Well-Tolerated Amphotericin B Derivatives That Effectively Treat Visceral Leishmaniasis

Chemotherapy against the neglected tropical disease visceral leishmaniasis (VL) is suboptimal with only four licensed drugs. Amphotericin B (AmB), despite its toxicity, remained a second line drug for a long time. However, the demonstration that liposomal AmB is highly effective against VL propelled it, despite its cost, to a first line drug in many countries. While several ongoing efforts are aiming at finding cheaper and stable AmB-formulations, an alternative strategy is the development of less-toxic AmB derivatives. We show here that two less-toxic AmB derivatives with the carboxylate at position 16 of AmB derivatized to a methyl urea (AmB-MU) or amino urea (AmB-AU) are active in vitro against Leishmania donovani, both as free-living parasites as well as their intracellular form. Both less-toxic derivatives, similarly to AmB, target the ergosterol pathway of L. donovani. While the AmB-AU derivative showed female-specific liver toxicity in vivo, the AmB-MU derivative was well-tolerated and more effective than AmB against experimental VL. These studies are an important step for improving AmB-based therapy against a prevalent parasitic disease.

Automated summary

Chemotherapy for visceral leishmaniasis is limited, with liposomal Amphotericin B emerging as a first-line drug in many countries despite its cost. Research is focused on finding cheaper and stable formulations of AmB, as well as developing less-toxic derivatives. Two less-toxic AmB derivatives, particularly AmB-MU, show promising efficacy and tolerability in vitro, making them potential candidates for improving treatment of this prevalent parasitic disease.