Artemisinin and Leishmaniasis: Insights into Therapeutic Applications

BACKGROUND AND OBJECTIVESLeishmaniasis, a chronic disease, has afflicted over ۱۲ million individuals across ۹۸ nations, predominantly within tropical zones. The ailment arises from flagellated protozoa within the Leishmania genus, encompassing more than twenty distinct species. These obligate intracellular parasites propagate via mosquito bites. Artemisinin (art), a sesquiterpene possessing an endoperoxide moiety sourced from Artemisia annua, stands out for its remarkable effectiveness and minimal toxicity, positioning it as the primary therapeutic agent against parasitic diseases. Therefore, this study delves into Artemisinin's efficacy as a treatment modality for leishmaniasis.MATERIALS AND METHODSIn this review study, we investigate English articles from online databases, including PubMed, Scopus, ProQuest, Web of Science, and Google Scholar using “artemisinin”, “Treatment”, and “leishmania” keywords, spanning ۲۰۱۹ to ۲۰۲۳.RESULTS AND DISCUSSIONLow-temperature electron paramagnetic resonance (EPR) spectroscopy of Leishmania revealed that Art changes the redox state of the sensitive iron pool less than ascaridol EP, questioning its role as a major activator of Atr in Leishmania. By inductively coupled plasma methods (ICP-OES, ICP-MS) it was found that these inhibitors do not block iron (heme) accumulation, but are absorbed and act in Leishmania. These inhibitors blocked the conversion of hemin to bilirubin in Leishmania homogenates, indicating that HO-like enzyme activity exists in Leishmania. NADPH-dependent degradation of Art and hemin was highest in the small granule and microsomal fraction of Leishmania. EPR spin trapping in the Art/hemin system revealed that NADPH, ascorbate, and cysteine are suitable reductants and ultimately activate Art to acyl-carbon radicals. These findings suggest that it is the main activator of Art in Leishmania, both through HO-like enzymatic activities and/or chemical interaction with Art.CONCLUSIONArtemisinin-based treatment exhibits potential efficacy in counteracting Leishmania's impact on human health. However, substantiating its effectiveness across various leishmaniasis forms necessitates further in vivo experimentation involving artemisinin and subsequent clinical investigations.

Keywords:

Artemisinin , Leishmania , Treatment