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Machado PRL, Lago A, Cardoso TM, Magalhaes A, Carvalho LP, Lago T, Carvalho AM, Costa R, Carvalho EM. Disseminated Leishmaniasis, a Severe Form of Leishmania braziliensis Infection. Emerg Infect Dis 2024; 30:510-518. [PMID: 38407142 PMCID: PMC10902519 DOI: 10.3201/eid3003.230786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Disseminated leishmaniasis (DL) is an emergent severe disease manifesting with multiple lesions. To determine the relationship between immune response and clinical and therapeutic outcomes, we studied 101 DL and 101 cutaneous leishmaniasis (CL) cases and determined cytokines and chemokines in supernatants of mononuclear cells stimulated with leishmania antigen. Patients were treated with meglumine antimoniate (20 mg/kg) for 20 days (CL) or 30 days (DL); 19 DL patients were instead treated with amphotericin B, miltefosine, or miltefosine and meglumine antimoniate. High levels of chemokine ligand 9 were associated with more severe DL. The cure rate for meglumine antimoniate was low for both DL (44%) and CL (60%), but healing time was longer in DL (p = 0.003). The lowest cure rate (22%) was found in DL patients with >100 lesions. However, meglumine antimoniate/miltefosine treatment cured all DL patients who received it; therefore, that combination should be considered as first choice therapy.
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Lago T, Medina L, Lago J, Santana N, Cardoso T, Rocha A, Leal-Calvo T, Carvalho EM, Castellucci LC. MicroRNAs regulating macrophages infected with Leishmania L. ( V.) Braziliensis isolated from different clinical forms of American tegumentary leishmaniasis. Front Immunol 2023; 14:1280949. [PMID: 38143766 PMCID: PMC10748487 DOI: 10.3389/fimmu.2023.1280949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Background Leishmaniasis is an infectious disease caused by protozoa of the genus Leishmania. There are still no vaccines, and therapeutic options are limited, indicating the constant need to understand the fine mechanisms of its pathophysiology. An approach that has been explored in leishmaniasis is the participation of microRNAs (miRNAs), a class of small non-coding RNAs that act, in most cases, to repress gene expression. miRNAs play a role in the complex and plastic interaction between the host and pathogens, either as part of the host's immune response to neutralize infection or as a molecular strategy employed by the pathogen to modulate host pathways to its own benefit. Methods Monocyte-derived macrophages from healthy subjects were infected with isolates of three clinical forms of L. braziliensis: cutaneous (CL), mucosal (ML), and disseminated (DL) leishmaniasis. We compared the expression of miRNAs that take part in the TLR/NFkB pathways. Correlations with parasite load as well as immune parameters were analyzed. Results miRNAs -103a-3p, -21-3p, 125a-3p -155-5p, -146a-5p, -132- 5p, and -147a were differentially expressed in the metastatic ML and DL forms, and there was a direct correlation between miRNAs -103a-3p, -21-3p, -155-5p, -146a-5p, -132-5p, and -9-3p and parasite load with ML and DL isolates. We also found a correlation between the expression of miR-21-3p and miR-146a-5p with the antiapoptotic gene BCL2 and the increase of viable cells, whereas miR-147a was indirectly correlated with CXCL-9 levels. Conclusion The expression of miRNAs is strongly correlated with the parasite load and the inflammatory response, suggesting the participation of these molecules in the pathogenesis of the different clinical forms of L. braziliensis.
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Affiliation(s)
- Tainã Lago
- Serviço de Imunologia da Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Ciências da Saúde da Universidade Federal da Bahia, Salvador, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil
| | - Lilian Medina
- Serviço de Imunologia da Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Ciências da Saúde da Universidade Federal da Bahia, Salvador, Brazil
| | - Jamile Lago
- Serviço de Imunologia da Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Ciências da Saúde da Universidade Federal da Bahia, Salvador, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil
| | - Nadja Santana
- Serviço de Imunologia da Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Ciências da Saúde da Universidade Federal da Bahia, Salvador, Brazil
| | - Thiago Cardoso
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil
- Laboratório de Pesquisas Clínicas (LAPEC), Instituto Gonçalo Moniz-FIOCRUZ, Sakvador, Bahia, Brazil
| | - Alan Rocha
- Laboratório de Pesquisas Clínicas (LAPEC), Instituto Gonçalo Moniz-FIOCRUZ, Sakvador, Bahia, Brazil
| | | | - Edgar M. Carvalho
- Serviço de Imunologia da Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Ciências da Saúde da Universidade Federal da Bahia, Salvador, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil
- Laboratório de Pesquisas Clínicas (LAPEC), Instituto Gonçalo Moniz-FIOCRUZ, Sakvador, Bahia, Brazil
| | - Léa Cristina Castellucci
- Serviço de Imunologia da Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-graduação em Ciências da Saúde da Universidade Federal da Bahia, Salvador, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência, Tecnologia, Inovações e Comunicações, CNPq, Brasília, DF, Brazil
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Nascimento MT, Viana DL, Peixoto FC, Arruda SM, Carvalho EM, Carvalho LP. Prostaglandin E2 contributes to L. braziliensis survival and therapeutic failure in cutaneous leishmaniasis. Emerg Microbes Infect 2023; 12:2261565. [PMID: 37729084 PMCID: PMC10540647 DOI: 10.1080/22221751.2023.2261565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/17/2023] [Indexed: 09/22/2023]
Abstract
Patients with cutaneous leishmaniasis (CL) present an exacerbated inflammatory response associated with tissue damage and ulcer development. In recent years, higher rates of failure to pentavalent antimoniate therapy have been observed, yet the underlying reason remains poorly understood. We hypothesize that the eicosanoid PGE2 favours the establishment of infection by L. braziliensis, which contributes to therapeutic failure. The aim of the present study was to investigate the influence of PGE2 on the survival of L. braziliensis in macrophages and rates of therapeutic failure in CL patients. PGE2, an eicosanoid derived from the metabolism of arachidonic acid by the COX-2 enzyme, plays several roles in immune response. We found that increased PGE2 decreases the microbicidal function of macrophages and is associated with disease severity and therapeutic failure. Additionally, the neutralization of COX-2 by NS398, a selective NSAID, increases the ability of macrophages to kill L. braziliensis and protects against the pathological inflammatory response. Our data suggest that NS398 may serve as an adjunct treatment for CL patients.
