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Alves LL, Freire ML, Troian IL, de Morais-Teixeira E, Cota G. Local amphotericin B therapy for Cutaneous Leishmaniasis: A systematic review. PLoS Negl Trop Dis 2024; 18:e0012127. [PMID: 38626196 PMCID: PMC11051593 DOI: 10.1371/journal.pntd.0012127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 04/26/2024] [Accepted: 04/01/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is characterized by potentially disfiguring skin ulcers carrying significant social stigma. To mitigate systemic drug exposure and reduce the toxicity from available treatments, studies addressing new local therapeutic strategies using available medications are coming up. This review systematically compiles preclinical and clinical data on the efficacy of amphotericin B (AmB) administered locally for cutaneous leishmaniasis. METHODOLOGY Structured searches were conducted in major databases. Clinical studies reporting cure rates and preclinical studies presenting any efficacy outcome were included. Exclusion criteria comprised nonoriginal studies, in vitro investigations, studies with fewer than 10 treated patients, and those evaluating AmB in combination with other antileishmanial drug components. PRINCIPAL FINDINGS A total of 21 studies were identified, encompassing 16 preclinical and five clinical studies. Preclinical assessments generally involved the topical use of commercial AmB formulations, often in conjunction with carriers or controlled release systems. However, the variation in the treatment schedules hindered direct comparisons. In clinical studies, topical AmB achieved a pooled cure rate of 45.6% [CI: 27.5-64.8%; I2 = 79.7; p = 0.002), while intralesional (IL) administration resulted in a 69.8% cure rate [CI: 52.3-82.9%; I2 = 63.9; p = 0.06). In the direct comparison available, no significant difference was noted between AmB-IL and meglumine antimoniate-IL administration (OR:1.7; CI:0.34-9.15, I2 = 79.1; p = 0.00), however a very low certainty of evidence was verified. CONCLUSIONS Different AmB formulations and administration routes have been explored in preclinical and clinical studies. Developing therapeutic technologies is evident. Current findings might be interpreted as a favorable proof of concept for the local AmB administration which makes this intervention eligible to be explored in future well-designed studies towards less toxic treatments for leishmaniasis.
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Affiliation(s)
- Líndicy Leidicy Alves
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana Lourenço Freire
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Isadora Lana Troian
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Eliane de Morais-Teixeira
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Cota
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
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Shmueli M, Ben-Shimol S. Review of Leishmaniasis Treatment: Can We See the Forest through the Trees? Pharmacy (Basel) 2024; 12:30. [PMID: 38392937 PMCID: PMC10892631 DOI: 10.3390/pharmacy12010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
There are three known clinical syndromes of leishmaniasis: cutaneous (CL), mucocutaneous (MCL), and visceral disease (VL). In MCL and VL, treatment must be systemic (either oral or intravenous), while CL treatment options vary and include observation-only localized/topical treatment, oral medications, or parenteral drugs. Leishmaniasis treatment is difficult, with several factors to be considered. First, the efficacy of treatments varies among different species of parasites prevalent in different areas on the globe, with each species having a unique clinical presentation and resistance profile. Furthermore, leishmaniasis is a neglected tropical disease (NTD), resulting in a lack of evidence-based knowledge regarding treatment. Therefore, physicians often rely on case reports or case series studies, in the absence of randomized controlled trials (RCT), to assess treatment efficacy. Second, defining cure, especially in CL and MCL, may be difficult, as death of the parasite can be achieved in most cases, while the aesthetic result (e.g., scars) is hard to predict. This is a result of the biological nature of the disease, often diagnosed late in the course of disease (with possible keloid formation, etc.). Third, physicians must consider treatment ease of use and the safety profile of possible treatments. Thus, topical or oral treatments (for CL) are desirable and promote adherence. Fourth, the cost of the treatment is an important consideration. In this review, we aim to describe the diverse treatment options for different clinical manifestations of leishmaniasis. For each currently available treatment, we will discuss the various considerations mentioned above (efficacy, ease of use, safety, and cost).
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Affiliation(s)
- Moshe Shmueli
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva 8410115, Israel
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Rostami H, Babaali F, Moradi L, Golfakhrabadi F, Abdi L. Evaluation of the Effect of Barberry Root (Berberis Vulgaris) on the Prevention of Metabolic Syndrome Caused by Atypical Antipsychotic Drugs in Patients with Schizophrenia: A Three-Blind Placebo-Controlled Clinical Trial. Iran J Psychiatry 2023; 18:362-368. [PMID: 37575603 PMCID: PMC10422947 DOI: 10.18502/ijps.v18i3.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 08/15/2023]
Abstract
Objective: Metabolic syndrome is a potential side effect of atypical antipsychotics which are the current standard treatment for schizophrenia. Therefore, we aimed to examine the effect of barberry root (Berberis vulgaris) on the prevention of metabolic syndrome caused by atypical antipsychotic drugs in patients with schizophrenia. Method : Our research was a three-blind randomized clinical trial. The participants included all patients who were diagnosed with schizophrenia through the SCID-5 questionnaire and based on the DSM-5-TR criteria by two psychiatric experts. These patients were randomly divided into intervention and placebo groups. During a three-month treatment period, the intervention group received three 500 mg capsules of barberry root extract daily, whereas the placebo group received the same capsules containing 500 mg of starch powder. Metabolic syndrome variables including fasting blood glucose, serum lipids (triglyceride and cholesterol), blood pressure, weight and waist circumference were measured before and after the treatment as outcome measure. Chi-square and t-tests were used for data analysis using SPSS-22 software. Results: At the beginning of the study, there was no significant difference between the intervention group (n = 41) and the placebo group (n = 47) in terms of demographic factors, and pre-treatment assessments including weight, waist size, fasting blood HDL, fasting blood triglycerides and systolic and diastolic blood pressure and fasting blood glucose (P > 0.05). Within group analysis showed that some metabolic factors significantly increased in both groups after the treatment (P < 0.05). Indeed, in both groups, metabolic syndrome measures worsened after the three-month treatment period. The parameters of weight and waist size were significantly higher in the intervention group than the placebo group after treatment (P < 0.05). Conclusion: Barberry root extract was not able to control the Effects of antipsychotic drugs on metabolic syndrome in schizophrenia.
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Affiliation(s)
- Hamzeh Rostami
- Department of Psychiatry, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farzaneh Babaali
- Department of Psychiatry, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Moradi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fereshteh Golfakhrabadi
- Department of Pharmacognosy, School of Pharmacy, Medicinal Plant Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Abdi
- Department of Psychiatry, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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De Meyer F, Carlier A. Ecotin: A versatile protease inhibitor of bacteria and eukaryotes. Front Microbiol 2023; 14:1114690. [PMID: 36760512 PMCID: PMC9904509 DOI: 10.3389/fmicb.2023.1114690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023] Open
Abstract
Serine protease inhibitors are a large family of proteins involved in important pathways and processes, such as inflammatory responses and blood clotting. Most are characterized by a precise mode of action, thereby targeting a narrow range of protease substrates. However, the serine-protease inhibitor ecotin is able to inhibit a broad range of serine proteases that display a wide range of specificities. This specificity is driven by special structural features which allow unique flexibility upon binding to targets. Although frequently observed in many human/animal-associated bacteria, ecotin homologs may also be found in plant-associated taxa and environmental species. The purpose of this review is to provide an update on the biological importance, role in host-microbe interactions, and evolutionary relationship between ecotin orthologs isolated from Eukaryotic and Prokaryotic species across the Tree of Life.
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Affiliation(s)
- Frédéric De Meyer
- Laboratory of Microbiology, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium
| | - Aurélien Carlier
- Laboratory of Microbiology, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium,LIPME, Université de Toulouse, INRAE, CNRS, Castanet-Tolosan, France,*Correspondence: Aurélien Carlier, ✉
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Severino P, Santana W, Lisboa ES, Santos VLSD, Lima ETDS, Cardoso JC, Albuquerque-junior RLCD, Naveros BC, Santini A, Souto EB, Jain S. Cutaneous/Mucocutaneous Leishmaniasis Treatment for Wound Healing: Classical versus New Treatment Approaches. Microbiology Research 2022; 13:836-52. [DOI: 10.3390/microbiolres13040059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (ML) show clinical spectra that can range from a localized lesion (with a spontaneous healing process) to cases that progress to a generalized systemic disease with a risk of death. The treatment of leishmaniasis is complex since most of the available drugs show high toxicity. The development of an effective topical drug formulation for CL and ML treatment offers advantages as it will improve patient’s compliance to the therapy given the possibility for self-administration, as well as overcoming the first pass metabolism and the high costs of currently available alternatives. The most common dosage forms include solid formulations, such as membranes and semi-solid formulations (e.g., ointments, creams, gels, and pastes). Topical treatment has been used as a new route of administration for conventional drugs against leishmaniasis and its combinations, as well as to exploit new substances. In this review, we discuss the advantages and limitations of using topical drug delivery for the treatment of these two forms of leishmaniasis and the relevance of combining this approach with other pharmaceutical dosage forms. Emphasis will also be given to the use of nanomaterials for site-specific delivery.
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Hill N, Irwin A, Graham N, Leung C, Francis JR, Wall N, Nourse C. Treatment of Cutaneous Leishmaniasis in a Nonendemic Country: A Case Series of Children in Australia. Pediatr Infect Dis J 2022; 41:e177-81. [PMID: 34966136 DOI: 10.1097/INF.0000000000003445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe 4 cases of cutaneous leishmaniasis in children in Australia. Treatment is challenging given lack of firm guidelines and limited access to conventional modalities used in endemic countries. Topical paromomycin or oral fluconazole were effective outpatient-based first-line treatments, however, topical paromomycin use was limited by expense to import or compound locally.
