Miltefosine

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Miltefosine
Miltefosine.svg
Systematic (IUPAC) name
2-(hexadecoxy-oxido-phosphoryl)oxyethyl-trimethyl-azanium
Clinical data
AHFS/Drugs.com International Drug Names
Legal status ?
Routes Oral
Pharmacokinetic data
Bioavailability High
Half-life 6 to 8 days and 31 days [1]
Identifiers
CAS number 58066-85-6 N
ATC code L01XX09
PubChem CID 3599
ChemSpider 3473 YesY
UNII 53EY29W7EC YesY
KEGG D02494 YesY
ChEBI CHEBI:75283 N
ChEMBL CHEMBL125 YesY
NIAID ChemDB 130571
Chemical data
Formula C21H46NO4P 
Mol. mass 407.568 g/mol
 N (what is this?)  (verify)

Miltefosine (INN, trade names Impavido and Miltex) is a phospholipid drug. Chemically it is a derivative of alkylphosphocholine compounds discovered in the early 1980s. It was developed in the late 1980s as an anticancer drug by German scientists Hansjörg Eibl and Clemens Unger.[2] Simultaneously but independently it was found that the drug could kill Leishmania parasites, and since the mid-1990s successful clinical trials were conducted. The drug became the first (and still the only prescribed) oral drug in the treatment of leishmaniasis. It is now known to be a broad-spectrum antimicrobial drug, active against pathogenic bacteria and fungi,[1][3] as well as human trematode Schistosoma mansoni and its vector host, the snail Biomphalaria alexandrina.[4] It can be administered orally and topically.

In the target cell, it acts as an Akt inhibitor. Therefore, it is also under investigation as a potential therapy against HIV infection.[5][6]

Medical uses[edit]

Miltefosine is usedfor the treatment of visceral and cutaneous leishmaniasis, and is undergoing clinical trials for this use in several other countries, such as Brazil[7] and Guatemala.[8] Several medical agents have some efficacy against visceral or cutaneous leishmaniasis, however a 2005 survey concluded that miltefosine is the only effective oral treatment for both forms of leishmaniasis.[9]

Side effects[edit]

The main side effects reported with miltefosine treatment are nausea and vomiting, which occur in 60% of patients. Adverse effect is more severe in women and young children. The overall effects are quite mild and easily reverse.[10] It is embryotoxic and fetotoxic in rats and rabbits, and teratogenic in rats but not in rabbits. It is therefore contraindicated for use during pregnancy, and contraception is required beyond the end of treatment in women of child-bearing age.[11]

History[edit]

Phospholipid group alkylphosphocholine were known since the early 1980s, particularly in terms of their binding affinity with cobra venom.[12] In 1987 the phosholids were found to potent toxins on leukemic cell culture.[13] Initial in vivo investigation on the antineoplastic activity showed positive result, but then only at high dosage and at high toxicity.[14] At the same time in Germany, Hansjörg Eibl, at the Max Planck Institute for Biophysical Chemistry, and Clemens Unger, at the University of Göttingen, demonstrated that the antineoplastic activity of the phospholipid analogue miltefosine (at the time known as hexadecylphosphocholine) was indeed tumour-specific. It was highly effective against methylnitrosourea-induced mammary carcinoma, but less so on transplantable mammary carcinomas and autochthonous benzo(a)pyrene-induced sarcomas, and relatively inactive on Walker 256 carcinosarcoma and autochthonous acetoxymethylmethylnitrosamine-induced colonic tumors of rats.[15][16] It was subsequently found that miltefosine was strucrally unique among lipds having anticancer property in that it lacks the glycerol group, is highly selective on cell types and acts through different mechanism.[17][18]

In the same year as the discovery of the acticancer property, miltefosine was reported by S. L. Croft and his team at the London School of Hygiene and Tropical Medicine as having antileishmanial effect as well. The compound was effective against Leishmania donovani amastigotes in cultured mouse peritoneal macrophages at a dose of 12.8 mg/kg/day in a five-day course.[19] However priority was given to the development of the compound for cutaneous metastases of breast cancer. In 1992 a new research was reported in which the compound was highly effective in mouse against different life cycle stages of different Leishmania species, and in fact more potent than the conventional sodium stibogluconate therapy by a factor of more than 600.[20] Results of the first clinical trial in humans were reported from Indian patients with chronic leishmaniasis with high degree of success and safety.[21] This promising development promulgated a unique public–private partnership collaboration between ASTA Medica (later Zentaris GmbH), the WHO Special Programme for Research and Training in Tropical Diseases, and the Government of India. Eventually, several successful Phase II and III trials led to the approval of miltefosine in 2002 as the first and only oral drug for leishmaniasis.[1]

