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CpG ODN D35 可提高非人类灵长类动物皮肤利什曼病模型中短程低剂量五价锑治疗的应答。

CpG ODN D35 improves the response to abbreviated low-dose pentavalent antimonial treatment in non-human primate model of cutaneous leishmaniasis.

机构信息

Laboratory of Immunology, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, United States of America.

Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland.

出版信息

PLoS Negl Trop Dis. 2020 Feb 28;14(2):e0008050. doi: 10.1371/journal.pntd.0008050. eCollection 2020 Feb.

Abstract

Cutaneous leishmaniasis (CL) affects the lives of 0.7-1 million people every year causing lesions that take months to heal. These lesions can result in disfiguring scars with psychological, social and economic consequences. Antimonials are the first line of therapy for CL, however the treatment is lengthy and linked to significant toxicities; further, its efficacy is variable and resistant parasites are emerging. Shorter or lower dose antimonial treatment regimens, which would decrease the risk of adverse events and improve patient compliance, have shown reduced efficacy and further increase the risk emergence of antimonial-resistant strains. The progression of lesions in CL is partly determined by the immune response it elicits, and previous studies showed that administration of immunomodulatory type D CpG ODNs, magnifies the immune response to Leishmania and reduces lesion severity in nonhuman primates (NHP) challenged with Leishmania major or Leishmania amazonensis. Here we explored whether the addition of a single dose of immunomodulating CpG ODN D35 augments the efficacy of a short-course, low-dose pentavalent antimonial treatment regimen. Results show that macaques treated with D35 plus 5mg/kg sodium stibogluconate (SbV) for 10 days had smaller lesions and reduced time to re-epithelization after infection with Leishmania major. No toxicities were evident during the studies, even at doses of D35 10 times higher than those used in treatment. Critically, pentavalent antimonial treatment did not modify the ability of D35 to induce type I IFNs. The findings support the efficacy of D35 as adjuvant therapy for shorter, low dose pentavalent antimonial treatment.

摘要

皮肤利什曼病(CL)每年影响 0.7-100 万人的生活,导致需要数月才能愈合的病变。这些病变可能导致毁容性疤痕,造成心理、社会和经济后果。锑剂是 CL 的一线治疗药物,但其治疗时间长且毒性大;此外,其疗效不一,耐药寄生虫正在出现。较短或较低剂量的锑剂治疗方案可降低不良反应风险并提高患者依从性,但已显示出疗效降低,并进一步增加了出现耐药株的风险。CL 病变的进展部分取决于其引发的免疫反应,先前的研究表明,给予免疫调节型 D 型 CpG ODN,可放大对利什曼原虫的免疫反应,并减少感染大疱性利什曼原虫或亚马逊利什曼原虫的非人类灵长类动物(NHP)的病变严重程度。在这里,我们探讨了单次给予免疫调节型 CpG ODN D35 是否能增强短疗程、低剂量五价锑剂治疗方案的疗效。结果表明,用 D35 加 5mg/kg 葡甲胺锑治疗 10 天的猕猴,在感染大疱性利什曼原虫后,病变较小,再上皮化时间缩短。研究过程中没有出现明显的毒性,即使 D35 的剂量比治疗时高 10 倍。关键的是,五价锑剂治疗并没有改变 D35 诱导 I 型 IFNs 的能力。这些发现支持 D35 作为辅助治疗较短、低剂量五价锑剂治疗的疗效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2540/7075640/44f7eef49179/pntd.0008050.g001.jpg

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