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Calvo A, Moreno E, Aldalur I, Sanmartín C, Larrea E, González-Peñas E, Irache JM, Espuelas S. OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1072-1081. [PMID: 35086139 PMCID: PMC9000957 DOI: 10.1093/jac/dkac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives More effective topical treatments remain an unmet need for the localized forms of cutaneous leishmaniasis (CL). The aim of this study was to evaluate the efficacy and safety of a topical berberine cream in BALB/c mice infected with Leishmania major parasites. Methods A cream containing 0.5% berberine-β-glycerophosphate salt and 2.5% menthol was prepared. Its physicochemical and stability properties were determined. The cream was evaluated for its capacity to reduce lesion size and parasitic load as well as to promote wound healing after twice-a-day administration for 35 days. Clinical biochemical profile was used for estimating off-target effects. In vitro time-to-kill curves in L. major-infected macrophages and skin and plasma pharmacokinetics were determined, aiming to establish pharmacokinetic/pharmacodynamic relationships. Results The cream was stable at 40°C for 3 months and at 4°C for at least 8 months. It was able to halt lesion progression in all treated mice. At the end of treatment, parasite load in the skin was reduced by 99.9% (4 log) and genes involved in the wound healing process were up-regulated compared with untreated mice. The observed effects were higher than expected from in vitro time-to-kill kinetic and plasma berberine concentrations, which ranged between 0.07 and 0.22 μM. Conclusions The twice-a-day administration of a topical berberine cream was safe, able to stop parasite progression and improved the appearance of skin CL lesions. The relationship between drug plasma levels and in vivo effect was unclear.
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Affiliation(s)
- Alba Calvo
- ISTUN Institute of Tropical Health, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Chemistry and Pharmaceutical Technology Department, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
| | - Esther Moreno
- ISTUN Institute of Tropical Health, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Chemistry and Pharmaceutical Technology Department, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Navarra Institute for Health Research, IdisNA, Pamplona, Spain
| | - Irati Aldalur
- ISTUN Institute of Tropical Health, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Chemistry and Pharmaceutical Technology Department, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
| | - Carmen Sanmartín
- ISTUN Institute of Tropical Health, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Chemistry and Pharmaceutical Technology Department, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Navarra Institute for Health Research, IdisNA, Pamplona, Spain
| | - Esther Larrea
- ISTUN Institute of Tropical Health, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Navarra Institute for Health Research, IdisNA, Pamplona, Spain
| | - Elena González-Peñas
- Chemistry and Pharmaceutical Technology Department, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
| | - Juan Manuel Irache
- Chemistry and Pharmaceutical Technology Department, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Navarra Institute for Health Research, IdisNA, Pamplona, Spain
| | - Socorro Espuelas
- ISTUN Institute of Tropical Health, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Chemistry and Pharmaceutical Technology Department, University of Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- Navarra Institute for Health Research, IdisNA, Pamplona, Spain
- Corresponding author. E-mail:
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Abstract
Pharmacological efficacy is obtained when adequate concentrations of a potent drug reach the target site. In cutaneous leishmaniasis, a heterogeneous disease characterised by a variety of skin manifestations from simple nodules, skin discoloration, plaques to extensive disseminated forms, the parasites are found in the dermal layers of the skin. Treatment thus involves the release of the active compound from the formulation (administered either topically or systemically), it's permeation into the skin, accumulation by the local macrophages and further transport into the phagolysosome of the macrophage. The pharmacodynamic activity of a drug against the parasite is relatively straight forward to evaluate both in vivo and in vitro. The pharmacokinetic processes taking place inside the skin are more complex to elucidate due to the multi-lamellar structure of the skin, heterogeneous distribution of drugs within the tissue, the difficulty of accessing the site of infection complicating sampling and the lack of surrogate markers reflecting the activity of a drug in the skin. This review will discuss the difficulties encountered when investigating drug distribution, PK PD relationships and efficacy in the skin with a focus on cutaneous leishmaniasis treatment.
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Affiliation(s)
- Katrien Van Bocxlaer
- Department of Biology, York Biomedical Research Institute, University of York York YO10 5DD UK +44 (0) 19 0432 8855
| | - Simon L Croft
- Department of Infection Biology, London School of Hygiene & Tropical Medicine London WC1E 7HT UK
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Riezk A, Van Bocxlaer K, Yardley V, Murdan S, Croft SL. Activity of Amphotericin B-Loaded Chitosan Nanoparticles against Experimental Cutaneous Leishmaniasis. Molecules 2020; 25:E4002. [PMID: 32887341 PMCID: PMC7504813 DOI: 10.3390/molecules25174002] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022] Open
Abstract
Chitosan nanoparticles have gained attention as drug delivery systems (DDS) in the medical field as they are both biodegradable and biocompatible with reported antimicrobial and anti-leishmanial activities. We investigated the application of chitosan nanoparticles as a DDS for the treatment of cutaneous leishmaniasis (CL) by preparing two types of chitosan nanoparticles: positively charged with tripolyphosphate sodium (TPP) and negatively charged with dextran sulphate. Amphotericin B (AmB) was incorporated into these nanoparticles. Both types of AmB-loaded nanoparticles demonstrated in vitro activity against Leishmania major intracellular amastigotes, with similar activity to unencapsulated AmB, but with a significant lower toxicity to KB-cells and red blood cells. In murine models of CL caused by L. major, intravenous administration of AmB-loaded chitosan-TPP nanoparticles (Size = 69 ± 8 nm, Zeta potential = 25.5 ± 1 mV, 5 mg/kg/for 10 days on alternate days) showed a significantly higher efficacy than AmBisome® (10 mg/kg/for 10 days on alternate days) in terms of reduction of lesion size and parasite load (measured by both bioluminescence and qPCR). Poor drug permeation into and through mouse skin, using Franz diffusion cells, showed that AmB-loaded chitosan nanoparticles are not appropriate candidates for topical treatment of CL.
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Affiliation(s)
- Alaa Riezk
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK or (A.R.); (K.V.B.); (V.Y.)
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, London WC1N 1AX, UK;
| | - Katrien Van Bocxlaer
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK or (A.R.); (K.V.B.); (V.Y.)
- Department of Biology, York Biomedical Research Institute, University of York, York YO10 5DD, UK
| | - Vanessa Yardley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK or (A.R.); (K.V.B.); (V.Y.)
| | - Sudaxshina Murdan
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, London WC1N 1AX, UK;
| | - Simon L. Croft
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK or (A.R.); (K.V.B.); (V.Y.)
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Matos A, Viçosa A, Ré M, Ricci-júnior E, Holandino C. A review of current treatments strategies based on paromomycin for leishmaniasis. J Drug Deliv Sci Technol 2020; 57:101664. [DOI: 10.1016/j.jddst.2020.101664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Rabia S, Khaleeq N, Batool S, Dar MJ, Kim DW, Din FU, Khan GM. Rifampicin-loaded nanotransferosomal gel for treatment of cutaneous leishmaniasis: passive targeting via topical route. Nanomedicine (Lond) 2020; 15:183-203. [PMID: 31916472 DOI: 10.2217/nnm-2019-0320] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aim: In this study, the targeting of rifampicin (RIF)-loaded nanotransfersomes (NTs) incorporated in chitosan gel for leishmania-infected macrophages via the topical route was investigated. Materials & methods: NTs were prepared through a thin-film hydration process and incorporated into chitosan gel. Results: The mean particle size of the NTs was 190 nm, with 83% encapsulation efficiency. The permeation rate of the NTs was threefold higher than that of the RIF solution. The NTs improved cellular internalization via passive targeting, which was confirmed by macrophage uptake evaluation. A low IC50 value, flow cytometry analysis and in vivo study demonstrated the RIF-loaded NTs enhanced apoptosis and had better antileishmanial effects. Conclusion: RIF-loaded NT gel could be a fitting carrier for the delivery of antileishmanial drugs in cutaneous leishmaniasis.
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Affiliation(s)
- Samreen Rabia
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45230, Pakistan
| | - Nadra Khaleeq
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45230, Pakistan
| | - Sibgha Batool
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45230, Pakistan
| | | | - Dong Wuk Kim
- College of Pharmacy, Kyungpook National University, Daegu, South Korea
| | - Fakhar-Ud Din
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45230, Pakistan
| | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45230, Pakistan
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Vacas A, Fernández-Rubio C, Algarabel M, Peña-Guerrero J, Larrea E, Rocha Formiga F, García-Sosa AT, Nguewa PA. The Novel Serine/Threonine Protein Kinase LmjF.22.0810 from Leishmania major may be Involved in the Resistance to Drugs such as Paromomycin. Biomolecules 2019; 9:E723. [PMID: 31718000 DOI: 10.3390/biom9110723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
The identification and clarification of the mechanisms of action of drugs used against leishmaniasis may improve their administration regimens and prevent the development of resistant strains. Herein, for the first time, we describe the structure of the putatively essential Ser/Thr kinase LmjF.22.0810 from Leishmania major. Molecular dynamics simulations were performed to assess the stability of the kinase model. The analysis of its sequence and structure revealed two druggable sites on the protein. Furthermore, in silico docking of small molecules showed that aminoglycosides preferentially bind to the phosphorylation site of the protein. Given that transgenic LmjF.22.0810-overexpressing parasites displayed less sensitivity to aminoglycosides such as paromomycin, our predicted models support the idea that the mechanism of drug resistance observed in those transgenic parasites is the tight binding of such compounds to LmjF.22.0810 associated with its overexpression. These results may be helpful to understand the complex machinery of drug response in Leishmania.
