https://doi.org/10.5812/jjm.77302

The In Vitro Effect of Hydroalcoholic Extract of Artemisia absinthium on the Growth of Leishmania major (MRHO/IR/75/ER) in Peritoneal Macrophages from BALB/c Mice

authors:

avatar Ali Rahiminejad 1 , 2 , avatar Khosrow Hazrati Tappeh 1 , 2 , * , avatar Shahram Seyyedi 3 , avatar Peyman Mikaili 4

Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran
Department of Parasitology and Mycology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
Department of Immunology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
Department of Pharmacology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
Jundishapur Journal of Microbiology: Vol.11, issue 11; e77302
published online: October 7, 2018
article type: Research Article
received: May 12, 2018
revised: September 24, 2018
accepted: September 27, 2018

How To Cite Rahiminejad A, Hazrati Tappeh K, Seyyedi S, Mikaili P. The In Vitro Effect of Hydroalcoholic Extract of Artemisia absinthium on the Growth of Leishmania major (MRHO/IR/75/ER) in Peritoneal Macrophages from BALB/c Mice. Jundishapur J Microbiol. 2018;11(11):e77302. https://doi.org/10.5812/jjm.77302.

Abstract

Background:

Leishmaniasis is a protozoan disease ranging from simple to mucocutaneous, diffuse, and visceral lesions. Current chemical medicines, including Glucantime, have high toxicity, side effects, and drug resistance. Herbal medicines are unlimited sources for discovering new medications to treat infectious diseases.

Objectives:

This study aimed to examine the in vitro effect of hydroalcoholic extract of Artemisia absinthium on the growth of Leishmania major in peritoneal macrophages from BALB/c mice.

Methods:

In this experimental study, the hydroalcoholic extract of A. absinthium was prepared and dissolved in 2% dimethyl sulfoxide (DMSO). Leishmania major (MRHO/IR/75/ER) was cultured in RPMI1640 medium containing 15% fetal bovine serum (FBS). Peritoneal macrophages were extracted from BALB/c mice and were infected with promastigotes at a ratio of 1:10. The extract was added to Leishmania-infected macrophages and promastigotes at different concentrations. After 24, 48, and 72 hours, the effectiveness of A. absinthium on promastigotes was assessed using Trypan blue test and methyl thiazole tetrazolium (MTT) colorimetric assay, and the half maximal inhibitory concentration (IC50) of A. absinthium extract was obtained. Giemsa staining was used to evaluate the effect of A. absinthium extract on amastigotes. Also, inducible nitric oxide synthase (iNOs) level was measured from Leishmania-infected macrophages. The data were analyzed by ANOVA in SPSS software.

Results:

The hydroalcoholic extract of A. absinthium showed a significant anti-Leishmania activity against promastigotes and amastigotes at various concentrations after 48 and 72 hours. The IC50 values of the alcoholic extract of A. absinthium were obtained at 56 mg/mL and 51 mg/mL concentrations of promastigotes and amastigotes, respectively. The lowest levels of iNOs were seen at 100 and 50 mg/mL concentrations of A. absinthium in treated macrophages. The former was obtained at 60.8 and 58.8 ng/mL after 24 and 48 hours and the latter at 55.5 ng/mL and 50 mg/mL of A. absinthium, respectively, after 72 hours.

Conclusions:

Findings of the present study showed the anti-parasitic effects of A. absinthium on both promastigotes and amastigotes. Further studies are recommended to be conducted on animal models and the active ingredients of A. absinthium extract to accurately assess the effects of this extract on the growth of L. major.

1. Background

Leishmaniasis is a zoonotic disease caused by a protozoan parasite, called Leishmania, belonging to Kinetoplastida protozoa. Depending on the type of lesion in the human body, leishmaniasis is classified into cutaneous, visceral, and mucocutaneous types and is mainly transmitted by various species of sandflies (1, 2). It is estimated that 1 to 1.5 million cases of cutaneous leishmaniasis occur annually, and over 370 million people are at risk of this infection (3). As reported previously, more than 90% of cutaneous leishmaniasis cases are from Iran, Iraq, Afghanistan, Syria, Pakistan, Palestine, and Yemen (4). Common antimony compounds, including meglumine antimonate (Glucantime) and sodium stibogluconate (Pentostam), are considered as the first-line drugs for treating leishmaniasis. These medications prevent the production of adenosine triphosphate through affecting parasitic enzymes, especially disruption of phosphokinase (5).

