: 993] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Di Giorgio C, Shimi K, Boyer G, Delmas F, Galy JP. Synthesis and antileishmanial activity of 6-mono-substituted and 3,6-di-substituted acridines obtained by acylation of proflavine. Eur J Med Chem 2007; 42:1277-84. [PMID: 17418916 DOI: 10.1016/j.ejmech.2007.02.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 02/13/2007] [Accepted: 02/13/2007] [Indexed: 11/25/2022]
Abstract
Two new series of diaminoacridinic derivatives obtained from proflavine and N-(6-amino-3-acridinyl)acetamide were synthesised and assessed for their cytotoxic and antileishmanial activities. Two compounds, N-[6-(acetylamino)-3-acridinyl]acetamide and N-[6-(benzoylamino)-3-acridinyl]benzamide demonstrated highly specific antileishmanial properties against the intracellular amastigote form of the parasite. Structure-activity relationships established that the antiproliferative activity against human cells was greatly enhanced by the presence of a benzoylamino group in 6-mono-substituted acridines, while the presence of two acetylamino or benzoylamino groups in 3,6-di-substituted acridines strongly increased the specificity of the molecules for Leishmania parasite, suggesting that symmetric conformations could preferentially interfere with Leishmania metabolism.
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Affiliation(s)
- Carole Di Giorgio
- Laboratoire de Parasitologie, Hygiene et Zoologie, Faculté de Pharmacie, 27 Bd. Jean Moulin, 13385 Marseille Cedex 05, France.
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Prina E, Roux E, Mattei D, Milon G. Leishmania DNA is rapidly degraded following parasite death: an analysis by microscopy and real-time PCR. Microbes Infect 2007; 9:1307-15. [PMID: 17890124 DOI: 10.1016/j.micinf.2007.06.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 06/04/2007] [Accepted: 06/10/2007] [Indexed: 10/23/2022]
Abstract
Control of human leishmaniases relies on appropriate diagnosis and reliable methods for monitoring chemotherapy. The current method used for estimation of parasite burden during chemotherapy patient follow-up as well as in pharmacological studies performed in experimental models involves PCR-based assays. Compared to time-consuming conventional methods, this type of Leishmania DNA detection-based method is extremely sensitive, but could fail in distinguishing viable Leishmania from slowly degenerating ones. We have used an in vitro model to monitor the duration of Leishmania DNA persistence in mouse macrophages following exposure to l-leucine ester, a molecule otherwise known to rapidly kill intracellular Leishmania amazonensis amastigotes. At 1h of post l-leucine ester exposure, more than 98% of amastigote-loaded macrophages harbored killed parasites and parasite remnants, as assessed by microscopy. This dramatic decrease in parasite load and the microscopic parasite follow-up over the 120 h time period studied were correlated with Leishmania DNA as quantified by real-time PCR. Our results indicate that kinetoplast and nuclear parasite DNA degradation occurs very rapidly after amastigote death. These data add further weight to the argument that PCR assays represent not only a robust method for diagnosis but can also be reliable for monitoring parasite size reduction rate post any intervention (Leishmania-targeting molecules, immunomodulators...).
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Affiliation(s)
- Eric Prina
- Unité d'Immunophysiologie et Parasitisme Intracellulaire, Département de Parasitologie et Mycologie, Institut Pasteur 25-28 rue du Dr Roux, 75724 Paris cédex 15, France.
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