In Leishmania amazonensis, kinetoplastid membrane protein-11 (KMP-11) expression increases during metacyclogenesis and is higher in amastigotes than in promastigotes, suggesting a role for this protein in the infection of the mammalian host. We show that the addition of KMP-11 exacerbates L. amazonensis infection in peritoneal macrophages from BALB/c mice by increasing interleukin (IL)-10 secretion and arginase activity while reducing nitric oxide (NO) production. The doses of KMP-11, the IL-10 levels and the intracellular amastigote loads were strongly, positively and significantly correlated. The increase in parasite load induced by KMP-11 was inhibited by anti-KMP-11 or anti-IL-10 neutralising antibodies, but not by isotype controls. The neutralising antibodies, but not the isotype controls, were also able to significantly decrease the parasite load in macrophages cultured without the addition of KMP-11, demonstrating that KMP-11-induced exacerbation of the infection is not dependent on the addition of exogenous KMP-11 and that the protein naturally expressed by the parasite is able to promote it. In this study, the exacerbating effect of KMP-11 on macrophage infection with Leishmania is for the first time demonstrated, implicating it as a virulence factor in L. amazonensis. The stimulation of IL-10 production and arginase activity and the inhibition of NO synthesis are likely involved in this effect

Este ensaio discute as necessidades de aprimoramento do modelo de governança da Secretaria Especial de Saúde Indígena do Ministério da Saúde brasileiro, e das suas competências como órgão responsável pela gestão e execução da Política Nacional de Atenção à Saúde dos Povos Indígenas e a sua articulação com as demais políticas do Sistema Único de Saúde, aborda as dificuldades encontradas com o atual modelo e a sua aplicabilidade frente às especificidades e diversidades étnicas dos 305 povos indígenas do Brasil e apresenta como proposta de complementariedade e superação a criação do Instituto Nacional de Saúde Indígena.

Although the importance of Pharmaceutical Assistance, there is no global instrument that specifically justifies its necessity on the specificity of indigenous health. This article lists existing studies on pharmaceutical assistance in an indigenous context. It has a qualitative character, conducted through an integrative literature review. National and international databases were consulted for the scientific articles searching, using specific descriptions of the object of interest. Three thousand nine hundred fifteen articles were found in the databases searched, related to the object of interest, in this case, Indigenous Pharmaceutical Assistance. Many studies did not have any relation with the object of interest, and most of them aimed to understand, from the conventional biomedical perspective, the mechanisms of the therapeutic resources of the indigenous people in the world, as well as to investigate scientifically plant and animal materials used in the indigenous traditional medicine, by using known conventional methodologies. A range of studies has addressed specifically illnesses through case studies, in which the focus is the evolution of the disease or western therapy were applied to the indigenous subject, in a research form that tries to indicate different clinical responses to the treatment and the outcome of the pathology. Researches involving planning, implementation, development, and evaluation of Indigenous Pharmaceutical Assistance are crucial for the future development of global policies for these people.

There are indigenous people on the North and South American continents who dwelled there before the Portuguese, Spanish, French, English, or Dutch invasions. With the European colonization, much of the indigenous population was enslaved, Christianized, and decimated almost completely. Presently, besides everyday challenges, such as rights and access to the homeland, agribusiness clashes, and other threats, there is a precariousness in the management and provision of healthcare provided to the Amerindians. This paper aims to draw a timeline on the state of health of Brazilian indigenous people, identifying its subjects, assessing its contexts, and discussing the legal milestones. Indigenous health policies hold (or at least should hold) a central position in the provision of healthcare to the indigenous population wherein they offer integral, universal, and equanimous healthcare services. Despite this, the urge to recognize some fragility restrains the management and provision of the health policies for the indigenous people.

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