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Anstey NM, Tham WH, Shanks GD, Poespoprodjo JR, Russell BM, Kho S. The biology and pathogenesis of vivax malaria. Trends Parasitol 2024; 40:573-590. [PMID: 38749866 DOI: 10.1016/j.pt.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 07/06/2024]
Abstract
Plasmodium vivax contributes significantly to global malaria morbidity. Key advances include the discovery of pathways facilitating invasion by P. vivax merozoites of nascent reticulocytes, crucial for vaccine development. Humanized mouse models and hepatocyte culture systems have enhanced understanding of hypnozoite biology. The spleen has emerged as a major reservoir for asexual vivax parasites, replicating in an endosplenic life cycle, and contributing to recurrent and chronic infections, systemic inflammation, and anemia. Splenic accumulation of uninfected red cells is the predominant cause of anemia. Recurring and chronic infections cause progressive anemia, malnutrition, and death in young children in high-transmission regions. Endothelial activation likely contributes to vivax-associated organ dysfunction. The many recent advances in vivax pathobiology should help guide new approaches to prevention and management.
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Affiliation(s)
- Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Wai-Hong Tham
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia; Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia; Research School of Biology, Australian National University, Canberra, ACT, Australia
| | - G Dennis Shanks
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Jeanne R Poespoprodjo
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Centre for Child Health and Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Central Papua, Indonesia; Mimika District Hospital and District Health Authority, Timika, Central Papua, Indonesia
| | - Bruce M Russell
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Central Papua, Indonesia
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2
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Malla P, Wang Z, Brashear A, Yang Z, Lo E, Baird K, Wang C, Cui L. Effectiveness of an Unsupervised Primaquine Regimen for Preventing Plasmodium vivax Malaria Relapses in Northeast Myanmar: A Single-Arm Nonrandomized Observational Study. J Infect Dis 2024; 229:1557-1564. [PMID: 38041857 PMCID: PMC11095535 DOI: 10.1093/infdis/jiad552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Plasmodium vivax presents a significant challenge for malaria elimination in the Greater Mekong Subregion. We evaluated the effectiveness of primaquine for reducing relapses of vivax malaria. METHODS Patients with uncomplicated P vivax malaria from eastern Myanmar received chloroquine (25-mg base/kg given in 3 days) plus unsupervised PQ (0.25 mg/kg/d for 14 days) without screening for glucose-6-phosphate dehydrogenase deficiency and were followed for a year. RESULTS A total of 556 patients were enrolled to receive the chloroquine/primaquine treatment from February 2012 to August 2013. During the follow-up, 38 recurrences were detected, presenting a cumulative recurrence rate of 9.1% (95% CI, 4.1%-14.1%). Genotyping at the pvmsp1 and pvmsp3α loci by amplicon deep sequencing and model prediction indicated that 13 of the 27 recurrences with genotyping data were likely due to relapses. Notably, all confirmed relapses occurred within the first 6 months. CONCLUSIONS The unsupervised standard dose of primaquine was highly effective as a radical cure for P vivax malaria in eastern Myanmar. The high presumed effectiveness might have benefited from the health messages delivered during the enrollment and follow-up activities. Six-month follow-ups in the Greater Mekong Subregion are sufficient for detecting most relapses.