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Jaafari MR, Hatamipour M, Alavizadeh SH, Abbasi A, Saberi Z, Rafati S, Taslimi Y, Mohammadi AM, Khamesipour A. Development of a topical liposomal formulation of Amphotericin B for the treatment of cutaneous leishmaniasis. Int J Parasitol Drugs Drug Resist 2019; 11:156-65. [PMID: 31582344 DOI: 10.1016/j.ijpddr.2019.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 09/14/2019] [Accepted: 09/17/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Currently, there is no topical treatment available for any form of cutaneous leishmaniasis (CL) in most of the endemic areas. The aim of the current study was to develop a topical nano-liposomal Amphotericin B (AmB) for the treatment of CL. METHODOLOGY/PRINCIPAL FINDINGS Liposomes containing 0.1, 0.2 and 0.4% AmB (Lip-AmB) were formulated and characterized for the size, entrapment efficiency, long term stability, and skin penetration properties using Franz diffusion cells. Liposomes diameters were around 100 nm with no change during more than 20 months' storage either at 4 °C or at room temperature. Franz diffusion cells studies showed that almost 4% of the applied formulations penetrated across the skin and the highest skin retention (73.92%) observed with Lip-AmB 0.4%. The median effective doses (ED50), the doses of AmB required to kill 50% of L. major amastigotes were 0.151, 0.151, and 0.0856 (μg/mL) in Lip-AmB 0.1, 0.2, 0.4%, respectively. Lip-AmB 0.4% caused 80% reduction in fluorescence intensity of GFP+ L. tropica infected macrophages at 5 μg/mL of AmB concentration. Topical Lip-AmB was applied twice a day for 4 weeks to the skin of BALB/c mice to treat lesions caused by L. major. Results showed the superiority of Lip-AmB 0.4% compared to Lip-AmB 0.2 and 0.1%. The parasite was completely cleared from the skin site of infection and spleens at week 8 and 12 post-infection in mice treated with Lip-AmB 0.4%. The results suggest that topical Lip-AmB 0.4% may be a useful tool in the treatment of CL and merits further investigation.
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Malli S, Pomel S, Ayadi Y, Deloménie C, Da Costa A, Loiseau PM, Bouchemal K. Topically Applied Chitosan-Coated Poly(isobutylcyanoacrylate) Nanoparticles Are Active Against Cutaneous Leishmaniasis by Accelerating Lesion Healing and Reducing the Parasitic Load. ACS Appl Bio Mater 2019; 2:2573-2586. [DOI: 10.1021/acsabm.9b00263] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Sophia Malli
- Institut Galien Paris Sud, UMR CNRS 8612, Univ. Paris-Sud, Université Paris-Saclay, Faculté de Pharmacie, 5, rue J.B. Clément, 92296 Cedex Châtenay-Malabry, France
- BioCIS Biomolécules: Conception, Isolement, Synthèse, Chimiothérapie Antiparasitaire, UMR CNRS 8076, Univ. Paris-Sud, Université Paris-Saclay, Faculté de Pharmacie, 5, rue J.B. Clément, 92296 Cedex Châtenay-Malabry, France
| | - Sebastien Pomel
- BioCIS Biomolécules: Conception, Isolement, Synthèse, Chimiothérapie Antiparasitaire, UMR CNRS 8076, Univ. Paris-Sud, Université Paris-Saclay, Faculté de Pharmacie, 5, rue J.B. Clément, 92296 Cedex Châtenay-Malabry, France
| | - Yasmine Ayadi
- Institut Galien Paris Sud, UMR CNRS 8612, Univ. Paris-Sud, Université Paris-Saclay, Faculté de Pharmacie, 5, rue J.B. Clément, 92296 Cedex Châtenay-Malabry, France
- BioCIS Biomolécules: Conception, Isolement, Synthèse, Chimiothérapie Antiparasitaire, UMR CNRS 8076, Univ. Paris-Sud, Université Paris-Saclay, Faculté de Pharmacie, 5, rue J.B. Clément, 92296 Cedex Châtenay-Malabry, France
| | - Claudine Deloménie
- Faculté de Pharmacie, Institut Paris Saclay d’Innovation Thérapeutique, UMS Inserm CNRS UPSud, Université Paris-Saclay, 92296 Cedex Châtenay-Malabry, France
| | - Antonio Da Costa
- Université d’Artois, CNRS, Centrale Lille, ENSCL, Université Lille, UMR 8181, Unité de Catalyse et de Chimie du Solide (UCCS), Faculté Jean-Perrin, Rue Jean Souvras − SP 18, 62307 Lens, France
| | - Philippe M. Loiseau
- BioCIS Biomolécules: Conception, Isolement, Synthèse, Chimiothérapie Antiparasitaire, UMR CNRS 8076, Univ. Paris-Sud, Université Paris-Saclay, Faculté de Pharmacie, 5, rue J.B. Clément, 92296 Cedex Châtenay-Malabry, France
| | - Kawthar Bouchemal
- Institut Galien Paris Sud, Junior Member of the Institut Universitaire de France, UMR CNRS 8612, Univ. Paris-Sud, Université Paris-Saclay, Faculté de Pharmacie, 5, rue J.B. Clément, 92296 Cedex Châtenay-Malabry, France
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Malli S, Pomel S, Dennemont I, Loiseau PM, Bouchemal K. Combination of amphotericin B and chitosan platelets for the treatment of experimental cutaneous leishmaniasis: Histological and immunohistochemical examinations. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2018.12.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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16
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Neira LF, Mantilla JC, Escobar P. Anti-leishmanial activity of a topical miltefosine gel in experimental models of New World cutaneous leishmaniasis. J Antimicrob Chemother 2019; 74:1634-1641. [DOI: 10.1093/jac/dkz049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/26/2018] [Accepted: 01/14/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- Laura Fernanda Neira
- Centro de Investigación en Enfermedades Tropicales (CINTROP-UIS), Departamento de Ciencias Básicas, Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Julio Cesar Mantilla
- PAT-UIS, Departamento de Patología, Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Patricia Escobar
- Centro de Investigación en Enfermedades Tropicales (CINTROP-UIS), Departamento de Ciencias Básicas, Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, Colombia
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17
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Nguyen AK, Yang K, Bryant K, Li J, Joice AC, Werbovetz KA, Narayan RJ. Microneedle-Based Delivery of Amphotericin B for Treatment of Cutaneous Leishmaniasis. Biomed Microdevices 2019; 21. [DOI: 10.1007/s10544-018-0355-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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18
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Escobar P, Vera AM, Neira LF, Velásquez AO, Carreño H. Photodynamic therapy using ultradeformable liposomes loaded with chlorine aluminum phthalocyanine against L. (V.) braziliensis experimental models. Exp Parasitol 2018; 194:45-52. [DOI: 10.1016/j.exppara.2018.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 04/29/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
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Khanra S, Kumar YP, Dash J, Banerjee R. In vitro screening of known drugs identified by scaffold hopping techniques shows promising leishmanicidal activity for suramin and netilmicin. BMC Res Notes 2018; 11:319. [PMID: 29784022 PMCID: PMC5963029 DOI: 10.1186/s13104-018-3446-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/15/2018] [Indexed: 01/07/2023] Open
Abstract
Objective The rapid emergence of drug resistant Leishmanial strains makes it imperative to continue the development of cheap and effective drugs against the parasite. Due to the absence of effective vaccines against leishmaniasis, current therapeutic measures exclusively rely on chemotherapy. Here we attempt, to identify novel antileishmanial from a list of known drugs determined from a previous bioinformatics study. Synergism between various drug combinations (involving netilmicin, suramin, paromomycin and curcumin) have been estimated to identify potent multidrug therapies to combat the disease. Results The drugs were screened against Leishmania promastigotes by utilizing the MTT assay and against intracellular amastigotes using murine Macrophage like tumor cell, RAW 264.7 as a host. In vitro drug interactions were tested for several drug combinations with a modified fixed ratio isobologram method against both Leishmania major and Leishmania donovani. This work reports the in vitro antileishmanial activity for the aminoglycoside netilmicin (for some Leishmania parasites) and the anti-trypanosomatid suramin. Synergism was also observed between paromomycin–suramin and netilmicin–curcumin. Electronic supplementary material The online version of this article (10.1186/s13104-018-3446-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Supriya Khanra
- Crystallography and Molecular Biology Division, Saha Institute of Nuclear Physics, Sector 1, Block AF, Bidhannagar, Kolkata, 700064, India
| | - Y Pavan Kumar
- Department of Organic Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata, 700032, India
| | - Jyotirmayee Dash
- Department of Organic Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata, 700032, India
| | - Rahul Banerjee
- Crystallography and Molecular Biology Division, Saha Institute of Nuclear Physics, Sector 1, Block AF, Bidhannagar, Kolkata, 700064, India. .,Homi Bhabha National Institute, Anushakti Nagar, Mumbai, 400094, India.
