allopurinol-riboside and Leishmaniasis

Pentavalent antimony has been considered to be the standard treatment for leishmaniasis, but more recently, the orally administrable agent allopurinol ribonucleoside has been the subject of several clinical trials. In this study, these two agents were evaluated in patients with Ecuadorian cutaneous leishmaniasis. Patients were randomly assigned to the two treatment groups. The mean reduction in lesion size for the 28 patients treated with Pentostam (20 mg Sb/kg/day intramuscularly for 20 days) was 61%, 23%, and 11% after one, two, and three weeks, respectively. There was a wide range in the individual values, and some lesions markedly enlarged in the first week of therapy. An initially healed lesion was defined as one that had greater than 80% re-epithelialized by the 1.5-month post-treatment followup. All Pentostam patients demonstrated this degree of lesion resolution (100% initial healing rate), but one patient showed evidence of relapse at the three month followup resulting in a 96% complete healing rate for the 12 month observation period. Patients in the untreated control group demonstrated a strikingly high rate of healing with 9 of 12 patients having re-epithelialized all lesions after 1.5 months observation (75% initial healing rate). The mean reduction in lesion size for the untreated patients was 56%, 29%, and 25% after one, two, and three weeks, respectively. Twenty-one patients received allopurinol ribonucleoside (1,500 mg QID) plus probenecid (500 mg QID) for 28 days. Lesions in nine of these patients were healed at the time of the 1.5 month followup (41% healing rate).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Allopurinol; Antimony Sodium Gluconate; Antiprotozoal Agents; Ecuador; Humans; Leishmaniasis; Ribonucleosides

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.

Topics: Adult; Allopurinol; Animals; Antiprotozoal Agents; Biopsy; Clinical Trials as Topic; Drug Therapy, Combination; Humans; Leishmania braziliensis; Leishmaniasis; Male; Middle Aged; Probenecid; Ribonucleosides; Skin

Allopurinol and allopurinol ribonucleoside tested in vitro and in vivo for activity against Leishmania donovani. Activity in vitro was low against the amastigote form of this parasite with ED50 values of the order of 54 and 96 microM and 86 and 213 microM respectively for the two compounds. In vivo inhibition of up to 47% was achieved with allopurinol ribonucleoside given in the drinking water. However, low blood levels were found in the mouse relative to those in man. Low in vivo activity was also seen with allopurinol ribonucleoside against L. major and other species of Leishmania causing cutaneous lesions. The metabolism of allopurinol ribonucleoside in aldehyde oxidase deficient mice (inbred strains DBA/1, DBA/2) resembled that of man, but the antileishmanial activity remained low. Other compounds, formycin B, sinefungin and the lepidine WR6026 were highly active against mice infected with L. donovani or L. major.

Topics: Adenosine; Allopurinol; Aminoquinolines; Animals; Antiprotozoal Agents; Cricetinae; Female; Formycins; Leishmania; Leishmaniasis; Leishmaniasis, Visceral; Macrophages; Mice; Mice, Inbred Strains; Ribonucleosides; Thionucleosides

A number of 3,4-disubstituted pyrazolo[3,4-d]pyrimidine ribonucleosides were synthesized and tested for their biological activity. Glycosylation of persilylated as well as nonsilylated 3-bromoallopurinol with 1-O-acetyl-2,3,5-tri-O-benzoyl-D-ribofuranose (4) provided the key intermediate 3-bromo-1-(2,3,5-tri-O-benzoyl-beta-D-ribofuranosyl)-pyrazolo[3,4-d] pyrimidin-4(5H)-one (5a). Similar glycosylations of 3-cyanoallopurinol and 3-(methylthio)allopurinol furnished the corresponding protected N-1 glycosyl derivatives (5b and 5c). Debenzoylation of these nucleosides (5a-c) gave the corresponding 3-bromo-, 3-cyano-, and 3-(methylthio)allopurinol nucleosides (6a-c). The site of glycosylation and anomeric configuration of 6a and 6c were assigned on the basis of spectral studies as well as conversion to allopurinol ribonucleoside, whereas the structural assignment of 6b was made by single-crystal X-ray analysis. Conventional functional group transformation of 5a and 5b provided a number of novel 3-substituted allopurinol nucleosides, which included 10a and 18a-d. Glycosylation of 4-amino-3-bromopyrazolo[3,4-d]pyrimidine (14) with 4 and subsequent debenzoylation gave 3-bromo-4-aminopyrazolo[3,4-d]pyrimidine ribonucleoside (13a) from which 3,4-diamino-1-beta-D-ribofuranosylpyrazolo[3,4-d]pyrimidine (13b) was obtained by amination. Thiation of 5b, followed by deblocking, gave 3-cyanothiopurinol ribonucleoside (20). All of these compounds were tested in vitro against certain viruses, tumor cells, and the parasite Leishmania tropica. Among the 3-substituted allopurinol nucleosides, 18b and 18c showed significant activity against Para 3 virus and were found to be potent inhibitors of growth of L1210 and P388 leukemia. Compound 20 exhibited the most significant broad-spectrum in vitro antiviral and antitumor activity. 3-Bromoallopurinol ribonucleoside (6a) was found to be more active than allopurinol ribonucleoside against Leishmania tropica within human macrophages in vitro.

Topics: Animals; Antineoplastic Agents; Antiviral Agents; Cells, Cultured; Humans; Leishmaniasis; Mice; Pyrimidine Nucleosides; Rats