In recent years, increased resistance to pentavalent antimonials has led to the introduction of new anti-leishmanial compounds, such as miltefosine, amphotericin B, ketoconazole, and paromomycin (6). Most of the medications employed to treat leishmaniasis have one or more limitations. They are mostly uneconomical and have problems like administration route, toxicity, and increased parasite resistance to these medications, which is the most important issue. Currently, increased resistance to antimony compounds is alarming and a major challenge to successful treatment (7, 8). Hence, a need to develop effective, low-cost, and orally administered anti-Leishmania compounds with low toxicity is felt more than ever. In many developing countries, people pay special attention to traditional medicines and use them to meet their health needs. Given that herbal medicines often do not have any side effects and are available and cheap, the importance of using native herbs in each region is highlighted (9-12).

Artemisia absinthium is one of the oldest medicinal plants in the world whose name has been mentioned in most of the ancient scientists’ works. Artemisia absinthium is a perennial herbaceous plant of the family Asteraceae (Compositae) and has many active and anti-cancer ingredients, including glycoside, tannin, thujone, potassium nitrate, organic acids, Artacebin, Thujylalcohol, tincture, isovaleric acid, camphene, chamazulene, p-Coumaric acid, beta-Carotene, salicylic acid, ascorbic acid, chlorogenic acid, protocatechuic acid, vanillic acid, isoquercitrin, and rutin. In addition, there is a bitter substance in the leaves of this plant named absinthin, which its essence contains Cadinene and phellandrene and has worm-killing property. This is the reason that this plant is also called worm wood.

Absinthin has also anti-parasitic, appetizing, digestive, and reinforcing properties (13-15). Extensive body of evidence has indicated that the induction of macrophages defense mechanisms against Leishmania is closely related to IFN-γ and nitric oxide secretion. Some of the herbal extracts have immune-modulatory properties and increase secretion of nitric oxide.

2. Objectives

This study aimed to determine the anti-Leishmania and immune-modulatory effects of A. absinthium extract on the growth of Leishmania major (MRHO/IR/75/ER) in mouse peritoneal macrophages.

3. Methods

3.1. Ethics Statement

The study was approved by the Ethics Committee of Urmia University of Medical Sciences (code: IR.UMSU.REC.1393.102).

3.2. Preparation of Hydroalcoholic Extract of A. absinthium

Artemisia absinthium samples were collected from northwest of Iran, and their herbarium codes were obtained (9526). The percolation method was used for extraction. In short, after drying and grinding, the plant was soaked in 70% alcohol for 48 hours. The obtained liquid was dried at 37°C after passing through a filter. An amount of 800 mg/mL stock solution was prepared from the obtained extract and kept in a refrigerator. Based on a previous study, different concentrations of 6.5, 12.5, 25, 50, 100, 200, 400, and 800 mg/mL were prepared (16).

3.3. Cultivation of Leishmania major

The standard strain of L. major promastigotes (MRHO/IR/75/ER) was cultured in RPMI1640 medium containing 15% fetal bovine serum (FBS), 100 IU/mL penicillin, and 100 µg/mL streptomycin at 24°C ± 1°C. Promastigotes in stationary phase were counted and used for the study.

3.4. Evaluation of the Anti-Leishmania Effects Using the MTT and Trypan Blue Tests

The parasitic suspension containing 106 promastigotes was added to sterile ELISA microplate wells and incubated for 24 hours. Afterwards, 100 µL of different dilutions of the extract was added to the wells and incubated for 24, 48, and 72 hours. Microplates were centrifuged at 201 RCF (18 g) for 5 minutes. The supernatant was removed, and 20 μL of the working 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide (MTT) solution was added to each well (17-22). Four hours after centrifugation, the supernatant was removed and 100 μL dimethyl sulfoxide (DMSO) was added. After 15 minutes, optical densities (ODs) were read using an ELISA reader (Stat fax 2100, USA) at the wavelength of 492 nm with an additional 630 nm filter. Trypan blue test was also performed to assess the anti-Leishmania effect of the extract. Finally, promastigotes were counted, and calculations were conducted according to the Neubauer chamber formula using the Trypan blue test.