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Van Bocxlaer K, Gaukel E, Hauser D, Park SH, Schock S, Yardley V, Randolph R, Plattner JJ, Merchant T, Croft SL, Jacobs RT, Wring SA. Topical Treatment for Cutaneous Leishmaniasis: Dermato-Pharmacokinetic Lead Optimization of Benzoxaboroles. Antimicrob Agents Chemother 2018; 62:e02419-17. [PMID: 29507073 PMCID: PMC5923108 DOI: 10.1128/aac.02419-17] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/24/2018] [Indexed: 11/20/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is caused by several species of the protozoan parasite Leishmania, affecting an estimated 10 million people worldwide. Previously reported strategies for the development of topical CL treatments have focused primarily on drug permeation and formulation optimization as the means to increase treatment efficacy. Our approach aims to identify compounds with antileishmanial activity and properties consistent with topical administration. Of the test compounds, five benzoxaboroles showed potent activity (50% effective concentration [EC50] < 5 μM) against intracellular amastigotes of at least one Leishmania species and acceptable activity (20 μM < EC50 < 30 μM) against two more species. Benzoxaborole compounds were further prioritized on the basis of the in vitro evaluation of progression criteria related to skin permeation, such as the partition coefficient and solubility. An MDCKII-hMDR1 cell assay showed overall good permeability and no significant interaction with the P-glycoprotein transporter for all substrates except LSH002 and LSH031. The benzoxaboroles were degraded, to some extent, by skin enzymes but had stability superior to that of para-hydroxybenzoate compounds, which are known skin esterase substrates. Evaluation of permeation through reconstructed human epidermis showed LSH002 to be the most permeant, followed by LSH003 and LSH001. Skin disposition studies following finite drug formulation application to mouse skin demonstrated the highest permeation for LSH001, followed by LSH003 and LSH002, with a significantly larger amount of LSH001 than the other compounds being retained in skin. Finally, the efficacy of the leads (LSH001, LSH002, and LSH003) against Leishmania major was tested in vivo LSH001 suppressed lesion growth upon topical application, and LSH003 reduced the lesion size following oral administration.
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Affiliation(s)
- Katrien Van Bocxlaer
- London School of Hygiene & Tropical Medicine, Faculty of Infections and Tropical Diseases, London, United Kingdom
| | - Eric Gaukel
- Scynexis Inc., Research Triangle Park, North Carolina, USA
| | - Deirdre Hauser
- Scynexis Inc., Research Triangle Park, North Carolina, USA
| | - Seong Hee Park
- Scynexis Inc., Research Triangle Park, North Carolina, USA
| | - Sara Schock
- Scynexis Inc., Research Triangle Park, North Carolina, USA
| | - Vanessa Yardley
- London School of Hygiene & Tropical Medicine, Faculty of Infections and Tropical Diseases, London, United Kingdom
| | - Ryan Randolph
- Scynexis Inc., Research Triangle Park, North Carolina, USA
| | | | - Tejal Merchant
- Anacor Pharmaceuticals, Inc., Palo Alto, California, USA
| | - Simon L Croft
- London School of Hygiene & Tropical Medicine, Faculty of Infections and Tropical Diseases, London, United Kingdom
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Kaur L, Singh K, Paul S, Singh S, Singh S, Jain SK. A Mechanistic Study to Determine the Structural Similarities Between Artificial Membrane Strat-M™ and Biological Membranes and Its Application to Carry Out Skin Permeation Study of Amphotericin B Nanoformulations. AAPS PharmSciTech 2018; 19:1606-1624. [PMID: 29488196 DOI: 10.1208/s12249-018-0959-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/15/2018] [Indexed: 11/30/2022] Open
Abstract
Type of biological membrane used in skin permeation experiment significantly affects skin permeation and deposition potential of tested formulations. In this study, a comparative study has been carried out to evaluate the potential of a synthetic membrane (Strat-M™) with rat, human, and porcine ear skin to carry out skin permeation study of nanoformulations of a high molecular weight drug, amphotericin B. Results demonstrated that the permeation of this high molecular weight drug through Strat-M™ showed close similitude to human skin. Value of correlation coefficient (R2) of log diffusion between Strat-M™ and human skin was found to be 0.99 which demonstrated the similarities of Strat-M™ membrane to the human skin. In similarity factor analysis, the value of f2 was also found to be 85, which further demonstrated the similarities of Strat-M™ membrane to human skin. Moreover, scanning electron microscopy (SEM), transmission electron microscopy (TEM), and Brunauer-Emmett-Teller (BET) analysis of synthetic and biological membranes depicted almost similar morphological features (thickness, pore size, surface morphology, and diameter) of synthetic membrane with human skin. The results of the study demonstrated Strat-M™ as a better alternative to carry out skin permeation experiment due to the consistent results, reproducibility, easy availability, and minimum variability with human skin.
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Abstract
New drugs and treatments for diseases caused by intracellular pathogens, such as leishmaniasis and the Leishmania species, have proved to be some of the most difficult to discover and develop. The focus of discovery research has been on the identification of potent and selective compounds that inhibit target enzymes (or other essential molecules) or are active against the causative pathogen in phenotypic in vitro assays. Although these discovery paradigms remain an essential part of the early stages of the drug R & D pathway, over the past two decades additional emphasis has been given to the challenges needed to ensure that the potential anti-infective drugs distribute to infected tissues, reach the target pathogen within the host cell and exert the appropriate pharmacodynamic effect at these sites. This review will focus on how these challenges are being met in relation to Leishmania and the leishmaniases with lessons learned from drug R & D for other intracellular pathogens.
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Wijerathna T, Gunathilaka N, Gunawardana K, Rodrigo W. Potential Challenges of Controlling Leishmaniasis in Sri Lanka at a Disease Outbreak. Biomed Res Int 2017; 2017:6931497. [PMID: 28630867 DOI: 10.1155/2017/6931497] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present works reviewed the existing information on leishmaniasis in Sri Lanka and in other countries, focusing on challenges of controlling leishmaniasis in the country, in an outbreak. Evidence from recent studies suggests that there is a possibility of a leishmaniasis outbreak in Sri Lanka in the near future. Difficulty of early diagnosis due to lack of awareness and unavailability or inadequacy of sensitive tests are two of the main challenges for effective case management. Furthermore, the absence of a proper drug for treatment and lack of knowledge about vector biology, distribution, taxonomy and bionomics, and reservoir hosts make the problem serious. The evident potential for visceralization in the cutaneous variant of L. donovani in Sri Lanka may also complicate the issue. Lack of knowledge among local communities also reduces the effectiveness of vector and reservoir host control programs. Immediate actions need to be taken in order to increase scientific knowledge about the disease and a higher effectiveness of the patient management and control programs must be achieved through increased awareness about the disease among general public and active participation of local community in control activities.
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Wolf Nassif P, De Mello TFP, Navasconi TR, Mota CA, Demarchi IG, Aristides SMA, Lonardoni MVC, Teixeira JJV, Silveira TGV. Safety and efficacy of current alternatives in the topical treatment of cutaneous leishmaniasis: a systematic review. Parasitology 2017; 144:995-1004. [DOI: 10.1017/s0031182017000385] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
SUMMARYStudies of topical treatments for leishmaniasis were systematically reviewed, to evaluate the therapeutic efficacy, safety and any adverse effects of these treatments. The papers identified in the databases PubMed and Web of Knowledge involved eight studies with a total of 1744 patients. The majority of trials was from Iran (4/8), covered a period of 8 years (2003–2011), and included patients 4–85 years of age. The most frequent Leishmania species in the studies were L. tropica (4/8) and L. major (2/8). The treatments administered were thermotherapy, paromomycin and combinations, CO2 laser, 5-aminolevulinic acid hydrochloride (10%) plus visible red light (633 nm) and cryotherapy. Six articles reported cure rates over 80·0%. Six studies reported on failure rates, three of them reporting rates lower than 10%. Four studies did not report relapses or recurrences, while the other studies reported low rates (1·8–6·3%). The most common adverse effects of the topical treatments were redness/erythema, pain, pruritus burning, oedema, vesicles and hyper- or hypopigmentation. The results provide strong evidence that the treatments topical evaluated showed high cure rates, safety and effectiveness, with low side-effects, relapse and recurrence rates, except for cryotherapy, which showed a moderate cure rate.
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Ginouvès M, Simon S, Nacher M, Demar M, Carme B, Couppié P, Prévot G. In Vitro Sensitivity of Cutaneous Leishmania Promastigote Isolates Circulating in French Guiana to a Set of Drugs. Am J Trop Med Hyg 2017; 96:1143-1150. [PMID: 28167598 DOI: 10.4269/ajtmh.16-0373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractAnti-leishmaniasis drug resistance is a common problem worldwide. The aim of this study was to inventory the general in vitro level of sensitivity of Leishmania isolates circulating in French Guiana and to highlight potential in vitro pentamidine-resistant isolates. This sensitivity study was conducted on 36 patient-promastigote isolates for seven drugs (amphotericin B, azithromycin, fluconazole, meglumine antimoniate, miltefosine, paromomycin, and pentamidine) using the Cell Counting Kit-8 viability test. The IC50 values obtained were heterogeneous. One isolate exhibited high IC50 values for almost all drugs tested. Pentamidine, which is the first-line treatment in French Guiana, showed efficacy at very low doses (mean of 0.0038 μg/mL). The concordance of the in vitro pentamidine results with the patients' clinical outcomes was 94% (K = 0.82).
