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Immuno-pharmacokinetics of Meglumine Antimoniate in Patients With Cutaneous Leishmaniasis Caused by Leishmania (Viannia).

Authors
  • Gómez, María Adelaida1, 2
  • Navas, Adriana1, 2
  • Prieto, Miguel Dario1
  • Giraldo-Parra, Lina1, 2
  • Cossio, Alexandra1, 2
  • Alexander, Neal1, 2
  • Gore Saravia, Nancy1, 2
  • 1 Centro Internacional de Entrenamiento e Investigaciones Médicas-CIDEIM, Cali, Colombia. , (Colombia)
  • 2 Universidad Icesi, Cali, Colombia. , (Colombia)
Type
Published Article
Journal
Clinical Infectious Diseases
Publisher
Oxford University Press
Publication Date
May 18, 2021
Volume
72
Issue
10
Identifiers
DOI: 10.1093/cid/ciaa1206
PMID: 32818964
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Control of cutaneous leishmaniasis (CL) relies on chemotherapy, yet gaps in our understanding of the determinants of therapeutic outcome impede optimization of antileishmanial drug regimens. Pharmacodynamic (PD) parameters of antimicrobials are based on the relationship between drug concentrations/exposure and microbial kill. However, viable Leishmania persist in a high proportion of individuals despite clinical resolution, indicating that determinants other than parasite clearance are involved in drug efficacy. In this study, the profiles of expression of neutrophils, monocytes, Th1 and Th17 gene signatures were characterized in peripheral blood mononuclear cells (PBMCs) during treatment with meglumine antimoniate (MA) and clinical cure of human CL caused by Leishmania (Viannia). We explored relationships of immune gene expression with plasma and intracellular antimony (Sb) concentrations. Our findings show a rapid and orchestrated modulation of gene expression networks upon exposure to MA. We report nonlinear pharmacokinetic/pharmacodynamic (PK/PD) relationships of Sb and gene expression dynamics in PBMCs , concurring with a time lag in the detection of intracellular drug concentrations and with PK evidence of intracellular Sb accumulation. Our results quantitatively portray the immune dynamics of therapeutic healing, and provide the knowledge base for optimization of antimonial drug treatments, guiding the selection and/or design of targeted drug delivery systems and strategies for targeted immunomodulation. © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.

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