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Background To overcome the current problems in leishmaniasis chemotherapy, natural products have become an interesting alternative over the past few decades. Flavonoids have been studied as promising family of compounds for leishmaniasis treatment. 2’-Hydroxyflavanone (2HF) is a flavanone, a class of flavonoid that has shown promising results in cancer studies. In this study, we demonstrated the effects of 2HF in vitro and in vivo against wild-type and antimony-resistant Leishmania amazonensis promastigotes. Methodology/Principal findings 2HF was effective against promastigotes and the intracellular amastigote form, decreasing the infection index in macrophages infected with wild-type and antimony-resistant promastigotes, but it was not toxic to macrophages. In silico analysis indicated 2HF as a good oral candidate for leishmaniasis treatment. In vivo, 2HF was able to reduce the lesion size and parasite load in a murine model of cutaneous leishmaniasis using wild-type and antimony-resistant promastigotes, demonstrating no cross-resistance with antimonials. Conclusions/Significance Taken together, these results suggest 2HF as a potential candidate for leishmaniasis chemotherapy for cutaneous leishmaniasis caused by both wild-type and antimony-resistant Leishmania species by oral administration. Furthermore, studies should be conducted to determine the ideal dose and therapeutic regimen., Author summary Leishmaniasis is a parasitic disease endemic to 98 countries, affecting more than 12 million people globally, and there are more than 350 million people in risk areas. Although there are many drugs available as alternatives for leishmaniasis treatment, they remain mostly ineffective, expensive and longstanding, in addition to generating side effects and resistance. Antimonial resistance is currently one of the biggest obstacles in leishmaniasis chemotherapy. Due to the poor chemotherapy scenario and the need for a drug able to overcome resistance problems and therapeutic failures, natural products have become an important alternative for leishmaniasis treatment. Here, we evaluated the antileishmanicidal activity of 2HF in vitro and in vivo against wild-type and antimony-resistant L. amazonensis cells. 2HF inhibited the cellular proliferation of promastigotes and the intracellular amastigote form in a dose-dependent manner in both wild-type and antimony-resistant cells. Furthermore, 2HF reduced the lesion size and parasitic load in a murine model of cutaneous leishmaniasis using wild-type and antimony-resistant promastigotes without altering hematological parameters and serological toxicology markers. This is the first time that the activity of a flavonoid on the antimony-resistant L. amazonensis has been demonstrated in vitro and in vivo by the oral route.

11 p.-5 fig. Ferreira Cunha-Júnior, Edézio et al., Background The leishmanicidal action of tricyclic antidepressants has been studied and evidences have pointed that their action is linked to inhibition of trypanothione reductase, a key enzyme in the redox metabolism of pathogenic trypanosomes. Cyclobenzaprine (CBP) is a tricyclic structurally related to the antidepressant amitriptyline, differing only by the presence of a double bond in the central ring. This paper describes the effect of CBP in experimental visceral leishmaniasis, its inhibitory effect in trypanothione reductase and the potential immunomodulatory activity., Methodology/Principal Findings In vitro antileishmanial activity was determined in promastigotes and in L. infantum-infected macrophages. For in vivo studies, L. infantum-infected BALB/c mice were treated with CBP by oral gavage for five days and the parasite load was estimated. Trypanothione reductase activity was assessed in the soluble fraction of promastigotes of L. infantum. For evaluation of cytokines, L. infantum-infected macrophages were co-cultured with BALB/c splenocytes and treated with CBP for 48 h. The supernatant was analyzed for IL-6, IL-10, MCP-1, IFN-γ and TNF-α. CBP demonstrated an IC50 of 14.5±1.1μM and an IC90 of 74.5±1.2 μM in promastigotes and an IC50 of 12.6±1.05 μM and an IC90 of 28.7±1.3 μM in intracellular amastigotes. CBP also reduced the parasite load in L. infantum-infected mice by 40.4±10.3% and 66.7±10.5% in spleen at 24.64 and 49.28 mg/kg, respectively and by 85.6±5.0 and 89.3±4.8% in liver at 24.64 and 49.28mg/kg, after a short-term treatment. CBP inhibited the trypanothione reductase activity with a Ki of 86 ± 7.7 μM and increased the ROS production in promastigotes. CBP inhibited in 53% the production of IL-6 in infected macrophages coculture., Conclusion/Significance To the best of our knowledge, this study is the first report of the in vivo antileishmanial activity of the FDA-approved drug CBP. Modulation of immune response and induction of oxidative stress in parasite seem to contribute to this efficacy., This work was supported by Programa Estratégico de Apoio à Pesquisa em Saúde,FIOCRUZ/Conselho Nacional de Desenvolvimento Científico e Tecnológico - www.cnpq.br, (PAPES/ CNPq 407680/2012-8 to ECTS and 407590/2012-9 to EEAA), Fundação de Apoio a Pesquisa do Estado do Rio de Janeiro ± www.faperj.br (Fellow and grant E-26/010.001828/2016 to EFCJ), Conselho Nacional de Desenvolvimento CientõÂfico e TecnoloÂgico (CNPq/Universal grant 470627/2013-1 to EEAA), São Paulo Research Foundation - www.fapesp.br (FAPESP 2015/23403-9 to AGT),Programa Estatal de Investigación, Desarrollo e Innovación Orientada a los Retos de la Sociedad FEDER - www.idi.mineco.gob.es/ (SAF2015-65740-R) and Subdirección General de Redes y Centros de Investigación Cooperativa-FEDER -www.isciii.es/ (RD12/0018/0007) (to LR).

