Leishmaniasis: Transmission, Pathogenesis and Treatment

A special issue of Pathogens (ISSN 2076-0817). This special issue belongs to the section "Parasitic Pathogens".

Deadline for manuscript submissions: closed (25 April 2024) | Viewed by 16145

Special Issue Editors


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Guest Editor
Istituto Zooprofilattico Sperimentale della Sicilia, Palermo, Italy
Interests: Leishmania and Leishmaniasis; diagnosis; pathogenesis

E-Mail Website
Guest Editor
Istituto Zooprofilattico Sperimentale della Siciliadisabled, Palermo, Italy
Interests: Leishmania and Leishmaniasis; diagnosis; pathogenesis

Special Issue Information

Dear Colleagues,

Leishmaniasis is a vector-borne, zoonotic disease caused by obligate intracellular parasitic protozoa of the genus Leishmania. Leishmaniasis is a disease of major public health concern that fulfills the One Health paradigm and is driven by environmental change that can affect animal reservoirs and human infection. The aim of this Special Issue is to provide a collection of articles that showcase the current issues in the study of “Leishmaniasis: Transmission, Pathogenesis and Treatment “, in order to provide information on this vector-borne disease, and to explore strategies for diagnosis, mechanisms of infection and pathogenesis, and strategies for prevention and treatment. We are also interested in natural products, being potentially rich sources of novel active molecules that may serve structural templates for drug discovery.

Dr. Germano Castelli
Dr. Federica Bruno
Guest Editors

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Keywords

  • Leishmania
  • Leishmaniasis
  • diagnosis
  • pathogenesis
  • disease prevention
  • treatment
  • drug discovery

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Published Papers (10 papers)

