title: Delivery of antihuman African trypanosomiasis drugs across the blood-brain and blood-CSF barriers.
abstract: Human African trypanosomiasis (HAT or sleeping sickness) is a potentially fatal disease caused by the parasite, Trypanosoma brucei sp. The parasites are transmitted by the bite of insect vectors belonging to the genus Glossina (tsetse flies) and display a life cycle strategy that is equally spread between human and insect hosts. T.b. gambiense is found in western and central Africa whereas, T.b. rhodesiense is found in eastern and southern Africa. The disease has two clinical stages: a blood stage after the bite of an infected tsetse fly, followed by a central nervous system (CNS) stage where the parasite penetrates the brain; causing death if left untreated. The blood-brain barrier (BBB) makes the CNS stage difficult to treat because it prevents 98% of all known compounds from entering the brain, including some anti-HAT drugs. Those that do enter the brain are toxic compounds in their own right and have serious side effects. There are only a few drugs available to treat HAT and those that do are stage specific. This review summarizes the incidence, diagnosis, and treatment of HAT and provides a close examination of the BBB transport of anti-HAT drugs and an overview of the latest drugs in development.
authors.affiliation: King's College London, Institute of Pharmaceutical Sciences, London, United Kingdom.
authors.forename: Gayathri N
authors.initials: GN
authors.lastname: Sekhar
authors.affiliation: King's College London, Institute of Pharmaceutical Sciences, London, United Kingdom.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Watson
authors.affiliation: King's College London, Institute of Pharmaceutical Sciences, London, United Kingdom.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Fidanboylu
authors.affiliation: King's College London, Institute of Pharmaceutical Sciences, London, United Kingdom.
authors.forename: Lisa
authors.initials: L
authors.lastname: Sanderson
authors.affiliation: King's College London, Institute of Pharmaceutical Sciences, London, United Kingdom. Electronic address: sarah.thomas@kcl.ac.uk.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Thomas
mesh_terms: D000818:Animals; D001812:Blood-Brain Barrier / Q000378:metabolism*; D002555:Cerebrospinal Fluid / Q000378:metabolism*; D006801:Humans; D014344:Trypanocidal Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D014347:Trypanosoma brucei gambiense; D016833:Trypanosoma brucei rhodesiense; D014353:Trypanosomiasis, African / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism*; D014370:Tsetse Flies / Q000469:parasitology
chemical_list: D014344:Trypanocidal Agents
keywords: Blood–brain barrier; Breast cancer resistance protein; Eflornithine; Human African trypanosomiasis; Melarsoprol; Multidrug resistance-associated protein; Nifurtumox; P-glycoprotein; Pentamidine; Suramin