BACKGROUND Treatment-refractory visceral leishmaniasis (VL) has become an important problem in many countries. OBJECTIVES We evaluated the antimony-resistance mechanisms of Leishmania infantum isolated from VL patients refractory or responsive to treatment with pentavalent antimony. METHODS Strains isolated from antimony-refractory patients (in vitro antimony-resistant isolates) and antimony-responsive patients (in vitro antimony-sensitive isolates) were examined. Morphological changes were evaluated by transmission electron microscopy after trivalent antimony exposure. P-glycoprotein (P-gp) efflux pump activity was evaluated using the pump-specific inhibitor verapamil hydrochloride, and the role of thiol in trivalent antimony resistance was investigated using the enzymatic inhibitor L-buthionine sulfoximine. FINDINGS Antimony treatment induced fewer alterations in the cellular structure of L. infantum resistant isolates than in that of sensitive isolates. P-gp efflux activity was not involved in antimony resistance in these isolates. Importantly, the resistant isolates contained higher levels of thiol compared to the sensitive isolates, and inhibition of thiol synthesis in the resistant isolates recovered their sensitivity to trivalent antimony treatment, and enhanced the production of reactive oxygen species in promastigotes exposed to the drug. MAIN CONCLUSIONS Our results demonstrate that isolates from patients with antimony-refractory VL exhibited higher thiol levels than antimony-sensitive isolates. This indicates that redox metabolism plays an important role in the antimony-resistance of New World VL isolates.

Leishamaniasis is a disease that affects more than 2 million people worldwide, whose causative agent is Leishmania spp. The current therapy for leishmaniasis is far from satisfactory. All available drugs, including pentavalent antimony, require parenteral administration and are potentially toxic. Moreover, an increase in clinical resistance to these drugs has been reported. In this scenario, plant essential oils used traditionally in folk medicine are emerging as alternative sources for chemotherapeutic compounds. In this study, in vitro leishmanicidal effects of a thymol- and a carvacrol-rich essential oil from leaves of Lippia sidoides Cham. were investigated. The essential oils were extracted and their constituents were characterized by gas chromatography coupled to mass spectrometry (GC/MS). Both essential oils showed significant activity against promastigote forms of Leishmania chagasi. However, we found that carvacrol-rich essential oil was more effective, with IC50/72 h of 54.8 μg/mL compared to 74.1 μg/mL for thymol-rich oil. Carvacrol also showed lower IC50 than thymol. Our data suggest that L. sidoides essential oils are indeed promising sources of leishmanicidal compounds.

Para avaliar se os níveis séricos de IFN-gama e TNF-alfa podem ser usados como marcadores da resposta terapêutica na leishmaniose cutânea, 54 pacientes com história de uma única lesão ulcerada com duração de até 30 dias foram arrolados para o estudo. IFN-gama e TNF-alfa foram mensurados por ELISA no sobrenadante de cultura de linfócitos, antes e 60 dias após início da terapia. Cicatrização completa da lesão 60 dias após o tratamento foi considerada critério de cura. Os níveis de IFN-gama e TNF-alfa foram similares em ambos os grupos antes da terapia. Houve tendência de aumento dos níveis de IFN-gama nos pacientes curados aos 60 dias, os valores não alcançam significância estatística. Em ambos os grupos de pacientes, os níveis iniciais de TNF-alfa foram semelhantes antes da terapia e caíram significantemente após tratamento independente da cura ou manutenção da lesão ativa.

To evaluate if IFN-gamma and TNF-alpha levels could be used as markers of therapeutic response in cutaneous leishmaniasis, 54 patients with history of one ulcerated cutaneous lesion, with up to 30 days onset, were enrolled in the study. IFN-gammaand TNF-alpha were measured by ELISA in lymphocyte cultures supernatant before and 60 days after initiating therapy. Cure was considered to be a complete healing of lesion 60 days after treatment. IFN-gamma and TNF-alpha levels were similar in both groups of patients before therapy. There was a tendency to increase IFN-gamma levels in patients that were cured in 60 days, however the values did not reach statistical significance. In both groups of patients, TNF-alpha levels were similar before therapy and fell significantly after treatment, irrespective of cure or maintenance of active lesion.

O teste de Montenegro, utilizado no diagnóstico da leishmaniose tegumentar, tem sido recentemente considerado marcador de imunogenicidade após vacinação. Neste estudo, avaliou-se o poder sensibilizante deste teste e a produção de y-IFN in vitro, em indivíduos não expostos a Leishmania. Utilizaram-se para o teste antígenos de L. amazonensis produzido em nosso laboratório (grupo I) ou produzido pela FIOCRUZ-RJ (grupo II). No dia 30, 33% dos indivíduos do grupo I e 42% do grupo II converteram o teste para positivo, comparando-se com 67% do grupo I e 50% do grupo II no dia 90. y-IFN foi detectado em 56% dos indivíduos do grupo I e 17% do grupo II no dia 30 (169±309 e 11±36pg/ml) e em 67% do grupo I e 58% do grupo II no dia 360 (69±107 e 18±20pg/ml). Estes dados demonstram que o teste de Montenegro induz, além de hipersensibilidade tardia, a produção de y-IFN.

The Montenegro skin test, used to diagnose cutaneous leishmaniasis, is now being considered to detect immunogenicity after vaccination. In this study, we evaluated the ability of this test to induce immune response and IFN-g production in subjects not previously exposed to Leishmania. The Montenegro skin test was performed using antigens of L. amazonensis produced by our laboratory (group I) or by FIOCRU-RJ (group II). At day 30, 33% of the subjects from group I and 42% from group II were positive, compared to 67% from group I and 50% from group II at day 90. IFN-y was detected in 56 % of subjects from group I and 17% from group II at day 30 (169±309 and 11±36pg/ml) and in 67% from group I and 58% from group II by day 360 (69±107 and 18±20pg/ml). These data demonstrate that the Montenegro skin test induces not only a delayed hypersensitivity reaction, but also IFN-y production.