Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Microb Pathog. 2019 Mar;128:162-170. doi: 10.1016/j.micpath.2018.12.040. Epub 2018 Dec 21.
Currently, there is no satisfactory treatment modality available for cutaneous leishmaniasis (CL). The major objective of the present study was to explore the effect of immunomodulator-levamisole in combination with Glucantime in end-stage unresponsive patients with anthroponotic CL (ACL). Twenty end-stage unresponsive patients with ACL were identified for participation in this single-group trial study. Simultaneously, each patient was received a combination of levamisole pills along with Glucantime during the remedy course. Several in vitro complementary experiments were performed to evaluate the mode of action of levamisole and Glucantime alone and in combination using a macrophage model, in vitro MTT assay, flow cytometry and quantitative real time PCR (qPCR). Overall, 75% of the patients showed complete clinical cure, 10% partially improved and the remaining (15%) had underlying chronic diseases demonstrated no response to the treatment regimen. In in vitro studies, there was no cytotoxic effect associated with these drugs in the range of our experiments. The findings by the flow cytometric analysis represented that the highest apoptotic values corresponded to the drugs combination (32.23%) at 200 μg/ml concentration. Finally, the gene expression level of IL-12 p40, iNOS and TNF-α promoted while the level of IL-10 and TGF-β genes reduced as anticipated. The findings clearly indicated that the combination of levamisole and Glucantime should be considered in end-stage unresponsive patients with ACL who have not responded to basic treatments. The immunomodulatory role of levamisole in mounting immune system as documented by the in vitro experiments and further substantiated by this single-group trail study was highlighted.
目前,皮肤利什曼病(CL)尚无令人满意的治疗方法。本研究的主要目的是探讨免疫调节剂左旋咪唑联合葡萄糖酸锑钠治疗人源利什曼病(ACL)晚期无反应患者的效果。本单组试验研究共纳入 20 例 ACL 晚期无反应患者。同时,每位患者在治疗过程中均接受左旋咪唑片联合葡萄糖酸锑钠治疗。通过巨噬细胞模型、体外 MTT 测定、流式细胞术和实时定量 PCR(qPCR)等体外补充实验,评估左旋咪唑和葡萄糖酸锑钠单独和联合应用的作用模式。总的来说,75%的患者完全临床治愈,10%部分改善,其余(15%)有基础慢性病的患者对治疗方案无反应。在体外研究中,这些药物在我们实验的范围内没有细胞毒性作用。流式细胞术分析的结果表明,在 200μg/ml 浓度下,药物联合使用的凋亡值最高(32.23%)。最后,IL-12 p40、iNOS 和 TNF-α的基因表达水平升高,而 IL-10 和 TGF-β基因的水平降低。这些发现清楚地表明,对于未对基础治疗产生反应的 ACL 晚期无反应患者,应考虑使用左旋咪唑和葡萄糖酸锑钠联合治疗。体外实验证明了左旋咪唑在增强免疫系统方面的免疫调节作用,本单组试验研究进一步证实了这一点。
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