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Affiliation(s)
- Pallavi Malla
- Department of Internal Medicine, Morsani College of Medicine
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa
| | - Zenglei Wang
- MHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Beijing Union Medical College
| | - Awtum Brashear
- Department of Internal Medicine, Morsani College of Medicine
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, China
| | - Eugenia Lo
- Department of Microbiology and Immunology, College of Medicine, Drexel University
| | - Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Chengqi Wang
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine
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Gomes F, Ribeiro AC, Sanches GS, Borges HS, Takahashi LAU, Daniel-Ribeiro CT, Tedesco AC, Nascimento JWL, Carvalho LJM. A nanochitosan-D-galactose formulation increases the accumulation of primaquine in the liver. Antimicrob Agents Chemother 2024; 68:e0091523. [PMID: 38517190 PMCID: PMC11064505 DOI: 10.1128/aac.00915-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/25/2024] [Indexed: 03/23/2024] Open
Abstract
Primaquine is the mainstream antimalarial drug to prevent Plasmodium vivax relapses. However, this drug can induce hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency. Nanostructure formulations of primaquine loaded with D-galactose were used as a strategy to target the drug to the liver and decrease the hemolytic risks. Nanoemulsion (NE-Pq) and nanochitosan (NQ-Pq) formulations of primaquine diphosphate containing D-galactose were prepared and characterized by their physicochemistry properties. Pharmacokinetic and biodistribution studies were conducted using Swiss Webster mice. A single dose of 10 mg/kg of each nanoformulation or free primaquine solution was administered by gavage to the animals, which were killed at 0.5, 1, 2, 4, 8, and 24 hours. Blood samples and tissues were collected, processed, and analyzed by high-performance liquid chromatography. The nanoformulation showed sizes around 200 nm (NE-Pq) and 400 nm (NQ-Pq) and physicochemical stability for over 30 days. Free primaquine solution achieved higher primaquine Cmax in the liver than NE-Pq or NQ-Pq at 0.5 hours. However, the half-life and mean residence time (MRT) of primaquine in the liver were three times higher with the NQ-Pq formulation than with free primaquine, and the volume distribution was four times higher. Conversely, primaquine's half-life, MRT, and volume distribution in the plasma were lower for NQ-Pq than for free primaquine. NE-Pq, on the other hand, accumulated more in the lungs but not in the liver. Galactose-coated primaquine nanochitosan formulation showed increased drug targeting to the liver compared to free primaquine and may represent a promising strategy for a more efficient and safer radical cure for vivax malaria.
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Affiliation(s)
- F. Gomes
- Laboratory of Malaria Research, Oswaldo Cruz Institute (IOC/Fiocruz), Reference Center for Malaria Research, Diagnosis and Training, Rio de Janeiro, Brazil
| | - A. C. Ribeiro
- Laboratory of Malaria Research, Oswaldo Cruz Institute (IOC/Fiocruz), Reference Center for Malaria Research, Diagnosis and Training, Rio de Janeiro, Brazil
- Department of Pharmacology (LaFaCE) - ICB, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - G. S. Sanches
- Laboratory of Malaria Research, Oswaldo Cruz Institute (IOC/Fiocruz), Reference Center for Malaria Research, Diagnosis and Training, Rio de Janeiro, Brazil
| | - H. S. Borges
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering - Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L. A. U. Takahashi
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering - Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - C. T. Daniel-Ribeiro
- Laboratory of Malaria Research, Oswaldo Cruz Institute (IOC/Fiocruz), Reference Center for Malaria Research, Diagnosis and Training, Rio de Janeiro, Brazil
| | - A. C. Tedesco
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering - Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - J. W. L. Nascimento
- Department of Pharmacology (LaFaCE) - ICB, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - L. J. M. Carvalho
- Laboratory of Malaria Research, Oswaldo Cruz Institute (IOC/Fiocruz), Reference Center for Malaria Research, Diagnosis and Training, Rio de Janeiro, Brazil
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Salazar YEAR, Louzada J, Puça MCSDB, Guimarães LFF, Vieira JLF, de Siqueira AM, Gil JP, de Brito CFA, de Sousa TN. Delayed gametocyte clearance in Plasmodium vivax malaria is associated with polymorphisms in the cytochrome P450 reductase (CPR). Antimicrob Agents Chemother 2024; 68:e0120423. [PMID: 38411047 PMCID: PMC10989009 DOI: 10.1128/aac.01204-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/31/2024] [Indexed: 02/28/2024] Open
Abstract
Primaquine (PQ) is the main drug used to eliminate dormant liver stages and prevent relapses in Plasmodium vivax malaria. It also has an effect on the gametocytes of Plasmodium falciparum; however, it is unclear to what extent PQ affects P. vivax gametocytes. PQ metabolism involves multiple enzymes, including the highly polymorphic CYP2D6 and the cytochrome P450 reductase (CPR). Since genetic variability can impact drug metabolism, we conducted an evaluation of the effect of CYP2D6 and CPR variants on PQ gametocytocidal activity in 100 subjects with P. vivax malaria. To determine gametocyte density, we measured the levels of pvs25 transcripts in samples taken before treatment (D0) and 72 hours after treatment (D3). Generalized estimating equations (GEEs) were used to examine the effects of enzyme variants on gametocyte densities, adjusting for potential confounding factors. Linear regression models were adjusted to explore the predictors of PQ blood levels measured on D3. Individuals with the CPR mutation showed a smaller decrease in gametocyte transcript levels on D3 compared to those without the mutation (P = 0.02, by GEE). Consistent with this, higher PQ blood levels on D3 were associated with a lower reduction in pvs25 transcripts. Based on our findings, the CPR variant plays a role in the persistence of gametocyte density in P. vivax malaria. Conceptually, our work points to pharmacogenetics as a non-negligible factor to define potential host reservoirs with the propensity to contribute to transmission in the first days of CQ-PQ treatment, particularly in settings and seasons of high Anopheles human-biting rates.
