Leishmania are eukaryotic parasites that have retained the ability to produce extracellular vesicles (EVs) through evolution. To date, it has been unclear if different DNA entities could be associated with Leishmania EVs and whether these could constitute a mechanism of horizontal gene transfer (HGT). Herein, we investigate the DNA content of EVs derived from drug-resistant parasites, as well as the EVs' potential to act as shuttles for DNA transfer. Next-generation sequencing and PCR assays confirm the enrichment of amplicons carrying drug-resistance genes associated with EVs. Transfer assays of drug-resistant EVs highlight a significant impact on the phenotype of recipient parasites induced by the expression of the transferred DNA. Recipient parasites display an enhanced growth and better control of oxidative stress. We provide evidence that eukaryotic EVs function as efficient mediators in HGT, thereby facilitating the transmission of drug-resistance genes and increasing the fitness of cells when encountering stressful environments.

The use of next generation sequencing has the power to expedite the identification of drug resistance determinants and biomarkers and was applied successfully to drug resistance studies in Leishmania. This allowed the identification of modulation in gene expression, gene dosage alterations, changes in chromosome copy numbers and single nucleotide polymorphisms that correlated with resistance in Leishmania strains derived from the laboratory and from the field. An impressive heterogeneity at the population level was also observed, individual clones within populations often differing in both genotypes and phenotypes, hence complicating the elucidation of resistance mechanisms. This review summarizes the most recent highlights that whole genome sequencing brought to our understanding of Leishmania drug resistance and likely new directions.

Significance: Gain-of-function screens using overexpression genomic libraries are powerful tools for discovering drug target/resistance genes, but several limitations make this technique less amenable to high-throughput screening. Using cosmid-based functional screening coupled to next-generation sequencing, an approach that we term Cosmid Sequencing (or “Cos-Seq”), we followed the dynamics of cosmid enrichment during drug pressure in Leishmania , the parasite responsible for leishmaniasis, a neglected tropical disease. This improved and sensitive method has led to the identification and functional characterization of an unprecedented number of drug target/resistance genes against all drugs currently used to treat leishmaniasis.

Trypanosoma cruzi, Trypanosoma bruceiandLeishmania(Trypanosomatidae: Kinetoplastida) are parasitic protozoan causing Chagas disease, African Trypanosomiasis and Leishmaniases worldwide. They are vector borne diseases transmitted by triatomine bugs, Tsetse fly, and sand flies, respectively. Those diseases cause enormous economic losses and morbidity affecting not only rural and poverty areas but are also spreading to urban areas. During the parasite-host interaction, those organisms release extracellular vesicles (EVs) that are crucial for the immunomodulatory events triggered by the parasites. EVs are involved in cell-cell communication and can act as important pro-inflammatory mediators. Therefore, interface between EVs and host immune responses are crucial for the immunopathological events that those diseases exhibit. Additionally, EVs from these organisms have a role in the invertebrate hosts digestive tracts prior to parasite transmission. This review summarizes the available data on how EVs from those medically important trypanosomatids affect their interaction with vertebrate and invertebrate hosts.

Leishmania infantum is an etiological agent of the life-threatening visceral form of leishmaniasis. Liposomal amphotericin B (AmB) followed by a short administration of miltefosine (MF) is a drug combination effective for treating visceral leishmaniasis in endemic regions of India. Resistance to MF can be due to point mutations in the miltefosine transporter (MT). Here we show that mutations in MT are also observed in Leishmania AmB-resistant mutants. The MF-induced MT mutations, but not the AmB induced mutations in MT, alter the translocation/uptake of MF. Moreover, mutations in the MT selected by AmB or MF have a major impact on lipid species that is linked to cross-resistance between both drugs. These alterations include changes of specific phospholipids, some of which are enriched with cyclopropanated fatty acids, as well as an increase in inositolphosphoceramide species. Collectively these results provide evidence of the risk of cross-resistance emergence derived from current AmB-MF sequential or co-treatments for visceral leishmaniasis. Miltefosine and amphotericin B are two leading molecules in the fight against the vector-borne disease Leishmaniasis. We demonstrate here that different point mutations in a P-type ATPase could play an important role in resistance, not only to miltefosine, but also to amphotericin B. Furthermore, macrophage-infecting amastigotes that are resistant to one drug are cross-resistant to the other one. Our experimental findings demonstrate that one of the mechanisms driving miltefosine and amphotericin B resistance in Leishmania parasites involve major changes in a number of lipid species. In addition, we experimentally show that different mutations in the P-type ATPase participate in resistance against these two leading leishmanicidal agents with mechanistic differences. Miltefosine-induced mutations cause a defect in miltefosine uptake, but this mechanism of resistance is not observed for the amphotericin B-induced mutations. These results point to profound clinical implications as combination therapy involving these two drugs is being promoted for the treatment of visceral Leishmaniasis.