Research[edit]

antiprotozoal and antifungal[edit]

Miltefosine is being investigated by researchers interested in finding treatments for infections which have become resistant to existing drugs. Animal and in vitro studies suggest it may have broad anti-protozoal and anti-fungal properties:

  • An in vitro study found that miltefosine is effective against metronidazole-resistant variants of Trichomonas vaginalis, a sexually transmitted protozoal disease.[24]

HIV[edit]

Miltefosine targets HIV infected macrophages, which play a role in vivo as long-lived HIV-1 reservoirs. The HIV protein Tat activates pro-survival PI3K/Akt pathway in primary human macrophages. Miltefosine acts by inhibiting the PI3K/Akt pathway, thus removing the infected macrophages from circulation, without affecting healthy cells.[5] It significantly reduces replication of HIV-1 in cocultures of human dendritic cells (DCs) and CD4(+) T cells, which is due to a rapid secretion of soluble factors and is associated with induction of type-I interferon (IFN) in the human cells.[28]

References[edit]

  1. ^ a b c Dorlo, T. P. C.; Balasegaram, M.; Beijnen, J. H.; de Vries, P. J. (2012). "Miltefosine: a review of its pharmacology and therapeutic efficacy in the treatment of leishmaniasis". Journal of Antimicrobial Chemotherapy 67 (11): 2576–2597. doi:10.1093/jac/dks275. PMID 22833634. 
  2. ^ Eibl, H; Unger, C (1990 Sep). "Hexadecylphosphocholine: a new and selective antitumor drug.". Cancer Treatment Reviews 17 (2-3): 233–42. PMID 2272038. 
  3. ^ Almeida Pachioni, JD; Magalhães, JG; Cardoso Lima, EJ; Moura Bueno, LD; Barbosa, JF; Malta de Sá, M; Rangel-Yagui, CO (2013). "Alkylphospholipids - a promising class of chemotherapeutic agents with a broad pharmacological spectrum.". Journal of Pharmacy & Pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques 16 (5): 742–59. PMID 24393556. 
  4. ^ Eissa, Maha M; El Bardicy, Samia; Tadros, Menerva (2011). "Bioactivity of miltefosine against aquatic stages of Schistosoma mansoni, Schistosoma haematobium and their snail hosts, supported by scanning electron microscopy". Parasites & Vectors 4 (1): 73. doi:10.1186/1756-3305-4-73. PMC 3114006. PMID 21569375. 
  5. ^ a b Chugh P, Bradel-Tretheway B, Monteiro-Filho CM, et al. (2008). "Akt inhibitors as an HIV-1 infected macrophage-specific anti-viral therapy". Retrovirology 5 (1): 11. doi:10.1186/1742-4690-5-11. PMC 2265748. PMID 18237430. 
  6. ^ "Parasitic Drug Shows HIV-Fighting Promise". AIDSmeds.com. 2008-02-01. Retrieved 2008-02-02. 
  7. ^ Cristina, Márcia; Pedrosa, Robert (September 2005). "Hospital de Doenças Tropicais testa droga contra calazar". Sapiência (in Portuguese) (Fundação de Amparo à Pesquisa do Estado do Piauí). Archived from the original on 2006-08-22. Retrieved 2006-09-01. 
  8. ^ Soto J, Berman J (2006). "Treatment of New World cutaneous leishmaniasis with miltefosine.". Trans R Soc Trop Med Hyg 100: S34. doi:10.1016/j.trstmh.2006.02.022. PMID 16930649. 
  9. ^ Berman, J. (2005). "Clinical status of agents being developed for leishmaniasis". Expert Opinion on Investigational Drugs 14 (11): 1337–1346. doi:10.1517/13543784.14.11.1337. PMID 16255674. 
  10. ^ S.D. Seth (2008). "Drug therapy of leishmaniasis". In S.D. Seth. Textbook of Pharmacology. Elsevier India. p. 31. ISBN 9788131211588. 
  11. ^ Sindermann, H.; Engel, J. (December 2006). "Development of miltefosine as an oral treatment for leishmaniasis". Transactions of the Royal Society of Tropical Medicine and Hygiene 100 (Suppl 1): S17–S20. doi:10.1016/j.trstmh.2006.02.010. PMID 16730362. 
  12. ^ Teshima, K; Ikeda, K; Hamaguchi, K; Hayashi, K (1983). "Bindings of cobra venom phospholipases A2 to micelles of n-hexadecylphosphorylcholine.". Journal of Biochemistry 94 (1): 223–32. PMID 6619110. 
