Chemotherapy of Chagas disease

In this article we review the current status of chemotherapeutic approaches for the specific treatment of Chagas disease or American Trypanosomiasis, as well as new rational approaches being developed as a consequence on the increased understanding of the biochemistry and physiology of its causative agent, the protozoan parasite Trypanosoma cruzi. Currently available drugs (nitrofurans and nitroimidazoles), developed empirically over three decades ago, are unsatisfactory due to frequent toxic side effects and limited efficacy, particularly in the prevalent chronic form of the disease. Furthermore, studies of their mechanism of action have shown that their antiparasitic activity is inextricably linked to mammalian host toxicity. Recent advances in this field include the demonstration that new triazole derivatives, with selective inhibitory activity on the parasite's de novo sterol biosynthesis and special pharmacokinetic properties, can induce radical parasitological cure of both acute and chronic Chagas experimental disease. These compounds are active against nitrofuran- and nitroimidazole-resistant T.cruzi strains and maintain their activity even if the hosts are immunosuppressed and are thus logical candidates for clinical trials with Chagas disease patients. Inhibitors of cruzipain, a cathepsin L-like protease responsible for the major proteolytic activity in all stages of the life cycle of the parasite, can selectively block the proliferation of T.cruzi, both in vitro and in vivo and have curative activity in murine models of acute Chagas disease; a significant effort is being devoted to their development as antiparasitic drugs. Alkyl-lysophospholipids, which selectively block phosphatidyl-choline biosynthesis in T.cruzi, are promising antiparasitic agents with good oral activity and low toxicity. Other biochemical pathways have been identified as potential chemotherapeutic targets, including hypoxanthine-guanine phosphoribosyl transferase and the enzymes involved in the synthesis and metabolism of trypanothione and inorganic pyrophosphate.