3.5. Extraction of Mouse Peritoneal Macrophages and Exposure to Leishmania Promastigotes

To extract macrophages, 1.5 mL of phosphate-buffered saline (PBS) containing 3% thioglycolate was injected into the peritoneum of the mice. After two days, the mice were anesthetized with ether and killed. Under sterile conditions, 8 mL of PBS was injected intraperitoneally to release more macrophages. The macrophages were washed three times with cold sterile RPMI1640 in a refrigerated centrifuge (Centurion 5413 IT 249R, West Sussex, UK) at 700 RCF (18 g) for 5 minutes. The extracted cells were counted, and the macrophages were diluted five times and counted again four times; the average of live macrophages counted was 17.75. The number of cells was calculated according to the formula as follows: the number of viable cells × 104 × 5 = cell/mL culture. This cell suspension was transferred to cell culture flasks and incubated in a humid condition in 5% CO2 at 37°C for three hours. Then, flask supernatant was evacuated and discarded. Ten promastigotes per macrophage cell were added to the wells.

The flasks were incubated in 5% CO2 at 37°C for 24 hours with adequate humidity to provide an opportunity for infection of the macrophages with L. major. After 24 hours, the slides were prepared and stained with Giemsa and examined under a light microscope at magnification × 40. A total of 100 infected and non-infected macrophages were counted, and the percentage of infected macrophages was determined. Leishmania-infected macrophages were placed in the macrophage culture wells, and 100 µL of different concentrations of A. absinthium extract (12.5, 25, 50, 100, 200, and 400 mg/mL) was added. Also, 100 µL of Glucantime (positive control) with the concentration of 100 mg/mL (23, 24) and 100 µL of the contents of the flask without extract and medication (negative control) were added to the control wells. Cell culture plates were incubated in 5% CO2 at 37°C for 72 hours with optimal humidity, and the slides were prepared from wells and stained with Giemsa stain daily. Finally, the number of infected macrophages and the mean number of amastigotes were determined.

3.6. iNOs Measurement of Leishmania-Infected Macrophages

To measure specific iNOs from infected macrophages, cells were incubated with different concentrations of A. absinthium extract following 24, 48, and 72 hours of exposure. The supernatant was removed, and an ELISA test was performed to measure the enzyme level (iNOS) according to the kit’s instruction.

3.7. Statistical Analysis

OD of parasitic samples was entered in the Excel software, and the IC50 value was calculated using linear regression curve. The OD obtained was directly associated with the number of living and active cells.

4. Results

This study examined the anti-leishmanial effects of different concentrations of A. absinthium extract on the growth of promastigotes and amastigotes using the MTT assay, Trypan blue test, and Giemsa staining. First, the effect of different concentrations (6.5, 12.5, 25, 50, 100, 200, 400, and 800 mg/mL) of the extract on promastigotes was examined, and then the IC50 value was determined (Table 1). In the next step, after preparing peritoneal macrophages from BALB/c mice and infecting macrophages with stationary phase promastigotes and counting amastigotes and determining the percentage of infected macrophages, the effect of different concentrations of A. absinthium extract (12.5, 25, 50, 100, 200, and 400 mg/mL) and controls on amastigotes and infected macrophages was evaluated. By examining the effect of different concentrations of A. absinthium extract on promastigotes after 24 hours of exposure, we found that concentrations of 400 and 800 mg/mL had more than 50% leishmaniacidal effect, and concentrations less than 50 mg/mL had almost no effect (Figure 1). After 48 hours of exposure, the IC50 value of A. absinthium extract was calculated as 50 mg/mL. Leishmanicidal effect of concentrations greater than 200 mg/mL ranged from 65% to 80%. After 72 hours of incubation, concentrations of 12.5 mg/mL and lower were ineffective, and concentrations equal to or greater than 50 mg/mL had 50% to 98% leishmaniacidal effect. This effect increased depending on exposure time and concentration (Figure 2).

Table 1.

Average Number of Live Promastigotes After Exposure to Different Concentrations of A. absinthium Extract After 24, 48, and 72 Hours Incubation

Incubation Time (H)Concentration (mg/mL)
Control (Negative)6.2512.52550100a200a400a800a
2476 ± 4.3376 ± 0.9076 ± 2.2273 ± 3.4869.5 ± 7.0257.75 ± 4.1153 ± 1.7340.75 ± 2.0732.5 ± 2.87
4875.75 ± 4.2373.25 ± 4.2170.75 ± 1.7151 ± 1.82a43.5 ± 2.5a30.75 ± 3.2526.75 ± 0.620.25 ± 0.8514 ± 1.49
7273 ± 1.8270.25 ± 2.0264 ± 5.1640.7 ± 2.8a27.25 ± 4.41a16 ± 1.77.25 ± 15 ± 1.10.5 ± 0.5

a Mean reported as standard errors (P < 0.05).

