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Tang M, Hu X, Wang Y, Yao X, Zhang W, Yu C, Cheng F, Li J, Fang Q. Ivermectin, a potential anticancer drug derived from an antiparasitic drug. Pharmacol Res 2021; 163:105207. [PMID: 32971268 PMCID: PMC7505114 DOI: 10.1016/j.phrs.2020.105207] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 12/30/2022]
Abstract
Ivermectin is a macrolide antiparasitic drug with a 16-membered ring that is widely used for the treatment of many parasitic diseases such as river blindness, elephantiasis and scabies. Satoshi ōmura and William C. Campbell won the 2015 Nobel Prize in Physiology or Medicine for the discovery of the excellent efficacy of ivermectin against parasitic diseases. Recently, ivermectin has been reported to inhibit the proliferation of several tumor cells by regulating multiple signaling pathways. This suggests that ivermectin may be an anticancer drug with great potential. Here, we reviewed the related mechanisms by which ivermectin inhibited the development of different cancers and promoted programmed cell death and discussed the prospects for the clinical application of ivermectin as an anticancer drug for neoplasm therapy.
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Affiliation(s)
- Mingyang Tang
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province 233030, China; Clinical Medical Department, Bengbu Medical College, Bengbu, Anhui Province 233030, China.
| | - Xiaodong Hu
- Department of Histology and Embryology, Bengbu Medical College, Bengbu, Anhui Province 233030, China.
| | - Yi Wang
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province 233030, China; Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui Province 233030, China.
| | - Xin Yao
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province 233030, China; Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui Province 233030, China.
| | - Wei Zhang
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province 233030, China; Clinical Medical Department, Bengbu Medical College, Bengbu, Anhui Province 233030, China.
| | - Chenying Yu
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province 233030, China; Clinical Medical Department, Bengbu Medical College, Bengbu, Anhui Province 233030, China.
| | - Fuying Cheng
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province 233030, China; Clinical Medical Department, Bengbu Medical College, Bengbu, Anhui Province 233030, China.
| | - Jiangyan Li
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province 233030, China; Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui Province 233030, China.
| | - Qiang Fang
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province 233030, China; Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui Province 233030, China; School of Fundamental Sciences, Bengbu Medical College, Bengbu, Anhui Province 233030, China.
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A Model for Assessing the Quantitative Effects of Heterogeneous Affinity in Malaria Transmission along with Ivermectin Mass Administration. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10238696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Using an agent-based model of malaria, we present numerical evidence that in communities of individuals having an affinity varying within a broad range of values, disease transmission may increase up to 300%. Moreover, our findings provide new insight into how to combine different strategies for the prevention of malaria transmission. In particular, we uncover a relationship between the level of heterogeneity and the level of conventional and unconventional anti-malarial drug administration (ivermectin and gametocidal agents), which, when taken together, will define a control parameter, tuning between disease persistence and elimination. Finally, we also provide evidence that the entomological inoculation rate, as well as the product between parasite and sporozoite rates are both good indicators of malaria incidence in the presence of heterogeneity in disease transmission and may configure a possible improvement in that setting, upon classical standard measures such as the basic reproductive number.
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Dabira ED, Soumare HM, Lindsay SW, Conteh B, Ceesay F, Bradley J, Kositz C, Broekhuizen H, Kandeh B, Fehr AE, Nieto-Sanchez C, Ribera JM, Peeters Grietens K, Smit MR, Drakeley C, Bousema T, Achan J, D'Alessandro U. Mass Drug Administration With High-Dose Ivermectin and Dihydroartemisinin-Piperaquine for Malaria Elimination in an Area of Low Transmission With High Coverage of Malaria Control Interventions: Protocol for the MASSIV Cluster Randomized Clinical Trial. JMIR Res Protoc 2020; 9:e20904. [PMID: 33211022 PMCID: PMC7714640 DOI: 10.2196/20904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND With a decline in malaria burden, innovative interventions and tools are required to reduce malaria transmission further. Mass drug administration (MDA) of artemisinin-based combination therapy (ACT) has been identified as a potential tool to further reduce malaria transmission, where coverage of vector control interventions is already high. However, the impact is limited in time. Combining an ACT with an endectocide treatment that is able to reduce vector survival, such as ivermectin (IVM), could increase the impact of MDA and offer a new tool to reduce malaria transmission. OBJECTIVE The study objective is to evaluate the impact of MDA with IVM plus dihydroartemisinin-piperaquine (DP) on malaria transmission in an area with high coverage of malaria control interventions. METHODS The study is a cluster randomized trial in the Upper River Region of The Gambia and included 32 villages (16 control and 16 intervention). A buffer zone of ~2 km was created around all intervention clusters. MDA with IVM plus DP was implemented in all intervention villages and the buffer zones; control villages received standard malaria interventions according to the Gambian National Malaria Control Program plans. RESULTS The MDA campaigns were carried out from August to October 2018 for the first year and from July to September 2019 for the second year. Statistical analysis will commence once the database is completed, cleaned, and locked. CONCLUSIONS This is the first cluster randomized clinical trial of MDA with IVM plus DP. The results will provide evidence on the impact of MDA with IVM plus DP on malaria transmission. TRIAL REGISTRATION ClinicalTrials.gov NCT03576313; https://clinicaltrials.gov/ct2/show/NCT03576313. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20904.
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Affiliation(s)
- Edgard Diniba Dabira
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Harouna M Soumare
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Steven W Lindsay
- Department of Biosciences, Durham University, Durham, United Kingdom
| | - Bakary Conteh
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Fatima Ceesay
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - John Bradley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christian Kositz
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Balla Kandeh
- National Malaria Control Program, The Gambia, Banjul, Gambia
| | - Alexandra E Fehr
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Vrije Universiteit Amsterdam, Athena Institute, Amsterdam, Netherlands
| | - Claudia Nieto-Sanchez
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joan Muela Ribera
- Medial Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | - Koen Peeters Grietens
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Menno Roderick Smit
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands, Amsterdam, Netherlands
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Teun Bousema
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jane Achan
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
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Abstract
BACKGROUND Despite being preventable, malaria remains an important public health problem. The World Health Organization (WHO) reports that overall progress in malaria control has plateaued for the first time since the turn of the century. Researchers and policymakers are therefore exploring alternative and supplementary malaria vector control tools. Research in 1900 indicated that modification of houses may be effective in reducing malaria: this is now being revisited, with new research now examining blocking house mosquito entry points or modifying house construction materials to reduce exposure of inhabitants to infectious bites. OBJECTIVES To assess the effects of house modifications on malaria disease and transmission. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (PubMed); Embase (OVID); Centre for Agriculture and Bioscience International (CAB) Abstracts (Web of Science); and the Latin American and Caribbean Health Science Information database (LILACS), up to 1 November 2019. We also searched the WHO International Clinical Trials Registry Platform (www.who.int/ictrp/search/en/), ClinicalTrials.gov (www.clinicaltrials.gov), and the ISRCTN registry (www.isrctn.com/) to identify ongoing trials up to the same date. SELECTION CRITERIA Randomized controlled trials, including cluster-randomized controlled trials (cRCTs), cross-over studies, and stepped-wedge designs were eligible, as were quasi-experimental trials, including controlled before-and-after studies, controlled interrupted time series, and non-randomized cross-over studies. We only considered studies reporting epidemiological outcomes (malaria case incidence, malaria infection incidence or parasite prevalence). We also summarised qualitative studies conducted alongside included studies. DATA COLLECTION AND ANALYSIS Two review authors selected eligible studies, extracted data, and assessed the risk of bias. We used risk ratios (RR) to compare the effect of the intervention with the control for dichotomous data. For continuous data, we presented the mean difference; and for count and rate data, we used rate ratios. We presented all results with 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS Six cRCTs met our inclusion criteria, all conducted in sub-Saharan Africa; three randomized by household, two by village, and one at the community level. All trials assessed screening of windows, doors, eaves, ceilings or any combination of these; this was either alone, or in combination with eave closure, roof modification or eave tube installation (a "lure and kill" device that reduces mosquito entry whilst maintaining some airflow). In two trials, the interventions were insecticide-based. In five trials, the researchers implemented the interventions. The community implemented the interventions in the sixth trial. At the time of writing the review, two of the six trials had published results, both of which compared screened houses (without insecticide) to unscreened houses. One trial in Ethiopia assessed screening of windows and doors. Another trial in the Gambia assessed full screening (screening of eaves, doors and windows), as well as screening of ceilings only. Screening may reduce clinical malaria incidence caused by Plasmodium falciparum (rate ratio 0.38, 95% CI 0.18 to 0.82; 1 trial, 184 participants, 219.3 person-years; low-certainty evidence; Ethiopian study). For malaria parasite prevalence, the point estimate, derived from The Gambia study, was smaller (RR 0.84, 95% CI 0.60 to 1.17; 713 participants, 1 trial; moderate-certainty evidence), and showed an effect on anaemia (RR 0.61, 95% CI 0.42, 0.89; 705 participants; 1 trial, moderate-certainty evidence). Screening may reduce the entomological inoculation rate (EIR): both trials showed lower estimates in the intervention arm. In the Gambian trial, there was a mean difference in EIR between the control houses and treatment houses ranging from 0.45 to 1.50 (CIs ranged from -0.46 to 2.41; low-certainty evidence), depending on the study year and treatment arm. The Ethiopian trial reported a mean difference in EIR of 4.57, favouring screening (95% CI 3.81 to 5.33; low-certainty evidence). Pooled analysis of the trials showed that individuals living in fully screened houses were slightly less likely to sleep under a bed net (RR 0.84, 95% CI 0.65 to 1.09; 2 trials, 203 participants). In one trial, bed net usage was also lower in individuals living in houses with screened ceilings (RR 0.69, 95% CI 0.50 to 0.95; 1 trial, 135 participants). AUTHORS' CONCLUSIONS Based on the two trials published to date, there is some evidence that screening may reduce malaria transmission and malaria infection in people living in the house. The four trials awaiting publication are likely to enrich the current evidence base, and we will add these to this review when they become available.