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Research

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19 pages, 3273 KiB  
Article
The Impact of Climatological Factors on the Incidence of Cutaneous Leishmaniasis (CL) in Colombian Municipalities from 2017 to 2019
by Daniel Muñoz Morales, Fernanda Suarez Daza, Oliva Franco Betancur, Darly Martinez Guevara and Yamil Liscano
Pathogens 2024, 13(6), 462; https://doi.org/10.3390/pathogens13060462 - 30 May 2024
Viewed by 733
Abstract
Cutaneous leishmaniasis (CL) is a zoonotic disease caused by protozoa of the Leishmania genus, transmitted by vectors from the Phlebotominae subfamily. The interaction between the vector, reservoir, and parasite is susceptible to climate change. This study explores how temperature and rainfall influenced the [...] Read more.
Cutaneous leishmaniasis (CL) is a zoonotic disease caused by protozoa of the Leishmania genus, transmitted by vectors from the Phlebotominae subfamily. The interaction between the vector, reservoir, and parasite is susceptible to climate change. This study explores how temperature and rainfall influenced the incidence of CL in 15 Colombian municipalities between 2017 and 2019. Epidemiological data were obtained from Colombia’s Instituto Nacional de Salud, while climatological data came from the Instituto de Hidrología, Meteorología y Estudios Ambientales. Using Spearman’s rank correlation coefficient, we examined the relationships between monthly climatic variables and the cumulative incidence of CL, considering various lag times. The data were further analyzed using Locally Weighted Scatterplot Smoothing (LOWESS). Our findings reveal both significant positive and negative correlations, depending on locality and climate variables. LOWESS analysis indicates that while rainfall-related incidence remains stable, temperature impacts incidence in a parabolic trend. This study underscores the significant yet complex influence of climatic factors on CL incidence. The insights gained could aid public health efforts by improving predictive models and crafting targeted interventions to mitigate the disease’s impact, particularly in regions vulnerable to climate variability. Full article
(This article belongs to the Special Issue Leishmaniasis: Transmission, Pathogenesis and Treatment)
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13 pages, 2555 KiB  
Article
Anti-Leishmania major Properties of Nuphar lutea (Yellow Water Lily) Leaf Extracts and Purified 6,6′ Dihydroxythiobinupharidine (DTBN)
by Orit Shmuel, Aviv Rasti, Melodie Zaknoun, Nadav Astman, Avi Golan-Goldhirsh, Orly Sagi and Jacob Gopas
Pathogens 2024, 13(5), 384; https://doi.org/10.3390/pathogens13050384 - 6 May 2024
Viewed by 979
Abstract
Cutaneous leishmaniasis (CL) is a zoonotic disease, manifested as chronic ulcers, potentially leaving unattractive scars. There is no preventive vaccination or optimal medication against leishmaniasis. Chemotherapy generally depends upon a small group of compounds, each with its own efficacy, toxicity, and rate of [...] Read more.
Cutaneous leishmaniasis (CL) is a zoonotic disease, manifested as chronic ulcers, potentially leaving unattractive scars. There is no preventive vaccination or optimal medication against leishmaniasis. Chemotherapy generally depends upon a small group of compounds, each with its own efficacy, toxicity, and rate of drug resistance. To date, no standardized, simple, safe, and highly effective regimen for treating CL exists. Therefore, there is an urgent need to develop new optimal medication for this disease. Sesquiterpen thio-alkaloids constitute a group of plant secondary metabolites that bear great potential for medicinal uses. The nupharidines found in Nuphar lutea belong to this group of compounds. We have previously published that Nuphar lutea semi-purified extract containing major components of nupharidines has strong anti-leishmanial activity in vitro. Here, we present in vivo data on the therapeutic benefit of the extract against Leishmania major (L. major) in infected mice. We also expanded these observations by establishing the therapeutic effect of the extract-purified nupharidine 6,6′-dihydroxythiobinupharidine (DTBN) in vitro against promastigotes and intracellular amastigotes as well as in vivo in L. major-infected mice. The results suggest that this novel anti-parasitic small molecule has the potential to be further developed against Leishmania. Full article
(This article belongs to the Special Issue Leishmaniasis: Transmission, Pathogenesis and Treatment)
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9 pages, 934 KiB  
Communication
Pentavalent Antimony Associated with G-CSF in the Treatment of Cutaneous Leishmaniasis Caused by Leishmania (Viannia) braziliensis
by Carvel Suprien, Luiz H. Guimarães, Lucas P. de Carvalho and Paulo R. L. Machado
Pathogens 2024, 13(4), 301; https://doi.org/10.3390/pathogens13040301 - 4 Apr 2024
Viewed by 1122
Abstract
Cutaneous leishmaniasis (CL), caused by Leishmania braziliensis, in recent decades has shown decreasing cure rates after treatment with meglumine antimoniate (MA). Granulocyte colony-stimulating factor (G-CSF) is a cytokine associated with epithelialization and healing processes. Methods: This study compares the effectiveness of G-CSF associated [...] Read more.