Viability of L. major promastigotes treated with different concentrations of A. absinthium extracts (after at various temperatures)
Viability of L. major promastigotes treated with different concentrations of A. absinthium extracts (after at various temperatures)
Figure 1.

Viability of L. major promastigotes treated with different concentrations of A. absinthium extracts (after at various temperatures)

The effect of A. Absinthium extract in different concentrations and at various temperatures on L. major promastigotes. (Average percentage of infected macrophages). After 72 hours of incubation, concentrations of 12.5 mg/mL and lower were ineffective and concentrations equal to or greater than 50 mg/ml had 50% to 98% leishmaniacidal effect. This effect was increased depending on the time and concentration.
The effect of A. Absinthium extract in different concentrations and at various temperatures on L. major promastigotes. (Average percentage of infected macrophages). After 72 hours of incubation, concentrations of 12.5 mg/mL and lower were ineffective and concentrations equal to or greater than 50 mg/ml had 50% to 98% leishmaniacidal effect. This effect was increased depending on the time and concentration.
Figure 2.

The effect of A. Absinthium extract in different concentrations and at various temperatures on L. major promastigotes. (Average percentage of infected macrophages). After 72 hours of incubation, concentrations of 12.5 mg/mL and lower were ineffective and concentrations equal to or greater than 50 mg/ml had 50% to 98% leishmaniacidal effect. This effect was increased depending on the time and concentration.

After 24, 48, and 72 hours of incubation, the effect of different concentrations of A. absinthium extract on the growth of amastigotes was examined using Giemsa staining in 5% CO2 with optimal moisture at 37°C (Figure 3). According to the IC50 value of A. absinthium extract at the promastigote stage, very high and very low concentrations of A. absinthium extract were not used. After 24 hours of incubation under appropriate conditions, concentrations of 100, 200, and 400 mg/mL had 43.5%, 54%, and 58.5% leishmaniacidal effects on amastigotes, respectively. However, other concentrations had less effects. After 48 hours of incubation, concentrations of 400 and 200 mg/mL had 100% leishmaniacidal effects on amastigotes. The IC50 value of A. absinthium extract was calculated as 50 mg/mL. After 72 hours of incubation, concentrations greater than 100 mg/mL had 100% leishmaniacidal effect, and concentrations of 12.5, 25, and 50 mg/mL had 36%, 65%, and 72% leishmaniacidal effects on amastigotes, respectively.

Microscopic image of mouse peritoneal macrophage infected with L. major amastigotes in vitro and stained with Giemsa reagent, viewed under oil immersion (magnification × 1000). The arrows show amastigotes-infected macrophage.
Microscopic image of mouse peritoneal macrophage infected with L. major amastigotes in vitro and stained with Giemsa reagent, viewed under oil immersion (magnification × 1000). The arrows show amastigotes-infected macrophage.
Figure 3.

Microscopic image of mouse peritoneal macrophage infected with L. major amastigotes in vitro and stained with Giemsa reagent, viewed under oil immersion (magnification × 1000). The arrows show amastigotes-infected macrophage.

After 24 and 48 hours of incubation under appropriate conditions, the high concentrations of A. absinthium extract and positive control (Glucantime) had no effects on non-infected macrophages. A gradual reduction in iNOs level and the lowest level of iNOs were evident at the 100 mg/mL concentration of A. absinthium after 24 and 48 hours of incubation, and the lowest level of iNOs affected by various concentrations of A. absinthium occurred at the 100 mg/mL concentration. Hence, after 24 and 48 hours of incubation, the optimal concentration of A. absinthium was 100 mg/mL, and after 72 hours of incubation, 50 mg/mL and 100 mg/mL produced the lowest levels of iNOs, respectively (Table 2).

Table 2.

Levels of iNOs From Leishmania-Infected Macrophages in Different Concentrations of A. absinthium Extracta,b

Incubation Time (H)Concentration (mg/mL)
2550100200400iMQaGlucantimeb
246670.260.867.867.577.9569.15
4862.96258.86563.57267
7262.755.557.864.860.868.662.1

a Macrophages infected with L. major; these cells were incubated without exposure to A. absinthin extract.

b Control positive.

5. Discussion

According to the World Health Organization, more than 80% of the world’s population (about 5 billion people) still use herbal medicines to treat diseases (25-29). Almost 50% of medications produced in the world are of plant origin, which are extracted directly from plants or synthesized based on herbal compounds. Plants are a potential source for anti-protozoan medications. Biological activity of plant extracts originates from compounds belonging to several chemical groups, including alkaloids, flavonoids, and steroids, which give anti-bacterial, anti-parasitic, and anti-oxidant properties to the plant (30, 31).