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Affiliation(s)
- Joanna Furnival-Adams
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Evelyn A Olanga
- Malaria Alert Centre of the College of Medicine, Blantyre, Malawi
| | - Mark Napier
- Council for Scientific and Industrial Research, Pretoria, South Africa
- Centre for Development Support, University of the Free State, Bloemfontein, South Africa
| | - Paul Garner
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Kridaningsih TN, Sukmana DJ, Mufidah H, Diptyanusa A, Kusumasari RA, Burdam FH, Kenangalem E, Poespoprodjo JR, Fuad A, Mahendradhata Y, Supargiyono S, Utzinger J, Becker SL, Murhandarwati EEH. Epidemiology and risk factors of Strongyloides stercoralis infection in Papua, Indonesia: a molecular diagnostic study. Acta Trop 2020; 209:105575. [PMID: 32505594 DOI: 10.1016/j.actatropica.2020.105575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/19/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Strongyloides stercoralis is a parasitic worm that is of considerable clinical relevance. Indeed, it may persist asymptomatically for many years, but can lead to potentially fatal dissemination when the host's immune status is impaired. As commonly employed stool microscopy techniques (e.g. Kato-Katz thick smear) fail to detect S. stercoralis, the epidemiology is poorly understood. In 2013, we conducted a cross-sectional household survey in the district of Mimika in Papua, Indonesia. A total of 331 individuals, aged 1 month to 44 years, had a single stool sample subjected to real-time polymerase chain reaction (PCR) for S. stercoralis diagnosis. The prevalence of S. stercoralis infection was 32.0% (106/331 individuals); higher than any of the three main soil-transmitted helminths (Ascaris lumbricoides, 23.9%; Trichuris trichiura, 18.4%; and hookworm, 17.2%). Amongst the S. stercoralis-infected individuals, 73.6% were concurrently infected with another helminth, with hookworm being the most frequent co-infection (27.4%). Fourteen percent of the S. stercoralis infections had low cycle threshold values on real-time PCR, which may indicate a higher infection intensity. Multivariate logistic regression analysis revealed that age ≥5 years (adjusted odds ratio (OR) 5.8, 95% confidence interval (CI): 3.1-10.8) was significantly associated with S. stercoralis infection. There is a need for in-depth clinical and diagnostic studies to elucidate the public health impact of S. stercoralis infection in Indonesia.
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Safety, Pharmacokinetics, and Activity of High-Dose Ivermectin and Chloroquine against the Liver Stage of Plasmodium cynomolgi Infection in Rhesus Macaques. Antimicrob Agents Chemother 2020; 64:AAC.00741-20. [PMID: 32660993 PMCID: PMC7449176 DOI: 10.1128/aac.00741-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022] Open
Abstract
Previously, ivermectin (1 to 10 mg/kg of body weight) was shown to inhibit the liver-stage development of Plasmodium berghei in orally dosed mice. Here, ivermectin showed inhibition of the in vitro development of Plasmodium cynomolgi schizonts (50% inhibitory concentration [IC50], 10.42 μM) and hypnozoites (IC50, 29.24 μM) in primary macaque hepatocytes when administered as a high dose prophylactically but not when administered in radical cure mode. Previously, ivermectin (1 to 10 mg/kg of body weight) was shown to inhibit the liver-stage development of Plasmodium berghei in orally dosed mice. Here, ivermectin showed inhibition of the in vitro development of Plasmodium cynomolgi schizonts (50% inhibitory concentration [IC50], 10.42 μM) and hypnozoites (IC50, 29.24 μM) in primary macaque hepatocytes when administered as a high dose prophylactically but not when administered in radical cure mode. The safety, pharmacokinetics, and efficacy of oral ivermectin (0.3, 0.6, and 1.2 mg/kg) with and without chloroquine (10 mg/kg) administered for 7 consecutive days were evaluated for prophylaxis or radical cure of P. cynomolgi liver stages in rhesus macaques. No inhibition or delay to blood-stage P. cynomolgi parasitemia was observed at any ivermectin dose (0.3, 0.6, and 1.2 mg/kg). Ivermectin (0.6 and 1.2 mg/kg) and chloroquine (10 mg/kg) in combination were well-tolerated with no adverse events and no significant pharmacokinetic drug-drug interactions observed. Repeated daily ivermectin administration for 7 days did not inhibit ivermectin bioavailability. It was recently demonstrated that both ivermectin and chloroquine inhibit replication of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro. Further ivermectin and chloroquine trials in humans are warranted to evaluate their role in Plasmodium vivax control and as adjunctive therapies against COVID-19 infections.
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El-Saber Batiha G, Alqahtani A, Ilesanmi OB, Saati AA, El-Mleeh A, Hetta HF, Magdy Beshbishy A. Avermectin Derivatives, Pharmacokinetics, Therapeutic and Toxic Dosages, Mechanism of Action, and Their Biological Effects. Pharmaceuticals (Basel) 2020; 13:E196. [PMID: 32824399 PMCID: PMC7464486 DOI: 10.3390/ph13080196] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
Avermectins are a group of drugs that occurs naturally as a product of fermenting Streptomyces avermitilis, an actinomycetes, isolated from the soil. Eight different structures, including ivermectin, abamectin, doramectin, eprinomectin, moxidectin, and selamectin, were isolated and divided into four major components (A1a, A2a, B1a and B2a) and four minor components (A1b, A2b, B1b, and B2b). Avermectins are generally used as a pesticide for the treatment of pests and parasitic worms as a result of their anthelmintic and insecticidal properties. Additionally, they possess anticancer, anti-diabetic, antiviral, antifungal, and are used for treatment of several metabolic disorders. Avermectin generally works by preventing the transmission of electrical impulse in the muscle and nerves of invertebrates, by amplifying the glutamate effects on the invertebrates-specific gated chloride channel. Avermectin has unwanted effects or reactions, especially when administered indiscriminately, which include respiratory failure, hypotension, and coma. The current review examines the mechanism of actions, biosynthesis, safety, pharmacokinetics, biological toxicity and activities of avermectins.
