Evaluating the Potential of Paratransgenesisas a Leishmaniasis Disease Control Strategyin the Mediterranean Basin. A Critical Review

eishmaniasis, caused by the protozoan parasite Leishmania, impacts the lives of anestimated 700,000 around the world. With the geographic spread of disease on therise and effective treatments slow to advance, novel research into infection control isin high demand. The Mediterranean Basin is largely affected by visceral andcutaneous leishmaniasis, infecting both humans and canine reservoirs. Predictions ofworsening incidence, as a result of climate change, highlights that research in thisregion is imperative. Leishmania parasite development in the sandfly midgut indicatesa potential transmission control target, the gut microbiome of the sandfly vector. Thedynamic nature of the microbiome is susceptible for manipulation, allowing possiblebreakthroughs in preventing Leishmania transmission by paratransgenesis.Paratransgenic engineering produces transgenic bacteria that express effectormolecules to inhibit parasite development, and control transmission of disease tohuman and animal host reservoirs. The identification of candidate bacterium formanipulation has already begun for controlling mosquito-borne diseases. As a highlyresearched disease model, malaria highlights areas of opportunity for leishmaniasisresearch. Combining past and current studies suggest that the microbiome, incombination with therapy drugs, has the capability of reducing human leishmaniasisincidence. Whilst this is apparent, considerable knowledge gaps and limitations to pastresearch exist, highlighting this concept is one that requires extensive study.Emphasised in this review is the essential nature of basic microbiome research andthe conclusion that this must take place before paratransgenesis can be a successfulleishmaniasis control strategy.