By examining the effect of different concentrations of A. absinthium extract on promastigotes using Trypan blue staining after 24 hours of exposure, we found that the concentrations of 800 and 400 mg/mL have more than 50% leishmaniacidal effects, and concentrations lower than 50 mg/mL had less effects. After 48 hours of exposure, the IC50 value of A. absinthium extract was 56 mg/mL and the leishmaniacidal effect of concentrations greater than 200 mg/mL ranged from 65% to 80%. After 72 hours of incubation, the concentrations of 12.5 and 6.25 mg/mL were ineffective and those equal to or greater than 50 mg/mL had 50% to 98% leishmaniacidal effects. After 48 hours, the bactericidal effects of Glucantime at the concentrations of 25 and 50 mg/mL were 36% and 54%, respectively, and other concentrations had 75% and 100% leishmaniacidal effects. This effect increased depending on exposure time and concentration such that after 72 hours, the concentration of 25 mg/mL showed to have 83% and the other three concentrations had 100% leishmaniacidal effects.

An in vitro study similar to our study was conducted on mice to examine the effect of two native plants namely Artemisia sieberi besser and Scrophularia striata boiss on the growth of L. major. The results showed that 20% and 25% concentrations of Artemisia extract completely destroyed promastigotes on the first day, highlighting the effectiveness of Artemisia in inhibiting the parasite’s growth; this result is consistent with the in vitro phase of our study (32). Another investigation has assessed the synergistic effects of mixed Achillea millefolium, A. absinthium, and walnut leaf extracts on L. major in vitro and found that plant extracts increase the immobility of parasites, which was directly associated with exposure time. That in vitro investigation, the same as the present study, confirmed the effectiveness of A. absinthium extract in inhibiting the growth of L. major (33, 34). Another study evaluated the anti-leishmanial effect of hydroalcoholic extract of Calendula officinalis on L. major promastigotes in vitro. This extract killed all parasites at a concentration of 500 µg/mL, and lower concentrations showed dose-dependent anti-Leishmania activity, and after 24 hours, the IC50 values in the alcoholic and aqueous extracts were obtained at 170 µg/mL and 215 µg/mL concentrations, respectively (35).

In concordance to our results, Azizi et al. have investigated the in vitro efficacy of ethanolic extract of A. absinthium against L. major using MTT and flow cytometry assays. They found some contrasting relationships between A. absinthium concentrations and the viability of L. major promastigotes. It could be concluded that it is likely that one or more chemical constituents within the herbal extract of A. absinthium at high concentrations control cell division and affect the relevant activity within the only one giant mitochondrion in this flagellate parasite (36). In our study, after 24, 48, and 72 hours of incubation, the effect of different concentrations of A. absinthium extract on the growth of amastigotes was examined using Giemsa staining at 37°C in 5% CO2 with optimal moisture.

According to the IC50 value of A. absinthium extract at the promastigote stage, very high and very low concentrations of extract were not used. Given that 100 mg/mL of Glucantime had the highest effect on promastigotes, this concentration was used as the positive control in the assessment of the effect of A. absinthium on amastigotes. In our study, the repeated measures analysis of variance showed a significant reduction in the number of L. major parasites in terms of time (P < 0.05), indicating the effect of Artemisia extract on reducing the number of promastigotes. Artemisia absinthium extract had also different effects at different times (P < 0.05). Further, 800 and 400 mg/mL concentrations of Artemisia absinthium extract had the same effects on the growth of L. major at different times (P > 0.05). The number of Leishmania parasites in the control medium (without medication or extract) was equal to the number of basic parasites, and it was not significant. There was also no significant reduction in Leishmania parasite growth (P > 0.05).

The results of our study showed the impact of different concentrations of the extract on the iNOs secretion from amastigote-infected macrophages. Our results also indicated that in early exposure and the innate immune system functioning, this medicinal plant activated and reinforced macrophages. In addition, the secretion of iNOs from amastigotes-infected macrophages reduced after 24-hour exposure to various concentrations of A. absinthium extract so that iNOs reached its lowest level at the concentration of 100 mg/mL. Besides, iNOs secretion decreased at 72, 48, and 24 hours, respectively, which displays an immune shift to Th1 and cellular immunity and more production of classic macrophages in the absence of iNOs. The classic macrophage (M1) can be created when this enzyme is reduced, which shifts immunity to cellular immunity (37, 38).