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Affiliation(s)
- Marine Ginouvès
- Laboratoire Associé, Centre National de Référence Leishmania, Laboratoire Hospitalo-Universitaire de Parasitologie et Mycologie, General Hospital, Cayenne, French Guiana.,Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana
| | - Stéphane Simon
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana.,Laboratoire Associé, Centre National de Référence Leishmania, Laboratoire Hospitalo-Universitaire de Parasitologie et Mycologie, General Hospital, Cayenne, French Guiana
| | - Mathieu Nacher
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana.,Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC EC 1424, General Hospital, Cayenne, French Guiana
| | - Magalie Demar
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana.,Laboratoire Associé, Centre National de Référence Leishmania, Laboratoire Hospitalo-Universitaire de Parasitologie et Mycologie, General Hospital, Cayenne, French Guiana.,Laboratoire Hospitalo-Universitaire de Parasitologie et Mycologie, General Hospital, Cayenne, French Guiana
| | - Bernard Carme
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana
| | - Pierre Couppié
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana.,Service de Dermatologie, Institut Guyanais de Dermatologie Tropicale, General Hospital, Cayenne, French Guiana
| | - Ghislaine Prévot
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana
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Abstract
Cutaneous and visceral leishmaniasis are amongst the most devastating infectious diseases of our time, affecting millions of people worldwide. The treatment of these serious diseases rely on a few chemotherapeutic agents, most of which are of parenteral use and induce severe side-effects. Furthermore, rates of treatment failure are high and have been linked to drug resistance in some areas. Here, we reviewed data on current chemotherapy practice in leishmaniasis. Drug resistance and mechanisms of resistance are described as well as the prospects for applying drug combinations for leishmaniasis chemotherapy. It is clear that efforts for discovering new drugs applicable to leishmaniasis chemotherapy are essential. The main aspects on the various steps of drug discovery in the field are discussed.
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Kharaji MH, Doroud D, Taheri T, Rafati S. Drug Targeting to Macrophages With Solid Lipid Nanoparticles Harboring Paromomycin: an In Vitro Evaluation Against L. major and L. tropica. AAPS PharmSciTech 2016; 17:1110-9. [PMID: 26552399 DOI: 10.1208/s12249-015-0439-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/19/2015] [Indexed: 02/02/2023] Open
Abstract
Leishmaniasis is a worldwide disease that leads to high mortality and morbidity in human populations. Today, leishmaniasis is managed via drug therapy. The drugs that are already in clinical use are limited to a number of toxic chemical compounds and their parasite drug resistance is increasing. It is therefore essential, in order to circumvent the current difficulties, to design a new anti-leishmanial drug treatment strategy. Besides producing new, active anti-leishmanial entities, another promising strategy could be developing novel delivery systems and formulations of the existing pharmaceutical ingredients to improve drug efficacy. In the present study, paromomycin sulfate (PM), as one of the promising anti-leishmanial drugs, was formulated in solid lipid nanoparticles (SLN), and its in vitro efficacy was investigated against different strains of Leishmania using a MTT test, Parasite-Rescue-Transformation-Assay, SYTO Green staining, and fluorescent microscope imaging. The results show that PM-loaded SLN is significantly more effective than PM in inhibiting parasite propagation (P < 0.05) and that cytotoxicity of PM-SLN formulations is size dependent. According to our results, delivery of the drugs to the macrophages via nanoparticle utilization seems to be an accessible and practical approach.
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28
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Van Bocxlaer K, Yardley V, Murdan S, Croft SL. Drug permeation and barrier damage in Leishmania-infected mouse skin. J Antimicrob Chemother 2016; 71:1578-85. [PMID: 26903275 DOI: 10.1093/jac/dkw012] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/08/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Pathological disorder can disrupt the barrier integrity of the skin, thereby altering the drug delivery from topical formulations to the target site. Cutaneous leishmaniasis (CL) is an infection of the dermal layers of the skin and manifests as a variety of skin lesions from defined nodular forms to plaques and chronic ulcers. The aim of this work was to characterize the physiology and barrier integrity of the Leishmania-infected BALB/c mouse skin and how they impacted delivery of drugs into the skin. METHODS A histological evaluation of the structural differences between uninfected and infected skin was performed using haematoxylin/eosin, elastic Van Gieson and Iba-1 stains. As a CL nodule developed and progressed, the skin pH, hydration and trans-epidermal water loss (TEWL) were recorded. Finally, Franz diffusion cells were used to evaluate the influence of the infection on drug delivery through the skin. RESULTS We found: (i) structural changes in both the epidermal and dermal layers due to the ingress of inflammatory cells, as shown by immunohistochemistry; (ii) a significant increase in TEWL; and (iii) significantly higher permeation of the model permeants caffeine and ibuprofen and the antileishmanial drugs buparvaquone and paromomycin, for Leishmania-infected skin compared with uninfected skin. The infection had no measurable influence on skin pH and hydration. CONCLUSIONS We report profound changes in the skin barrier physiology, function and permeability to drugs of Leishmania-infected skin.
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Affiliation(s)
- Katrien Van Bocxlaer
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK Department of Infection and Immunology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Vanessa Yardley
- Department of Infection and Immunology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sudaxshina Murdan
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Simon L Croft
- Department of Infection and Immunology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Eddaikra N, Kherachi Djenad I, Benbetka S, Benikhlef R, Aït-Oudhia K, Moulti-Mati F, Oury B, Sereno D, Harrat Z. Development of a Murine Infection Model with Leishmania killicki, Responsible for Cutaneous Leishmaniosis in Algeria: Application in Pharmacology. Biomed Res Int 2016; 2016:7985104. [PMID: 26949705 DOI: 10.1155/2016/7985104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/30/2015] [Accepted: 01/06/2016] [Indexed: 01/19/2023]
Abstract
In Algeria, Leishmania infantum, Leishmania major, and Leishmania killicki (Leishmania tropica) are responsible for cutaneous leishmaniosis. We established a murine model of L. killicki infection to investigate its infective capacity, some immunophysiopathological aspects, and its suitability for pharmacological purposes. Following the injection of L. major or L. killicki metacyclic promastigotes in the ear dermis of BALB/c mice, the course of infection was followed. The infection with L. killicki caused slower lesion formation than with L. major. The presence of L. killicki or L. major DNA and parasites was detected in the ear dermis and in lymph nodes, spleen, and liver. Lesions induced by L. killicki were nonulcerative in their aspect, whereas those caused by L. major were highly ulcerative and necrotic, which matches well with the lesion phenotype reported in humans for L. killicki and L. major, respectively. The treatment of L. killicki lesions by injection of Glucantime® significantly reduced the lesion thickness and parasite burden. Ear dermal injection of BALB/c mice constitutes a model to study lesions physiopathology caused by L. killicki and presents interest for in vivo screening of new compounds against this pathogen, emerging in Algeria.
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Abstract
Diagnosis and therapy of cutaneous leishmaniasis (CL) can be difficult due to the variability of the clinical pictures and resistance to therapy. There is no vaccine currently available for CL. The aim of the present review is to describe different topical treatment modalities for old world CL. The mainstays of treatment for old world CL are pentavalent antimony compounds which are administered parenterally or intralesionally. New topical treatment alternatives have been available within the past few years. Amongst several treatments used topically, physical therapies including cryotherapy, heat therapy and CO2 laser are promising for the treatment of old world CL. Along with that, other randomized placebo controlled trials should be designed to find new effective therapeutic regimens.
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Espuelas S. Conventional formulations and emerging delivery systems for the topical treatment of Cutaneous Leishmaniasis. Ther Deliv 2015; 6:101-3. [PMID: 25690078 DOI: 10.4155/tde.14.107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kaur L, Jain SK, Manhas RK, Sharma D. Nanoethosomal formulation for skin targeting of amphotericin B: anin vitroandin vivoassessment. J Liposome Res 2014; 25:294-307. [DOI: 10.3109/08982104.2014.995670] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Schwartz J, Moreno E, Fernández C, Navarro-blasco I, Nguewa PA, Palop JA, Irache JM, Sanmartín C, Espuelas S. Topical treatment of L. major infected BALB/c mice with a novel diselenide chitosan hydrogel formulation. Eur J Pharm Sci 2014; 62:309-16. [DOI: 10.1016/j.ejps.2014.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/22/2014] [Accepted: 06/13/2014] [Indexed: 11/15/2022]
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Abstract
Background Leishmaniasis is a disease caused by infection with the protozoan parasite Leishmania, which is responsible for three main types of disease: cutaneous leishmaniasis, visceral leishmaniasis and mucocutaneous leishmaniasis based to the site of infection for the particular species. This presents a major challenge to successful drug treatment, as a drug must not only reach antileishmanial concentrations in infected macrophages, the parasites' host cell, but also reach infected cells in locations specific to the type of disease. In this paper we discuss how studies using Leishmania have contributed to our knowledge on how drug delivery systems can be used to improve drug efficacy and delivery.
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Affiliation(s)
- CD Shaw
- Strathclyde Institute of Pharmacy & Biomedical Sciences University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, Scotland, UK
| | - KC Carter
- Strathclyde Institute of Pharmacy & Biomedical Sciences University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, Scotland, UK
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Moreno E, Schwartz J, Fernández C, Sanmartín C, Nguewa P, Irache JM, Espuelas S. Nanoparticles as multifunctional devices for the topical treatment of cutaneous leishmaniasis. Expert Opin Drug Deliv 2014; 11:579-97. [PMID: 24620861 DOI: 10.1517/17425247.2014.885500] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Cutaneous and mucocutaneous leishmaniasis are major tropical skin diseases. Topical treatment is currently limited to the least severe forms of cutaneous leishmaniasis (CL) without risk of dissemination. It is also recommended in combination with systemic therapy for more severe forms. Progresses in this modality of treatment are hindered by the heterogeneity of the disease and shortcomings in the clinical trials. AREAS COVERED This review overlooks three major modalities of topical therapies in use or under investigation against CL: chemotherapy, photodynamic therapy and immunotherapy; either with older compounds such as paramomycin or more recent nitric oxide donors, antimicrobial peptides or silver derivatives. The advantages and limitations of their administration with newer formulation strategies such as nanoparticles (NPs) are discussed. EXPERT OPINION The efficacy of a topical treatment against CL depends not only on the intrinsic antileishmanial activity of the drug but also on the amount of drug available in the dermis. NPs as sustained release systems and permeation enhancers could favour the creation of a drug reservoir in the dermis. Additionally, certain NPs have immunomodulatory properties or wound healing capabilities of benefit in CL treatment. Pending task is the selective delivery of active compounds to intracellular amastigotes, because even small NPs are unable to penetrate deeply into the skin to encounter infected macrophages (except in ulcerative lesions).
