Differences in the Cellular Immune Response during and after Treatment of Sudanese Patients with Post-kala-azar Dermal Leishmaniasis, and Possible Implications for Outcome.

Autor: Torres A; WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III (ISCIII), Majadahonda (Madrid), Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain., Younis BM; Department of Clinical Pathology & Immunology, Institute for Endemic Diseases, University of Khartoum, Khartoum, Sudan., Alamin M; Department of Clinical Pathology & Immunology, Institute for Endemic Diseases, University of Khartoum, Khartoum, Sudan., Tesema S; Drugs for Neglected Diseases Initiative, Nairobi, Kenya., Bernardo L; WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III (ISCIII), Majadahonda (Madrid), Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain., Solana JC; WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III (ISCIII), Majadahonda (Madrid), Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain., Moreno J; WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III (ISCIII), Majadahonda (Madrid), Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain., Mustafa AA; Department of Clinical Pathology & Immunology, Institute for Endemic Diseases, University of Khartoum, Khartoum, Sudan., Alves F; Drugs for Neglected Diseases Initiative, Geneva, Switzerland., Musa AM; Department of Clinical Pathology & Immunology, Institute for Endemic Diseases, University of Khartoum, Khartoum, Sudan. amusa@iend.org., Carrillo E; WHO Collaborating Centre for Leishmaniasis, Spanish National Center for Microbiology, Instituto de Salud Carlos III (ISCIII), Majadahonda (Madrid), Spain. ecarrillo@isciii.es.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain. ecarrillo@isciii.es.
Jazyk: angličtina
Zdroj: Journal of epidemiology and global health [J Epidemiol Glob Health] 2024 Sep; Vol. 14 (3), pp. 1167-1179. Date of Electronic Publication: 2024 Jul 15.
DOI: 10.1007/s44197-024-00270-0
Abstrakt: Background: The host cellular immune response associated with two treatments for post-kala-azar dermal leishmaniasis (PKDL) - paromomycin plus miltefosine (Arm 1), and liposomal amphotericin B plus miltefosine (Arm 2) - was examined in Sudanese patients before treatment (D0), at the end of treatment (D42), and during the post-treatment period (D180).
Methods: Whole blood samples were stimulated with soluble Leishmania antigen for 24 h (whole blood assay [WBA]) and the concentrations of Th1/Th2/Th17-associated cytokines, IP-10, PDL-1 and granzyme B were determined.
Results: The Arm 1 treatment (98.2% cure rate) induced a Th1/Th2/Th17 response, while the Arm 2 treatment (80% cure rate) induced a Th1/Th2 response. Five Arm 2 patients relapsed and showed lower IFN-γ, TNF and IL-1β concentrations at D0 than non-relapsers in this Arm. In patients with low-IFN-γ-production at D0, Arm 1 treatment led to a better host immune response and clinical outcome than Arm 2 treatment.
Conclusions: A Th1/Th2/Th17 response was associated with a higher cure rate. Patients with low IFN-γ, TNF and IL-1β before treatment are more likely to relapse if they undergo Arm 2-type treatment. Determining IFN-γ, TNF and IL-10 levels prior to treatment could help predict patients at higher risk of relapse/recovery from PKDL.
Trial Registration: ClinicalTrials.gov NCT03399955, Registered 17 January 2018, https://clinicaltrials.gov/study/ NCT03399955.
(© 2024. The Author(s).)
Databáze: MEDLINE
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