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In Vivo Experiments Demonstrate the Potent Antileishmanial Efficacy of Repurposed Suramin in Visceral Leishmaniasis

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In Vivo Experiments Demonstrate the Potent Antileishmanial Efficacy of Repurposed Suramin in Visceral Leishmaniasis PLOS NEGLECTED TROPICAL DISEASES RESEARCH ARTICLE In vivo experiments demonstrate the potent antileishmanial efficacy of repurposed suramin in visceral leishmaniasis Supriya Khanra1, Subir Kumar Juin2, Junaid Jibran Jawed3, Sweta Ghosh2, 4 5 6 4 Shreyasi Dutta , Shaik Abdul Nabi , Jyotirmayee DashID , Dipak Dasgupta , 2 1,7 Subrata Majumdar *, Rahul BanerjeeID * 1 Crystallography and Molecular Biology Division, Saha Institute of Nuclear Physics, Bidhannagar, Kolkata India, 2 Division of Molecular Medicine, Bose Institute, Kolkata, India, 3 School of Biotechnology, Department of Life Sciences, Presidency University-New Campus, Kolkata, India, 4 Biophysics and a1111111111 Structural Genomics Division, Saha Institute of Nuclear Physics, Bidhannagar, Kolkata, India, 5 Department a1111111111 of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, Kolkata, India, a1111111111 6 Department of Organic Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata, a1111111111 India, 7 Homi Bhabha National Institute, Anushakti Nagar, Mumbai, India a1111111111 * subrata@jcbose.ac.in (SM); rahul.banerjee@saha.ac.in (RB) Abstract OPEN ACCESS Citation: Khanra S, Juin SK, Jawed JJ, Ghosh S, Dutta S, Nabi SA, et al. (2020) In vivo experiments Background demonstrate the potent antileishmanial efficacy of Treatment failure and resistance to the commonly used drugs remains a major obstacle for repurposed suramin in visceral leishmaniasis. PLoS Negl Trop Dis 14(8): e0008575. https://doi. successful chemotherapy against visceral leishmaniasis (VL). Since the development of org/10.1371/journal.pntd.0008575 novel therapeutics involves exorbitant costs, the effectiveness of the currently available anti- Editor: Abhay R. Satoskar, Ohio State University, trypanosomatid drug suramin has been investigated as an antileishmanial, specifically for UNITED STATES VL,in vitro and in animal model experiments. Received: November 19, 2019 Methodology/Principal Accepted: July 7, 2020 Leishmania donovani promastigotes were treated with suramin and studies were performed Published: August 31, 2020 to determine the extent and mode of cell mortality, cell cycle arrest and other in vitro parame- Copyright: 2020 Khanra et al. This is an open © ters. In addition, L. donovani infected BALB/c mice were administered suramin and a host of access article distributed under the terms of the Creative Commons Attribution License, which immunological parameters determined to estimate the antileishmanial potency of the drug. permits unrestricted use, distribution, and Finally, isothermal titration calorimetry (ITC) and enzymatic assays were used to probe the reproduction in any medium, provided the original interaction of the drug with one of its putative targets namely parasitic phosphoglycerate author and source are credited. kinase (LmPGK). Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Findings Funding: The work reported in the manuscript has The in vitro studies revealed the potential efficacy of suramin against the Leishmania para- been supported by the intramural grants from site. This observation was further substantiated in the in vivo murine model, which demon- Department of Atomic Energy, Government of India strated that upon suramin administration, the Leishmania infected BALB/c mice were able (Projects of SINP:-MSACR [XII-R&D-SIN-5.04- to reduce the parasitic burden and also generate the host protective immunological 0102]). The funders had no role in study design, data collection and analysis, decision to publish, or responses. ITC and enzyme assays confirmed the binding and consequent inhibition of preparation of the manuscript. LmPGK due to the drug. PLOS Neglected Tropical Diseases | https://doi.org/10.1371/journal.pntd.0008575 August 31, 2020 1 / 20 PLOS NEGLECTED TROPICAL DISEASES Effect of suramin on visceral leishmaniasis Competing interests: The authors have declared Conclusions/Significance that no competing interests exist. All experiments affirmed the efficacy of suramin against L. donovani infection, which could possibly lead to its inclusion in the repertoire of drugs against VL. Author summary Visceral Leishmaniasis (VL) or Kala-azar, classed as a neglected tropical disease, is still a major problem worldwide, aggravated by increasing parasitic resistance against the drugs commonly used for its treatment. Since the development of novel therapeutics involves exorbitant costs, the effectiveness of the currently available antitrypanosomatid drug sura- min has been investigated as an antileishmanial, specifically for VL, in vitro and