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Affiliation(s)
- Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, Egypt
| | - Ali Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia;
| | - Omotayo B. Ilesanmi
- Department of Biochemistry, Faculty of Science, Federal University Otuoke, Otuoke 561, Nigeria;
| | - Abdullah A. Saati
- Department of Community Medicine & Pilgrims Healthcare, Faculty of Medicine, Umm Al-Qura University Makkah, Mecca 24382, Saudi Arabia;
| | - Amany El-Mleeh
- Department of Pharmacology, Faculty of Veterinary Medicine, Menoufia University, Shibin Al Kawm 32511, Egypt;
| | - Helal F. Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45221, USA
| | - Amany Magdy Beshbishy
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Nishi 2-13, Inada-cho, Obihiro 080-8555, Hokkaido, Japan
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Repurposing Drugs to Fight Hepatic Malaria Parasites. Molecules 2020; 25:molecules25153409. [PMID: 32731386 PMCID: PMC7435416 DOI: 10.3390/molecules25153409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/16/2022] Open
Abstract
Malaria remains one of the most prevalent infectious diseases worldwide, primarily affecting some of the most vulnerable populations around the globe. Despite achievements in the treatment of this devastating disease, there is still an urgent need for the discovery of new drugs that tackle infection by Plasmodium parasites. However, de novo drug development is a costly and time-consuming process. An alternative strategy is to evaluate the anti-plasmodial activity of compounds that are already approved for other purposes, an approach known as drug repurposing. Here, we will review efforts to assess the anti-plasmodial activity of existing drugs, with an emphasis on the obligatory and clinically silent liver stage of infection. We will also review the current knowledge on the classes of compounds that might be therapeutically relevant against Plasmodium in the context of other communicable diseases that are prevalent in regions where malaria is endemic. Repositioning existing compounds may constitute a faster solution to the current gap of prophylactic and therapeutic drugs that act on Plasmodium parasites, overall contributing to the global effort of malaria eradication.
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Abstract
As the world gets closer to eliminating malaria, the scientific community worldwide has begun to realize the importance of malaria transmission-blocking interventions. The onus of breaking the life cycle of the human malaria parasite Plasmodium falciparum predominantly rests upon transmission-blocking drugs because of emerging resistance to commonly used schizonticides and insecticides. This third part of our review series on malaria transmission-blocking entails transmission-blocking potential of preclinical transmission-blocking antimalarials and other non-malaria drugs/experimental compounds that are not in clinical or preclinical development for malaria but possess transmission-blocking potential. Collective analysis of the structure and the activity of these experimental compounds might pave the way toward generation of novel prototypes of next-generation transmission-blocking drugs.
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Hsiang MS, Ntuku H, Roberts KW, Dufour MSK, Whittemore B, Tambo M, McCreesh P, Medzihradsky OF, Prach LM, Siloka G, Siame N, Gueye CS, Schrubbe L, Wu L, Scott V, Tessema S, Greenhouse B, Erlank E, Koekemoer LL, Sturrock HJW, Mwilima A, Katokele S, Uusiku P, Bennett A, Smith JL, Kleinschmidt I, Mumbengegwi D, Gosling R. Effectiveness of reactive focal mass drug administration and reactive focal vector control to reduce malaria transmission in the low malaria-endemic setting of Namibia: a cluster-randomised controlled, open-label, two-by-two factorial design trial. Lancet 2020; 395:1361-1373. [PMID: 32334702 PMCID: PMC7184675 DOI: 10.1016/s0140-6736(20)30470-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/23/2020] [Accepted: 02/25/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND In low malaria-endemic settings, screening and treatment of individuals in close proximity to index cases, also known as reactive case detection (RACD), is practised for surveillance and response. However, other approaches could be more effective for reducing transmission. We aimed to evaluate the effectiveness of reactive focal mass drug administration (rfMDA) and reactive focal vector control (RAVC) in the low malaria-endemic setting of Zambezi (Namibia). METHODS We did a cluster-randomised controlled, open-label trial using a two-by-two factorial design of 56 enumeration area clusters in the low malaria-endemic setting of Zambezi (Namibia). We randomly assigned these clusters using restricted randomisation to four groups: RACD only, rfMDA only, RAVC plus RACD, or rfMDA plus RAVC. RACD involved rapid diagnostic testing and treatment with artemether-lumefantrine and single-dose primaquine, rfMDA involved presumptive treatment with artemether-lumefantrine, and RAVC involved indoor residual spraying with pirimiphos-methyl. Interventions were administered within 500 m of index cases. To evaluate the effectiveness of interventions targeting the parasite reservoir in humans (rfMDA vs RACD), in mosquitoes (RAVC vs no RAVC), and in both humans and mosquitoes (rfMDA plus RAVC vs RACD only), an intention-to-treat analysis was done. For each of the three comparisons, the primary outcome was the cumulative incidence of locally acquired malaria cases. This trial is registered with ClinicalTrials.gov, number NCT02610400. FINDINGS Between Jan 1, 2017, and Dec 31, 2017, 55 enumeration area clusters had 1118 eligible index cases that led to 342 interventions covering 8948 individuals. The cumulative incidence of locally acquired malaria was 30·8 per 1000 person-years (95% CI 12·8-48·7) in the clusters that received rfMDA versus 38·3 per 1000 person-years (23·0-53·6) in the clusters that received RACD; 30·2 per 1000 person-years (15·0-45·5) in the clusters that received RAVC versus 38·9 per 1000 person-years (20·7-57·1) in the clusters that did not receive RAVC; and 25·0 per 1000 person-years (5·2-44·7) in the clusters that received rfMDA plus RAVC versus 41·4 per 1000 person-years (21·5-61·2) in the clusters that received RACD only. After adjusting for imbalances in baseline and implementation factors, the incidence of malaria was lower in clusters receiving rfMDA than in those receiving RACD (adjusted incidence rate ratio 0·52 [95% CI 0·16-0·88], p=0·009), lower in clusters receiving RAVC than in those that did not (0·48 [0·16-0·80], p=0·002), and lower in clusters that received rfMDA plus RAVC than in those receiving RACD only (0·26 [0·10-0·68], p=0·006). No serious adverse events were reported. INTERPRETATION In a low malaria-endemic setting, rfMDA and RAVC, implemented alone and in combination, reduced malaria transmission and should be considered as alternatives to RACD for elimination of malaria. FUNDING Novartis Foundation, Bill & Melinda Gates Foundation, and Horchow Family Fund.
