Trypanosomatid parasites, translational research in a One Health, One World environment

Adequate policies to achieve universal access to high-quality diagnostics and therapeutics in the challenge represented by Trypanosomatidae-borne diseases remain essential to command surveillance as a successful tool and a way to delay the unavoidable surge of resistance toward the currently used drugs. In the case of leishmaniasis, even for uncomplicated cutaneous leishmaniasis, most patients in endemic regions are treated with systemic therapies due to reasons such as local protocol misalignment, limited access to new technologies, and lesions being located in anatomical areas other than the face or near the joints. These facts constitute a challenge for rural patients, especially in endemic areas, with limited access to medical facilities and compromising treatment adherence and clinical follow-up, thus increasing the evolution of treatment failure. In pharmacological-pharmaceutical terms, this means that there is an urgent need to minimize the rate of drug attrition and maximize the potential for success. For example, in silico computational chemistry data with no inclusion of in vitro or experimental data can produce more difficulties than advantages. The main reason is that the disparity between computational estimates and in vitro/in vivo studies may result in data that cycle within a never-ending loop, causing, despite enormous efforts, no great advance in producing novel compounds against parasites to treat the diseases. Thus, while considerable progress has been made in diagnosis, prevention, and treatment of Trypanosomatidae-transmitted diseases, significant challenges remain in the effort to develop new drugs in a One Health, One World environment. The consequence is high failure rates worldwide, a challenge we should all overcome to improve the outcome for a new drug portfolio.