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Affiliation(s)
- Esther Moreno
- University of Navarra, Tropical Health Institute , Irunlarrea, 1 E-31008 Pamplona , Spain +34948425600 ; +34948425619 ;
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Iraji F, Sadeghinia A. Efficacy of paromomycin ointment in the treatment of cutaneous leishmaniasis: results of a double-blind, randomized trial in Isfahan, Iran. Annals of Tropical Medicine & Parasitology 2013; 99:3-9. [PMID: 15701249 DOI: 10.1179/136485905x16372] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Although pentavalent antimonials are often used in the first-line treatment of cutaneous leishmaniasis (CL), they have several adverse effects. Intralesional administration of antimonials and other antileishmanial drugs can be painful. In the present, double-blind, randomized study, to determine if topical treatment with paromomycin is effective in the treatment of CL, 35 cases of CL were treated, twice daily for 30 days, with a commercial skin-care lotion containing 10% urea (the placebo) and another 30 were similarly treated with the same lotion to which paromomycin sulphate had been added (to give a concentration of 15%). Each case was assessed clinically 7, 14, 21 and 30 days after treatment began, and parasitologically 30 and 60 days after the initiation of treatment. Five (17%) and five (17%) of the cases treated with paromomycin showed complete healing, with the apparent clearance of amastigotes from their lesions, 30 and 60 days after treatment began, respectively. At the same time-points, however, the lesions on six (17%) and seven (20%) of the cases in the placebo group, respectively, also appeared to have healed completely. Ointment containing 15% paromomycin therefore appears ineffective in the treatment of CL, at least when applied twice daily for 30 days to the lesions of cases from an endemic area of Isfahan, Iran.
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Affiliation(s)
- F Iraji
- Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
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Jafari F, Nourian A, Fazaeli A, Yazdinezhad A, Haniloo A. In vitro activity of Alkanna frigida extracts in comparison with glucantime against Leishmania major. Iran J Microbiol 2013; 5:177-82. [PMID: 23825738 PMCID: PMC3696856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Current chemotherapies of cutaneous leihmaniasis have faced to some problems and limitations; Development of new leishmanicidal drugs from different sources like herbal plants, are crucially important. The objective of the present study was evaluation of in vitro activity of Alkanna frigida extracts in comparison with glucantime against Leishmania major. MATERIALS AND METHODS L. major promastigotes were exposed to different concentrations of the A. frigida extracts, processed by ethyl acetate, ethanol, hexane and chloroform. The inhibitory effect, as the IC50, were calculated after 24, 48 and 72 hours by linear regression analysis values of the concentrations employed. RESULTS The significant inhibition was observed after 24 and 48 hours with different concentrations of compounds (p < 0.05 in all tests). All extracts had potent activity against proliferation of the promastigotes, comparing to the untreated negative control. It could compete with the glucantime efficacy in some concentrations. Ethyl acetate and ethanol extractions showed potent IC50 value, 106 µg/ml and 86 µg/ml, respectively. Hexane and chloroform extractions had poor efficacy after 24 hours; however, the efficacy increased after 48 and 72 hours. CONCLUSION The results indicated that the A. frigida has appropriate inhibitory effects on the growth of L. major promastigotes in vitro and can be of herbal targets for further investigation in vivo.
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Affiliation(s)
- Fariba Jafari
- Department of Medical Parasitoloy and Mycology, Medical School, Zanjan University of Medical Sciences and Health Services
| | - Abbasali Nourian
- Department of Medical Parasitoloy and Mycology, Medical School, Zanjan University of Medical Sciences and Health Services, Corresponding author: Abbasali Nourian, Address: Department of Medical Parasitology and Mycology, Medical School, Zanjan University of Medical Sciences and Health Services, Zanjan, Iran. Tel: +98-241-4240301-3. Fax: +98-241-4249553. E-mail
| | - Asghar Fazaeli
- Department of Medical Parasitoloy and Mycology, Medical School, Zanjan University of Medical Sciences and Health Services
| | - Alireza Yazdinezhad
- Department of Pharmacognozy, Faculty of Pharmacy. Zanjan University of Medical Sciences and Health Services, Zanjan, Iran
| | - Ali Haniloo
- Department of Medical Parasitoloy and Mycology, Medical School, Zanjan University of Medical Sciences and Health Services
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Ben Salah A, Ben Messaoud N, Guedri E, Zaatour A, Ben Alaya N, Bettaieb J, Gharbi A, Belhadj Hamida N, Boukthir A, Chlif S, Abdelhamid K, El Ahmadi Z, Louzir H, Mokni M, Morizot G, Buffet P, Smith PL, Kopydlowski KM, Kreishman-Deitrick M, Smith KS, Nielsen CJ, Ullman DR, Norwood JA, Thorne GD, McCarthy WF, Adams RC, Rice RM, Tang D, Berman J, Ransom J, Magill AJ, Grogl M. Topical paromomycin with or without gentamicin for cutaneous leishmaniasis. N Engl J Med 2013; 368:524-32. [PMID: 23388004 DOI: 10.1056/nejmoa1202657] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a need for a simple and efficacious treatment for cutaneous leishmaniasis with an acceptable side-effect profile. METHODS We conducted a randomized, vehicle-controlled phase 3 trial of topical treatments containing 15% paromomycin, with and without 0.5% gentamicin, for cutaneous leishmaniasis caused by Leishmania major in Tunisia. We randomly assigned 375 patients with one to five ulcerative lesions from cutaneous leishmaniasis to receive a cream containing 15% paromomycin-0.5% gentamicin (called WR 279,396), 15% paromomycin alone, or vehicle control (with the same base as the other two creams but containing neither paromomycin nor gentamicin). Each lesion was treated once daily for 20 days. The primary end point was the cure of the index lesion. Cure was defined as at least 50% reduction in the size of the index lesion by 42 days, complete reepithelialization by 98 days, and absence of relapse by the end of the trial (168 days). Any withdrawal from the trial was considered a treatment failure. RESULTS The rate of cure of the index lesion was 81% (95% confidence interval [CI], 73 to 87) for paromomycin-gentamicin, 82% (95% CI, 74 to 87) for paromomycin alone, and 58% (95% CI, 50 to 67) for vehicle control (P<0.001 for each treatment group vs. the vehicle-control group). Cure of the index lesion was accompanied by cure of all other lesions except in five patients, one in each of the paromomycin groups and three in the vehicle-control group. Mild-to-moderate application-site reactions were more frequent in the paromomycin groups than in the vehicle-control group. CONCLUSIONS This trial provides evidence of the efficacy of paromomycin-gentamicin and paromomycin alone for ulcerative L. major disease. (Funded by the Department of the Army; ClinicalTrials.gov number, NCT00606580.).
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Bavarsad N, Fazly Bazzaz BS, Khamesipour A, Jaafari MR. Colloidal, in vitro and in vivo anti-leishmanial properties of transfersomes containing paromomycin sulfate in susceptible BALB/c mice. Acta Trop 2012; 124:33-41. [PMID: 22750480 DOI: 10.1016/j.actatropica.2012.06.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 06/11/2012] [Accepted: 06/13/2012] [Indexed: 11/26/2022]
Abstract
The aim of this study was to develop transfersomal formulation with respect to dermal delivery of paromomycin sulfate (PM) for possible topical therapy of cutaneous leishmaniasis (CL). PM transfersomal formulations (PMTFs) with different percent of soy phosphatidylcholine, sodium cholate (Na-Ch) and ethanol were prepared and characterized for the size, zeta potential and encapsulation efficiency. The results showed that the most stable formulations with suitable colloidal properties were obtained by 2% Na-Ch which had average size of around 200 nm. The in vitro permeation study using Franz diffusion cells fitted with mouse skin at 37°C for 24h showed that almost 23% of the PMTFs applied penetrated the mouse skin, and the amount retained in the skin was about 67% for both formulations; however, the percent of penetration and retention for PM conventional cream was 49 and 13, respectively. The 50% effective doses of PMTFs against Leishmania major promastigotes and amastigotes in culture were significantly less than cream and/or solution of PM. Selected PMTFs and empty transfersomes showed no cytotoxicity in J774 A.1 mouse macrophage cell line. Selected PMTFs was used topically twice a day for 4 weeks to treat L. major lesions on BALB/c mice, and the results showed a significantly (P<0.05) smaller lesion size in the mice in the treated groups than in the mice in the control groups, which received either empty transfersomes or phosphate-buffered saline (PBS) and also PM cream. The spleen parasite burden was significantly (P<0.01) lower in mice treated with selected PMTFs than in mice treated with PBS or control transfersomes, and PM cream. The results of this study showed that PMTFs prepared with 2% of Na-Ch with and without 5% ethanol might be useful as a candidate for the topical treatment of CL.