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Affiliation(s)
- Michelle S Hsiang
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
| | - Henry Ntuku
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn W Roberts
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Mi-Suk Kang Dufour
- Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Brooke Whittemore
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Munyaradzi Tambo
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Patrick McCreesh
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Oliver F Medzihradsky
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Lisa M Prach
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Griffith Siloka
- Zambezi Ministry of Health and Social Services, Katima, Namibia
| | - Noel Siame
- Zambezi Ministry of Health and Social Services, Katima, Namibia
| | - Cara Smith Gueye
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Leah Schrubbe
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Lindsey Wu
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Valerie Scott
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Sofonias Tessema
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Bryan Greenhouse
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Erica Erlank
- Wits Research Institute for Malaria, South African Medical Research Council Collaborating Centre for Multi-Disciplinary Research on Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lizette L Koekemoer
- Wits Research Institute for Malaria, South African Medical Research Council Collaborating Centre for Multi-Disciplinary Research on Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hugh J W Sturrock
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Agnes Mwilima
- Zambezi Ministry of Health and Social Services, Katima, Namibia
| | - Stark Katokele
- National Vector-Borne Diseases Control Programme, Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Petrina Uusiku
- National Vector-Borne Diseases Control Programme, Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer L Smith
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Immo Kleinschmidt
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Wits Research Institute for Malaria, South African Medical Research Council Collaborating Centre for Multi-Disciplinary Research on Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Southern African Development Community, Malaria Elimination Eight Secretariat, Windhoek, Namibia
| | - Davis Mumbengegwi
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA; Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
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Nodari R, Corbett Y, Varotto-Boccazzi I, Porretta D, Taramelli D, Epis S, Bandi C. Effects of combined drug treatments on Plasmodium falciparum: In vitro assays with doxycycline, ivermectin and efflux pump inhibitors. PLoS One 2020; 15:e0232171. [PMID: 32324826 PMCID: PMC7179878 DOI: 10.1371/journal.pone.0232171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022] Open
Abstract
There is great concern regarding the rapid emergence and spread of drug-resistance in Plasmodium falciparum, the parasite responsible for the most severe form of human malaria. Parasite populations resistant to some or all the currently available antimalarial treatments are present in different world regions. Considering the need for novel and integrated approaches to control malaria, combinations of drugs were tested on P. falciparum. The primary focus was on doxycycline, an antibiotic that specifically targets the apicoplast of the parasite. In combination with doxycycline, three different drugs known to inhibit efflux pumps (verapamil, elacridar and ivermectin) were tested, with the assumption that they could increase the intracellular concentration of the antibiotic and consequently its efficacy against P. falciparum. We emphasize that elacridar is a third-generation ABC transporters inhibitor, never tested before on malaria parasites. In vitro experiments were performed on asexual stages of two strains of P. falciparum, chloroquine-sensitive (D10) and chloroquine-resistant (W2). Incubation times on asynchronous or synchronous cultures were 72h or 96h, respectively. The antiplasmodial effect (i.e. the IC50) was determined by measuring the activity of the parasite lactate dehydrogenase, while the interaction between drugs was determined through combination index (CI) analyses. Elacridar achieved an IC50 concentration comparable to that of ivermectin, approx. 10-fold lower than that of verapamil, the other tested ABC transporter inhibitor. CI results showed synergistic effect of verapamil plus doxycycline, which is coherent with the starting hypothesis, i.e. that ABC transporters represent potential targets, worth of further investigations, towards the development of companion molecules useful to enhance the efficacy of antimalarial drugs. At the same time, the observed antagonistic effect of doxycycline in combination with ivermectin or elacridar highlighted the importance of drug testing, to avoid the de-facto generation of a sub-dosage, a condition that facilitates the development of drug resistance.
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Affiliation(s)
- Riccardo Nodari
- Department of Biosciences and Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy
- Centro Interuniversitario di Ricerca sulla Malaria/Italian Malaria Network, Milan, Italy
| | - Yolanda Corbett
- Department of Biosciences and Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy
- Centro Interuniversitario di Ricerca sulla Malaria/Italian Malaria Network, Milan, Italy
| | - Ilaria Varotto-Boccazzi
- Department of Biosciences and Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy
- Centro Interuniversitario di Ricerca sulla Malaria/Italian Malaria Network, Milan, Italy
| | - Daniele Porretta
- Department of Environmental Biology, Sapienza University of Rome, Rome, Italy
| | - Donatella Taramelli
- Centro Interuniversitario di Ricerca sulla Malaria/Italian Malaria Network, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Sara Epis
- Department of Biosciences and Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy
- Centro Interuniversitario di Ricerca sulla Malaria/Italian Malaria Network, Milan, Italy
| | - Claudio Bandi
- Department of Biosciences and Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy
- Centro Interuniversitario di Ricerca sulla Malaria/Italian Malaria Network, Milan, Italy
- * E-mail:
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62
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James SL, Marshall JM, Christophides GK, Okumu FO, Nolan T. Toward the Definition of Efficacy and Safety Criteria for Advancing Gene Drive-Modified Mosquitoes to Field Testing. Vector Borne Zoonotic Dis 2020; 20:237-251. [PMID: 32155390 PMCID: PMC7153640 DOI: 10.1089/vbz.2019.2606] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Mosquitoes containing gene drive systems are being developed as complementary tools to prevent transmission of malaria and other mosquito-borne diseases. As with any new tool, decision makers and other stakeholders will need to balance risks (safety) and benefits (efficacy) when considering the rationale for testing and deploying gene drive-modified mosquito products. Developers will benefit from standards for judging whether an investigational gene drive product meets acceptability criteria for advancing to field trials. Such standards may be formalized as preferred product characteristics and target product profiles, which describe the desired attributes of the product category and of a particular product, respectively. This report summarizes discussions from two scientific workshops aimed at identifying efficacy and safety characteristics that must be minimally met for an investigational gene drive-modified mosquito product to be deemed viable to move from contained testing to field release and the data that will be needed to support an application for first field release.
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Affiliation(s)
- Stephanie L James
- Foundation for the National Institutes of Health, North Bethesda, Maryland
| | | | | | | | - Tony Nolan
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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63
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Billingsley P, Binka F, Chaccour C, Foy B, Gold S, Gonzalez-Silva M, Jacobson J, Jagoe G, Jones C, Kachur P, Kobylinski K, Last A, Lavery JV, Mabey D, Mboera D, Mbogo C, Mendez-Lopez A, Rabinovich NR, Rees S, Richards F, Rist C, Rockwood J, Ruiz-Castillo P, Sattabongkot J, Saute F, Slater H, Steer A, Xia K, Zullinger R. A Roadmap for the Development of Ivermectin as a Complementary Malaria Vector Control Tool. Am J Trop Med Hyg 2020; 102:3-24. [PMID: 31971144 PMCID: PMC7008306 DOI: 10.4269/ajtmh.19-0620] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022] Open
Abstract
In the context of stalling progress against malaria, resistance of mosquitoes to insecticides, and residual transmission, mass drug administration (MDA) of ivermectin, an endectocide used for neglected tropical diseases (NTDs), has emerged as a promising complementary vector control method. Ivermectin reduces the life span of Anopheles mosquitoes that feed on treated humans and/or livestock, potentially decreasing malaria parasite transmission when administered at the community level. Following the publication by WHO of the preferred product characteristics for endectocides as vector control tools, this roadmap provides a comprehensive view of processes needed to make ivermectin available as a vector control tool by 2024 with a completely novel mechanism of action. The roadmap covers various aspects, which include 1) the definition of optimal dosage/regimens for ivermectin MDA in both humans and livestock, 2) the risk of resistance to the drug and environmental impact, 3) ethical issues, 4) political and community engagement, 5) translation of evidence into policy, and 6) operational aspects of large-scale deployment of the drug, all in the context of a drug given as a prevention tool acting at the community level. The roadmap reflects the insights of a multidisciplinary group of global health experts who worked together to elucidate the path to inclusion of ivermectin in the toolbox against malaria, to address residual transmission, counteract insecticide resistance, and contribute to the end of this deadly disease.