Cutaneous leishmaniasis (CL), caused by Leishmania braziliensis, in recent decades has shown decreasing cure rates after treatment with meglumine antimoniate (MA). Granulocyte colony-stimulating factor (G-CSF) is a cytokine associated with epithelialization and healing processes. Methods: This study compares the effectiveness of G-CSF associated with MA in the treatment of CL. A total of 32 patients aged between 18 and 50 years with CL confirmed for L. braziliensis were included in this study. G-CSF or placebo (0.9% saline) was applied by intralesional infiltration at four equidistant points on the edges of the largest ulcer on days 0 and 15 of treatment associated with intravenous MA. Results: Males predominated in the G-CSF group (59%), while females predominated in the control group (53%). Injuries to the lower limbs predominated in both study groups. The cure rate in the G-CSF group was 65% and in the control group it was 47%, 90 days after initiation of therapy. Conclusions: Our data indicate that the association of G-CSF with MA is not superior to MA monotherapy. Although not significant, the potential benefit of this combination deserves further investigation. The use of higher doses or other routes of application of G-CSF in a greater number of patients should contribute to a definitive response. Full article
(This article belongs to the Special Issue Leishmaniasis: Transmission, Pathogenesis and Treatment)
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11 pages, 1606 KiB  
Article
Inflammatory CD11b+ Macrophages Produce BAFF in Spleen of Mice Infected with Leishmania donovani
by Kazuki Nagai, Wataru Fujii, Junya Yamagishi, Chizu Sanjoba and Yasuyuki Goto
Pathogens 2024, 13(3), 232; https://doi.org/10.3390/pathogens13030232 - 6 Mar 2024
Viewed by 2105
Abstract
Visceral leishmaniasis (VL) is an infectious disease caused by parasitic protozoa of the genus Leishmania and manifests clinical symptoms such as splenomegaly, hepatomegaly, anemia, and fever. It has previously been shown that B-cell-activating factor (BAFF) is involved in splenomegaly during VL. Although BAFF [...] Read more.
Visceral leishmaniasis (VL) is an infectious disease caused by parasitic protozoa of the genus Leishmania and manifests clinical symptoms such as splenomegaly, hepatomegaly, anemia, and fever. It has previously been shown that B-cell-activating factor (BAFF) is involved in splenomegaly during VL. Although BAFF is known to be expressed by a variety of cells, the mechanism of elevated BAFF expression in VL is not clear. In this study, we aimed to identify BAFF-producing cells in the spleens of mice infected with Leishmania donovani. Splenocytes of L. donovani-infected mice showed elevated BAFF expression compared to that of naive mice. In the infected spleen, the number of both CD11b+ and F4/80+ cells increased, and the major BAFF-producing cells were CD11b+ cells, which did not serve as host cells of Leishmania. Immunohistochemical/immunofluorescent staining of spleens of infected mice revealed that the increased CD11b+ cells were primarily MRP14+ mononuclear cells. Together, these results suggest the increased BAFF expression in the spleen of L. donovani-infected mice involves a recruitment of inflammatory macrophages distinct from host macrophages for the parasites. Full article
(This article belongs to the Special Issue Leishmaniasis: Transmission, Pathogenesis and Treatment)
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9 pages, 1149 KiB  
Article
Autochthonous and Imported Visceral Leishmaniasis in Bulgaria—Clinical Experience and Treatment of Patients
by Kamenna Vutova, Nina Yancheva-Petrova, Rossitsa Tchipeva and Valeri Velev
Pathogens 2024, 13(3), 205; https://doi.org/10.3390/pathogens13030205 - 26 Feb 2024
Viewed by 1539
Abstract
Visceral leishmaniasis (VL) is a severe endemic disease with a fatal outcome if left untreated. The symptoms of patients are diverse and atypical. Against the background of anemia and pancytopenia, the condition of the patients gradually worsens with marked cachexia. Through sharing our [...] Read more.
Visceral leishmaniasis (VL) is a severe endemic disease with a fatal outcome if left untreated. The symptoms of patients are diverse and atypical. Against the background of anemia and pancytopenia, the condition of the patients gradually worsens with marked cachexia. Through sharing our experience, we aim to draw attention to this deadly disease. Clinical and laboratory data for 58 patients with VL treated over a forty-five-year period are presented. The diagnosis was established within a duration of 1 to 28 months of illness. Continuous fever (38–42 °C), splenomegaly, hepatomegaly, severe anemia (decreased hemoglobin to lowest values of 31 g/L), leucopenia (lowest values of leucocytes et 0.5 g/L), and thrombocytopenia (reduced thrombocyte count to 29 g/L) were observed. The diagnosis was made on the basis of microscopic evidence of amastigote forms in bone marrow smears and serological tests. The patients were treated with Glucantime for 17 to 21 days. Relapses were observed in seven patients (12.1%) and fatal outcome was observed in two patients (3.5%) during treatment, who developed acute respiratory and cardiovascular failure. In Bulgaria, Visceral leishmaniasis is primarily endemic in the southern regions and should be suspected not only in patients who have returned from tropical and subtropical countries, but also in those who have not traveled abroad. The challenges associated with VL stem from delayed diagnosis of patients, as this disease remains unrecognized by physicians. Full article
(This article belongs to the Special Issue Leishmaniasis: Transmission, Pathogenesis and Treatment)
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11 pages, 591 KiB  
Article