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Affiliation(s)
- Yanka Evellyn Alves Rodrigues Salazar
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Jaime Louzada
- Universidade Federal de Roraima, Boa Vista, Roraima, Brazil
| | - Maria Carolina Silva de Barros Puça
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Luiz Felipe Ferreira Guimarães
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | | | - André Machado de Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Pedro Gil
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Solna, Sweden
| | - Cristiana Ferreira Alves de Brito
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Tais Nobrega de Sousa
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Solna, Sweden
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Skorokhod O, Vostokova E, Gilardi G. The role of P450 enzymes in malaria and other vector-borne infectious diseases. Biofactors 2024; 50:16-32. [PMID: 37555735 DOI: 10.1002/biof.1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
Vector-borne infectious diseases are still an important global health problem. Malaria is the most important among them, mainly pediatric, life-threatening disease. Malaria and other vector-borne disorders caused by parasites, bacteria, and viruses have a strong impact on public health and significant economic costs. Most vector-borne diseases could be prevented by vector control, with attention to the ecological and biodiversity conservation aspects. Chemical control with pesticides and insecticides is widely used as a measure of prevention although increasing resistance to insecticides is a serious issue in vector control. Metabolic resistance is the most common mechanism and poses a big challenge. Insect enzyme systems, including monooxygenase CYP P450 enzymes, are employed by vectors mainly to metabolize insecticides thus causing resistance. The discovery and application of natural specific inhibitors/blockers of vector P450 enzymes as synergists for commonly used pesticides will contribute to the "greening" of insecticides. Besides vector CYPs, host CYP enzymes could also be exploited to fight against vector-borne diseases: using mostly their detoxifying properties and involvement in the immune response. Here, we review published research data on P450 enzymes from all players in vector-borne infections, that is, pathogens, vectors, and hosts, regarding the potential role of CYPs in disease. We discuss strategies on how to exploit cytochromes P450 in vector-borne disease control.
