Treatment of S2 requires that the drug crosses the blood–brain barrier (BBB); the highly specialised microvasculature that separates the cerebral tissue from the blood circulation ( Abbott et al., 2006). S1 acting drugs are pentamidine and suramin which are effective against T. b. gambiense and T. b. rhodesiense, respectively ( Brun et al., learn more 2010, Sanderson et al., 2007 and Sands et al., 1985). S2 drugs are melarsoprol, eflornithine and nifurtimox. Several

recent reviews discuss the S2 acting drugs in further detail ( Brun et al., 2010 and Lutje et al., 2010). Our research group has investigated the ability of suramin, pentamidine, eflornithine and nifurtimox to cross the BBB using an in situ brain/choroid plexus perfusion technique in anaesthetised

mice ( Jeganathan et al., 2011, Sanderson et al., 2007, Sanderson et al., 2008 and Sanderson et al., 2009). Our latest study focused on nifurtimox, an anti-parasitic nitrofuran that was originally used to treat Chagas disease; a closely related condition to HAT caused by Trypanosoma cruzi ( Gonnert and Bock, 1972 and Haberkorn and Gonnert, 1972), but has since been used in compassionate treatment for HAT when other methods have failed ( Moens et al., 1984 and Van Nieuwenhove, 1992). Nifurtimox is now used against S2 in combination with eflornithine ( Checchi et al., 2007). Nifurtimox is cheap, orally active and effective against T. b. gambiense and, to a lesser extent, T. b. rhodesiense ( Bouteille et al., 2003, Haberkorn, 1979 and Lutje et al.,

2010). Importantly, our group have shown that nifurtimox selleck is able to cross the murine BBB in situ, but undergoes an efflux removal process from the brain via an unidentified process, in which the adenosine triphosphate (ATP) binding cassette (ABC) transporter P-glycoprotein, (P-gp) is not involved ( Jeganathan et al., 2011). The identify of this efflux mechanism is of special interest with the fact that nifurtimox–eflornithine combination therapy (NECT) is now becoming the first course of treatment against S2 HAT ( Yun et al., 2010), having been shown to both improve efficacy and reduce harmful side Carbohydrate effects ( Priotto et al., 2007 and Priotto et al., 2009). The precise mechanisms behind the success of this particular combination therapy (CT) have yet to be fully revealed, however, it is possible CT could improve delivery to the brain. Our group have shown that nifurtimox delivery to the mouse brain is improved with the addition of the S1 acting drug pentamidine ( Jeganathan et al., 2011), which we have previously identified as being a substrate for cellular transport mechanisms at the BBB, including P-gp ( Sanderson et al., 2009). These findings highlight not only the need to elucidate the transport mechanisms utilized by nifurtimox at the BBB, but also the effect of CT on its delivery.