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Affiliation(s)
| | - Fred Binka
- University of Health and Allied Sciences
| | | | | | | | | | | | | | | | | | | | - Anna Last
- London School of Hygiene and Tropical Medicine
| | | | - David Mabey
- London School of Hygiene and Tropical Medicine
| | | | | | | | | | | | | | - Cassidy Rist
- Virginia-Maryland College of Veterinary Medicine at Virginia Tech
| | | | | | | | | | | | | | - Kang Xia
- School of Plant and Environmental Sciences, Virginia Tech
| | - Rose Zullinger
- US President’s Malaria Initiative/US Centers for Disease Control and Prevention
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64
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Orsborne J, Mohammed AR, Jeffries CL, Kristan M, Afrane YA, Walker T, Yakob L. Evidence of extrinsic factors dominating intrinsic blood host preferences of major African malaria vectors. Sci Rep 2020; 10:741. [PMID: 31959845 PMCID: PMC6971008 DOI: 10.1038/s41598-020-57732-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/02/2019] [Indexed: 11/20/2022] Open
Abstract
One of the key determinants of a haematophagous vector’s capacity to transmit pathogens is its selection of which host to secure a blood meal from. This choice is influenced by both intrinsic (genetic) and extrinsic (environmental) factors, but little is known of their relative contributions. Blood fed Anopheles mosquitoes were collected from a malaria endemic village in Ghana. Collections were conducted across a range of different host availabilities and from both indoor and outdoor locations. These environmental factors were shown to impact dramatically the host choice of caught malaria vectors: mosquitoes caught indoors were ten-fold more likely to have sourced their blood meal from humans; and a halving in odds of being human-fed was found for mosquitoes caught only 25 m from the centre of the village. For the first time, we demonstrate that anthropophagy was better explained by extrinsic factors (namely, local host availability and indoor/outdoor trapping location) than intrinsic factors (namely, the (sibling) species of the mosquito caught) (respective Akaike information criterion estimates: 243.0 versus 359.8). Instead of characterizing biting behaviour on a taxonomic level, we illustrate the importance of assessing local entomology. Accounting for this behavioural plasticity is important, both in terms of measuring effectiveness of control programmes and in informing optimal disease control strategies.
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Affiliation(s)
- James Orsborne
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Abdul Rahim Mohammed
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Korle Bu, Accra, Ghana
| | - Claire L Jeffries
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Mojca Kristan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Yaw A Afrane
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Korle Bu, Accra, Ghana
| | - Thomas Walker
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
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65
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Sheele JM, Lesser E, Li X, Schlatzer D, Ridge G. Ivermectin and Moxidectin Can Incapacitate Different Strains of the Common Bed Bug Cimex lectularius L.: A Study. Cureus 2020; 12:e6714. [PMID: 32104637 PMCID: PMC7032599 DOI: 10.7759/cureus.6714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The common bed bug Cimex lectularius L. (C. lectularius) is a hematophagous ectoparasite that has recently resurged in many western industrialized nations, in part due to pesticide resistance. Using a laboratory feeding system, we found that the antiparasitic drugs ivermectin and moxidectin did not show higher incapacitation rates in pyrethroid-resistant strains of C. lectularius compared to a pyrethroid-susceptible strain. Additionally, we developed a high-performance liquid chromatography (HPLC) and mass spectroscopy (MS) assay to measure the concentrations of ivermectin inside C. lectularius and found that ivermectin persists in the insects for up to one month. HPLC/MS will be useful in understanding the pathophysiology behind the long-term morbidity observed in C. lectularius that consumes a sublethal dose of ivermectin.
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Affiliation(s)
| | | | - Xiaolin Li
- Emergency Medicine, Case Western Reserve University, Cleveland, USA
| | - Danie Schlatzer
- Emergency Medicine, Case Western Reserve University, Cleveland, USA
| | - Gale Ridge
- Emergency Medicine, The Connecticut Agricultural Experiment Station, New Haven, USA
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66
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Ahmed AE, Alshehri A, Al-Kahtani MA, Elbehairi SEI, Alshehri MA, Shati AA, Alfaifi MY, Al-Doais AA, Taha R, Morsy K, El-Mansi AA. Vitamin E and selenium administration synergistically mitigates ivermectin and doramectin-induced testicular dysfunction in male Wistar albino rats. Biomed Pharmacother 2020; 124:109841. [PMID: 31972360 DOI: 10.1016/j.biopha.2020.109841] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 01/09/2023] Open
Abstract
Avermectins are broad-spectrum antiparasitic drugs in veterinary and human medication. The current study aimed to examine the toxic effects of ivermectin (IVM) and doramectin (DRM), with or without co-treatment of vitamin E (Vit.E) and selenium (Se) on apoptosis, oxidative stress and male fertility in Wistar rats. Twenty five adult male animals were divided into five groups; G1; was control (CTL) received saline, G2; IVM (0.2 mg/kg b.w), G3; IVM plus Vit.E/Se (80/1.6 mg/kg b.w, respectively), G4; DRM (0.2 mg/kg b.w), and G5; DRM plus Vit.E/Se. Both IVM and DRM were given by subcutaneous (s.c) injections while Vit.E/Se was orally given. All treatments were administered once weekly for four consecutive weeks. By 24 h after the last treatment, the animals were sacrificed. Blood and tissue samples were collected for hematology, serobiochemistry, histopathology, and molecular assays for hepatic/ renal toxicities, oxidative stress, cell viability and fertility parameters. Apoptosis of the hepatic cells obtained from the treated rats was assayed by detection of annexin-V using the flow cytometric assay (FCA). The proliferating cellular nuclear antigen (PCNA) and DNA fragmentation in the treated rats' testicular tissues were also assayed. Moreover, the direct effects of IVM or DRM with or without concomitant administration of Vit.E/Se on testicular cells isolated from adult rat were also performed in vitro. Apoptosis of those cultured testicular cells in response to the different treatments was assayed by detection of the inhibition-concentration fifty (IC50) using the SRB method, and evaluating the viable versus apoptotic cells microscopically after staining with acridine orange-ethidium bromide (AO/EB). In conclusion, both avermectins induced apoptosis in the living and cultured cells, while those antioxidants; Vit.E and Se, reduced the oxidative stress and cytotoxicity both in vivo and in vitro, either. Furthermore, the reprotoxicity and reduced male fertility were seriously evoked by IVM, but not DRM with dramatic ameliorative effect of Vit.E/Se if concomitantly administered. Avermectins, especially ivermectin, should be given according to the dose recommended by the manufacturer company and repeated dosages should be given with Vit.E/Se.
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Affiliation(s)
- Ahmed Ezzat Ahmed
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia; Department of Theriogenology, Faculty of Veterinary Medicine, South Valley University, Qena 83523, Egypt.
| | - Ali Alshehri
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia
| | - M A Al-Kahtani
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia
| | | | - Mohammed A Alshehri
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia
| | - Ali A Shati
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia
| | - Mohammad Y Alfaifi
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia
| | - Amin A Al-Doais
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia
| | - Ramadan Taha
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia
| | - Kareem Morsy
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia; Department of Zoology, Faculty of Science, Cairo University, Cairo 12613, Egypt
| | - Ahmed A El-Mansi
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia; Zoology Dept., Faculty of Science, Mansoura University, Mansoura, Egypt
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67
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Ivermectin as a novel complementary malaria control tool to reduce incidence and prevalence: a modelling study. THE LANCET. INFECTIOUS DISEASES 2020; 20:498-508. [PMID: 31948767 DOI: 10.1016/s1473-3099(19)30633-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/30/2019] [Accepted: 10/21/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ivermectin is a potential new vector control tool to reduce malaria transmission. Mosquitoes feeding on a bloodmeal containing ivermectin have a reduced lifespan, meaning they are less likely to live long enough to complete sporogony and become infectious. We aimed to estimate the effect of ivermectin on malaria transmission in various scenarios of use. METHODS We validated an existing population-level mathematical model of the effect of ivermectin mass drug administration (MDA) on the mosquito population and malaria transmission against two datasets: clinical data from a cluster- randomised trial done in Burkina Faso in 2015 wherein ivermectin was given to individuals taller than 90 cm and entomological data from a study of mosquito outcomes after ivermectin MDA for onchocerciasis or lymphatic filariasis in Burkina Faso, Senegal, and Liberia between 2008 and 2013. We extended the existing model to include a range of complementary malaria interventions (seasonal malaria chemoprevention and MDA with dihydroartemisinin-piperaquine) and to incorporate new data on higher doses of ivermectin with a longer mosquitocidal effect. We consider two ivermectin regimens: a single dose of 400 μg/kg (1 × 400 μg/kg) and three consecutive daily doses of 300 μg/kg per day (3 × 300 μg/kg). We simulated the effect of these two doses in a range of usage scenarios in different transmission settings (highly seasonal, seasonal, and perennial). We report percentage reductions in clinical incidence and slide prevalence. FINDINGS We estimate that MDA with ivermectin will reduce prevalence and incidence and is most effective in areas with highly seasonal transmission. In a highly seasonal moderate transmission setting, three rounds of ivermectin only MDA at 3 × 300 μg/kg (rounds spaced 1 month apart) and 70% coverage is predicted to reduce clinical incidence by 71% and prevalence by 34%. We predict that adding ivermectin MDA to seasonal malaria chemoprevention in this setting would reduce clinical incidence by an additional 77% in children younger than 5 years compared with seasonal malaria chemoprevention alone; adding ivermectin MDA to MDA with dihydroartemisinin-piperaquine in this setting would reduce incidence by an additional 75% and prevalence by an additional 64% (all ages) compared with MDA with dihydroartemisinin-piperaquine alone. INTERPRETATION Our modelling predictions suggest that ivermectin could be a valuable addition to the malaria control toolbox, both in areas with persistently high transmission where existing interventions are insufficient and in areas approaching elimination to prevent resurgence. FUNDING Imperial College Junior Research Fellowship.