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Affiliation(s)
- Oleksii Skorokhod
- Department of Life Sciences and Systems Biology, University of Torino, Torino, Italy
| | - Ekaterina Vostokova
- Department of Life Sciences and Systems Biology, University of Torino, Torino, Italy
| | - Gianfranco Gilardi
- Department of Life Sciences and Systems Biology, University of Torino, Torino, Italy
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Dowd S, Chen N, Gatton ML, Edstein MD, Cheng Q. Cytochrome P450 2D6 profiles and anti-relapse efficacy of tafenoquine against Plasmodium vivax in Australian Defence Force personnel. Antimicrob Agents Chemother 2023; 67:e0101423. [PMID: 37971260 PMCID: PMC10720419 DOI: 10.1128/aac.01014-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/21/2023] [Indexed: 11/19/2023] Open
Abstract
Plasmodium vivax infections and relapses remain a major health problem for malaria-endemic countries, deployed military personnel, and travelers. Presumptive anti-relapse therapy and radical cure using the 8-aminoquinoline drugs primaquine and tafenoquine are necessary to prevent relapses. Although it has been demonstrated that the efficacy of primaquine is associated with Cytochrome P450 2D6 (CYP2D6) activity, there is insufficient data on the role of CYP2D6 in the anti-relapse efficacy of tafenoquine. We investigated the relationship between CYP2D6 activity status and tafenoquine efficacy in preventing P. vivax relapses retrospectively using plasma samples collected from Australian Defence Force personnel deployed to Papua New Guinea and Timor-Leste who participated in clinical trials of tafenoquine during 1999-2001. The CYP2D6 gene was amplified from plasma samples and fully sequenced from 92 participant samples, comprised of relapse (n = 31) and non-relapse (n = 61) samples, revealing 14 different alleles. CYP2D6 phenotypes deduced from combinations of CYP2D6 alleles predicted that among 92 participants 67, 15, and 10 were normal, intermediate, and poor metabolizers, respectively. The deduced CYP2D6 phenotype did not correlate with the corresponding participant's plasma tafenoquine concentrations that were determined in the early 2000s by high-performance liquid chromatography or liquid chromatography-mass spectrometry. Furthermore, the deduced CYP2D6 phenotype did not associate with P. vivax relapse outcomes. Our results indicate that CYP2D6 does not affect plasma tafenoquine concentrations and the efficacy of tafenoquine in preventing P. vivax relapses in the assessed Australian Defence Force personnel.
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Affiliation(s)
- Simone Dowd
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Nanhua Chen
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Michelle L. Gatton
- Centre for Immunology and Infection Control, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Michael D. Edstein
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Qin Cheng
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
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7
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Sutanto I, Soebandrio A, Ekawati LL, Chand K, Noviyanti R, Satyagraha AW, Subekti D, Santy YW, Crenna-Darusallam C, Instiaty I, Budiman W, Prasetya CB, Lardo S, Elyazar I, Duparc S, Cedar E, Rolfe K, Fernando D, Berni A, Jones S, Kleim JP, Fletcher K, Sharma H, Martin A, Taylor M, Goyal N, Green JA, Tan LK, Baird JK. Tafenoquine co-administered with dihydroartemisinin-piperaquine for the radical cure of Plasmodium vivax malaria (INSPECTOR): a randomised, placebo-controlled, efficacy and safety study. THE LANCET. INFECTIOUS DISEASES 2023; 23:1153-1163. [PMID: 37236221 PMCID: PMC10533414 DOI: 10.1016/s1473-3099(23)00213-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Tafenoquine, co-administered with chloroquine, is approved for the radical cure (prevention of relapse) of Plasmodium vivax malaria. In areas of chloroquine resistance, artemisinin-based combination therapies are used to treat malaria. This study aimed to evaluate tafenoquine plus the artemisinin-based combination therapy dihydroartemisinin-piperaquine for the radical cure of P vivax malaria. METHODS In this double-blind, double-dummy, parallel group study, glucose-6-phosphate dehydrogenase-normal Indonesian soldiers with microscopically confirmed P vivax malaria were randomly assigned by means of a computer-generated randomisation schedule (1:1:1) to dihydroartemisinin-piperaquine alone, dihydroartemisinin-piperaquine plus a masked single 300-mg dose of tafenoquine, or dihydroartemisinin-piperaquine plus 14 days of primaquine (15 mg). The primary endpoint was 6-month relapse-free efficacy following tafenoquine plus dihydroartemisinin-piperaquine versus dihydroartemisinin-piperaquine alone in all randomly assigned patients who received at least one dose of masked treatment and had microscopically confirmed P vivax at baseline (microbiological intention-to-treat population). Safety was a secondary outcome and the safety population comprised all patients who received at least one dose of masked medication. This study is registered with ClinicalTrials.gov, NCT02802501 and is completed. FINDINGS Between April 8, 2018, and Feb 4, 2019, of 164 patients screened for eligibility, 150 were randomly assigned (50 per treatment group). 