Estudo comparativo entre o antimoniato-n-metilglucamina (glucantime) e o isotionato de pentamidina (pentacarinat) em lesões cutâneas da leishmaniose tegumentar / Comparative study of antimony-n-methylglucamine (glucantime) and pentamidine isethionate (Pentacarinat) in skin lesions of cutaneous leishmaniasis

O prognóstico da leishmaniose cutânea (LC) com o uso dos antimoniais pentavalentes (Sb+5) de um modo geral é considerado bom, embora alguns casos tornem-se refratários à terapêutica tradicional. Infelizmente, não existem marcadores de gravidade da doença ou marcadores de resposta terapêutica, limitando a utilização de formas de tratamento mais efetivas. Em alguns casos, porém, existe a necessidade de utilizar outras drogas, como a anfotericina B (desoxocolato) e as pentamidinas (isotionato e mesilato), consideradas como drogas de 2ª escolha no tratamento das leishmanioses, sendo de fundamental importância à busca de novos esquemas terapêuticos. O objetivo do estudo foi comparar a eficácia entre o antimoniato-N-metilglucamina (Glucantime®) e o isotionato de pentamidina (Pentacarinat®) no tratamento da forma cutânea da leishmaniose tegumentar (LT)...

The prognosis of cutaneous leishmaniasis (CL) with the use of pentavalents antimonials (Sb+5) is generally considered good, although in some cases have become refractory to conventional therapy. Unfortunately there are no markers of disease severity or markers of therapeutic response, limiting the use of more effective forms of treatment. In some cases, however, there is a need for other drugs such as amphotericin B (desoxycholate) and pentamidine (isethionate and mesylate), which are considered as the second choice in the treatment of leishmaniasis, since few studies with reduced doses of these drugs demonstrated encouraging results in tegumentary leishmaniasis (TL), which is paramount in the search for new therapeutic regimens using proven antileishmanial drugs. We have compared the effectiveness between the N-methylglucamine antimoniate (Glucantime®) and pentamidine isethionate (Pentacarinat®) in the treatment of CL in an endemic area of tegumentary leishmaniasis (TL)...

Application of monoclonal antibodies to measure metabolism of an anti-trypanosomal compound in vitro and in vivo.

Human African trypanosomiasis (HAT), also called African sleeping sickness, is a neglected tropical parasitic disease indigenous to sub-Saharan Africa. Diamidine compounds, including pentamidine and CPD-0801, are potent anti-trypanosomal molecules. The latter is a potential drug in the development at the UNC based Consortium for Parasitic Drug Development. An orally bioavailable prodrug of CPD-0801, DB868, is metabolized primarily in the liver to the active form. A monoclonal antibody developed against a pentamidine derivative has shown significant reactivity with CPD-0801 (EC(50) 65.1 nM), but not with the prodrug (EC(50)>18,000 nM). An inhibitory enzyme-linked immunosorbent assay (IELISA) has been used to quantitatively monitor prodrug metabolism by detecting the production of the active compound over time in a sandwich culture rat hepatocyte system and in rats. These results were compared with the results of the standard LC/MS/MS assay. Spearman coefficients of 0.96 and 0.933 (in vitro and in vivo, respectively) indicate a high correlation between these two measurement methods. This novel IELISA provides a facile, inexpensive, and accurate method for drug detection that may aide in elucidating the mechanisms of action and toxicity of existing and future diamidine compounds.

Prophylaxis for human immunodeficiency virus-related Pneumocystis carinii pneumonia: using simulation modeling to inform clinical guidelines.

BACKGROUND: Human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) have experienced a dramatic decrease in Pneumocystis carinii pneumonia (PCP), necessitating reassessment of clinical guidelines for prophylaxis. METHODS: A simulation model of HIV infection was used to estimate the lifetime costs and quality-adjusted life expectancy (QALE) for alternative CD4 cell count criteria for stopping primary PCP prophylaxis in patients with CD4 cell count increases receiving HAART and alternative agents for second-line PCP prophylaxis in those intolerant of trimethoprim-sulfamethoxazole (TMP/SMX). The target population was a cohort of HIV-infected patients in the United States with initial CD4 cell counts of 350/microL who began PCP prophylaxis after their first measured CD4 lymphocyte count less than 200/microL. Data were from randomized controlled trials and other published literature. RESULTS: For patients with CD4 cell count increases during HAART, waiting to stop prophylaxis until the first observed CD4 cell count was greater than 300/microL prevented 9 additional cases per 1000 patients and cost $9400 per quality-adjusted life year (QALY) gained compared with stopping prophylaxis at 200/microL. For patients intolerant of TMP/SMX, using dapsone increased QALE by 2.7 months and cost $4500 per QALY compared with no prophylaxis. Using atovaquone rather than dapsone provided only 3 days of additional QALE and cost more than $1.5 million per QALY. CONCLUSIONS: Delaying discontinuation of PCP prophylaxis until the first observed CD4 cell count greater than 300/microL is cost-effective and provides an explicit "PCP prophylaxis stopping criterion." In TMP/SMX-intolerant patients, dapsone is more cost-effective than atovaquone.

Immunoassays for pentamidine and related compounds: development of a facile inhibitory ELISA suitable for clinical use.

Aromatic dicationic drugs have a broad spectrum of activity against protozoal and fungal pathogens including Pneumocystis carinii, Leishmania mexicana amazonensis, Cryptosporidium parvum and Cryptococcus neoformans. Pentamidine serves as the exemplar for an extensive collection of newly synthesized related compounds, which have reduced toxicity and a wider range of target organisms. Assays of pentamidine and related compounds have depended on HPLC-tandem mass spectrometry (HPLC-TMS) for the quantitation and identification of drug and metabolites. Immunoassays for pentamidine would have many advantages over the HPLC methods including relative simplicity of assay format and required equipment, convenience in sample preparation and reduction in time and cost of assays. In this report we describe a simple ELISA based immunoassay for pentamidine and pentamidine-like drugs with requisite sensitivity and specificity for use as a clinical assay (EC50 value of about 50 nanomolar). Immunogen was synthesized by coupling the hapten aminopentamidine to ovalbumin (chemically modified to provide an optimal number of -SH groups) using sulfo-MBS. Maleic-anhydride activated ELISA plates were covalently sensitized using the aminopentamidine hapten and used in an inhibitory ELISA assay format whereby the ability of analyte to suppress antibody binding to sensitized plate was measured. The assay detects primarily the phenolic amidine of pentamidine when in a para position and hence can also detect structurally related derivatives of pentamidine of potential interest as new therapeutic agents.