Molecular Typing of Leishmania spp. Causing Tegumentary Leishmaniasis in Northeastern Italy, 2014–2020
by Tommaso Gritti, Elena Carra, Gert Van der Auwera, José Carlos Solana, Valeria Gaspari, Silvana Trincone, Margherita Ortalli, Alice Rabitti, Alessandro Reggiani, Gianluca Rugna, Stefania Varani and The Skin_Leish_RER Network
Pathogens 2024, 13(1), 19; https://doi.org/10.3390/pathogens13010019 - 24 Dec 2023
Viewed by 1485
Abstract
Tegumentary leishmaniasis (TL) is endemic but neglected in southern Europe. Therefore, this study aimed to analyze the Leishmania strains causing TL cases in northeastern Italy, where an upsurge of TL cases has been observed in the last decade. Sections from 109 formalin-fixed and [...] Read more.
Tegumentary leishmaniasis (TL) is endemic but neglected in southern Europe. Therefore, this study aimed to analyze the Leishmania strains causing TL cases in northeastern Italy, where an upsurge of TL cases has been observed in the last decade. Sections from 109 formalin-fixed and paraffin-embedded (FFPE) biopsies of skin and mucosal tissues were collected from TL cases in the selected area. Two DNA targets were amplified and sequenced: the ribosomal internal transcribed spacer 1 (ITS1) and the heat-shock protein 70 gene (hsp70). An in silico analysis was also performed on 149 genomes belonging to the Leishmania donovani complex. A total of 88 out of 109 (80.7%) samples from 83 TL cases were successfully typed by ITS1 and/or hsp70. ITS1 analysis identified L. infantum in 67 cases (91.8%), while L. major (n = 4, 5.5%) and L. tropica (n = 2, 2.7%) were detected in the remaining cases that were categorized as imported. Further, the hsp70 typing of 75 autochthonous cases showed the presence of eight distinct sequence variants belonging to the Leishmania donovani complex, with high genetic variability when compared to known L. infantum populations. In conclusion, our findings show that peculiar L. infantum variants are emerging in the novel focus on TL in northeastern Italy. Full article
(This article belongs to the Special Issue Leishmaniasis: Transmission, Pathogenesis and Treatment)
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18 pages, 1879 KiB  
Article
FeliLeish: An Update on Feline Leishmaniosis and Factors Associated with Infection in Different Feline Populations from Italy
by Eva Spada, Germano Castelli, Federica Bruno, Fabrizio Vitale, Francesco La Russa, Vito Biondi, Sara Accettulli, Antonella Migliazzo, Aurora Rossi, Roberta Perego, Luciana Baggiani and Daniela Proverbio
Pathogens 2023, 12(11), 1351; https://doi.org/10.3390/pathogens12111351 - 14 Nov 2023
Viewed by 1221
Abstract
Feline leishmaniosis is a worldwide infection caused by the parasite of the genus Leishmania transmitted by sandflies. Based on the complexity of epidemiology and diagnosis of this infection, the role of cats in the epidemiology and clinical impact of disease is still under [...] Read more.
Feline leishmaniosis is a worldwide infection caused by the parasite of the genus Leishmania transmitted by sandflies. Based on the complexity of epidemiology and diagnosis of this infection, the role of cats in the epidemiology and clinical impact of disease is still under debate. By using serological and molecular methods, this study aimed to update the epidemiology of the infection in different feline populations from various areas of Italy and to study factors associated with the infection. Of 1490 cats tested, 124 (8.3%, 95% CI 6.9–9.9) were infected, 96 had only specific L. infantum IgG, 18 were only positive for parasite DNA and 10 were both IFAT and qPCR positive. Risk factors for infection were sampling in the winter season (OR = 3.2, 95% CI 2.2–4.8), originating from the Sicily region (OR = 2.0, 95% CI 1.3–3.0), male gender (OR = 1.8, 95% CI 1.1–3.2), outdoor lifestyle (OR = 2.3, 95% CI 0.9–5.6) and seropositivity for FIV antibodies (OR = 2.2, 95% CI 1.2–4.2), while sampling in the spring (OR = 0.5, 95% CI 0.3–0.7) and summer (OR = 0.3, 95% CI 0.1–0.7), and originating from the Lazio region (OR = 0.1, 95% CI 0.05–0.4) were protective factors for infection. In endemic areas, Leishmania infection should be investigated by using both serological and molecular methods and cats should be protected from sandfly bites, particularly if they are FIV infected. Full article
(This article belongs to the Special Issue Leishmaniasis: Transmission, Pathogenesis and Treatment)
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13 pages, 2087 KiB  
Article
Retrospective Long-Term Evaluation of Miltefosine-Allopurinol Treatment in Canine Leishmaniosis
by Manuela Gizzarelli, Valentina Foglia Manzillo, Antonio Inglese, Serena Montagnaro and Gaetano Oliva
Pathogens 2023, 12(7), 864; https://doi.org/10.3390/pathogens12070864 - 22 Jun 2023
Cited by 1 | Viewed by 1881
Abstract
Miltefosine-Allopurinol (MIL-AL) combination is reported to be one of the most effective treatments for canine leishmaniosis, thanks to its oral administration and MIL-documented low impact on renal function. However, MIL-AL is considered a second-choice treatment when compared to meglumine-antimoniate—allopurinol combination, mainly due to [...] Read more.
