Treatment of Leishmaniasis

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Parasitology".

Deadline for manuscript submissions: closed (31 December 2020) | Viewed by 24395

Special Issue Editor


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Guest Editor
Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow G4 0RE, UK
Interests: drug treatment; drug carrier systems; drug resistance; vaccine development and immunity to Leishmania
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Special Issue Information

Dear Colleagues,

Microorganism is announcing a Special Issue on “Leishmania”, which will be open for studies on different aspects of research on the treatment of leishmaniasis.

Leishmaniasis is caused by infection with various species of Leishmania, which presents as different types of clinical disease, each with its own treatment challenges. There is a limited number of drugs to treat leishmaniasis, and drug resistance in endemic parasite populations is limiting the clinical efficacy of current clinically used drugs. Novel therapies designed to inhibit novel target(s) in the organism or novel ways of packaging existing drugs so that they are delivered more effectively, ideally by a non-invasive route, are required. In the case of cutaneous leishmaniasis, it may be possible to combat the infection using topic photodynamic treatment.

We invite publications from scientists investigating new compounds for the treatment of leishmaniasis or novel drug delivery systems that can be used to target antileishmanial drugs to the sites of infection. We are also interested in studies investigating the use of non-drug-based therapies, e.g., light treatment, or strategies that can enhance drug treatment, e.g., immunotherapeutic interventions.

Dr. Katharine Carter
Guest Editor

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Keywords

  • Leishmania genus 
  • Drug treatment 
  • Drug carrier systems 
  • Site-specific drug delivery 
  • Topical treatment 
  • Drug targeting
  • Immunotherapy 
  • Light treatment 
  • Non-invasive route 
  • Drug resistance

Published Papers (8 papers)

