The standard treatment of human visceral leishmaniasis involves the use of pentavalent antimony (Sb V ). Its mechanism of action is unknown because of the limited information available about intracellular antimony metabolism and about the genes that regulate these processes. Herein, flow injection-inductively coupled plasma mass spectrometry (ICP-MS), flow injection hydride generation ICP-MS, and ion chromatography ICP-MS were used to measure antimony accumulation and intracellular metabolism in the human protozoan parasite Leishmania donovani. V reduction has yet to be identified, and it may or may not be enzymatic. This is the first description of intracellular Sb V reducing activity in Leishmania as well as in any prokaryotic or eukaryotic cell.Leishmania donovani is the major causative agent of visceral leishmaniasis. In nature, the parasite exists either as an extracellular promastigote found in the alimentary tract of sandflies or as an obligatory intracellular amastigote found in phagolysosomes of mammalian macrophages(1-3). During the last several years, a number of laboratories have utilized axenic culture of L. donovani amastigotes for the direct evaluation of cell biological and biochemical processes in the amastigote, devoid of the host macrophage (4 -7,8,9,10). This technique has also been used to investigate the mechanism of drug action and resistance as well as for screening of potential new drugs(11-13). The treatment of choice of human visceral leishmaniasis is the administration of pentavalent antimony (Sb V )-containing drugs such as sodium stibogluconate (Pentostam, Wellcome, Beckenham, UK) or meglumine antimoniate (Glucantime, Rhone-Poulenc, Paris, France). Despite extensive use of these compounds over the last decades, the mechanism of action remains unclear.It has been hypothesized that Sb V is not toxic to Leishmania, but rather that it is enzymatically reduced, probably by the host macrophage, to Sb III , the form of antimony that is highly Leishmania-toxic (14 -18). In contrast, it has been shown that Sb V is directly toxic to axenic amastigotes (12,13,19), thus negating the necessity of the macrophage for Sb V reduction. Furthermore, these data imply that either the parasite reduces Sb V to Sb III intracellularly, and thus Sb III is directly toxic to amastigotes, or that both oxidation states of antimony are active against Leishmania amastigotes. The modes of action of the two oxidation states of antimony (Sb III and Sb V ) on Leishmania are, as yet, not fully understood.Several groups have shown obligatory cross-resistance between Sb V , Sb III , and arsenite (As III ) in Leishmania tarentolae, Leishmania major, Leishmania mexicana, L. donovani and Leishmania infantum (11,[20][21][22]. In contrast, it has been suggested that, at least in L. donovani, such cross-resistance does not necessarily occur (12). Furthermore, it has been demonstrated that, when bound to organic compounds, structural similarities exist between Sb III and Sb V (23). For example, the trivalent antimony comp...