Benznidazole/Itraconazole Combination Treatment Enhances Anti-Trypanosoma cruzi Activity in Experimental Chagas Disease

PLoS One. 2015 Jun 15;10(6):e0128707. doi: 10.1371/journal.pone.0128707. eCollection 2015.

Abstract

The nitroheterocyclic drugs nifurtimox and benznidazole are first-line drugs available to treat Chagas disease; however, they have limitations, including long treatment courses and toxicity. Strategies to overcome these limitations include the identification of new drugs with specific target profiles, re-dosing regimens for the current drugs, drug repositioning and combination therapy. In this work, we evaluated combination therapy as an approach for optimization of the current therapeutic regimen for Chagas disease. The curative action of benznidazole/itraconazole combinations was explored in an established infection of the mice model with the T. cruzi Y strain. The activities of the benznidazole/itraconazole combinations were compared with the results from those receiving the same dosage of each individual drug. The administration of benznidazole/itraconazole in combination eliminated parasites from the blood more efficiently than each drug alone. Here, there was a significant reduction of the number of treatment days (number of doses) necessary to induce parasitemia suppression with the benznidazole/itraconazole combination, as compared to each compound administered alone. These results clearly indicate the enhanced effects of these drugs in combination, particularly at the dose of 75 mg/kg, as the effects observed with the drug combinations were four times more effective than those of each drug used alone. Moreover, benznidazole/itraconazole treatment was shown to prevent or decrease the typical lesions associated with chronic experimental Chagas disease, as illustrated by similar levels of inflammatory cells and fibrosis in the cardiac muscle tissue of healthy and treated mice. These results emphasize the importance of exploring the potential of combination treatments with currently available compounds to specifically treat Chagas disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antibodies, Protozoan / immunology
  • Chagas Disease / drug therapy
  • Chagas Disease / immunology
  • Chagas Disease / parasitology*
  • Chagas Disease / pathology
  • Disease Models, Animal
  • Drug Therapy, Combination
  • Female
  • Immunoglobulin G / immunology
  • Itraconazole / administration & dosage
  • Itraconazole / pharmacology*
  • Mice
  • Myocardium / pathology
  • Nitroimidazoles / administration & dosage
  • Nitroimidazoles / pharmacology*
  • Parasite Load
  • Trypanocidal Agents / administration & dosage
  • Trypanocidal Agents / pharmacology*
  • Trypanosoma cruzi / drug effects*
  • Trypanosoma cruzi / immunology

Substances

  • Antibodies, Protozoan
  • Immunoglobulin G
  • Nitroimidazoles
  • Trypanocidal Agents
  • Itraconazole
  • benzonidazole

Grants and funding

This work received financial support from the Drugs for Neglected Diseases initiative (DNDi; Geneva, Switzerland); Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG); Universidade Federal de Ouro Preto (UFOP); Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and research fellowships from CNPq (MTB) and CAPES (LFD). DNDi would like to thank the following donors for their support: Department for International Development (DFID), UK; Médecins Sans Frontières/Doctors without Borders (MSF), International; Spanish Agency for International Development Cooperation (AECID), Spain; Swiss Agency for Development and Cooperation (SDC), Switzerland. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.