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68
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Metzger WG, Theurer A, Pfleiderer A, Molnar Z, Maihöfer-Braatting D, Bissinger AL, Sulyok Z, Köhler C, Egger-Adam D, Lalremruata A, Esen M, Lee Sim K, Hoffman S, Rabinovich R, Chaccour C, Alonso P, Mordmüller BG, Kremsner PG. Ivermectin for causal malaria prophylaxis: a randomised controlled human infection trial. Trop Med Int Health 2020; 25:380-386. [PMID: 31808594 DOI: 10.1111/tmi.13357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Ivermectin is safe and widely used for treating helminth infections. It also kills arthropods feeding on treated subjects, including malaria vectors. Thus, ivermectin mass drug administration as an additional tool for malaria control is being evaluated by WHO. As in vitro data, animal experiments and epidemiological observations suggest that ivermectin has a direct effect on the liver stages of the malaria parasite, this study was designed to assess the prophylactic effect of ivermectin on Plasmodium falciparum controlled human malaria infection. METHODS A total of 4 volunteers were randomised to placebo, and 8 volunteers were randomised to receive ivermectin 0.4 mg/kg, orally, once 2 h before being experimentally infected intravenously with 3200 P. falciparum sporozoites. The primary endpoint was time to parasitaemia detected by positive thick blood smear; RT-qPCR was performed in parallel. RESULTS All but one volunteer became thick blood smear positive between day 11 and day 12 after infection, and there was no significant effect of ivermectin on parasitaemia. CONCLUSION Ivermectin - at the dose used - has no clinically relevant activity against the pre-erythrocytic stages of P. falciparum.
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Affiliation(s)
- Wolfram G Metzger
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany
| | - Antje Theurer
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany
| | - Anne Pfleiderer
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany
| | - Zsofia Molnar
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany
| | | | - Alfred L Bissinger
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany
| | - Zita Sulyok
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany
| | - Carsten Köhler
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany
| | - Diane Egger-Adam
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany
| | - Albert Lalremruata
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany
| | - Meral Esen
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany
| | | | | | | | | | | | - Benjamin G Mordmüller
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Peter G Kremsner
- Institute for Tropical Medicine, German Center for Infection Research, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
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69
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Kobylinski KC, Jittamala P, Hanboonkunupakarn B, Pukrittayakamee S, Pantuwatana K, Phasomkusolsil S, Davidson SA, Winterberg M, Hoglund RM, Mukaka M, van der Pluijm RW, Dondorp A, Day NPJ, White NJ, Tarning J. Safety, Pharmacokinetics, and Mosquito-Lethal Effects of Ivermectin in Combination With Dihydroartemisinin-Piperaquine and Primaquine in Healthy Adult Thai Subjects. Clin Pharmacol Ther 2019; 107:1221-1230. [PMID: 31697848 PMCID: PMC7285759 DOI: 10.1002/cpt.1716] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/15/2019] [Indexed: 12/30/2022]
Abstract
Mass administration of antimalarial drugs and ivermectin are being considered as potential accelerators of malaria elimination. The safety, tolerability, pharmacokinetics, and mosquito‐lethal effects of combinations of ivermectin, dihydroartemisinin‐piperaquine, and primaquine were evaluated. Coadministration of ivermectin and dihydroartemisinin‐piperaquine resulted in increased ivermectin concentrations with corresponding increases in mosquito‐lethal effect across all subjects. Exposure to piperaquine was also increased when coadministered with ivermectin, but electrocardiograph QT‐interval prolongation was not increased. One subject had transiently impaired liver function. Ivermectin mosquito‐lethal effect was greater than predicted previously against the major Southeast Asian malaria vectors. Both Anopheles dirus and Anopheles minimus mosquito mortality was increased substantially (20‐fold and 35‐fold increase, respectively) when feeding on volunteer blood after ivermectin administration compared with in vitro ivermectin‐spiked blood. This suggests the presence of ivermectin metabolites that impart mosquito‐lethal effects. Further studies of this combined approach to accelerate malaria elimination are warranted.
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Affiliation(s)
- Kevin C Kobylinski
- Department of Entomology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.,Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Podjanee Jittamala
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Borimas Hanboonkunupakarn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sasithon Pukrittayakamee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,The Royal Society of Thailand, Dusit, Bangkok, Thailand
| | - Kanchana Pantuwatana
- Department of Entomology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Siriporn Phasomkusolsil
- Department of Entomology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Silas A Davidson
- Department of Entomology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.,Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Markus Winterberg
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Richard M Hoglund
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Rob W van der Pluijm
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Arjen Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Joel Tarning
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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70
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Azevedo R, Mendes AM, Prudêncio M. Inhibition of Plasmodium sporogonic stages by ivermectin and other avermectins. Parasit Vectors 2019; 12:549. [PMID: 31752986 PMCID: PMC6873674 DOI: 10.1186/s13071-019-3805-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/12/2019] [Indexed: 12/15/2022] Open
Abstract
Background The transmissible forms of Plasmodium parasites result from a process of sporogony that takes place inside their obligatory mosquito vector and culminates in the formation of mammalian-infective parasite forms. Ivermectin is a member of the avermectin family of endectocides, which has been proposed to inhibit malaria transmission due its insecticidal effect. However, it remains unclear whether ivermectin also exerts a direct action on the parasite’s blood and transmission stages. Methods We employed a rodent model of infection to assess the impact of ivermectin treatment on P. berghei asexual and sexual blood forms in vivo. We then made use of a newly established luminescence-based methodology to evaluate the activity of ivermectin and other avermectins against the sporogonic stages of P. berghei parasites in vitro independent of their role on mosquito physiology. Results Our results show that whereas ivermectin does not affect the parasite’s parasitemia, gametocytemia or exflagellation in the mammalian host, several members of the avermectin family of compounds exert a strong inhibitory effect on the generation and development of P. berghei oocysts. Conclusions Our results shed light on the action of avermectins against Plasmodium transmission stages and highlight the potential of these compounds to help prevent the spread of malaria.
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Affiliation(s)
- Raquel Azevedo
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal
| | - António M Mendes
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal.
| | - Miguel Prudêncio
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal.
