amphotericin b-loaded extracellular vesicles derived from leishmania major enhancing cutaneous leishmaniasis treatment through in vitro and in vivo studies

Background: recent studies have shown an increasing number of patients with cutaneous leishmaniasis (cl) who do not respond to pentavalent antimonials as the first line of treatment for cl. nanocarriers such as extracellular vesicles (evs) are efficient vehicles that might be used as drug delivery systems for the treatment of diseases. therefore, we aimed to isolate and characterize the evs of leishmania major, load them with amphotericin b (amb), and investigate the toxicity and efficacy of the prepared drug form.methods: the evs of l. major were isolated, characterized, and loaded with amphotericin b (amb), and the evs-amphotericin b (evs-amb) form was synthesized. relevant in vitro and in vivo methods were performed to evaluate the toxicity and efficacy of evs-amb compared to the control.results: the anti-leishmanial activity of the evs-amb showed a higher percentage inhibition (pi%) (p = 0.023) compared to the amb at different concentrations and time points. obtained data showed a significant increase in the lesion size and parasite load in the lesion, pbs, and evs mice groups in comparison with evs-amb, amb, and glucantime groups (p < 0.05), evs-amb had a significant decrease in lesion sizes in comparison with amb (p < 0.05). results showed that evs-amb decreased its toxicity to the kidneys and liver (p < 0.05).conclusion: evs-amb improved the efficacy of amb in mouse skin lesions and reduced hepatorenal toxicity. furthermore, evs could be a promising nanoplatform for the delivery of amb in cl caused by l. major.