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Research

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22 pages, 5097 KiB  
Article
Drug-Induced Lipid Remodeling in Leishmania Parasites
by Sneider Alexander Gutierrez Guarnizo, Elena B. Tikhonova, Masoud Zabet-Moghaddam, Kai Zhang, Carlos Muskus, Andrey L. Karamyshev and Zemfira N. Karamysheva
Microorganisms 2021, 9(4), 790; https://doi.org/10.3390/microorganisms9040790 - 09 Apr 2021
Cited by 9 | Viewed by 2284
Abstract
Leishmania parasites efficiently develop resistance against several types of drugs including antimonials, the primary antileishmanial drug historically implemented. The resistance to antimonials is considered to be a major risk factor for effective leishmaniasis treatment. To detect biomarkers/biopatterns for the differentiation of antimony-resistant Leishmania [...] Read more.
Leishmania parasites efficiently develop resistance against several types of drugs including antimonials, the primary antileishmanial drug historically implemented. The resistance to antimonials is considered to be a major risk factor for effective leishmaniasis treatment. To detect biomarkers/biopatterns for the differentiation of antimony-resistant Leishmania strains, we employed untargeted global mass spectrometry to identify intracellular lipids present in antimony sensitive and resistant parasites before and after antimony exposure. The lipidomic profiles effectively differentiated the sensitive and resistant phenotypes growing with and without antimony pressure. Resistant phenotypes were characterized by significant downregulation of phosphatidylcholines, sphingolipid decrease, and lysophosphatidylcholine increase, while sensitive phenotypes were characterized by the upregulation of triglycerides with long-chain fatty acids and a tendency toward the phosphatidylethanolamine decrease. Our findings suggest that the changes in lipid composition in antimony-resistant parasites contribute to the physiological response conducted to combat the oxidative stress unbalance caused by the drug. We have identified several lipids as potential biomarkers associated with the drug resistance. Full article
(This article belongs to the Special Issue Treatment of Leishmaniasis)
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16 pages, 4137 KiB  
Article
High Content Analysis of Macrophage-Targeting EhPIb-Compounds against Cutaneous and Visceral Leishmania Species
by Helena Fehling, Hanno Niss, Annika Bea, Nadine Kottmayr, Christine Brinker, Stefan Hoenow, Julie Sellau, Tim-Wolf Gilberger, Frederic Ting, Dirk Landschulze, Chris Meier, Joachim Clos and Hannelore Lotter
Microorganisms 2021, 9(2), 422; https://doi.org/10.3390/microorganisms9020422 - 18 Feb 2021
Cited by 4 | Viewed by 2614
Abstract
An immunostimulatory glycolipid molecule from the intestinal protozoan parasite Entamoeba histolytica (Eh) and its synthetic analogs derived from its phosphatidylinositol-b-anchor (EhPIb) previously showed considerable immunotherapeutic effects against Leishmania major infection in vitro and in vivo. Here, we describe a [...] Read more.
An immunostimulatory glycolipid molecule from the intestinal protozoan parasite Entamoeba histolytica (Eh) and its synthetic analogs derived from its phosphatidylinositol-b-anchor (EhPIb) previously showed considerable immunotherapeutic effects against Leishmania major infection in vitro and in vivo. Here, we describe a high content screening assay, based on primary murine macrophages. Parasites detection is based on a 90 kDA heat shock protein-specific staining, enabling the detection of several Leishmania species. We validated the assay using L. major, L. braziliensis, L. donovani, and L. infantum as well as investigated the anti-leishmanial activity of six immunostimulatory EhPIb-compounds (Eh-1 to Eh-6). Macrophages infected with dermotropic species were more sensitive towards treatment with the compounds as their viability showed a stronger reduction compared to macrophages infected with viscerotropic species. Most compounds caused a significant reduction of the infection rates and the parasite burdens depending on the infecting species. Only compound Eh-6 was found to have activity against all Leishmania species. Considering the challenges in anti-leishmanial drug discovery, we developed a multi-species screening assay capable of utilizing non-recombinant parasite strains, and demonstrated its usefulness by screening macrophage-targeting EhPIb-compounds showing their potential for the treatment of cutaneous and visceral leishmaniasis. Full article
(This article belongs to the Special Issue Treatment of Leishmaniasis)
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16 pages, 1854 KiB  
Article
Evaluation of a New Topical Treatment for the Control of Cutaneous Leishmaniasis
by Berenice Martínez-Salazar, Vanessa Carregaro Pereira, Yazmin Hauyon-La-Torre, Ali Khamesipour and Fabienne Tacchini-Cottier
Microorganisms 2020, 8(11), 1803; https://doi.org/10.3390/microorganisms8111803 - 17 Nov 2020
Cited by 5 | Viewed by 2467
Abstract
Leishmania major (L. major) causes cutaneous leishmaniasis in the Old World. The infection mostly induces a localized lesion restricted to the sand fly bite. The costs and the side effects of current treatments render imperative the development of new therapies that [...] Read more.
Leishmania major (L. major) causes cutaneous leishmaniasis in the Old World. The infection mostly induces a localized lesion restricted to the sand fly bite. The costs and the side effects of current treatments render imperative the development of new therapies that are affordable and easy to administrate. Topical treatment would be the ideal option for the treatment of cutaneous leishmaniasis. MF29 is a 3-haloacetamidobenzoate that was shown in vitro to inhibit tubulin assembly in Leishmania. Here, we tested a topical cream formulated with MF29. BALB/c mice were infected in the ear dermis with L. major metacyclic promastigotes and once the lesion appeared, mice were treated with different concentrations of MF29 and compared to the control group treated with the cream used as the vehicle. We observed that topical application of MF29 reduced the progression of the infection while control groups developed an unhealing lesion that became necrotic. The treatment decreased the type 2 immune response. Comparison with SinaAmphoLeish, another topical treatment, revealed that MF29 treatment once a day was sufficient to control lesion development, while application SinaAmphoLeish needed applications twice daily. Collectively, our data suggest that MF-29 topical application could be a promising topical treatment for cutaneous leishmaniasis. Full article
(This article belongs to the Special Issue Treatment of Leishmaniasis)
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17 pages, 971 KiB  
Article
Structure and Antiparasitic Activity Relationship of Alkylphosphocholine Analogues against Leishmania donovani
by Humera Ahmed, Katharine C. Carter and Roderick A.M. Williams
Microorganisms 2020, 8(8), 1117; https://doi.org/10.3390/microorganisms8081117 - 24 Jul 2020
Cited by 6 | Viewed by 2022
Abstract
Miltefosine (Milt) is the only oral treatment for visceral leishmaniasis (VL) but its use is associated with adverse effects, e.g., teratogenicity, vomiting, diarrhoea. Understanding how its chemical structure induces cytotoxicity, whilst not compromising its anti-parasitic efficacy, could identify more effective compounds. Therefore, we [...] Read more.
Miltefosine (Milt) is the only oral treatment for visceral leishmaniasis (VL) but its use is associated with adverse effects, e.g., teratogenicity, vomiting, diarrhoea. Understanding how its chemical structure induces cytotoxicity, whilst not compromising its anti-parasitic efficacy, could identify more effective compounds. Therefore, we systemically modified the compound’s head, tail and linker tested the in vitro activity of three alkylphosphocholines (APC) series against Leishmania donovani strains with different sensitivities to antimony. The analogue, APC12, with an alkyl carbon chain of 12 atoms, was also tested for anti-leishmanial in vivo activity in a murine VL model. All APCs produced had anti-leishmanial activity in the micromolar range (IC50 and IC90, 0.46– > 82.21 µM and 4.14–739.89 µM; 0.01– > 8.02 µM and 0.09–72.18 µM, respectively, against promastigotes and intracellular amastigotes). The analogue, APC12 was the most active, was 4–10 fold more effective than the parent Milt molecule (APC16), irrespective of the strain’s sensitivity to antimony. Intravenous administration of 40 mg/kg APC12 to L. donovani infected BALB/c mice reduced liver and spleen parasite burdens by 60 ± 11% and 60 ± 19%, respectively, while oral administration reduced parasite load in the bone marrow by 54 ± 34%. These studies confirm that it is possible to alter the Milt structure and produce more active anti-leishmanial compounds. Full article
(This article belongs to the Special Issue Treatment of Leishmaniasis)
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22 pages, 4008 KiB  
Article
Novel 2D and 3D Assays to Determine the Activity of Anti-Leishmanial Drugs
by Alec O’Keeffe, Christine Hale, James A. Cotton, Vanessa Yardley, Kapish Gupta, Abhishek Ananthanarayanan, Sudaxshina Murdan and Simon L. Croft
Microorganisms 2020, 8(6), 831; https://doi.org/10.3390/microorganisms8060831 - 01 Jun 2020
Cited by 11 | Viewed by 2840
Abstract
The discovery of novel anti-leishmanial compounds remains essential as current treatments have known limitations and there are insufficient novel compounds in development. We have investigated three complex and physiologically relevant in vitro assays, including: (i) a media perfusion based cell culture model, (ii) [...] Read more.
The discovery of novel anti-leishmanial compounds remains essential as current treatments have known limitations and there are insufficient novel compounds in development. We have investigated three complex and physiologically relevant in vitro assays, including: (i) a media perfusion based cell culture model, (ii) two 3D cell culture models, and (iii) iPSC derived macrophages in place of primary macrophages or cell lines, to determine whether they offer improved approaches to anti-leishmanial drug discovery and development. Using a Leishmania major amastigote-macrophage assay the activities of standard drugs were investigated to show the effect of changing parameters in these assays. We determined that drug activity was reduced by media perfusion (EC50 values for amphotericin B shifted from 54 (51–57) nM in the static system to 70 (61–75) nM under media perfusion; EC50 values for miltefosine shifted from 12 (11–15) µM in the static system to 30 (26–34) µM under media perfusion) (mean and 95% confidence intervals), with corresponding reduced drug accumulation by macrophages. In the 3D cell culture model there was a significant difference in the EC50 values of amphotericin B but not miltefosine (EC50 values for amphotericin B were 34.9 (31.4–38.6) nM in the 2D and 52.3 (46.6–58.7) nM in 3D; EC50 values for miltefosine were 5.0 (4.9–5.2) µM in 2D and 5.9 (5.5–6.2) µM in 3D (mean and 95% confidence intervals). Finally, in experiments using iPSC derived macrophages infected with Leishmania, reported here for the first time, we observed a higher level of intracellular infection in iPSC derived macrophages compared to the other macrophage types for four different species of Leishmania studied. For L. major with an initial infection ratio of 0.5 parasites per host cell the percentage infection level of the macrophages after 72 h was 11.3% ± 1.5%, 46.0% ± 1.4%, 66.4% ± 3.5% and 75.1% ± 2.4% (average ± SD) for the four cells types, THP1 a human monocytic cell line, mouse bone marrow macrophages (MBMMs), human bone marrow macrophages (HBMMs) and iPSC derived macrophages respectively. Despite the higher infection levels, drug activity in iPSC derived macrophages was similar to that in other macrophage types, for example, amphotericin B EC50 values were 35.9 (33.4–38.5), 33.5 (31.5–36.5), 33.6 (30.5—not calculated (NC)) and 46.4 (45.8–47.2) nM in iPSC, MBMMs, HBMMs and THP1 cells respectively (mean and 95% confidence intervals). We conclude that increasing the complexity of cellular assays does impact upon anti-leishmanial drug activities but not sufficiently to replace the current model used in HTS/HCS assays in drug discovery programmes. The impact of media perfusion on drug activities and the use of iPSC macrophages do, however, deserve further investigation. Full article
(This article belongs to the Special Issue Treatment of Leishmaniasis)
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Review