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71
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Colebunders R, Kugler M, Fodjo JNS. Analysis of the RIMDAMAL trial. Lancet 2019; 394:1006. [PMID: 31544741 DOI: 10.1016/s0140-6736(19)31814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Robert Colebunders
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium.
| | - Marina Kugler
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium
| | - Joseph N Siewe Fodjo
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium
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72
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Affiliation(s)
- John Bradley
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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73
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Foy BD, Rao S, Parikh S, Slater HC, Dabiré RK. Analysis of the RIMDAMAL trial - Authors' reply. Lancet 2019; 394:1006-1007. [PMID: 31544742 DOI: 10.1016/s0140-6736(19)32139-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Brian D Foy
- Arthropod-borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523-1692, USA.
| | - Sangeeta Rao
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sunil Parikh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | - Roch K Dabiré
- Institute of Research in Health Sciences, Western Regional Direction, National Center for Scientific and Technological Research, Bobo-Dioulasso, Burkina Faso
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74
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Feachem RGA, Chen I, Akbari O, Bertozzi-Villa A, Bhatt S, Binka F, Boni MF, Buckee C, Dieleman J, Dondorp A, Eapen A, Sekhri Feachem N, Filler S, Gething P, Gosling R, Haakenstad A, Harvard K, Hatefi A, Jamison D, Jones KE, Karema C, Kamwi RN, Lal A, Larson E, Lees M, Lobo NF, Micah AE, Moonen B, Newby G, Ning X, Pate M, Quiñones M, Roh M, Rolfe B, Shanks D, Singh B, Staley K, Tulloch J, Wegbreit J, Woo HJ, Mpanju-Shumbusho W. Malaria eradication within a generation: ambitious, achievable, and necessary. Lancet 2019; 394:1056-1112. [PMID: 31511196 DOI: 10.1016/s0140-6736(19)31139-0] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/26/2019] [Accepted: 05/07/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Richard G A Feachem
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Ingrid Chen
- Global Health Group, University of California San Francisco, San Francisco, CA, USA.
| | - Omar Akbari
- Division of Biological Sciences, University of California San Diego, La Jolla, CA, USA
| | - Amelia Bertozzi-Villa
- Malaria Atlas Project, University of Oxford, Oxford, UK; Institute for Disease Modeling, Bellevue, WA, USA
| | - Samir Bhatt
- Malaria Atlas Project, University of Oxford, Oxford, UK
| | - Fred Binka
- School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Maciej F Boni
- Center for Infectious Disease Dynamics, Department of Biology, Penn State, University Park, PA, USA
| | - Caroline Buckee
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Joseph Dieleman
- Institute for Health Metrics, University of Washington, Seattle, WA, USA
| | - Arjen Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Alex Eapen
- National Institute of Malaria Research, Chennai, India
| | - Neelam Sekhri Feachem
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Scott Filler
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Peter Gething
- Malaria Atlas Project, University of Oxford, Oxford, UK
| | - Roly Gosling
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Annie Haakenstad
- Institute for Health Metrics, University of Washington, Seattle, WA, USA
| | - Kelly Harvard
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Arian Hatefi
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Dean Jamison
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Kate E Jones
- Department of Genetics, Evolution and Environment, University College London, London, UK
| | | | | | - Altaf Lal
- Sun Pharma Industries, Mumbai, India
| | - Erika Larson
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Margaret Lees
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Neil F Lobo
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Angela E Micah
- Institute for Health Metrics, University of Washington, Seattle, WA, USA
| | - Bruno Moonen
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Gretchen Newby
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Xiao Ning
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, China
| | - Muhammad Pate
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Martha Quiñones
- Department of Public Health, Universidad Nacional de Colombia, Bogota, Colombia
| | - Michelle Roh
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Ben Rolfe
- Asia Pacific Leaders Malaria Alliance, Singapore
| | | | - Balbir Singh
- Malaria Research Center, University Malaysia Sarawak, Sarawak, Malaysia
| | | | | | - Jennifer Wegbreit
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Hyun Ju Woo
- Global Health Group, University of California San Francisco, San Francisco, CA, USA
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75
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Selvaraj P, Suresh J, Wenger EA, Bever CA, Gerardin J. Reducing malaria burden and accelerating elimination with long-lasting systemic insecticides: a modelling study of three potential use cases. Malar J 2019; 18:307. [PMID: 31488139 PMCID: PMC6727392 DOI: 10.1186/s12936-019-2942-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/28/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND While bed nets and insecticide spraying have had significant impact on malaria burden in many endemic regions, outdoor vector feeding and insecticide resistance may ultimately limit their contribution to elimination and control campaigns. Complementary vector control methods such as endectocides or systemic insecticides, where humans or animals are treated with drugs that kill mosquitoes upon ingestion via blood meal, are therefore generating much interest. This work explores the conditions under which long-lasting systemic insecticides would have a substantial impact on transmission and burden. METHODS Hypothetical long-lasting systemic insecticides with effective durations ranging from 14 to 90 days are simulated using an individual-based mathematical model of malaria transmission. The impact of systemic insecticides when used to complement existing vector control and drug campaigns is evaluated in three settings-a highly seasonal high-transmission setting, a near-elimination setting with seasonal travel to a high-risk area, and a near-elimination setting in southern Africa. RESULTS At 60% coverage, a single round of long-lasting systemic insecticide with effective duration of at least 60 days, distributed at the start of the season alongside a seasonal malaria chemoprevention campaign in a high-transmission setting, results in further burden reduction of 30-90% depending on the sub-populations targeted. In a near-elimination setting where transmission is sustained by seasonal travel to a high-risk area, targeting high-risk travellers with systemic insecticide with effective duration of at least 30 days can result in likely elimination even if intervention coverage is as low as 50%. In near-elimination settings with robust vector control, the addition of a 14-day systemic insecticide alongside an anti-malarial in mass drug administration (MDA) campaigns can decrease the necessary MDA coverage from about 85% to the more easily achievable 65%. CONCLUSIONS While further research into the safety profile of systemic insecticides is necessary before deployment, models predict that long-lasting systemic insecticides can play a critical role in reducing burden or eliminating malaria in a range of contexts with different target populations, existing malaria control methods, and transmission intensities. Continued investment in lengthening the duration of systemic insecticides and improving their safety profile is needed for this intervention to achieve its fullest potential.
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Affiliation(s)
| | | | | | | | - Jaline Gerardin
- Institute for Disease Modeling, Bellevue, WA, USA. .,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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76
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Siewe Fodjo JN, Kugler M, Hotterbeekx A, Hendy A, Van Geertruyden JP, Colebunders R. Would ivermectin for malaria control be beneficial in onchocerciasis-endemic regions? Infect Dis Poverty 2019; 8:77. [PMID: 31439040 PMCID: PMC6706915 DOI: 10.1186/s40249-019-0588-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is accumulating evidence supporting the use of ivermectin as a malaria control tool. Recent findings from the repeat ivermectin mass drug administrations for control of malaria trial demonstrated a reduced incidence of malaria in villages which received repeated ivermectin mass drug administration (MDA; six doses) compared to those who had only one round of ivermectin. Several other studies investigating the benefits of ivermectin for malaria purposes are ongoing/planned. MAIN TEXT While ivermectin MDA offers promising perspectives in the fight against malaria, we highlight the added benefits and anticipated challenges of conducting future studies in onchocerciasis-endemic regions, which are confronted with a substantial disease burden including onchocerciasis-associated epilepsy. Increasing the frequency of ivermectin MDA in such places may reduce the burden of both malaria and onchocerciasis, and allow for more entomological investigations on both the Anopheles mosquitoes and the blackflies. Upfront, acceptability and feasibility studies are needed to assess the endorsement by the local populations, as well as the programmatic feasibility of implementing ivermectin MDA several times a year. CONCLUSIONS Onchocerciasis-endemic sites would doubly benefit from ivermectin MDA interventions, as these will alleviate onchocerciasis-associated morbidity and mortality, while potentially curbing malaria transmission. Involving onchocerciasis programs and other relevant stakeholders in the malaria/ivermectin research agenda would foster the implementation of pluri-annual MDA in target communities.