Miltefosine-Allopurinol (MIL-AL) combination is reported to be one of the most effective treatments for canine leishmaniosis, thanks to its oral administration and MIL-documented low impact on renal function. However, MIL-AL is considered a second-choice treatment when compared to meglumine-antimoniate—allopurinol combination, mainly due to the risk of earlier relapses. The aim of this study was to evaluate the efficacy of the MIL-AL protocol during a long-term follow-up with an average duration of nine years. Dogs were living in Southern Italy (Puglia, Italy) in an area considered endemic for Canine leishmaniosis (CanL). Inclusion criteria were clinical and/or clinicopathological signs consistent with CanL; positive result to Leishmania quantitative ELISA; and negativity to the most frequent canine vector-borne infections. All dogs received 2 mg/kg MIL for 28 days, and 10 mg/kg AL, BID, for a period varying between 2 and 12 months. Ancillary treatments were allowed according to the clinical condition of the dog. A total clinical score and a total clinicopathological score were calculated at each time point by attributing one point to each sign or alteration present and then by adding all points. Improvement after each treatment was defined by the reduction of at least 50% of the total score. A survival analysis (Kaplan–Meier curve) was performed for quantifying the probability of the events occurring during the study follow-up. The following events were considered: decreased and negative ELISA results; improvement/recovery of the clinical and clinicopathological alterations; and relapse of leishmaniasis. One hundred seventy-three dogs (75f and 98m) were retrospectively included in the study by examining their clinical records since the first diagnosis of CanL. One hundred forty-three (83%) dogs were under five years of age. The mean duration of the follow-up period was 5.4 (±1.1) years with a minimum of 3.2 years and a maximum of 9 years. All dogs received a first treatment of MIL-AL at inclusion; then, during the follow-up course, 30 dogs required a second treatment, 2 dogs required a third treatment and 1 dog required a fourth and a fifth treatment. The mean time interval between the first and the second treatment was 27.2 (±18.3) months. After the first treatment, all dogs had decreased ELISA levels, in an average interval of 2.6 (±1.6) months. One hundred seventy dogs (98%) experienced a clinical improvement (mean time 3.0 ± 4.9 months); 152 (88%) dogs were considered clinically recovered after a mean time of 16.7 ± 13.5 months. A similar trend was observed for clinicopathological alterations; interestingly, proteinuria decreased in most dogs (p < 0.0001—Chi-square for trends). Thirty dogs experienced relapses, the earliest after 4.8 months. The mean time without relapse was 90.4 (±2.5) months. In relapsed dogs, the mean time for clinical improvement after the second treatment was 8.6 (±12.6) months, whereas it was 11.0 (±15.4) months for clinicopathological alterations. Five dogs had limited gastrointestinal side effects associated with MIL treatment. The present study confirms that the MIL-AL protocol can be considered one of the most effective treatments for CanL therapy, mainly for its capacity to provide a long-time clinical improvement in a large majority of treated dogs. As reported in the literature, the clinical stabilization of dogs does not occur immediately after treatment, probably due to the particular pharmacokinetic properties of MIL. The efficacy of MIL-AL decreases in dogs that need more than one treatment, suggesting the necessity to alternate anti-Leishmania drugs for the treatment of relapses. Side effects were transient and slight, even in dogs that required several treatments. Full article
(This article belongs to the Special Issue Leishmaniasis: Transmission, Pathogenesis and Treatment)
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19 pages, 8699 KiB  
Article
Leishmania major-Infected Phlebotomus duboscqi Sand Fly Bites Enhance Mast Cell Degranulation
by Laura Sánchez-García, Armando Pérez-Torres, Marco E. Gudiño-Zayas, Jaime Zamora-Chimal, Claudio Meneses, Shaden Kamhawi, Jesus G. Valenzuela and Ingeborg Becker
Pathogens 2023, 12(2), 207; https://doi.org/10.3390/pathogens12020207 - 28 Jan 2023
Cited by 3 | Viewed by 2056
Abstract
Leishmania parasites infect mammalian hosts through the bites of sand fly vectors. The response by mast cells (MC) to the parasite and vector-derived factors, delivered by sand fly bites, has not been characterized. We analyzed MC numbers and their mediators in BALB/c mice [...] Read more.
Leishmania parasites infect mammalian hosts through the bites of sand fly vectors. The response by mast cells (MC) to the parasite and vector-derived factors, delivered by sand fly bites, has not been characterized. We analyzed MC numbers and their mediators in BALB/c mice naturally infected in the ear with Leishmania major through the bite of the sand fly vector Phlebotomus duboscqi and compared them to non-infected sand fly bites. MC were found at the bite sites of infective and non-infected sand flies throughout 48 h, showing the release of granules with intense TNF-α, histamine, and tryptase staining. At 30 min and 48 h, the MC numbers were significantly higher (p < 0.001) in infected as compared to non-infected bites or controls. Neutrophil recruitment was intense during the first 6 h in the skin of infected and non-infected sand fly bites and decreased thereafter. An influx of neutrophils also occurred in lymph nodes, where a strong TNF-α stain was observed in mononuclear cells. Our data show that MC orchestrate an early inflammatory response after infected and non-infected sand fly bites, leading to neutrophilic recruitment, which potentially provides a safe passage for the parasite within the mammalian host. Full article
(This article belongs to the Special Issue Leishmaniasis: Transmission, Pathogenesis and Treatment)
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Review

