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In areas endemic for Leishmania infantum, an asymptomatic infection may be an indicator of the extent of transmission. The main goal of this study was to evaluate the applicability of measuring circulating immunological biomarkers as an alternative strategy to characterize and monitor L. infantum asymptomatic infections in combination with serological methods. To this end, 179 children from a region endemic for visceral leishmaniasis (VL), aged 1–10 years old, selected from a cross-sectional study, were identified as asymptomatic (n = 81) or uninfected (n = 98) by qPCR and/or serological tests (ELISA using L. infantum soluble antigen and rK39), and, together with serum samples of children diagnosed with VL (n = 43), were subjected to avidity tests and cytokine levels measurement. Avidity rates (AR) ranging from 41 to 70% were found in 29 children (66%) from the asymptomatic group. On the other hand, high AR (above 70%) were observed in 27 children (64%) from the VL group. Logistic Regression and Classification and Regression Tree (CART) analyses demonstrated that lower AR and IFN-γ production associated with higher IL-17A levels were hallmarks in asymptomatic L. infantum infections. Therefore, this study proposes an association of immunological biomarkers that can be used as a complementary strategy for the characterization and monitoring of asymptomatic VL infections in children living in endemic areas.

The influence of the nucleobase (uracyl, U; cytosine, C; adenine, A; guanine, G) on the physicochemical characteristics and in vitro biological activities of SbV-ribonucleoside complexes has been investigated. The 1:1 Sb-U and Sb-C complexes were characterized by NMR and ESI-MS spectroscopies and elemental analysis. The stability constant and the apparent association and dissociation rate constants of 1:1 SbV-U, SbV-C and SbV-A complexes were determined. Although SbV most probably binds via oxygen atoms to the same 2' and 3' positions in the different nucleosides, the ribose conformational changes and the physicochemical characteristics of the complex depend on the nucleobase. The nucleobase had a strong influence on the cytotoxicity against macrophages and the antileishmanial activity of the SbV-ribonucleoside complexes. The SbV-purine complexes were more cytotoxic and more effective against Leishmania chagasi than the SbV-pyrimidine complexes, supporting the model that the interaction of SbV with purine nucleosides may mediate the antileishmanial activity of pentavalent antimonial drugs. A influência da nucleobase (uracila, U; citosina, C; adenina, A; guanina, G) nas propriedades físico-químicas e atividades biológicas in vitro dos complexos SbV-ribonucleosídeo foi investigada. Os complexos 1:1 Sb-U e Sb-C foram obtidos no estado sólido e caracterizados por RMN, ESI-MS e análise elementar. As constantes de estabilidade e as constantes aparentes de velocidade de formação e dissociação dos complexos 1:1 Sb-U, Sb-C e Sb-A foram determinadas. Embora o SbV se ligue através dos mesmos átomos de oxigênio das posições 2' e 3' nos diferentes nucleosídeos, as mudanças conformacionais na ribose e as propriedades físico-químicas do complexo dependem da nucleobase. A nucleobase influenciou fortemente as atividades citotóxica e leishmanicida dos complexos SbV-ribonucleosídeo. Os complexos SbV-nucleosídeos purínicos foram mais citotóxicos e eficazes contra a Leishmania chagasi do que os pirimidínicos, o que reforça o modelo de que a interação do SbV com os nucleosídeos purínicos pode mediar a atividade dos medicamentos antimoniais.

Background An important issue associated with the control of visceral leishmaniasis is the need to identify and understand the relevance of asymptomatic infection caused by Leishmania infantum. The aim of this study was to follow the course of asymptomatic L. infantum infection in children in an area of Brazil where it is endemic. The children were assessed twice during a 12-month period. Methodology In this population study, 1875 children, ranging from 6 months to 7 years of age, were assessed. Blood samples were collected on filter papers via finger prick and tested by ELISA (L. infantum soluble antigen and rk39). Seropositives samples (n = 317) and a number of seronegatives samples (n = 242) were subjected to qPCR. After 12 months, blood samples were collected from a subgroup of 199 children and tested for Leishmania spp. to follow the course of infection. Principal Findings At baseline qPCR testing identified 82 positive samples. The prevalence rate, as estimated for 1875 children based on the qPCR results, was 13.9%. The qPCR testing of whole blood samples collected from a cohort of children after 12 months (n = 199) yielded the following results: of the 44 (22.1%) children with positive qPCR results at baseline, only 10 (5.0%) remained positive, and 34 (17.1%) became negative; and of the 155 (77.9%) children with negative qPCR results, 131 (65.8%) remained negative, and 24 (12.1%) became positive at the follow-up measurement. The samples with positive findings at baseline (n = 82) had a mean of 56.5 parasites/mL of blood; and at follow-up the mean positive result was 7.8 parasites/mL. Conclusions The peripheral blood of asymptomatic children had a low and fluctuating quantity of Leishmania DNA and a significant decrease in parasitemia at 1-year follow-up. Quantitative PCR enables adequate monitoring of Leishmania infection., Author Summary In Brazil, visceral leishmaniasis (VL) is caused by the parasite protozoon Leishmania (Leishmania) infantum (syn chagasi), which is transmitted to humans by sandflies that have widespread wild and domestic animal reservoirs. An important issue associated with the control of VL is the need to identify and understand the relevance of asymptomatic infection in the transmission cycle of the parasite. We evaluated the course of asymptomatic infection in children by using molecular methods to detect parasite DNA and to monitor parasitemia level over time. The prevalence of VL, as detected by means of a molecular method, for 1875 children was 13.9%. The data demonstrated a significant decrease in parasitemia after 1 year. Furthermore, the level of parasitemia was generally lower in asymptomatic children than in sick children. None of the asymptomatic children showed signs or clinical symptoms associated with VL throughout the duration of the study. This molecular method of measuring parasitemia is adequate for monitoring VL transmission in areas where it is endemic.

No presente trabalho, foi avaliada a influência das nucleobases (guanina, adenina, citosina e uracila), sobre a atividade biológica in vitro dos complexos Sbv-ribonucleosídeos. A complexação do Sbv a purino-nucleosídeos, em especial a guanosina, influenciou na atividade citotóxica para macrófagos, nos níveis de incorporação de antimônio intracelular e potencializou a atividade anti-Leishmania do fármaco antimonial. Os complexos Sbv-purínicos estimularam o crescimento de formas promastigotas do parasito e foram mais citotóxicos e eficazes contra Leishmania chagasi que os Sbv-pirimidínicos, que apresentaram atividade equivalente àquela dos medicamentos antimoniais de referência, SbK e antimoniato de meglumina. Dos complexos Sbv-purínicos, o Sbv-G foi o mais tóxico e ativo em todos os ensaios, enquanto o Sbv-A embora tenha apresentado citotoxicidade e atividade anti-Leishmania, essa atividade não foi diferente dos compostos antimoniais de referência. Essas diferenças entre o potencial dos fármacos Sbv-purínicos Sbv-G e Sbv-A, pode ser devida ao fato dos nucleosídeos de guanosina e adenosina, desencadearem diferentes respostas quanto à produção de óxido nítrico em macrófagos segundo a literatura, o que interferiria diretamente na atividade anti-amastigota de cada fármaco. Os achados de citotoxicidade e atividade anti-Leishmania, reforçam o modelo de que a interação do Sbv com nucleosídeos purínicos pode mediar as ações farmacológicas dos antimoniais pentavalentes, e abrem perspectivas para novos estudos sobre a influência dos nucleosídeos purínicos adenosina e guanosina na resposta imune do macrófago a infecção por Leishmania chagasi.