6-month Kaplan-Meier relapse-free efficacy (microbiological intention to treat) was 11% (95% CI 4-22) in patients treated with dihydroartemisinin-piperaquine alone versus 21% (11-34) in patients treated with tafenoquine plus dihydroartemisinin-piperaquine (hazard ratio 0·44; 95% CI [0·29-0·69]) and 52% (37-65) in the primaquine plus dihydroartemisinin-piperaquine group. Adverse events over the first 28 days were reported in 27 (54%) of 50 patients treated with dihydroartemisinin-piperaquine alone, 29 (58%) of 50 patients treated with tafenoquine plus dihydroartemisinin-piperaquine, and 22 (44%) of 50 patients treated with primaquine plus dihydroartemisinin-piperaquine. Serious adverse events were reported in one (2%) of 50, two (4%) of 50, and two (4%) of 50 of patients, respectively. INTERPRETATION Although tafenoquine plus dihydroartemisinin-piperaquine was statistically superior to dihydroartemisinin-piperaquine alone for the radical cure of P vivax malaria, the benefit was not clinically meaningful. This contrasts with previous studies in which tafenoquine plus chloroquine was clinically superior to chloroquine alone for radical cure of P vivax malaria. FUNDING ExxonMobil, Bill & Melinda Gates Foundation, Newcrest Mining, UK Government all through Medicines for Malaria Venture; and GSK. TRANSLATION For the Indonesian translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Inge Sutanto
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | | | - Lenny L Ekawati
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | - Krisin Chand
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | | | | | - Decy Subekti
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | - Yulia Widya Santy
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | - Chelzie Crenna-Darusallam
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Mochtar Riady Institute for Nanotechnology, Banten, Indonesia
| | | | - Waras Budiman
- Health Service, Army of the Republic of Indonesia, Jakarta, Indonesia
| | | | - Soroy Lardo
- Health Service, Army of the Republic of Indonesia, Jakarta, Indonesia
| | - Iqbal Elyazar
- University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Kevin Baird
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Moore BR, Salman S, Tobe R, Benjamin J, Yadi G, Kasian B, Laman M, Robinson LJ, Page-Sharp M, Betuela I, Batty KT, Manning L, Mueller I, Davis TME. Short-course, high-dose primaquine regimens for the treatment of liver-stage vivax malaria in children. Int J Infect Dis 2023; 134:114-122. [PMID: 37269941 DOI: 10.1016/j.ijid.2023.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVES To assess the pharmacokinetics, safety, and tolerability of two high-dose, short-course primaquine (PQ) regimens compared with standard care in children with Plasmodium vivax infections. METHODS We performed an open-label pediatric dose-escalation study in Madang, Papua New Guinea (Clinicaltrials.gov NCT02364583). Children aged 5-10 years with confirmed blood-stage vivax malaria and normal glucose-6-phosphate dehydrogenase activity were allocated to one of three PQ treatment regimens in a stepwise design (group A: 0.5 mg/kg once daily for 14 days, group B: 1 mg/kg once daily for 7 days, and group C: 1 mg/kg twice daily for 3.5-days). The study assessments were completed at each treatment time point and fortnightly for 2 months after PQ administration. RESULTS Between August 2013 and May 2018, 707 children were screened and 73 met the eligibility criteria (15, 40, and 16 allocated to groups A, B, and C, respectively). All children completed the study procedures. The three regimens were safe and generally well tolerated. The pharmacokinetic analysis indicated that an additional weight adjustment of the conventionally recommended milligram per kilogram PQ doses is not necessary to ensure the therapeutic plasma concentrations in pediatric patients. CONCLUSIONS A novel, ultra-short 3.5-day PQ regimen has potential benefits for improving the treatment outcomes in children with vivax malaria that warrants further investigation in a large-scale clinical trial.
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Affiliation(s)
- Brioni R Moore
- Curtin Medical School, Curtin University, Perth, Australia; Curtin Health Innovation Research Institute, Curtin University, Perth, Australia; Medical School, The University of Western Australia, Perth, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.
