Recent developments in leishmaniasis.
OBJECTIVE
The leishmaniases, caused by protozoan parasites of the genus Leishmania, are a significant health problem in many regions of the world. This review highlights the recent advances in the study of leishmaniasis related to parasite biology, disease pathogenesis, clinical evaluation and treatment, and prevention.


RESULTS
Genetic heterogeneity and clonal diversity is common among Leishmania strains. Gene knockout, overexpression, and re-introduction studies have identified a number of genes that play a role in parasite virulence. Surprisingly, the importance of the surface lipophosphoglycan in parasite virulence appears to differ among Leishmania spp. Studies in experimental animal models have further defined the roles of CD4 and CD8 T cells, IL-4, IL-10, and IL-12 in the control, maintenance, or progression of disease. The effect of Leishmania on dendritic cells and macrophage effector function has also been an important area of investigation. A number of new vaccine candidates have been identified through experimental animal studies. Clinical studies of leishmaniasis have focused on the host determinants of disease (most notably HIV co-infection), serological and DNA-based diagnostic assays, and treatment. Antimony-resistant cases of cutaneous and visceral leishmaniasis have become more common; liposomal amphotericin and oral miltefosine are promising alternative therapies.


CONCLUSIONS
Significant advances have been made in the areas of pathogenesis, host defence, and treatment of leishmaniasis. A number of new vaccine candidates and potential targets of drug therapy have been identified, but progress from preclinical studies to clinical trials has been slow. Translational research, built upon the solid foundation of existing and ongoing basic investigation, is a high priority.
Melby
Peter C
PC
Medical Service, Department of Veterans Affairs Medical Center, South Texas Veterans Health Care System, USA. melby@uthscsa.edu
D000818:Animals; D006801:Humans; D007891:Leishmania / Q000235:genetics / Q000472:pathogenicity / Q000502:physiology; D007896:Leishmaniasis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D016052:Protozoan Vaccines / Q000276:immunology
D016052:Protozoan Vaccines