Recent advances in Curcumin treatment of Toxoplasma gondii

Current treatment modalities for T. gondii vary depending on the pregnancy and immune status of the patient and is often accompanied by the severe side effect profiles of the drugs used. Pregnant patients and infected neonates are treated differently, and pregnant patients are further stratified by the presence or absence of signs of fetal infection. The common regiments for treating T. gondii in pregnancy/neonates includes a combination of Spiramycin, Pyrimethamine, and Sulphadiazine, often with Folinic acid supplementation to counteract the negative effects of these drugs on fetal folic acid metabolism necessary for Neural Tube development among other things (Konstantinovic 2019). In immunocompromised patients, further antibiotics can be implemented beyond those listed previously, including Clindamycin, Trimethoprim, Sulfamethoxazole, and Atovaquone, as well as Corticosteroids specifically being implemented in Toxoplasmosis encephalitis to reduce brain swelling and improve outcomes (Dunay 2018). Current treatment has shown evidence of reducing disease in fetal and neonatal infection, it also induces potentially severe and life-long side effects. Most commonly adverse outcomes were observed with the use of Pyrimethamine accounting for more than 1 in 4 of the adverse outcomes (Konstantinovic 2019). These resulting adverse events ranged from vomiting and rashes to neutropenia, pancytopenia, hepatocellular injury, and even fetal death. This is completely omitting the potential 3-8% of the population that are likely to experience sulfonamide allergies, thus resulting in potentially life-threatening anaphylaxis and rendering a pivotal drug in this treatment regimen useless (Konstantinovic 2019)(Dunay 2018). Furthermore, studies have estimated the yearly costs of these drugs to range from $500-$1500+ depending on drugs selected and frequency of doses required, not including logistical costs of handling and distributing of such drugs to impoverished or remote nations with dysfunctional healthcare systems unable to handle the requirements for treatment on their own (Sahai 1996)(Binquet 2019). Beyond these costs, the price of diagnostics is not factored in, neither are the long term consequences of illness to society in the form of lost productivity and potential life-long treatment of individuals disabled by the disease. Such prices, especially in developing nations, may result in severe lack of treatment for many populations, resulting in greater costs, not only financially in the treatment of pathological sequelae but also socioeconomically as potential functioning members of a nation and its economy are left disabled and unable to contribute. The reality is that in many instances, current treatment modalities are either financially unsustainable, or pose too great a risk to an already sick population and are only used because they may help make the best of an otherwise horrible situation. This leaves a current need for more effective and cost-efficient treatment modality for the treatment of T. gondii infection. In the search for new anti-parasitic agents, we can look at the implementation of natural products and their extracts for potential answers. Many current anti-parasitic drugs were first discovered as natural products in medicinal plants or secondary active metabolites of these plants (Ndjonka 2013). Medicinal plants, being complex living organisms requiring intricate metabolic demands, have a multitude of complex chemicals that have the potential to work in combination to combat disease. Examples of the medicinal use of plants include the bark of the cinchona tree as a source for the anti-malarial compound quinine, the sweet wormwood herb as a source for Artemisinin useful in the treatment of malaria as well as lymphatic filariasis and onchocerciasis among others (Ndjonka 2013). Curcumin is one such natural product that has been highly studied and shown to be effective in the treatment of parasitic infections as well as displaying additional anti-inflammatory and anti-cancer effects (Hussein 2017).