5.1. Conclusions

In sum, the effect of different concentrations of A. absinthium extract on the growth of L. major showed that all concentrations of this extract are able to reduce this parasite’s growth. According to our results, a significant decline was observed at different concentrations, and no significant reduction was observed in the growth of Leishmania parasites.

Acknowledgements

References

  • 1.

    Mueller MS, Runyambo N, Wagner I, Borrmann S, Dietz K, Heide L. Randomized controlled trial of a traditional preparation of Artemisia annua L. (annual wormwood) in the treatment of malaria. Trans R Soc Trop Med Hyg. 2004;98(5):318-21. [PubMed ID: 15109558]. https://doi.org/10.1016/j.trstmh.2003.09.001.

  • 2.

    Akhoundi M, Kuhls K, Cannet A, Votypka J, Marty P, Delaunay P, et al. A historical overview of the classification, evolution, and dispersion of leishmania parasites and sandflies. PLoS Negl Trop Dis. 2016;10(3). e0004349. [PubMed ID: 26937644]. [PubMed Central ID: PMC4777430]. https://doi.org/10.1371/journal.pntd.0004349.

  • 3.

    Desjeux P. Leishmaniasis: Current situation and new perspectives. Comp Immunol Microbiol Infect Dis. 2004;27(5):305-18. [PubMed ID: 15225981]. https://doi.org/10.1016/j.cimid.2004.03.004.

  • 4.

    Hotez PJ, Savioli L, Fenwick A. Neglected tropical diseases of the Middle East and North Africa: Review of their prevalence, distribution, and opportunities for control. PLoS Negl Trop Dis. 2012;6(2). e1475. [PubMed ID: 22389729]. [PubMed Central ID: PMC3289601]. https://doi.org/10.1371/journal.pntd.0001475.

  • 5.

    Croft SL, Yardley V. Chemotherapy of leishmaniasis. Curr Pharm Des. 2002;8(4):319-42. [PubMed ID: 11860369].

  • 6.

    Mishra BB, Kale RR, Singh RK, Tiwari VK. Alkaloids: Future prospective to combat leishmaniasis. Fitoterapia. 2009;80(2):81-90. [PubMed ID: 19015012]. https://doi.org/10.1016/j.fitote.2008.10.009.

  • 7.

    Rocha LG, Almeida JR, Macedo RO, Barbosa-Filho JM. A review of natural products with antileishmanial activity. Phytomedicine. 2005;12(6-7):514-35. [PubMed ID: 16008131]. https://doi.org/10.1016/j.phymed.2003.10.006.

  • 8.

    Kolodziej H, Kiderlen AF. Antileishmanial activity and immune modulatory effects of tannins and related compounds on Leishmania parasitised RAW 264.7 cells. Phytochemistry. 2005;66(17):2056-71. [PubMed ID: 16153409]. https://doi.org/10.1016/j.phytochem.2005.01.011.

  • 9.

    Lamidi M, DiGiorgio C, Delmas F, Favel A, Eyele Mve-Mba C, Rondi ML, et al. In vitro cytotoxic, antileishmanial and antifungal activities of ethnopharmacologically selected Gabonese plants. J Ethnopharmacol. 2005;102(2):185-90. [PubMed ID: 16046090]. https://doi.org/10.1016/j.jep.2005.06.011.

  • 10.

    Khademvatan S, Adibpour N, Eskandari A, Rezaee S, Hashemitabar M, Rahim F. In silico and in vitro comparative activity of novel experimental derivatives against Leishmania major and Leishmania infantum promastigotes. Exp Parasitol. 2013;135(2):208-16. [PubMed ID: 23872452]. https://doi.org/10.1016/j.exppara.2013.07.004.

  • 11.

    Yousefi E, Eskandari A, Gharavi MJ, Khademvatan S. In vitro activity and cytotoxicity of Crocus sativus extract against Leihmania major (MRHO/IR/75/ER). Infect Disord Drug Targets. 2014;14(1):56-60. [PubMed ID: 25159304].

  • 12.

    Gharavi M, Nobakht M, Khademvatan S, Fani F, Bakhshayesh M, Roozbehani M. The effect of aqueous garlic extract on interleukin-12 and 10 levels in Leishmania major (MRHO/IR/75/ER) infected macrophages. Iran J Public Health. 2011;40(4):105-11. [PubMed ID: 23113109]. [PubMed Central ID: PMC3481747].

  • 13.

