RESUMEN
Eighteen patients received 1,250 mg of allopurinol riboside (AR) four times daily for 28 d. Nine of the patients concurrently received 500 mg probenecid (PB) four times daily. Cure was assessed clinically and parasitologically. Patients who had culture-positive and nonhealing lesions 3 mo after therapy received pentavalent antimony. Of the nine patients who received AR alone, four (44%) had clinical improvement at the end of therapy and two (22%) were culture-negative. A third patient became culture negative at 2 mo after therapy. The culture-negative patients were completely healed at 1 mo and remained so at 1 y after therapy. Of the nine patients who received AR plus PB, four had complete healing and two had clinical improvement at the end of therapy; however, all patients remained culture-positive. At 2-3 mo after therapy, six (67%) of the patients were completely healed, and of these, five (56%) were culture-negative. The drug was well-tolerated.
Asunto(s)
Alopurinol/análogos & derivados , Antiprotozoarios/uso terapéutico , Leishmaniasis/tratamiento farmacológico , Ribonucleósidos/uso terapéutico , Adulto , Alopurinol/farmacología , Alopurinol/uso terapéutico , Animales , Antiprotozoarios/farmacología , Biopsia , Ensayos Clínicos como Asunto , Quimioterapia Combinada , Humanos , Leishmania braziliensis/efectos de los fármacos , Masculino , Persona de Mediana Edad , Probenecid/farmacología , Probenecid/uso terapéutico , Ribonucleósidos/farmacología , Piel/parasitologíaRESUMEN
Leishmania donovani and Leishmania braziliensis grown in culture formed millimolar concentrations of allopurinol ribonucleoside 5'-monophosphate from [6-14C]allopurinol. In addition, allopurinol 1-ribonucleoside, oxipurinol riboside 5'-monophosphate, and three new metabolites of allopurinol, namely, 4-aminopyrazolo(3,4-d)pyrimidine ribonucleoside 5'-monophosphate and the corresponding di- and triphosphates (1-ribosyl 4-aminopyrazolo(3,4-d)pyrimidine 5'-diphosphate and 1-ribosyl 4-aminopyrazolo(3,4-d)pyrimidine 5'-triphosphate) were identified in the parasitic cells. They were formed via a unique amination reaction from 1-ribosyl allopurinol 5'-phosphate, analogous to the conversion of IMP to AMP. [6-14C]Allopurinol was incorporated into RNA of L. donovani in the form of 4-aminopyrazolo(3,4-d)pyrimidine. Adenine reversed the growth inhibition of allopurinol and prevented its metabolism to all of the ribonucleotide metabolites. L. donovani was 2- to 4-fold more active in its metabolism of allopurinol to ribonucleotides than L. braziliensis. 4-Aminopyrazolo(3,4-d)pyrimidine inhibited cell growth and resulted in high intracellular levels of 1-ribosyl allopurinol 5'-phosphate and smaller amounts of the 4-aminopyrazolo(3,4-d)pyrimidine ribonucleotides. The metabolism of allopurinol to 4-aminopyrazolo(3,4-d)pyrimidine ribonucleotides and its resultant cytotoxicity occurs in these parasitic protozoans, but not in mammalian cells.
Asunto(s)
Adenina/análogos & derivados , Alopurinol/metabolismo , Leishmania/metabolismo , Oxipurinol/metabolismo , Pirimidinas/metabolismo , Adenina/metabolismo , Cromatografía Líquida de Alta Presión , Ribonucleósidos/metabolismo , Ribonucleótidos/metabolismo , Especificidad de la EspecieRESUMEN
We have studied purine metabolism in the culture forms of Leishmania donovani and Leishmania braziliensis. These organisms are incapable of synthesizing purines de novo from glycine, serine, or formate and require an exogenous purine for growth. This requirement is better satisfied by adenosine or hypoxanthine than by guanosine. Both adenine and inosine are converted to a common intermediate, hypoxanthine, before transformation to nucleotides. This is due to the activity of an adenine aminohydrolase ((EC 3.5.4.2), a rather unusual finding in a eukaryotic cell. There is a preferential synthesis of adenine nucleotides, even when guanine or xanthine are used as precursors. The pathways of purine nucleotide interconversions in these Leishmania resemble those found in mammalian cells except for the absence of de novo purine biosynthesis and the presence of an adenine-deaminating activiting.