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AFFLICTED A young Sudanese boy with visceral leishmaniasis. A. CRUMP, TDR, WHO/SCIENCE PHOTO LIBRARY |
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Although the mechanism of antimony toxicity to the parasite remained unclear, several therapeutic agents have been developed. In the early years, mainly trivalent antimony had been applied, which showed a nice ability to kill the parasite but unfortunately also to kill the human host. So the antimony was switched to the pentavalent oxidation state in the 1950s, resulting in much lower toxicity. Nowadays, mainly sodium stibogluconate (pentostam) and meglumine antimonite (glucantime) are used.
In the past decade, health officials noted that the disease was becoming resistant to antimony treatment. That led to increased efforts for the development of new therapeutic agents and the understanding of their mode of action. New techniques--both on the biomedical and on the chemical side--were developed for cell samples. Scientists succeeded in cultivating the parasite cells, the amastigotes, on media, giving the opportunity for direct investigation of antimony toxicity on them.
Meanwhile, in analytical chemistry, advances were being made in the field of speciation analysis, which deals with different oxidation states and the chemical bindings of metals and metalloids. Ideally, the conformation of the chemical compounds can directly be determined. Although there are numerous problems--for example, the stability of the compounds, the low concentrations of the species, and insufficient separation--much progress has been made in the past few years. It has been possible to differentiate between trivalent and pentavalent antimony in cell samples. In addition, the formation of chemical bindings between organic compounds in the cells, such as enzymes or proteins, and antimony has been observed.
The chemical analysis led to these results for the biological processes: The pentavalent antimony is reduced in the amastigote cells to the trivalent oxidation state. Afterward, the trivalent antimony takes effect on the parasite. The antimony resistance of some strains of the leishmaniasis parasite is possibly caused by the inability of these cells to effect the reduction, thereby interrupting the chemical reactions. In addition, some cell groups show a reduced antimony uptake or accelerated antimony excretion.
Speciation analysis in combination with biomedical experiments has helped explain much about the biochemistry of antimony in leishmaniasis. But much more research is needed before the mode of action of antimony in the parasite is fully understood. This knowledge then might be used as a basis for the development of new therapeutic agents that are more toxic to the parasites and cause fewer side effects.
Nina Ulrich is a professor of inorganic chemistry at the Institute of Inorganic Chemistry, University of Hannover, Germany.
Chemical & Engineering News
Copyright © 2003 American Chemical Society