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Affiliation(s)
- Maurício T. Nascimento
- Laboratório de Pesquisas Clínicas, LAPEC, Instituto Gonçalo Moniz – Fiocruz, Salvador, Brazil
- Serviço de Imunologia, SIM, Complexo Universitário Professor Edgar Santos, COM-HUPES, Salvador, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, PPgCS, Universidade Federal da Bahia, Salvador, Brazil
| | - Débora L. Viana
- Laboratório de Pesquisas Clínicas, LAPEC, Instituto Gonçalo Moniz – Fiocruz, Salvador, Brazil
| | - Fábio C. Peixoto
- Laboratório de Pesquisas Clínicas, LAPEC, Instituto Gonçalo Moniz – Fiocruz, Salvador, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, PPgCS, Universidade Federal da Bahia, Salvador, Brazil
| | - Sérgio M. Arruda
- Laboratório Avançado de Saúde Pública, LASP, Instituto Gonçalo Moniz – Fiocruz, Salvador, Brazil
| | - Edgar M. Carvalho
- Laboratório de Pesquisas Clínicas, LAPEC, Instituto Gonçalo Moniz – Fiocruz, Salvador, Brazil
- Serviço de Imunologia, SIM, Complexo Universitário Professor Edgar Santos, COM-HUPES, Salvador, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, PPgCS, Universidade Federal da Bahia, Salvador, Brazil
- Instituto de Ciência e Tecnologia em Doenças Tropicais, INCT-DT, Salvador, Brazil
| | - Lucas P. Carvalho
- Laboratório de Pesquisas Clínicas, LAPEC, Instituto Gonçalo Moniz – Fiocruz, Salvador, Brazil
- Serviço de Imunologia, SIM, Complexo Universitário Professor Edgar Santos, COM-HUPES, Salvador, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, PPgCS, Universidade Federal da Bahia, Salvador, Brazil
- Instituto de Ciência e Tecnologia em Doenças Tropicais, INCT-DT, Salvador, Brazil
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Shita EY, Semegn EN, Wubetu GY, Abitew AM, Andualem BG, Alemneh MG. Prevalence of Leishmania RNA virus in Leishmania parasites in patients with tegumentary leishmaniasis: A systematic review and meta-analysis. PLoS Negl Trop Dis 2022; 16:e0010427. [PMID: 35675332 PMCID: PMC9236231 DOI: 10.1371/journal.pntd.0010427] [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: 10/22/2021] [Revised: 06/27/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Cutaneous leishmaniasis is caused by different protozoan parasites of the genus Leishmania. Leishmania RNA virus (LRV) was identified as the first Leishmania infecting virus in 1998. Different studies showed the presence and role of the LRV in Leishmania parasites causing cutaneous leishmaniasis (CL). However, there is limited data on the pooled prevalence of LRV in Leishmania parasites causing CL. Therefore, the aim of this systematic review and meta-analysis was to determine the pooled prevalence of LRV in Leishmania parasite isolates and/or lesion biopsies in patients with CL from the available literature globally. Methodology We retrieved the studies from different electronic databases. The studies were screened and identified based on the inclusion and exclusion criteria. We excluded studies exclusively done in experimental animals and in vitro studies. The review was conducted in line with PRISMA guidelines. The meta-analysis was performed with Stata software version 14 with metan command. The forest plot with random-effect model was used to estimate the pooled prevalence with 95% confidence interval. Inverse variance index (I2) was used to assess the heterogeneity among the included articles. Principal findings A total of 1215 samples from 25 studies were included. Of these, 40.1% (487/1215) were positive for LRV. The overall pooled prevalence of LRV globally was 37.22% (95% CI: 27.54% - 46.90%). The pooled prevalence of LRV in the New World (NW) and Old World (OW) regions was 34.18% and 45.77%, respectively. Leishmania guyanensis, L. braziliensis, L. major, and L. tropica were the most studied species for the detection of LRV. The prevalence of LRV from Leishmania isolates and lesion biopsies was 42.9% (349/813) and 34.3% (138/402), respectively. Conclusion This systematic study revealed that there is high prevalence of LRV in Leishmania parasites isolated from patients with CL. More comprehensive studies would be required to investigate the presence of the LRV in other Leishmania species such as L. aethiopica to fully understand the role of LRV in different clinical manifestations and disease pathology presented in CL patients. Cutaneous leishmaniasis (CL) is among the most neglected tropical diseases affecting a significant proportion of the world population, impacting mostly on the poorest communities. CL can present as localized, mucocutaneous or diffuse cutaneous. There are various reports on the prevalence of Leishmania RNA virus (LRV) in Leishmania parasites and/or lesion biopsies in patients with CL from both the Old World and New World