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20 pages, 1214 KiB  
Review
Can We Harness Immune Responses to Improve Drug Treatment in Leishmaniasis?
by Raphael Taiwo Aruleba, Katharine C. Carter, Frank Brombacher and Ramona Hurdayal
Microorganisms 2020, 8(7), 1069; https://doi.org/10.3390/microorganisms8071069 - 17 Jul 2020
Cited by 15 | Viewed by 4662
Abstract
Leishmaniasis is a vector-borne parasitic disease that has been neglected in priority for control and eradication of malaria, tuberculosis, and HIV/AIDS. Collectively, over one seventh of the world’s population is at risk of being infected with 0.7–1.2 million new infections reported annually. Clinical [...] Read more.
Leishmaniasis is a vector-borne parasitic disease that has been neglected in priority for control and eradication of malaria, tuberculosis, and HIV/AIDS. Collectively, over one seventh of the world’s population is at risk of being infected with 0.7–1.2 million new infections reported annually. Clinical manifestations range from self-healing cutaneous lesions to fatal visceral disease. The first anti-leishmanial drugs were introduced in the 1950′s and, despite several shortcomings, remain the mainstay for treatment. Regardless of this and the steady increase in infections over the years, particularly among populations of low economic status, research on leishmaniasis remains under funded. This review looks at the drugs currently in clinical use and how they interact with the host immune response. Employing chemoimmunotherapeutic approaches may be one viable alternative to improve the efficacy of novel/existing drugs and extend their lifespan in clinical use. Full article
(This article belongs to the Special Issue Treatment of Leishmaniasis)
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24 pages, 930 KiB  
Review
Experimental Strategies to Explore Drug Action and Resistance in Kinetoplastid Parasites
by Magali Van den Kerkhof, Yann G.-J. Sterckx, Philippe Leprohon, Louis Maes and Guy Caljon
Microorganisms 2020, 8(6), 950; https://doi.org/10.3390/microorganisms8060950 - 24 Jun 2020
Cited by 11 | Viewed by 3806
Abstract
Kinetoplastids are the causative agents of leishmaniasis, human African trypanosomiasis, and American trypanosomiasis. They are responsible for high mortality and morbidity in (sub)tropical regions. Adequate treatment options are limited and have several drawbacks, such as toxicity, need for parenteral administration, and occurrence of [...] Read more.
Kinetoplastids are the causative agents of leishmaniasis, human African trypanosomiasis, and American trypanosomiasis. They are responsible for high mortality and morbidity in (sub)tropical regions. Adequate treatment options are limited and have several drawbacks, such as toxicity, need for parenteral administration, and occurrence of treatment failure and drug resistance. Therefore, there is an urgency for the development of new drugs. Phenotypic screening already allowed the identification of promising new chemical entities with anti-kinetoplastid activity potential, but knowledge on their mode-of-action (MoA) is lacking due to the generally applied whole-cell based approach. However, identification of the drug target is essential to steer further drug discovery and development. Multiple complementary techniques have indeed been used for MoA elucidation. In this review, the different ‘omics’ approaches employed to define the MoA or mode-of-resistance of current reference drugs and some new anti-kinetoplastid compounds are discussed. Full article
(This article belongs to the Special Issue Treatment of Leishmaniasis)
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Other

