Immunotherapeutics Combining a Recombinant Chimeric Protein, Monophosphoryl Lipid A, and Miltefosine Against Visceral Leishmaniasis

Current treatment for visceral leishmaniasis (VL) is associated with toxicity, a high cost, and the emergence of drug-resistant parasite strains. Moreover, no human vaccine is available. In this context, immunotherapeutics combining vaccination and chemotherapy have emerged as a promising alternative. In this study, we combined a recombinant chimeric protein (ChimT) with the adjuvant 3-<i>O</i>-desacyl-monophosphoryl lipid A (MPLA) and the antileishmanial drug miltefosine (Milt) and used it to treat <i>Leishmania infantum</i>-infected mice. Parasitological, immunological, and toxicological assays were performed at 1 and 30 days post treatment. The ChimT/MPLA/Milt combination was the most effective therapeutic regimen, inducing robust Th1-type cellular and humoral immune responses, as demonstrated by increased levels of IFN-γ, IL-12, and TNF-α cytokines, nitrite, and IgG2a antibodies. These responses were associated with significant reductions in parasite load across various organs. Furthermore, the treatment showed low renal and hepatic toxicity at both evaluation time points. By contrast, ChimT alone, ChimT/MPLA, and Milt induced lower immunological and parasitological responses when compared with the ChimT/MPLA/Milt group. The results observed at 1 and 30 days post treatment demonstrated the potential of ChimT/MPLA/Milt combination against VL.