regions. However, there is scarcity of comprehensive knowledge on the pooled prevalence of the virus in Leishmania parasites causing human CL. We searched different electronic databases and Google Scholar for published articles aimed to determine the presence of LRV in Leishmania parasites and/or lesion biopsies in patients with CL globally. The retrieved articles were screened according to the inclusion and exclusion parameters. Data was extracted based on the PRISMA guideline by reviewing the selected articles. Systematic review and meta-analysis would be one way to improve the level of evidence by providing pooled prevalence of the individual single studies regarding the presence of LRV in Leishmania parasites and/or lesion biopsies. This systematic review and meta-analysis revealed that a large proportion of the Leishmania parasites causing human CL harbour the endosymbiotic LRV. Further studies are needed to better understand the role of the virus in the clinical presentation of CL, as a potential target of treatment and vaccine development especially in Old World Leishmania parasites like L. aethiopica.
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Affiliation(s)
- Endalew Yizengaw Shita
- Department of Medical Laboratory Science, College of Medicine and Health science, Bahir Dar University, Bahir Dar, Ethiopia
- Institute of Biotechnology, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Endalkachew Nibret Semegn
- Institute of Biotechnology, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Biology, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Abaineh Munshea Abitew
- Institute of Biotechnology, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Biology, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Mekuanint Geta Alemneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Center for innovative Drug development and Therapeutic trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Carvalho AM, Bacellar O, Carvalho EM. Protection and Pathology in Leishmania braziliensis Infection. Pathogens 2022; 11:pathogens11040466. [PMID: 35456141 PMCID: PMC9024810 DOI: 10.3390/pathogens11040466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 01/05/2023] Open
Abstract
Leishmania killing is mediated by IFN-γ-activated macrophages, but IFN-γ production and macrophage activation are insufficient to control L. braziliensis infection. In American tegumentary leishmaniasis (ATL), pathology results from an exaggerated inflammatory response. This report presents an overview of our contributions regarding ATL pathogenesis, highlighting future directions to improve the management of L. braziliensis infection. Monocytes and lymphocytes from individuals exposed to L. braziliensis but who do not develop CL, i.e., subclinical infection (SC), exhibit lower respiratory burst and IFN-γ production, yet more efficiently kill L. braziliensis. As vaccines aimed at inducing IL-12 and IFN-γ do not sufficiently prevent CL, the elucidation of how subjects with SC infection kill Leishmania may lead to new approaches to controlling ATL. While inflammation arising from the recruitment of inflammatory cells via chemokines induced by IFN-γ and TNF or IL-17 is observed and contributes to pathology, cytotoxic CD8+ T cells and NK cells play a key role in the pathogenesis of L. braziliensis infection. The increased transcription of genes related to inflammation and cytotoxicity, e.g., granzyme A, granzyme B, NLRP3 and IL-1β, has been documented in CL tissue samples. The release of products by killed cells leads to NLRP3 inflammasome activation, IL-1β production and additional damage to skin and mucosal tissues. The use of drugs that downmodulate the inflammatory response in combination with chemotherapy improves the ATL cure rate and decreases healing time.
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Affiliation(s)
- Augusto M. Carvalho
- Laboratório de Pesquisas Clínicas (LAPEC), Instituto Gonçalo Moniz, FIOCRUZ, Salvador 40296710, Brazil;
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador 40110160, Brazil;
- National Institute of Science and Technology in Tropical Diseases (INCT-DT), CNPq, Salvador 40296710, Brazil
| | - Olívia Bacellar
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador 40110160, Brazil;
- National Institute of Science and Technology in Tropical Diseases (INCT-DT), CNPq, Salvador 40296710, Brazil
| | - Edgar M. Carvalho
- Laboratório de Pesquisas Clínicas (LAPEC), Instituto Gonçalo Moniz, FIOCRUZ, Salvador 40296710, Brazil;
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador 40110160, Brazil;
- National Institute of Science and Technology in Tropical Diseases (INCT-DT), CNPq, Salvador 40296710, Brazil
- Correspondence:
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