Immunotherapy of Localized, Intermediate, and Diffuse Forms of American Cutaneous Leishmaniasis

Abstract

The clinical efficacy of immunotherapy for localized American cutaneous leishmaniasis with a combination of heat-killed Leishmania mexicana amazonensis promastigotes and viable BCG (bacille Calmette Guérin) has been compared with meglumine antimoniate chemotherapy and with BCG alone in a controlled clinical study in 217 patients. The results in the first two groups were comparable, with greater than 90% clinical cures with an average time of 16-18 w required for healing. The cure rate was considerably lower (42%) and more prolonged in the group receiving BCG alone. Secondary effects were observed in less than 5% of the patients receiving combined immunotherapy or BCG alone. In contrast, 49% of the patients receiving chemotherapy showed side effects. High therapeutic efficacy was also observed using combined immunotherapy in patients with intermediate and diffuse cutaneous leishmaniasis who were previously unresponsive to chemotherapy. Cure or clinical improvement was seen in all 11 patients with intermediate forms of the disease, and marked clinical improvement was observed in 9 of 10 patients with diffuse disease. The results on the efficacy of the combined vaccine in immunotherapy for American cutaneous leishmaniasis provide a strong rationale for studying its effectiveness in prophylactic trials.

Immunotherapy for Visceral Leishmaniasis: Ability of Factors Produced during Anti-leishmania Responses of Skin Test Positive Adults to Inhibit Peripheral Blood Mononuclear Cell Activities Associated with Visceral Leishmaniasis

“…Similarly the antigens by themselves or as part of DS+A prevented the CD8+ T cell mediated IL-10 secretion increase from occurring in the P2 reconstitution assay. The ability of Leishmania antigens to lower IL-10 secretion is intriguing in light of reports of successful immunotherapy of cutaneous leishmaniasis with Leishmania antigens plus BCG (Convit et al 1987(Convit et al , 1989. The means by which Leishmania antigens decreased IL-10 secretion are not known.…”

Therapy of Venezuelan patients with severe mucocutaneous or early lesions of diffuse cutaneous leishmaniasis with a vaccine containing pasteurized Leishmania promastigotes and bacillus Calmette-Guerin: preliminary report

“…Leishmanin skin tests were carried out as described previously, by the intradermal injection in the forearm of 0.1 ml of an autoclaved suspension containing 6.25 x 10 6 L. (L.) pifanoi promastigotes/ml; induration was read at 48 h (Convit et al 1989).…”

“…Since these early studies, more than 11,500 Venezuelan patients with LCL have been treated with this form of IT, with clinical healing in more than 95% (Convit et al 2003). As reported previously (Convit et al 1989), a significant number of small groups of patients with MCL and DCL showed clinical improvement with the vaccine containing autoclaved promastigotes when chemotherapy was included in the therapeutic regime, but immunotherapy alone was not evaluated in these groups.…”

“…More than a decade ago, we reported the use of immunotherapy (IT) with a combined vaccine containing autoclaved L. (L.) amazonensis promastigotes and viable Bacillus Calmette-Guerin (BCG) in the treatment of LCL (Convit et al 1987(Convit et al , 1989. Since these early studies, more than 11,500 Venezuelan patients with LCL have been treated with this form of IT, with clinical healing in more than 95% (Convit et al 2003).…”

Subcutaneous immunization against Leishmania major - infection in mice: efficacy of formalin-killed promastigotes combined with adjuvants

“…Alum has been previously used in leishmania candidate vaccines alone or in combination with other adjuvants (KENNEY et al, 1999;MISRA et al, 2001;TONUI et al, 2004). Montanide ISA 720 (MISA 720) has been recommended by the manufacturer for clinical trials in humans (GOMEZ et al, 1999 as an adjuvant is regarded as an acceptable practice in humans, and at present this adjuvant is routinely used in vaccination and immunotherapy trials against leishmaniasis (CONVIT et al, 1989;BAHAR et al, 1996;SHARIFI et al, 1998;MOMENI et al, 1999;KHALIL et al, 2000). Despite the availability of numerous studies on development and evaluation of candidate vaccines against leishmaniasis, very limited data is available on the use of formalin-killed promastigotes in these studies.…”