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The Rationale for Use of Amiodarone and its Derivatives for the Treatment of Chagas’ Disease and Leishmaniasis

Author(s):

Gustavo Benaim*, Alberto E. Paniz-Mondolfi and Emilia Mia Sordillo   Pages 1 - 9 ( 9 )

Abstract:


The repurposing or repositioning of previously-approved drugs has become an accepted strategy for expansion of the pharmacopeia for neglected diseases. Accordingly, amiodarone, an inexpensive and extensively-used class III antiarrhythmic has been proposed as a treatment for Chagas’ disease and leishmaniasis. Amiodarone has a potent trypanocidal and leishmanicidal action, mainly acting through the disruption of parasite intracellular Ca2+ homeostasis, which is a recognized target of different drugs that have activity against trypanosomatids. Amiodarone collapses the mitochondrial electrochemical potential (Δφm) and induces the rapid alkalinization of parasite acidocalcisomes, driving a large increase in the intracellular Ca2+ concentration. Amiodarone also inhibits oxidosqualene cyclase activity, a key enzyme in the ergosterol synthesis pathway that is essential for trypanosomatid survival. In combination, these three effects lead to parasite death. Dronedarone, a drug synthesized with the objective of minimizing some of the adverse effects of amiodarone, displays trypanocidal and leishmanicidal activity through the same mechanisms, but curiously, being more potent on Leishmaniasis than its predecessor. In vitro studies suggest that other recently-synthesized benzofuran derivatives can act through the same mechanisms, and produce similar effects on different trypanosomatid species. Recently, the combination of amiodarone plus itraconazole, has been used successfully to treat 121 dogs naturally-infected by T. cruzi, strongly supporting the potential therapeutic use of this combination against human trypanosomatid infections.

Keywords:

Amiodarone, Dronedarone, Benzofuran derivatives, Calcium, Trypanosoma cruzi, Chagas disease, Leishmaniasis

Affiliation:

Instituto de Estudios Avanzados, Caracas, Instituto de Estudios Avanzados, Caracas, Institute for Health Sciences, Mount Sinai St Luke’s & Mount Sinai West, New York



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