Recent developments and future prospects in the treatment of visceral leishmaniasis

Abstract

Limited therapeutic options in visceral leishmaniasis (VL) make the treatment of this neglected disease very challenging. In addition to this, long treatment duration and toxic adverse effects make it even more difficult. With no effective vaccine available to date, treatment of VL is based only on chemotherapy. In the Indian subcontinent, a single dose of liposomal amphotericin B (L-AmB) and multidrug therapy (L-AmB þ miltefosine, LAmB þ paromomycin [PM], or miltefosine þ PM) are the treatments of choice for VL. In East Africa, however, combination therapy of pentavalent antimonials (Sb v ) and PM remains the treatment of choice, and in the Mediterranean region and South America, L-AmB is the recommended drug. Fexinidazole and PA-824 are new promising drugs which have shown encouraging results in preclinical studies.

Treating murine Kala‐azar with a Mayan plant induces immunochemical changes

“…However, recent pharmaceutical development such as the discovery of liposomal amphotericin B reduces side effects and represents a great advance in the treatment of human Kala-azar. [10][11][12][13] In this work, we showed that animals successfully treated with low concentrations of PAE did not present evidence of toxicity such as loss of weight or mobility. Animal response to SSG treatment is not effective in murine leishmaniasis as we corroborated in this and previous studies from our group and others.…”

“…These drugs present a series of side effects ranging from gastrointestinal discomfort to the development of diabetes or even death from cardiac complications. However, recent pharmaceutical development such as the discovery of liposomal amphotericin B reduces side effects and represents a great advance in the treatment of human Kala‐azar …”

“…Encapsulation of this highly toxic drug into lipidic vesicles reduces toxicity and enhances their effectiveness. Nevertheless this preparation is unaffordable to low‐income people in endemic areas and must be provided through government‐supported programs . Natural products are considered a good alternative to develop antileishmanial drugs as they are affordable and easy to obtain.…”

“…Nevertheless this preparation is unaffordable to low-income people in endemic areas and must be provided through government-supported programs. [10][11][12][13] Natural products are considered a good alternative to develop antileishmanial drugs as they are affordable and easy to obtain. Multiple plant-derived materials have been used to treat experimentally induced VL in Balb/c mice.…”

Antileishmanial effects of the alkaloid-rich fraction of Quassia amara L.

“…In addition, other drugs can be used such as pentamidine and paromomycin, which are more effective against the tegumentary form of the disease and miltefosine, the orally active drug indicated for VL treatment (Sundar and Singh, 2016;Dorlo et al, 2012;Frézard et al, 2009;Jhingran et al, 2009). However, these drugs present variable efficacies and high toxicity (e.g.…”