Efficacy of the Imiqualine analog EAPB0503 against Cutaneous Leishmaniasis : A promising new treatment paradigm

Cutaneous Leishmaniasis (CL) is a parasitic infection classified by the WHO as one of the most uncontrolled spreading neglected diseases. In the Middle East Region, CL is mostly endemic in Syria where it is mainly caused by Leishmania tropica and Leishmania major. CL has been lately introduced to under endemic countries, following the large-scale displacement of refugees from Syria fleeing the crisis. Therapeutic interventions against CL include local, systemic and physical treatments. However, the high risk for selection and spread of drug-resistant parasites is high; consequently new therapeutic approaches are still needed. Imiquimod is an FDA approved immunomodulatory compound with a tested efficacy against some leishmania species. In this study, our interest was to investigate the efficacy of an Imiquimod analog, EAPB0503 in comparison to the original compound, against promastigote and amastigote stages of L.tropica and L.major.We showed that Imiquimod affects the motility of promastigotes of both strains. EAPB0503 affected L. major promastigotes’ motility and impaired the invasion of L.tropica promastigotes into macrophages. Both drugs reduced amastigote replication, with a higher potency of EAPB0503. This activity is due to the upregulation of Toll-Like Receptor-7 (TLR7), mainly by Imiquimod, and to a lesser extent by EAPB0503. Importantly, both drugs activated the NF-κB canonical pathway leading to production of pro-inflammatory cytokines and upregulation of i-NOS levels. A decrease of anti-inflammatory cytokines secretion was obtained, explaining the leishmanicidal activity of both drugs. Importantly, EAPB0503 led to a prominent increase in TLR8 and TLR9 transcripts, presumably conferring protection against the infection.Collectively, our findings show the effect of Imiquimod against both strains especially, the aggressive L. tropica strain. We also show that EAPB0503 displays a more potent in vitro leishmanicidal activity than Imiquimod. These drugs seemingly activate different TLRs, but both activate the canonical NF-κB pathway and its subsequent mediated immune response. These results highlight the promising effect of immunomodulatory drugs against CL and warrant an in depth in vivo preclinical then clinical studies of these compounds.