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8 pages, 1390 KiB  
Case Report
Autochthonous Cases of Mucosal Leishmaniasis in Northeastern Italy: Clinical Management and Novel Treatment Approaches
by Valeria Gaspari, Irene Zaghi, Giovanni Macrì, Annalisa Patrizi, Nunzio Salfi, Francesca Locatelli, Elena Carra, Maria Carla Re and Stefania Varani
Microorganisms 2020, 8(4), 588; https://doi.org/10.3390/microorganisms8040588 - 18 Apr 2020
Cited by 7 | Viewed by 2692
Abstract
Mucosal leishmaniasis (ML) is a rare clinical variant of tegumentary leishmaniasis in Mediterranean Europe. Here we report on three autochthonous cases of head and neck ML in patients living in Northeastern Italy. Patients presented with non-specific, long-standing symptoms of upper respiratory tract involvement, [...] Read more.
Mucosal leishmaniasis (ML) is a rare clinical variant of tegumentary leishmaniasis in Mediterranean Europe. Here we report on three autochthonous cases of head and neck ML in patients living in Northeastern Italy. Patients presented with non-specific, long-standing symptoms of upper respiratory tract involvement, mimicking other diseases. Parasitological diagnosis was reached by histopathology, immunohistochemistry and molecular biology on tissue specimens. Leishmania infantum was identified by molecular typing in all three cases. All patients reached a complete remission with protracted multivalent antileishmanial drugs; in one case, a novel approach of combined medical and endoscopic surgical treatment was carried out. High clinical suspicion led to a prompt diagnosis and deployment of a multivalent treatment. ML should be considered in the differential diagnosis of nasal, oral, and pharyngolaryngeal lesions in endemic areas. A prompt diagnosis is mandatory to establish a correct management; different antileishmanial medications as well as endoscopic surgical options may be required to reach a complete remission. Full article
(This article belongs to the Special Issue Treatment of Leishmaniasis)
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