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Immunotherapy and immunochemotherapy in visceral leishmaniasis: promising treatments for this neglected disease

By Bruno Mendes Roatt, Bruno Mendes Roatt, Bruno Mendes Roatt, Rodrigo D.O. Aguiar-Soares, Rodrigo D.O. Aguiar-Soares, Wendel eCoura-Vital, Henrique G. Ker, Nádia das Dores Moreira, Juliana eVitoriano-Souza, Rodolfo Cordeiro Giunchetti, Rodolfo Cordeiro Giunchetti, Cláudia Martins Carneiro and Alexandre Barbosa Reis and Alexandre Barbosa Reis and Alexandre Barbosa Reis

Abstract

Leishmaniasis has several clinical forms: self-healing or chronic cutaneous leishmaniasis or post-kala-azar dermal leishmaniasis; mucosal leishmaniasis; and visceral leishmaniasis, which is fatal if left untreated. The epidemiology and clinical features of VL vary greatly due to the interaction of multiple factors including parasite strains, vectors, host genetics, and the environment. HIV infection, augments the severity of VL increasing the risk of developing active disease by 100 to 2320 times. An effective vaccine for humans is not yet available. Resistance to chemotherapy is a growing problem in many regions, and the costs associated with drug identification and development, make commercial production for leishmaniasis, unattractive. The toxicity of currently drugs, their long treatment course, and limited efficacy are significant concerns. For cutaneous disease, many studies have shown promising results with immunotherapy/immunochemotherapy, aimed to modulate and activate the immune response to obtain a therapeutic cure. Nowadays, the focus of many groups centers on treating canine VL by using vaccines and immunomodulators with or without chemotherapy. In human disease, the use of cytokines like Interferon-γ associated with pentavalent antimonials demonstrated promising results in patients that did not respond to conventional treatment. In mice, immunomodulation based on monoclonal antibodies to remove endogenous immunosuppressive cytokines (interleukin-10) or block their receptors, antigen-pulsed syngeneic dendritic cells, or biological products like Pam3Cys (TLR ligand) has already been shown as a prospective treatment of the disease. This review addresses VL treatment, particularly immunotherapy and/or immunochemotherapy as an alternative to conventional drug treatment in experimental models, canine VL, and human disease

Topics: Immunotherapy, Leishmania donovani, Leishmania infantum, Visceral leishmaniasis, immunochemotherapy, Immunologic diseases. Allergy, RC581-607
Publisher: Frontiers Media S.A.
Year: 2014
DOI identifier: 10.3389/fimmu.2014.00272
OAI identifier: oai:doaj.org/article:2e68632518ad4c51baae3250418b7d00
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