in animal model experiments. Our study showed that suramin is effective against L.donovani and significantly reduced the (splenic/hepatic) parasitic burden in L. donovani infected BALB/ c mice, switching the immune response in the infected BALB/c mice from TH2 to a TH1 type. The ITC data confirmed that suramin does indeed interact with parasitic phospho- glycerate kinase (LmPGK) and enzyme assays demonstrated the inhibition of LmPGK due to the drug. Therefore, our investigation raises the possibility of suramin being included in the repertoire of drugs used to treat VL. Introduction Visceral Leishmaniasis (VL) or Kala-azar, classed as a neglected tropical disease, afflicts about half a million people worldwide, with over 90% of the cases occurring primarily in the poverty stricken regions of Brazil, Ethiopia, India, Somalia, and Sudan [1]. VL caused by the protozoan parasite Leishmania donovani, (transmitted by the phlebotomine sand fly), is almost certainly lethal without timely clinical interventions [2]. The last decade has seen a significant drop in the incidence of VL primarily from India and Bangladesh (due to the widespread use of insec- ticide treated nets) though the epidemiological status of the disease in other African countries including Brazil continues to be negative [3]. In Brazil VL has gradually spread from predomi- nantly rural areas to densely populated urban centers. Thus, overall the threat to public health by VL remains unabated. The situation is further aggravated by the emergence of Leishmanial strains resistant to antimonial drugs [4], the traditional first line of defence against VL and also their replacements such as amphotericin B and miltefosine [5, 6]. Most of the drugs used to treat VL have severe side effects, can only be administered in hospital settings and are expen- sive [7].Therefore, there is an urgent need to identify economically viable and potent antileishmanials. Previous work in our laboratory had identified the efficacy of the polysulphonatednaphthy- lamine drug suramin as a potent antileishmanial against L. donovani[8]. Currently, suramin is used to treat the hemolymphatic stage of African trypanosomiasis (sleeping sickness) caused by Trypanosoma brucei rhodesiense and has been reported to inhibit the glycolytic enzymes of the parasite [9]. Suramin has also shown much promise as a prospective antiviral inhibiting the envelope mediated gene transfer and the replication of chinkungunya and ebola viruses [10, 11]. The ability of suramin to inhibit heparanase expression has been shown to cure the metastasis and proliferation of ovarian, cervical cancer cell lines [12]. In addition the pediatric approved drug has been found to decrease the peak viral load in rhesus monkeys, marking it as a possible therapy for severe EV71 infection in children [13]. PLOS Neglected Tropical Diseases | https://doi.org/10.1371/journal.pntd.0008575 August 31, 2020 2 / 20 PLOS NEGLECTED TROPICAL DISEASES Effect of suramin on visceral leishmaniasis In this work we continue to explore the efficacy of suramin against VL, both in vitro and in an in vivo BALB/c mice model. In addition, its biophysical interaction with the Leishmanial glycolytic enzyme phosphoglycerate kinase (LmPGK) has also been characterized in terms of enzymatic assays and isothermal titration calorimetry (ITC). Methods Ethics statements BALB/c mice (Mus musculus) were maintained under pathogen free conditions. The experi- mental use of mice was approved by the Institutional Animal Ethics Committee of Bose Insti- tute Kolkata, India (dated 26.02.2019; Ref. No. IAEC/BI/121/2019). All animal experiments were carried out according to the National Regulatory Guidelines issued by Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA), Ministry of Envi- ronment and Forest, Govt. of India. Effect of suramin on Leishmania donovani (AG83) promastigotes Measurement of drug efficacy of suramin. L. donovani (MHOM/IN/83/AG83) was rou- tinely cultured at 22ÊC in M199 medium (St. Louis,MO, USA) with 10% heat-inactivated Fetal Bovine Serum(FBS) (Gibco, USA). L. donovani (AG83) promastigotes were used to determine the efficacy of suramin (IC50) using the MTT assay [8]. Briefly, L. donovani parasites were plated on 96-well cell culture plates at a density of 2x106 parasites/well and incubated with different concentrations (10 μM, 20 μM, 50 μM, 100 μM, 300 μM and 500μM) of suramin for 48 hrs. The GraphPad Prism 5 software (version 5.03) was used to calculate the concentration which inhibited parasitic growth by 50% (IC50).Suramin which was used in all the experiments was purchased from Sigma-Aldrich (USA). Cytotoxicity in RAW 264.7 macrophages. Murine Macrophage (MØs) like tumor cell, RAW 264.7 was obtained from American Type Culture Collection and maintained in com- plete RPMI 1640 medium supplemented with 10% FBS
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