Introduction: Schistosomiasis, caused by Schistosoma sp. is one of the 20 neglected diseases that the World Health Organization aims to reduce or eliminate by 2030, affecting over 240 million people and transmitted through water contaminated by its cercarial form. Objective assessment of the disease and its impact is critical to achieving this goal. Treatment and prevention are effective strategies, but widespread use of praziquantel (PZQ) has resulted in diminishing efficacy due to the emergence of drug resistance in worms. Hence, alternative approaches such as combining and redirecting drugs are being explored to control geohelminthiasis.
Objectives: To identify new combinations and repositioning of drugs as an alternative for the treatment of schistosomiasis.
Method: Pubmed was searched using the keywords "schistosomiasis" and "(repurposing" or "repositioning") within the timeframe of 2018-2023 to obtain updated information. As selection criteria, we included drugs previously used in therapy (e.g. PZQ), as well as repositioned drugs for the treatment of schistosomiasis in their titles or reviews on the topic. In addition, promising articles were included to improve the quality of the study.
Results and discussions: Of the 47 articles found, 9 were selected. Various pharmacological classes were present in the selected studies, including antineoplastics, antirhythmics, antihistamines, intestinal antiseptics, antimalarials and non-steroidal anti-inflammatory drugs. They were: Tamoxifen (400 mg/kg single dose/ 100 mg/kg/day for 5 days, S. mansoni, in vitro test), celecoxib associated with lipid nanoparticles (20 mg/kg/day for 5 days, S. mansoni, in vivo), Amiodarone (400 mg/kg/ 100 mg/kg for 5 days, S. mansoni, in vitro), nifuroxazide (400 mg/kg, S. mansoni, in vitro, in vivo and in silico), vorinostat (10 µM, in vitro), promethazine (100mg/Kg for 5 days, S. mansoni, in vivo), mefenamic acid (400 mg/kg single dose/100 mg/kg for 5 days, in silico), artemisinin-naptokine (20 or 30 ?g/ml, S. haematobium, in vitro), desloratadine, rupatadine and cinnarizine (400 mg/kg single dose/100 mg/kg/day for 5 days, S. mansoni, in vivo) which have been shown to be effective in eliminating helminths, however some have only been shown to be effective in the early stages of infection, according to the information provided in the respective studies.Various mechanisms have been observed, such as integumental damage, decreased glucose uptake by the helminths, and reductions in egg counts.
Conclusion: The repurposing of drugs shows promising options for the treatment of schistosomiasis, even though some are only effective in the early stages of the disease. Considering a scenario of developing resistance to the only treatment established by international guidelines, looking at drugs that have proven safety and are available on the market as an alternative, albeit in different doses, is a prospect for new treatments.
Acknowledgement: This work was carried out with the support of the Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES) - Funding Code 001, as well as FACEPE and CNPq.
References:
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Comissão Organizadora
Francisco Mendonça Junior
Pascal Marchand
Teresinha Gonçalves da Silva
Isabelle Orliac-Garnier
Gerd Bruno da Rocha
Comissão Científica
Ricardo Olimpio de Moura
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