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Abstract
INTRODUCTION The parenteral administration of pentavalent antimonials for the treatment of all forms of leishmaniasis, including cutaneous leishamniasis (CL), has several limitations. Therapy is long, requiring repeated doses and the adverse reactions are frequent. Topical treatment is an attractive alternative for CL, offering significant advantages over systemic therapy: fewer adverse effects, ease of administration, and lower costs. AREAS COVERED This review covers, from 1984 to the present, the progress achieved for the development of topical treatment for CL, using different drugs such as paromomycin (PA), imiquimod, amphotericin B (AmB), miltefosine, and buparvaquone. PA is the most commonly studied drug, followed by AmB and Imiquimod. These drugs were incorporated in conventional dosage forms or loaded in lipid nanocarries, which have been used mainly for improved skin delivery and antileishmanial activity. EXPERT OPINION Developing an effective topical treatment for CL using these antileishmanial drugs still remains a great challenge. Insights into the most promising delivery strategies to improve treatment of CL with PA and AmB using conventional dosage forms, lipid nanocarriers, and combined therapy are presented and discussed. The results obtained with combined therapy and alternative delivery systems are promising perspectives for improving topical treatment of CL.
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Affiliation(s)
- Guilherme Carneiro
- Federal University of Minas Gerais, Faculty of Pharmacy, Belo Horizonte, Minas Gerais, Brazil
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Hobbie SN, Kaiser M, Schmidt S, Shcherbakov D, Janusic T, Brun R, Böttger EC. Genetic reconstruction of protozoan rRNA decoding sites provides a rationale for paromomycin activity against Leishmania and Trypanosoma. PLoS Negl Trop Dis 2011; 5:e1161. [PMID: 21629725 PMCID: PMC3101183 DOI: 10.1371/journal.pntd.0001161] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 03/17/2011] [Indexed: 12/04/2022] Open
Abstract
Aminoglycoside antibiotics target the ribosomal decoding A-site and are active against a broad spectrum of bacteria. These compounds bind to a highly conserved stem-loop-stem structure in helix 44 of bacterial 16S rRNA. One particular aminoglycoside, paromomycin, also shows potent antiprotozoal activity and is used for the treatment of parasitic infections, e.g. by Leishmania spp. The precise drug target is, however, unclear; in particular whether aminoglycoside antibiotics target the cytosolic and/or the mitochondrial protozoan ribosome. To establish an experimental model for the study of protozoan decoding-site function, we constructed bacterial chimeric ribosomes where the central part of bacterial 16S rRNA helix 44 has been replaced by the corresponding Leishmania and Trypanosoma rRNA sequences. Relating the results from in-vitro ribosomal assays to that of in-vivo aminoglycoside activity against Trypanosoma brucei, as assessed in cell cultures and in a mouse model of infection, we conclude that aminoglycosides affect cytosolic translation while the mitochondrial ribosome of trypanosomes is not a target for aminoglycoside antibiotics. Rational design of novel therapeutics relies on the knowledge and understanding of potential drug targets. Historically, the majority of therapeutics have not been rationally designed, but empirically discovered. Paromomycin, an aminoglycoside with antibacterial activity, has been found to show considerable activity against leishmaniasis, a disease caused by the protozoan parasite Leishmania. However, the mechanisms of aminoglycoside action against protozoan parasites have in part remained unclear. In this study we demonstrate that the cytosolic ribosome is the preferred drug target, and that the mitochondrial ribosome does not contribute to the antiprotozoal activity of aminoglycosides. As the cytosolic ribosome of Trypanosoma, the causative agent of sleeping sickness and Chagas disease, resembles that of Leishmania, we tested the efficacy of paromomycin against Trypanosoma. We found that paromomycin not only inhibits the growth of Trypanosoma in culture, but also suppresses trypanosomiasis in a mouse infection model. Our results point to the cytosolic ribosome as a promising drug target for antiprotozoal drug development.
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MESH Headings
- Animals
- Antiprotozoal Agents/pharmacology
- Disease Models, Animal
- Female
- Leishmania/drug effects
- Mice
- Parasitic Sensitivity Tests
- Paromomycin/pharmacology
- Protein Biosynthesis/drug effects
- RNA, Bacterial/genetics
- RNA, Bacterial/metabolism
- RNA, Protozoan/genetics
- RNA, Protozoan/metabolism
- RNA, Ribosomal/genetics
- RNA, Ribosomal/metabolism
- Recombination, Genetic
- Rodent Diseases/drug therapy
- Rodent Diseases/parasitology
- Trypanosoma brucei brucei/drug effects
- Trypanosomiasis, African/drug therapy
- Trypanosomiasis, African/parasitology
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Affiliation(s)
- Sven N. Hobbie
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Marcel Kaiser
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sebastian Schmidt
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Dmitri Shcherbakov
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Tanja Janusic
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Reto Brun
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Erik C. Böttger
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
- * E-mail:
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Garnier T, Mäntylä A, Järvinen T, Lawrence MJ, Brown MB, Croft SL. Topical buparvaquone formulations for the treatment of cutaneous leishmaniasis. J Pharm Pharmacol 2010; 59:41-9. [PMID: 17227619 DOI: 10.1211/jpp.59.1.0006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
As the part of a study to develop buparvaquone (BPQ) formulations for the treatment of cutaneous leishmaniasis, the topical delivery of BPQ and one of its prodrugs from a range of formulations was evaluated. In previous studies, BPQ and its prodrugs were shown to be potent antileishmanials in-vitro, with ED50 values in the nanomolar range. 3-Phosphono-oxymethyl-buparvaquone (3-POM-BPQ) was the most potent antileishmanial and was chosen, together with the parent drug, for further investigation. The ability of the parent and prodrug formulations to cross human and murine skin was tested in-vitro using the Franz diffusion cells. Formulations intended for topical application containing either BPQ or 3-POM-BPQ were developed using excipients that were either acceptable for topical use (GRAS or FDA inactive ingredients) or currently going through the regulatory process. BPQ was shown to penetrate both human epidermal membranes and full thickness BALB/c skin from a range of formulations (gels, emulsions). Similarly, 3-POM-BPQ penetrated full-thickness BALB/c skin from several gel formulations. In-vitro binding studies showed that BPQ bound melanin in a dose-dependent manner and preferably bound to delipidized skin over untreated BALB/c skin (on a weight to weight basis). The results confirm that BPQ and its prodrug 3-POM-BPQ can penetrate the skin from several formulations, making them potentially interesting candidates for further investigation of topical formulations using in-vivo models of cutaneous leishmaniasis.
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Affiliation(s)
- Tracy Garnier
- School of Pharmacy, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK.
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Carneiro G, Santos DC, Oliveira MC, Fernandes AP, Ferreira LS, Ramaldes GA, Nunan EA, Ferreira LA. Topical delivery andin vivoantileishmanial activity of paromomycin-loaded liposomes for treatment of cutaneous leishmaniasis. J Liposome Res 2010; 20:16-23. [DOI: 10.3109/08982100903015025] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shukla AK, Singh BK, Patra S, Dubey VK. Rational Approaches for Drug Designing Against Leishmaniasis. Appl Biochem Biotechnol 2010; 160:2208-18. [DOI: 10.1007/s12010-009-8764-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 08/24/2009] [Indexed: 10/20/2022]
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Ben-Amitai D, Danon Y, Ashkenazi S, Garty B. Topical treatment with paromomycin for cutaneous leishmaniasis. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639509097152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ben Salah A, Buffet PA, Morizot G, Ben Massoud N, Zâatour A, Ben Alaya N, Haj Hamida NB, El Ahmadi Z, Downs MT, Smith PL, Dellagi K, Grögl M. WR279,396, a third generation aminoglycoside ointment for the treatment of Leishmania major cutaneous leishmaniasis: a phase 2, randomized, double blind, placebo controlled study. PLoS Negl Trop Dis 2009; 3:e432. [PMID: 19415122 DOI: 10.1371/journal.pntd.0000432] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 04/09/2009] [Indexed: 11/19/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) is a disfiguring disease that confronts clinicians with a quandary: leave patients untreated or engage in a complex or toxic treatment. Topical treatment of CL offers a practical and safe option. Accordingly, the treatment of CL with WR279,396, a formulation of paromomycin and gentamicin in a hydrophilic base, was investigated in a phase 2 clinical study in Tunisia and France. Methods A phase 2, randomized, double blind, vehicle-controlled study was conducted to assess the safety and efficacy of topical WR279,396 when applied twice a day for 20 days as treatment for parasitologically confirmed CL. The study protocol established the primary efficacy end point as complete clinical response (CCR) defined as 50% or greater reduction in the ulceration size of an index lesion by day 50 (D50) followed by complete re-epithelialization by D100, and no relapse through D180. Results Ninety-two subjects were randomized. Leishmania major was identified in 66 of 68 isolates typed (97%). In the intent-to-treat population, 47 of 50 WR279,396 treated participants (94%) met the definition of CCR, compared with 30 of 42 vehicle-placebo participants (71%) [p = 0.0045]. Erythema occurred in 30% and 24% of participants receiving WR279,396 and placebo, respectively [p = 0.64]. There was no clinical or laboratory evidence of systemic toxicity. Conclusion Application of WR279,396 for 20 days was found to be safe and effective in treating L. major CL, and offers great potential as a new, simple, easily applicable, and inexpensive topical therapy for this neglected disease. Trial Registration ClinicalTrials.gov NCT00703924 Cutaneous leishmaniasis is due to a small parasite (Leishmania) that creates disfiguring sores, and affects more than one million persons (mainly children) each year. Treating lesions with a cream—instead of with injections as currently done—would greatly improve the well-being of affected patients. No cream formulation that would be efficient and would not create important skin irritation has been identified yet. Here, we tested a new cream formulation (WR279,396) containing paromomycin and gentamicin, two members of a well-known family of antibacterial antibiotics (aminoglycosides). Injectable paromomycin is efficient in other forms of the disease (visceral leishmaniasis). This was a carefully monitored study (phase 2) involving mainly children in Tunisia and France. The cream was applied twice a day for 20 days. The proportion of patients treated with the paromomycin-containing cream (active formulation) that cured (94%) was higher than that observed (71%) in patients treated with a cream that did not contain the active product (placebo formulation). Local irritation affected less than one-third of the patients and was usually mild. This new cream formulation was safe and effective in treating cutaneous leishmaniasis, thereby providing a new, simple, easily applicable, and inexpensive treatment for this neglected disease.