    Lachenmeier DW. Wormwood (Artemisia absinthium L.): A curious plant with both neurotoxic and neuroprotective properties? J Ethnopharmacol. 2010;131(1):224-7. [PubMed ID: 20542104]. https://doi.org/10.1016/j.jep.2010.05.062.

  • 14.

    Bahmani M, Saki K, Ezatpour B, Shahsavari S, Eftekhari Z, Jelodari M, et al. Leishmaniosis phytotherapy: Review of plants used in Iranian traditional medicine on leishmaniasis. Asian Pac J Trop Biomed. 2015;5(9):695-701. https://doi.org/10.1016/j.apjtb.2015.05.018.

  • 15.

    Martinez-Diaz RA, Ibanez-Escribano A, Burillo J, Heras Lde L, Prado GD, Agullo-Ortuno MT, et al. Trypanocidal, trichomonacidal and cytotoxic components of cultivated Artemisia absinthium Linnaeus (Asteraceae) essential oil. Mem Inst Oswaldo Cruz. 2015;110(5):693-9. [PubMed ID: 26107187]. [PubMed Central ID: PMC4569837]. https://doi.org/10.1590/0074-02760140129.

  • 16.

    Khalili Dehkordi B, Rafieian M, Hejazi SH, Yusefi HA, Yektaian N, Shirani Bidabadi L. [Effect of Achillea millefolium, Artemisia absinthium and Juglans regia leaves extracts on Trichomonas vaginalis, in vitra]. J Shahrekord Univ Med Sci. 2011;12(4):62-9. Persian.

  • 17.

    Albakhit S, Doudi M. [The evaluation of Methanolic and aqueous extracts effect of Zizyphus spina-Christi against Leishmania major (MHOM/IR/75/ER) promastigotes using MTT assay]. Iran J Med Microbiol. 2016;10(3):54-60. Persian.

  • 18.

    Tavakkol Afshari J, Rakhshandeh H, Zamani AR, Mahdavi Shahri N, Ghazezadeh L, Norozi M, et al. [Cytotoxicity effects of citrullus colocynthis on Hep2 and L929 cell lines]. Hakim Res Journal. 2005;8(2):47-54. Persian.

  • 19.

    Dalimi A, Ghaffarifar F, Sadraei J. [Cytotoxic effects of 5-fluorouracil on Leishmania major promastigotes and induction of apoptosis in the parasite]. Sci J Ilam Univ Med Sci. 2014;21(7):34-42. Persian.

  • 20.

    Esavand Heydari F, Ghaffarifar F, Soflaei S, Dalimi A. Comparison between in vitro effects of aqueous extract of Artemisia seiberi and artemisinin on Leishmania major. Jundishapur J Nat Pharm Prod. 2013;8(2):70-5. [PubMed ID: 24624191]. [PubMed Central ID: PMC3941912].

  • 21.

    Shokrzadeh M, Parvaresh A, Shahani S, Habibi E, Zalzar Z. [Cytotoxic effects of lagenaria siceraria standl. extract on cancer cell lin]. J Mazandaran Univ Med Sci. 2013;22(97):225-30. Persian.

  • 22.

    Khademvatan S, Gharavi MJ, Akhlaghi L, Samadikuchaksaraei A, Mousavizadeh K, Hadighi R, et al. Induction of apoptosis by miltefosine in Iranian strain of Leishmania infantum promastigotes. Iran J Parasitol. 2009;4(2):23-31.

  • 23.

    Talari SA, Dorodgar A, Ouzougi J. [In vitro effect of various concentrations of hedera helix extract and glucantime on visceral leishmaniosis]. J Kashan Univ Med Sci (Feyz). 1997;1(2):61-7. Persian.

  • 24.

    Sadeghi-Nejad B, Saki J. Effect of aqueous allium cepa and ixora brachiata root extract on Leishmania major promastigotes. Jundishapur J Nat Pharm Prod. 2014;9(2). e15442. [PubMed ID: 24872942]. [PubMed Central ID: PMC4036374].

  • 25.

    Calixto JB. Efficacy, safety, quality control, marketing and regulatory guidelines for herbal medicines (phytotherapeutic agents). Braz J Med Biol Res. 2000;33(2):179-89. [PubMed ID: 10657057].

  • 26.

    Boadu AA, Asase A. Documentation of herbal medicines used for the treatment and management of human diseases by some communities in southern Ghana. Evid Based Complement Alternat Med. 2017;2017:3043061. [PubMed ID: 28684965]. [PubMed Central ID: PMC5480049]. https://doi.org/10.1155/2017/3043061.