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Affiliation(s)
- Joseph Nelson Siewe Fodjo
- Global Health Institute, University of Antwerp, Kinsbergen centrum, Doornstraat 331, 2610, Antwerp, Belgium
| | - Marina Kugler
- Global Health Institute, University of Antwerp, Kinsbergen centrum, Doornstraat 331, 2610, Antwerp, Belgium
| | - An Hotterbeekx
- Global Health Institute, University of Antwerp, Kinsbergen centrum, Doornstraat 331, 2610, Antwerp, Belgium
| | - Adam Hendy
- Department of Pathology, University of Texas Medical Branch, Galveston, USA
| | | | - Robert Colebunders
- Global Health Institute, University of Antwerp, Kinsbergen centrum, Doornstraat 331, 2610, Antwerp, Belgium.
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77
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Tessier TM, Dodge MJ, Prusinkiewicz MA, Mymryk JS. Viral Appropriation: Laying Claim to Host Nuclear Transport Machinery. Cells 2019; 8:E559. [PMID: 31181773 PMCID: PMC6627039 DOI: 10.3390/cells8060559] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022] Open
Abstract
Protein nuclear transport is an integral process to many cellular pathways and often plays a critical role during viral infection. To overcome the barrier presented by the nuclear membrane and gain access to the nucleus, virally encoded proteins have evolved ways to appropriate components of the nuclear transport machinery. By binding karyopherins, or the nuclear pore complex, viral proteins influence their own transport as well as the transport of key cellular regulatory proteins. This review covers how viral proteins can interact with different components of the nuclear import machinery and how this influences viral replicative cycles. We also highlight the effects that viral perturbation of nuclear transport has on the infected host and how we can exploit viruses as tools to study novel mechanisms of protein nuclear import. Finally, we discuss the possibility that drugs targeting these transport pathways could be repurposed for treating viral infections.
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Affiliation(s)
- Tanner M Tessier
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Mackenzie J Dodge
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Martin A Prusinkiewicz
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Joe S Mymryk
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON N6A 3K7, Canada.
- Department of Otolaryngology, Head & Neck Surgery, The University of Western Ontario, London, ON N6A 3K7, Canada.
- Department of Oncology, The University of Western Ontario, London, ON N6A 3K7, Canada.
- London Regional Cancer Program, Lawson Health Research Institute, London, ON N6A 5W9, Canada.
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78
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Foy BD, Alout H, Seaman JA, Rao S, Magalhaes T, Wade M, Parikh S, Soma DD, Sagna AB, Fournet F, Slater HC, Bougma R, Drabo F, Diabaté A, Coulidiaty AGV, Rouamba N, Dabiré RK. Efficacy and risk of harms of repeat ivermectin mass drug administrations for control of malaria (RIMDAMAL): a cluster-randomised trial. Lancet 2019; 393:1517-1526. [PMID: 30878222 PMCID: PMC6459982 DOI: 10.1016/s0140-6736(18)32321-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Ivermectin is widely used in mass drug administrations for controlling neglected parasitic diseases, and can be lethal to malaria vectors that bite treated humans. Therefore, it could be a new tool to reduce plasmodium transmission. We tested the hypothesis that frequently repeated mass administrations of ivermectin to village residents would reduce clinical malaria episodes in children and would be well tolerated with minimal harms. METHODS We invited villages (clusters) in Burkina Faso to participate in a single-blind (outcomes assessor), parallel-assignment, two-arm, cluster-randomised trial over the 2015 rainy season. Villages were assigned (1:1) by random draw to either the intervention group or the control group. In both groups, all eligible participants who consented to the treatment and were at least 90 cm in height received single oral doses of ivermectin (150-200 μg/kg) and albendazole (400 mg), and those in the intervention group received five further doses of ivermectin alone at 3-week intervals thereafter over the 18-week treatment phase. The primary outcome was cumulative incidence of uncomplicated malaria episodes over 18 weeks (analysed on a cluster intention-to-treat basis) in an active case detection cohort of children aged 5 years or younger living in the study villages. This trial is registered with ClinicalTrials.gov, number NCT02509481. FINDINGS Eight villages agreed to participate, and four were randomly assigned to each group. 2712 participants (1333 [49%] males and 1379 [51%] females; median age 15 years [IQR 6-34]), including 590 children aged 5 years or younger, provided consent and were enrolled between May 22 and July 20, 2015 (except for 77 participants enrolled after these dates because of unavailability before the first mass drug administration, travel into the village during the trial, or birth), with 1447 enrolled into the intervention group and 1265 into the control group. 330 (23%) participants in the intervention group and 233 (18%) in the control group met the exclusion criteria for mass drug administration. Most children in the active case detection cohort were not treated because of height restrictions. 14 (4%) children in the intervention group and 10 (4%) in the control group were lost to follow-up. Cumulative malaria incidence was reduced in the intervention group (648 episodes among 327 children; estimated mean 2·00 episodes per child) compared with the control group (647 episodes among 263 children; 2·49 episodes per child; risk difference -0·49 [95% CI -0·79 to -0·21], p=0·0009, adjusted for sex and clustering). The risk of adverse events among all participants did not differ between groups (45 events [3%] among 1447 participants in the intervention group vs 24 events [2%] among 1265 in the control group; risk ratio 1·63 [1·01 to 2·67]; risk difference 1·21 [0·04 to 2·38], p=0·060), and no adverse reactions were reported. INTERPRETATION Frequently repeated mass administrations of ivermectin during the malaria transmission season can reduce malaria episodes among children without significantly increasing harms in the populace. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Brian D Foy
- Arthropod-borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA.
| | - Haoues Alout
- Arthropod-borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Jonathan A Seaman
- Arthropod-borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Sangeeta Rao
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Tereza Magalhaes
- Arthropod-borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Martina Wade
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Sunil Parikh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Dieudonné D Soma
- Institute of Research in Health Sciences, Western Regional Direction, National Center for Scientific and Technological Research, Bobo-Dioulasso, Burkina Faso; International Mixed Laboratory on Vector Diseases, Bobo-Dioulasso, Burkina Faso
| | - André B Sagna
- International Mixed Laboratory on Vector Diseases, Bobo-Dioulasso, Burkina Faso; Research Institute for Development, Infectious Diseases, and Vectors: Ecology, Genetics, Evolution and Control, National Centre for Scientific Research, University of Montpellier, Montpellier, France
| | - Florence Fournet
- International Mixed Laboratory on Vector Diseases, Bobo-Dioulasso, Burkina Faso; Research Institute for Development, Infectious Diseases, and Vectors: Ecology, Genetics, Evolution and Control, National Centre for Scientific Research, University of Montpellier, Montpellier, France
| | - Hannah C Slater
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Roland Bougma
- National Program for the Fight against Neglected Tropical Diseases, Department of Disease Control, Ministry of Health, Ouagadougou, Burkina Faso
| | - François Drabo
- National Program for the Fight against Neglected Tropical Diseases, Department of Disease Control, Ministry of Health, Ouagadougou, Burkina Faso
| | - Abdoulaye Diabaté
- Institute of Research in Health Sciences, Western Regional Direction, National Center for Scientific and Technological Research, Bobo-Dioulasso, Burkina Faso; International Mixed Laboratory on Vector Diseases, Bobo-Dioulasso, Burkina Faso
| | | | - Nöel Rouamba
- Institute of Research in Health Sciences, Western Regional Direction, National Center for Scientific and Technological Research, Bobo-Dioulasso, Burkina Faso
| | - Roch K Dabiré
- Institute of Research in Health Sciences, Western Regional Direction, National Center for Scientific and Technological Research, Bobo-Dioulasso, Burkina Faso; International Mixed Laboratory on Vector Diseases, Bobo-Dioulasso, Burkina Faso
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79
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Chaccour C, Rabinovich NR. Advancing the repurposing of ivermectin for malaria. Lancet 2019; 393:1480-1481. [PMID: 30878223 DOI: 10.1016/s0140-6736(18)32613-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/17/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Carlos Chaccour
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Instituto de Salud Tropical, Universidad de Navarra, Pamplona, Spain; Ifakara Health Institute, Ifakara, Tanzania
| | - N Regina Rabinovich
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Harvard T H Chan School of Public Health, Boston, MA 02115, USA.
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