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Kim DH, Chung HJ, Bleys J, Ghohestani RF. Is paromomycin an effective and safe treatment against cutaneous leishmaniasis? A meta-analysis of 14 randomized controlled trials. PLoS Negl Trop Dis 2009; 3:e381. [PMID: 19221595 PMCID: PMC2637543 DOI: 10.1371/journal.pntd.0000381] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 01/20/2009] [Indexed: 11/19/2022] Open
Abstract
Background High cost, poor compliance, and systemic toxicity have limited the use of pentavalent antimony compounds (SbV), the treatment of choice for cutaneous leishmaniasis (CL). Paromomycin (PR) has been developed as an alternative to SbV, but existing data are conflicting. Methodology/Principal Findings We searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials, without language restriction, through August 2007, to identify randomized controlled trials that compared the efficacy or safety between PR and placebo or SbV. Primary outcome was clinical cure, defined as complete healing, disappearance, or reepithelialization of all lesions. Data were extracted independently by two investigators, and pooled using a random-effects model. Fourteen trials including 1,221 patients were included. In placebo-controlled trials, topical PR appeared to have therapeutic activity against the old world and new world CL, with increased local reactions, when used with methylbenzethonium chloride (MBCL) compared to when used alone (risk ratio [RR] for clinical cure, 2.58 versus 1.01: RR for local reactions, 1.60 versus 1.07). In SbV-controlled trials, the efficacy of topical PR was not significantly different from that of intralesional SbV in the old world CL (RR, 0.70; 95% confidence interval, 0.26–1.89), whereas topical PR was inferior to parenteral SbV in treating the new world CL (0.67; 0.54–0.82). No significant difference in efficacy was found between parenteral PR and parenteral SbV in the new world CL (0.88; 0.56–1.38). Systemic side effects were fewer with topical or parenteral PR than parenteral SbV. Conclusions/Significance Topical PR with MBCL could be a therapeutic alternative to SbV in selected cases of the old world CL. Development of new formulations with better efficacy and tolerability remains to be an area of future research. Millions of people worldwide are suffering from cutaneous leishmaniasis that is caused by parasites of the genus Leishmania. Although pentavalent antimony compounds are the treatment of choice, their use is limited by high cost, poor compliance, and systemic toxicity. Paromomycin was developed to overcome such limitations. However, there is no consensus on its efficacy. This meta-analysis assessed the efficacy and safety of paromomycin compared with placebo and pentavalent antimony compounds. Fourteen randomized controlled trials, including 1,221 patients, met our selection criteria. Topical paromomycin appeared to have therapeutic activity against the old world and new world cutaneous leishmaniasis, with increased local reactions, when combined with methylbenzethonium chloride. Topical paromomycin was not significantly different from intralesional pentavalent antimony compounds in treating the old world form, whereas it was inferior to parenteral pentavalent antimony compounds in treating the new world form. However, a similar efficacy was found between parenteral paromomycin and pentavalent antimony compounds in treating the new world form. Fewer systemic side effects were observed with topical and parenteral paromomycin than pentavalent antimony compounds. These results suggest that topical paromomycin with methylbenzethonium chloride could be a therapeutic alternative to pentavalent antimony compounds for selected cases of the old world cutaneous leishmaniasis.
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Affiliation(s)
- Dae Hyun Kim
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Hye Jin Chung
- Department of Dermatology and Cutaneous Biology, Jefferson Medical College, Philadelphia, Pennsylvania, United States of America
| | - Joachim Bleys
- Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - Reza F. Ghohestani
- Division of Dermatology and Cutaneous Surgery, Department of Medicine, University of Texas Medical School at San Antonio, Texas, United States of America
- Texas Dermatology Institute, San Antonio, Texas, United States of America
- * E-mail:
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48
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Jaafari MR, Bavarsad N, Bazzaz BS, Samiei A, Soroush D, Ghorbani S, Heravi MM, Khamesipour A. Effect of topical liposomes containing paromomycin sulfate in the course of Leishmania major infection in susceptible BALB/c mice. Antimicrob Agents Chemother 2009; 53:2259-65. [PMID: 19223613 DOI: 10.1128/AAC.01319-08] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to evaluate the antileishmanial effects of topical liposomal paromomycin sulfate (PM) in Leishmania major-infected BALB/c mice. Liposomes containing 10 or 15% PM (Lip-PM-10 and Lip-PM-15, respectively) were prepared by the fusion method and were characterized for their size and encapsulation efficiency. The penetration of PM from the liposomal PM formulations (LPMFs) through and into skin was evaluated in vitro with Franz diffusion cells fitted with mouse skin at 37 degrees C for 8 h. The in vitro permeation data showed that almost 15% of the LPMFs applied penetrated the mouse skin, and the amount retained in the skin was about 60% for both formulations. The 50% effective doses of Lip-PM-10 and Lip-PM-15 against L. major promastigotes in culture were 65.32 and 59.73 microg/ml, respectively, and those against L. major amastigotes in macrophages were 24.64 and 26.44 microg/ml, respectively. Lip-PM-10 or Lip-PM-15 was used topically twice a day for 4 weeks to treat L. major lesions on BALB/c mice, and the results showed a significantly (P < 0.001) smaller lesion size in the mice in the treated groups than in the mice in the control group, which received either empty liposomes or phosphate-buffered saline (PBS). Eight weeks after the beginning of the treatment, every mouse treated with LPMFs was completely cured. The spleen parasite burden was significantly (P < 0.001) lower in mice treated with Lip-PM-10 or Lip-PM-15 than in mice treated with PBS or control liposomes, but no significant difference was seen between the two groups treated with either Lip-PM-10 or Lip-PM-15. The results suggest that topical liposomal PM may be useful for the treatment of cutaneous leishmaniasis.
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Santos AMD, Noronha EF, Ferreira LAM, Carranza-Tamayo CO, Cupolillo E, Romero GAS. Efeito de uma formulação hidrofílica de paromomicina tópica na leishmaniose cutânea em pacientes com contra-indicações de tratamento com antimonial pentavalente. Rev Soc Bras Med Trop 2008; 41:444-8. [DOI: 10.1590/s0037-86822008000500002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 09/01/2008] [Indexed: 11/22/2022] Open
Abstract
Descrevem-se o efeito terapêutico e os eventos adversos associados com o uso tópico de paromomicina 10% em gel na leishmaniose cutânea. Quinze pacientes com leishmaniose cutânea cumpriram os critérios de inclusão descritos a seguir: contra-indicação para o uso de antimoniato de meglumina, intradermorreação de Montenegro positiva e até quatro lesões ulceradas. A fórmula foi prescrita duas vezes ao dia por 20 dias. Quatorze pacientes estiveram disponíveis para a avaliação do desfecho terapêutico e a proporção de cura foi de 21,4% (3/14), 50% melhoraram até a epitelização completa e a proporção de falha foi de 28,6%. Nove pacientes que não apresentaram cura inicialmente foram re-tratados. Oito receberam uma nova série de paromomicina tópica e um foi tratado com antimoniato de meglumina. Dois pacientes não receberam novo tratamento e tiveram melhora lenta e contínua. Cinco de oito pacientes retratados com paromomicina tópica alcançaram a cura clínica, e três apresentaram falha, incluindo um paciente que tinha apresentado melhora com o primeiro tratamento. Os eventos adversos foram leves e locais em 53,3% dos pacientes e nunca levaram à suspensão do tratamento.
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El-On J, Bazarsky E, Sneir R. Leishmania major: in vitro and in vivo anti-leishmanial activity of paromomycin ointment (Leshcutan) combined with the immunomodulator Imiquimod. Exp Parasitol 2006; 116:156-62. [PMID: 17306255 DOI: 10.1016/j.exppara.2006.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Revised: 11/01/2006] [Accepted: 12/15/2006] [Indexed: 10/23/2022]
Abstract
Paromomycin at 25, 50 and 100 microg/ml, inhibited the growth of Leishmania major amastigotes by 34.5%, 61.2%, 74.9% and 85.4%, 89.9%, 95.7% on the 2nd and the 4th day of treatment in culture, respectively. Methylbenzethonium chloride at 0.1 and 0.5 microg/ml and Imiquimod at 5 and 10 microg/ml, administered separately, inhibited the parasite development by 39.5% and 65.2% and 31.5% and 47.7%, respectively. Imiquimod (5-10 microg/ml) combined with either paromomycin (25, 50 and 100 microg/ml) or methylbenzethonium chloride (0.1 and 0.5 microg/ml) showed an anti-leishmanial additive effect. A 10 day topical treatment, twice daily, with an ointment containing 15% paromomycin and 12% methylbenzethonium chloride (Leshcutan), either undiluted or diluted 1:5 in soft white paraffin combined with 5% Imiquimod cream (Aldara), was as effective as Leshcutan given alone. The present study suggests that a combination of Aldara and Leshcutan is as effective as Leshcutan given alone in the topical treatment of CL caused by L. major.
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Affiliation(s)
- Joseph El-On
- Department of Microbiology and Immunology, Faculty of Health Sciences, Ben-Gurion University of the Negev and Soroka University Medical Center, Beer Sheva 84105, Israel.
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