Immunomodulation of Macrophages May Benefit Cutaneous Leishmaniasis Outcome

• Published in: Current tropical medicine reports 2023-12, Vol.10 (4), p.281-294
• Main Authors: de Souza Lima, Lucas Bonatto, Menolli, Rafael Andrade, Ayala, Thais Soprani
• Format: Article
• Language: English
• Subjects: Behavioral Sciences; Infectious Diseases; Medicine; Medicine & Public Health; Parasitology; Review; Topical Collection on Neglected Diseases of the Americas; Tropical Medicine
• ISSN: 2196-3045; 2196-3045
• DOI: 10.1007/s40475-023-00303-x

Purpose of Review This review emerges from the necessity to gather information of quality on the possibility to directly modulate macrophages and its functions to improve cutaneous leishmaniasis treatment in order to improve the lesions of the infection without leaving a disfiguring scar. Recent Findings Cutaneous leishmaniasis often leaves disfiguring scars, a fact associated with improper infection resolution related to an inappropriate action of the macrophages. As these cells are the main target of Leishmania spp., these parasites subvert macrophages’ response to avoid a pro-inflammatory profile, with interferon-γ (IFN-γ) and tumoural necrosis factor-α (TNF-α), and induce an anti-inflammatory with the participation of IL-10. These are one of the many strategies that different species of Leishmania spp. used to escape the immune response, which also includes reducing oxidative stress and parasite killing. The use of immune mediators to induce pro-inflammatory macrophages has been showing success into eliminating the parasites and promoting a proper resolution of the infection. Summary The treatment of CL often eliminates the parasites; however, beyond its cytotoxicity, it takes time and still a disfiguring scar remain. Therefore, the treatment should be based on several aspects such as the clinical manifestation, localization of the lesions, and the possibility to integrate other medications beyond focusing only on parasite killing. Thus, the treatment aiming the modulation of the immune system together with traditional treatments, given that Leishmania can interfere in the pro-inflammatory pathway of the macrophages, could represent an alternative strategy to promote complete closure of the lesions without disfiguring scar.