New delivery systems for amphotericin B applied to the improvement of leishmaniasis treatment

Abstract

Leishmaniasis is one of the six major tropical diseases targeted by the World Health Organization. It is a life-threatening disease of medical, social and economic importance in endemic areas. No vaccine is yet available for human use, and chemotherapy presents several problems. Pentavalent antimonials have been the drugs of choice to treat the disease for more than six decades; however, they exhibit high toxicity and are not indicated for children, for pregnant or breastfeeding women or for chronically ill patients. Amphotericin B (AmpB) is a second-line drug, and although it has been increasingly used to treat visceral leishmaniasis (VL), its clinical use has been hampered due to its high toxicity. This review focuses on the development and in vivo usage of new delivery systems for AmpB that aim to decrease its toxicity without altering its therapeutic efficacy. These new formulations, when adjusted with regard to their production costs, may be considered new drug delivery systems that promise to improve the treatment of leishmaniasis, by reducing the side effects and the number of doses while permitting a satisfactory cost-benefit rati

Parasite Killing of Leishmania (V) braziliensis by Standardized Propolis Extracts

“…Leishmaniasis is a neglected vector-borne tropical disease caused by obligate protozoan parasites of the genus Leishmania [1–3]. Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis worldwide, representing 50–75% of all new cases.…”

“…Chemotherapy to treat leishmaniasis has been based on the parenteral administration of pentavalent antimonials for more than 60 years [9]. These compounds are highly toxic and expensive and have been associated with drug resistance [1]. Amphotericin B and Paromomycin, two other currently available second-line antileishmanial treatments [10, 11], also present significant shortcomings with regard to toxicity, cost, and duration of treatment.…”

Prophylactic properties of a Leishmania‐specific hypothetical protein in a murine model of visceral leishmaniasis

“…However, increased parasite resistance and side effects registered in the patients have been the important problems . Alternative drugs, such as amphotericin B and its liposomal formulations, pentamidine and miltefosine, have showed encouraging results; however, their toxicity, the increase of parasite resistance and/or high cost had limited their use . A VL elimination campaign has been initiated around the world, which will focus on vector control, early diagnosis and drug treatment strategies .…”

Efficacy and safety of amphotericin B deoxycholate versus N-methylglucamine antimoniate in pediatric visceral leishmaniasis: an open-label, randomized, and controlled pilot trial in Brazil

“…American VL needs parenteral administration of drugs with high toxicity levels 7 . Brazilian Ministry of Health suggested antimonials as first-line VL treatment and liposomal amphotericin B for patients at high mortality risk (infants, adults aged >50 years, immunosuppressed patients, patients with renal, hepatic or cardiac failure, etc.)…”