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Leishmaniasis is a vector-borne disease that is caused by obligate intra-macrophage protozoa of the Leishmania
species. Leishmaniasis can cause different clinical syndromes, including Cutaneous Leishmaniasis (CL) in
which the patient generally presents with one or several ulcer(s) or nodule(s) on the skin, resulting from the
infection of phagocytic cells located in the dermis. It often results into severe scar tissue in the skin. Most of
the twelve million people infected with Leishmania worldwide are CL cases, a 1.5 million new cases occur
annually. WHO has a program to develop new treatments for cutaneous leishmaniasis. This study establishes
a proof-of-concept that a tattoo device can target intra-dermal drug delivery against Cutaneous Leishmaniasis
(CL). The selected drug is Oleylphosphocholine (OlPC) formulated as liposomes, particles known to be prone
to macrophage ingestion. First is shown that treatment of cultured Leishmania-infected macrophages with
OlPC-liposomes results in a direct dose-dependent killing of intracellular parasites. Based on this, in vivo
efficacy is demonstrated using a 10-day tattooing-mediated treatment in mice infected with L. major and
L. mexicana. In both models this regimen results in rapid clinical recovery with complete regression of skin
lesions by Day 28. Parasite counts and histopathology examination confirm high treatment efficacy at the
parasitic level. Low amount of drug required for tattooing combined with fast clinical recovery may have a
positive impact on CL patient management. This first example of tattoo-mediated drug delivery could open to
new therapeutic interventions in the treatment of skin diseases. This study demonstrates that the use of a tattoo
instrument for drug delivery is possible in the treatment of cutaneous leishmaniasis and that this method
can successfully eliminate intracellular parasites at the site of infection. After showing that the selected drug
Oleylphosphocholine (OlPC) formulated as liposomes could efficiently reach intracellular parasites when in
contact with infected macrophages, the activity of the drug was compared in vivo in mouse models of old (L.
major) and new world (L. mexicana) leishmaniasis. Three routes of administrations of the same drug formulation
were investigated: Systemic (IP) administration, topical administration as a drop and administration via
the tattoo instrument. Evaluation parameters included clinical (lesion sizes) and parasitological parameters
(burdens) using quantitative and qualitative methods. In all experiments, the tattooing delivery procedure was
the most efficacious at both the clinical and parasitological levels.
Biography
Stef Stienstra has been working internationally for several medical and biotech companies as Scientific Advisory Board Member and is also an active Reserve-Officer of the Royal Dutch Navy in his rank as Commander (OF4). He is a Visiting Professor for the University of Rome Tor Vergata in Italy and Lecturer for the NATO School in Oberammergau in Germany.