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26 pages, 2847 KiB  
Review
Polyamine Metabolism for Drug Intervention in Trypanosomatids
by Yolanda Pérez-Pertejo, Carlos García-Estrada, María Martínez-Valladares, Sankaranarayanan Murugesan, Rosa M. Reguera and Rafael Balaña-Fouce
Pathogens 2024, 13(1), 79; https://doi.org/10.3390/pathogens13010079 - 16 Jan 2024
Cited by 3 | Viewed by 1989
Abstract
Neglected tropical diseases transmitted by trypanosomatids include three major human scourges that globally affect the world’s poorest people: African trypanosomiasis or sleeping sickness, American trypanosomiasis or Chagas disease and different types of leishmaniasis. Different metabolic pathways have been targeted to find antitrypanosomatid drugs, [...] Read more.
Neglected tropical diseases transmitted by trypanosomatids include three major human scourges that globally affect the world’s poorest people: African trypanosomiasis or sleeping sickness, American trypanosomiasis or Chagas disease and different types of leishmaniasis. Different metabolic pathways have been targeted to find antitrypanosomatid drugs, including polyamine metabolism. Since their discovery, the naturally occurring polyamines, putrescine, spermidine and spermine, have been considered important metabolites involved in cell growth. With a complex metabolism involving biosynthesis, catabolism and interconversion, the synthesis of putrescine and spermidine was targeted by thousands of compounds in an effort to produce cell growth blockade in tumor and infectious processes with limited success. However, the discovery of eflornithine (DFMO) as a curative drug against sleeping sickness encouraged researchers to develop new molecules against these diseases. Polyamine synthesis inhibitors have also provided insight into the peculiarities of this pathway between the host and the parasite, and also among different trypanosomatid species, thus allowing the search for new specific chemical entities aimed to treat these diseases and leading to the investigation of target-based scaffolds. The main molecular targets include the enzymes involved in polyamine biosynthesis (ornithine decarboxylase, S-adenosylmethionine decarboxylase and spermidine synthase), enzymes participating in their uptake from the environment, and the enzymes involved in the redox balance of the parasite. In this review, we summarize the research behind polyamine-based treatments, the current trends, and the main challenges in this field. Full article
(This article belongs to the Special Issue Leishmaniasis: Transmission, Pathogenesis and Treatment)
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