Background The treatment for leishmaniasis is currently based on pentavalent antimonials and amphotericin B; however, these drugs result in numerous adverse side effects. The lack of affordable therapy has necessitated the urgent development of new drugs that are efficacious, safe, and more accessible to patients. Natural products are a major source for the discovery of new and selective molecules for neglected diseases. In this paper, we evaluated the effect of apigenin on Leishmania amazonensis in vitro and in vivo and described the mechanism of action against intracellular amastigotes of L. amazonensis. Methodology/Principal Finding Apigenin reduced the infection index in a dose-dependent manner, with IC50 values of 4.3 μM and a selectivity index of 18.2. Apigenin induced ROS production in the L. amazonensis-infected macrophage, and the effects were reversed by NAC and GSH. Additionally, apigenin induced an increase in the number of macrophages autophagosomes after the infection, surrounding the parasitophorous vacuole, suggestive of the involvement of host autophagy probably due to ROS generation induced by apigenin. Furthermore, apigenin treatment was also effective in vivo, demonstrating oral bioavailability and reduced parasitic loads without altering serological toxicity markers. Conclusions/Significance In conclusion, our study suggests that apigenin exhibits leishmanicidal effects against L. amazonensis-infected macrophages. ROS production, as part of the mechanism of action, could occur through the increase in host autophagy and thereby promoting parasite death. Furthermore, our data suggest that apigenin is effective in the treatment of L. amazonensis-infected BALB/c mice by oral administration, without altering serological toxicity markers. The selective in vitro activity of apigenin, together with excellent theoretical predictions of oral availability, clear decreases in parasite load and lesion size, and no observed compromises to the overall health of the infected mice encourage us to supports further studies of apigenin as a candidate for the chemotherapeutic treatment of leishmaniasis., Author Summary Leishmaniasis is an important neglected disease caused by protozoa of the genus Leishmania and affects more than 12 million people worldwide. Pentavalent antimonials and amphotericin B have been used for decades to treat leishmaniasis; however, these drugs result in numerous adverse side effects, have variable efficacy and are subject to parasite resistance. The lack of suitable therapy necessitates the development of novel antileishmanial compounds. In this study, we investigated the antileishmanial activity of apigenin in vitro and in vivo and described the mechanism of action against intracellular amastigotes of Leishmania amazonensis. Apigenin reduced the infection index in a dose-dependent manner and increased reactive oxygen species (ROS) generation. Additionally, apigenin induced an increase in the number of macrophages autophagosomes after the infection, surrounding the parasitophorous vacuole, suggestive of the involvement of host autophagy probably due to ROS generation induced by apigenin. Furthermore, treatment with apigenin was also effective in vivo, showing oral bioavailability and significantly reducing lesion sizes and parasite burden without altering serological toxicity markers.

Background Leishmaniasis is a parasitic disease associated with extensive mortality and morbidity. The treatment for leishmaniasis is currently based on pentavalent antimonials and amphotericin B; however, these drugs result in numerous adverse side effects. Natural compounds have been used as novel treatments for parasitic diseases. In this paper, we evaluated the effect of (-)-epigallocatechin 3-O-gallate (EGCG) on Leishmania braziliensis in vitro and in vivo and described the mechanism of EGCG action against L. braziliensis promastigotes and intracellular amastigotes. Methodology/Principal Finding In vitro activity and reactive oxygen species (ROS) measurements were determined during the promastigote and intracellular amastigote life stages. The effect of EGCG on mitochondrial membrane potential (ΔΨm) was assayed using JC-1, and intracellular ATP concentrations were measured using a luciferin-luciferase system. The in vivo experiments were performed in infected BALB/c mice orally treated with EGCG. EGCG reduced promastigote viability and the infection index in a time- and dose-dependent manner, with IC50 values of 278.8 µM and 3.4 µM, respectively, at 72 h and a selectivity index of 149.5. In addition, EGCG induced ROS production in the promastigote and intracellular amastigote, and the effects were reversed by polyethylene glycol (PEG)-catalase. Additionally, EGCG reduced ΔΨm, thereby decreasing intracellular ATP concentrations in promastigotes. Furthermore, EGCG treatment was also effective in vivo, demonstrating oral bioavailability and reduced parasitic loads without altering serological toxicity markers. Conclusions/Significance In conclusion, our study demonstrates the leishmanicidal effects of EGCG against the two forms of L. braziliensis, the promastigote and amastigote. In addition, EGCG promotes ROS production as a part of its mechanism of action, resulting in decreased ΔΨm and reduced intracellular ATP concentrations. These actions ultimately culminate in parasite death. Furthermore, our data suggest that EGCG is orally effective in the treatment of L. braziliensis-infected BALB/c mice without altering serological toxicity markers., Author Summary Leishmaniasis is a parasitic disease that is endemic in 88 countries, primarily located in tropical and subtropical regions, that affects more than 12 million people worldwide. Leishmaniasis treatments are currently based on pentavalent antimonials and amphotericin B; however, these drugs result in numerous adverse side effects and variable efficacy. In addition, the drugs are expensive, and parasite resistance to these drugs has been observed. The lack of affordable therapy necessitates the development of novel antileishmanial therapies. We investigated the antileishmanial activity of EGCG in vitro and in vivo and described the mechanism of EGCG action against Leishmania braziliensis promastigotes and intracellular amastigotes. EGCG reduced promastigote viability and the infection index in a time- and dose-dependent manner with a selectivity index of 149.5. This effect was reversed by polyethylene glycol (PEG)-catalase, suggesting that ROS production is a mechanism of action in promastigotes and intracellular amastigotes. Additionally, EGCG reduced ΔΨm and intracellular ATP concentrations in promastigotes. Furthermore, EGCG treatment was also effective in vivo, demonstrating oral bioavailability and reduced lesion sizes and parasitic load (92% of reduction) without altering serological toxicity markers. Additional studies should be conducted to determine the ideal dose and therapeutic regimen.