  13. ^ Fleer, EA; Unger, C; Kim, DJ; Eibl, H (1987). "Metabolism of ether phospholipids and analogs in neoplastic cells.". Lipids 22 (11): 856–61. PMID 3444378. 
  14. ^ Berger, MR; Petru, E; Schmähl, D (1987). "Therapeutic ratio of mono or combination bacterial lipopolysaccharide therapy in methylnitrosourea-induced rat mammary carcinoma.". Journal of Cancer Research and Clinical Oncology 113 (5): 437–45. PMID 3624299. 
  15. ^ Muschiol, C; Berger, MR; Schuler, B; Scherf, HR; Garzon, FT; Zeller, WJ; Unger, C; Eibl, HJ; Schmähl, D (1987). "Alkyl phosphocholines: toxicity and anticancer properties.". Lipids 22 (11): 930–4. PMID 3444388. 
  16. ^ Berger, MR; Muschiol, C; Schmähl, D; Eibl, HJ (1987). "New cytostatics with experimentally different toxic profiles.". Cancer treatment Reviews 14 (3-4): 307–17. PMID 3440252. 
  17. ^ Hilgard, P; Stekar, J; Voegeli, R; Engel, J; Schumacher, W; Eibl, H; Unger, C; Berger, MR (1988). "Characterization of the antitumor activity of hexadecylphosphocholine (D 18506).". European Journal of Cancer & Clinical Oncology 24 (9): 1457–61. PMID 3141197. 
  18. ^ Eibl, H; Unger, C (1990 Sep). "Hexadecylphosphocholine: a new and selective antitumor drug.". Cancer Treatment Reviews 17 (2-3): 233–42. PMID 2272038. 
  19. ^ Croft, S.L.; Neal, R.A.; Pendergast, W.; Chan, J.H. (1987). "The activity of alkyl phosphorylcholines and related derivatives against Leishmania donovani". Biochemical Pharmacology 36 (16): 2633–2636. doi:10.1016/0006-2952(87)90543-0. 
  20. ^ Kuhlencord, A; Maniera, T; Eibl, H; Unger, C (1992). "Hexadecylphosphocholine: oral treatment of visceral leishmaniasis in mice.". Antimicrobial Agents and Chemotherapy 36 (8): 1630–1634. doi:10.1128/AAC.36.8.1630. PMC 192021. PMID 1329624. 
  21. ^ Sundar, Shyam; Rosenkaimer, Frank; Makharia, Manoj K; Goyal, Ashish K; Mandal, Ashim K; Voss, Andreas; Hilgard, Peter; Murray, Henry W (1998). "Trial of oral miltefosine for visceral leishmaniasis". The Lancet 352 (9143): 1821–1823. doi:10.1016/S0140-6736(98)04367-0. PMID 9851383. 
  22. ^ Saraiva V, Gibaldi D, Previato J, Mendonça-Previato L, Bozza M, Freire-De-Lima C, Heise N (2002). "Proinflammatory and cytotoxic effects of hexadecylphosphocholine (miltefosine) against drug-resistant strains of Trypanosoma cruzi.". Antimicrob Agents Chemother 46 (11): 3472–7. doi:10.1128/AAC.46.11.3472-3477.2002. PMC 128733. PMID 12384352. 
  23. ^ Widmer F, Wright L, Obando D, Handke R, Ganendren R, Ellis D, Sorrell T (2006). "Hexadecylphosphocholine (miltefosine) has broad-spectrum fungicidal activity and is efficacious in a mouse model of cryptococcosis.". Antimicrob Agents Chemother 50 (2): 414–21. doi:10.1128/AAC.50.2.414-421.2006. PMC 1366877. PMID 16436691. 
  24. ^ Blaha C, Duchêne M, Aspöck H, Walochnik J (2006). "In vitro activity of hexadecylphosphocholine (miltefosine) against metronidazole-resistant and -susceptible strains of Trichomonas vaginalis". J. Antimicrob. Chemother. 57 (2): 273–8. doi:10.1093/jac/dki417. PMID 16344287. 
  25. ^ Choubey V, Maity P, Guha M, et al. (February 2007). "Inhibition of Plasmodium falciparum choline kinase by hexadecyltrimethylammonium bromide: a possible antimalarial mechanism". Antimicrob. Agents Chemother. 51 (2): 696–706. doi:10.1128/AAC.00919-06. PMC 1797733. PMID 17145794. 
  26. ^ Naegleria fowleri - Primary Amebic Meningoencephalitis (PAM)
  27. ^ Brain-Eating Amoeba: How One Girl Survived
  28. ^ Garg, Ravendra; Tremblay, Michel J. (October 2012). "Miltefosine represses HIV-1 replication in human dendritic cell/T-cell cocultures partially by inducing secretion of type-I interferon". Virology 432 (2): 271–276. doi:10.1016/j.virol.2012.05.032. PMID 22704066. 

External links[edit]