  • 27.

    Calixto JB. Twenty-five years of research on medicinal plants in Latin America: A personal view. J Ethnopharmacol. 2005;100(1-2):131-4. [PubMed ID: 16006081]. https://doi.org/10.1016/j.jep.2005.06.004.

  • 28.

    Tariku Y, Hymete A, Hailu A, Rohloff J. In vitro evaluation of antileishmanial activity and toxicity of essential oils of Artemisia absinthium and Echinops kebericho. Chem Biodivers. 2011;8(4):614-23. [PubMed ID: 21480507]. https://doi.org/10.1002/cbdv.201000331.

  • 29.

    Gucwa K, Milewski S, Dymerski T, Szweda P. Investigation of the antifungal activity and mode of action of Thymus vulgaris, Citrus limonum, Pelargonium graveolens, Cinnamomum cassia, Ocimum basilicum, and Eugenia caryophyllus essential oils. Molecules. 2018;23(5). [PubMed ID: 29738503]. https://doi.org/10.3390/molecules23051116.

  • 30.

    Tiuman TS, Santos AO, Ueda-Nakamura T, Filho BP, Nakamura CV. Recent advances in leishmaniasis treatment. Int J Infect Dis. 2011;15(8):e525-32. [PubMed ID: 21605997]. https://doi.org/10.1016/j.ijid.2011.03.021.

  • 31.

    Da Silva BJM, Hage AAP, Silva EO, Rodrigues APD. Medicinal plants from the Brazilian Amazonian region and their antileishmanial activity: A review. J Integr Med. 2018;16(4):211-22. [PubMed ID: 29691188]. https://doi.org/10.1016/j.joim.2018.04.004.

  • 32.

    Dalimi A, Arbabi M, Naserifar R. [The effect of aqueous extraction of Artemisia sieberi besser and Scrophularia striata boiss. on Leishmania major under in vitro conditions]. Iran J Med Aromatic Plant. 2013;29(1). Persian. https://doi.org/10.22092/ijmapr.2013.2904.

  • 33.

    Soosaraei M, Fakhar M, Hosseini Teshnizi S, Ziaei Hezarjaribi H, Banimostafavi ES. Medicinal plants with promising antileishmanial activity in Iran: A systematic review and meta-analysis. Ann Med Surg (Lond). 2017;21:63-80. [PubMed ID: 28794869]. [PubMed Central ID: PMC5536386]. https://doi.org/10.1016/j.amsu.2017.07.057.

  • 34.

    Nikmehr B, Ghaznavi H, Rahbar A, Sadr S, Mehrzadi S. In vitro anti-leishmanial activity of methanolic extracts of Calendula officinalis flowers, Datura stramonium seeds, and Salvia officinalis leaves. Chin J Nat Med. 2014;12(6):423-7. [PubMed ID: 24969522]. https://doi.org/10.1016/S1875-5364(14)60066-2.

  • 35.

    Maspi N, Ghafarifar F, Bahrami AM, Bastaminejad S, Shamsi M. Evaluation of leishmanicidal effect of watery and ethanolic flowers calendula officinalis extract on promastigotes of Leishmania major (MRHO/IR/75/ER) in vitro. J Ilam Univ Med Sci. 2010;18(1):28-33.

  • 36.

    Azizi K, Shahidi-Hakak F, Asgari Q, Hatam GR, Fakoorziba MR, Miri R, et al. In vitro efficacy of ethanolic extract of Artemisia absinthium (Asteraceae) against Leishmania major L. using cell sensitivity and flow cytometry assays. J Parasit Dis. 2016;40(3):735-40. [PubMed ID: 27605775]. [PubMed Central ID: PMC4996182]. https://doi.org/10.1007/s12639-014-0569-5.

  • 37.

    Malik M, Jividen K, Padmakumar VC, Cataisson C, Li L, Lee J, et al. Inducible NOS-induced chloride intracellular channel 4 (CLIC4) nuclear translocation regulates macrophage deactivation. Proc Natl Acad Sci U S A. 2012;109(16):6130-5. [PubMed ID: 22474389]. [PubMed Central ID: PMC3341024]. https://doi.org/10.1073/pnas.1201351109.

  • 38.

    Qadoumi M, Becker I, Donhauser N, Rollinghoff M, Bogdan C. Expression of inducible nitric oxide synthase in skin lesions of patients with american cutaneous leishmaniasis. Infect Immun. 2002;70(8):4638-42. [PubMed ID: 12117977]. [PubMed Central ID: PMC128200].