title: Geographical Distribution of MDR1 Expression in Leishmania Isolates, from Greece and Cyprus, Measured by the Rhodamine-123 Efflux Potential of the Isolates, Using Flow Cytometry.
abstract: Leishmaniasis, a neglected vector-borne disease caused by the protozoan parasite Leishmania, is encountered in 98 countries causing serious concerns to public health. The most alarming is the development of parasite drug resistance, a phenomenon increasingly encountered in the field rendering chemotherapy ineffective. Although resistance to drugs is a complex phenomenon, the rate of efflux of the fluorescent dye Rhodamine-123 from the parasite body, using flow cytometry, is an indication of the isolate's ability to efflux the drug, thus avoiding death. The rate of efflux measured 275 Leishmania strains, isolated from patients and dogs from Greece and Cyprus, was measured and mapped to study the geographical distribution of the multidrug resistance (MDR) gene expression as an indication of the drug resistance of the parasite. The map showed that out of the seven prefectures, where dogs presented high efflux rates, five also had patients with high efflux rates. In one, out of the 59 prefectures studied, the highest number of isolates with efflux slope α > 1, in both human and dog isolates, was found; a fact which may suggest that spread of drug resistance is taking place. The virulence of the Leishmania strains, assessed after infecting human macrophages of the THP-1 cell line, fluctuated from 1% to 59.3% with only 2.5% of the isolates showing infectivity > 50%. The most virulent strains were isolated from Attica and Crete.
authors.affiliation: Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, Faculty of Medicine, University of Crete, Crete, Greece; Veterinary Services of Cyprus, Nicosia, Cyprus; Veterinary Services of Lasithi prefecture, Crete, Greece; Laboratory of Flow Cytometry, Faculty of Medicine, University of Crete, Crete, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsirigotakis
authors.affiliation: Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, Faculty of Medicine, University of Crete, Crete, Greece; Veterinary Services of Cyprus, Nicosia, Cyprus; Veterinary Services of Lasithi prefecture, Crete, Greece; Laboratory of Flow Cytometry, Faculty of Medicine, University of Crete, Crete, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Christodoulou
authors.affiliation: Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, Faculty of Medicine, University of Crete, Crete, Greece; Veterinary Services of Cyprus, Nicosia, Cyprus; Veterinary Services of Lasithi prefecture, Crete, Greece; Laboratory of Flow Cytometry, Faculty of Medicine, University of Crete, Crete, Greece.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Ntais
authors.affiliation: Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, Faculty of Medicine, University of Crete, Crete, Greece; Veterinary Services of Cyprus, Nicosia, Cyprus; Veterinary Services of Lasithi prefecture, Crete, Greece; Laboratory of Flow Cytometry, Faculty of Medicine, University of Crete, Crete, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Mazeris
authors.affiliation: Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, Faculty of Medicine, University of Crete, Crete, Greece; Veterinary Services of Cyprus, Nicosia, Cyprus; Veterinary Services of Lasithi prefecture, Crete, Greece; Laboratory of Flow Cytometry, Faculty of Medicine, University of Crete, Crete, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Koutala
authors.affiliation: Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, Faculty of Medicine, University of Crete, Crete, Greece; Veterinary Services of Cyprus, Nicosia, Cyprus; Veterinary Services of Lasithi prefecture, Crete, Greece; Laboratory of Flow Cytometry, Faculty of Medicine, University of Crete, Crete, Greece.
authors.forename: Ippokratis
authors.initials: I
authors.lastname: Messaritakis
authors.affiliation: Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, Faculty of Medicine, University of Crete, Crete, Greece; Veterinary Services of Cyprus, Nicosia, Cyprus; Veterinary Services of Lasithi prefecture, Crete, Greece; Laboratory of Flow Cytometry, Faculty of Medicine, University of Crete, Crete, Greece antoniou@med.uoc.gr.
authors.forename: Maria
authors.initials: M
authors.lastname: Antoniou
mesh_terms: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000235:genetics / Q000378:metabolism*; D000818:Animals; D002460:Cell Line; D003535:Cyprus / Q000453:epidemiology; D004283:Dog Diseases / Q000453:epidemiology / Q000469:parasitology*; D004285:Dogs; D005434:Flow Cytometry; D005786:Gene Expression Regulation / Q000502:physiology*; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007891:Leishmania / Q000378:metabolism*; D007896:Leishmaniasis / Q000469:parasitology / Q000662:veterinary*; D008264:Macrophages / Q000469:parasitology; D058069:Neglected Diseases; D020112:Rhodamine 123 / Q000378:metabolism*; D014774:Virulence
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D020112:Rhodamine 123