| | - Sam Salman
- Medical School, The University of Western Australia, Perth, Australia; Clinical Pharmacology and Toxicology Unit, PathWest, Perth, Australia
| | - Roselyn Tobe
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - John Benjamin
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Gumul Yadi
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Bernadine Kasian
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Moses Laman
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Leanne J Robinson
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, Australia; Burnet Institute, Melbourne, Australia
| | | | - Inoni Betuela
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Kevin T Batty
- Curtin Medical School, Curtin University, Perth, Australia; Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Laurens Manning
- Medical School, The University of Western Australia, Perth, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Ivo Mueller
- Department of Medical Biology, University of Melbourne, Melbourne, Australia; Burnet Institute, Melbourne, Australia
| | - Timothy M E Davis
- Medical School, The University of Western Australia, Perth, Australia
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9
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Yan H, Wei S, Sui Y, Lu S, Zhang W, Feng X, Liu Y, Zhang T, Ruan W, Xia J, Lin W, Ley B, Auburn S, Li S, Li J, Wang D. Analysis of the relapse of imported Plasmodium vivax and Plasmodium ovale in five provinces of China. Malar J 2023; 22:209. [PMID: 37443070 DOI: 10.1186/s12936-023-04642-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The global battle against malaria is facing formidable challenges, particularly in controlling Plasmodium vivax and Plasmodium ovale, whose cases have not been reduced as effectively as Plasmodium falciparum because of their relapse. This study investigates the current situation and underlying factors contributing to relapse or recrudescence of imported cases of P. vivax and P. ovale, and seeks to provide a reference for reducing relapse or recrudescence in malaria-free areas and offers a scientific basis for designing strategies to prevent imported re-transmission. METHODS This study analysed imported P. vivax and P. ovale in Anhui, Zhejiang, Henan, Hubei, and Guangxi provinces during 2014-2021 by retrospective analysis. A case-control study was conducted on patients who experienced relapse or recrudescence. RESULTS From 2014 to 2021, 306 cases of P.vivax and 896 cases of P.ovale were included in the study, while 75 cases had relapse or recrudescence, including 49 cases of P. ovale (65.33%) and 26 cases of P. vivax (34.67%). Within less than 5 weeks after returning to the country, 122 cases of P. vivax (39.87%, 122/306) and 265 cases of P. ovale (29.58%, 265/896) occurred. Within less than 53 weeks, the ratio of P. vivax was 94.77% (290/306), and that of P. ovale was 89.96% (806/896). Among the cases experiencing relapse or recrudescence, only 1 case of P. vivax (1/26 3.85%) and 3 cases of P. ovale (3/49 6.12%) occurred within less than 5 weeks after the first onset, whereas 21 cases of P. vivax (21/26 80.77%) and 42 cases of P. ovale (42/49 85.71%) occurred within less than 53 weeks after the first onset. The difference in relapse or recrudescence due to different drugs and medication regimens and medical activities at various levels of medical institutions was statistically significant. CONCLUSION In areas where malaria has been eliminated, routine health screening in a scientific time frame for people returning from at-risk areas can effectively improve the efficiency of preventing re-transmission, thereby reducing prevention costs and disease burden. Preventing patients from self-treating and strengthening medication regulations in health facilities are key measures to reduce relapse or recrudescence.
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Affiliation(s)
- Hui Yan
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Shujiao Wei
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Yuan Sui
- Brown School, Washington University, St. Louis, MO, USA
| | - Shenning Lu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology (National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention), 200025, Shanghai, China
| | - Weiwei Zhang
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Xiangyang Feng
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Ying Liu
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, 450016, China
| | - Tao Zhang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, 230601, China
| | - Wei Ruan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Jing Xia
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Wen Lin
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Shizhu Li
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Chinese Center for Tropical Diseases Research, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jun Li
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China.
| | - Duoquan Wang
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Chinese Center for Tropical Diseases Research, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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10
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Corder RM, Arez AP, Ferreira MU. Individual variation in Plasmodium vivax malaria risk: Are repeatedly infected people just unlucky? PLoS Negl Trop Dis 2023; 17:e0011020. [PMID: 36634044 PMCID: PMC9836309 DOI: 10.1371/journal.pntd.0011020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Extensive research has examined why some people have frequent Plasmodium falciparum malaria episodes in sub-Saharan Africa while others remain free of disease most of the time. In contrast, malaria risk heterogeneity remains little studied in regions where P. vivax is the dominant species. Are repeatedly infected people in vivax malaria settings such as the Amazon just unlucky? Here, we briefly review evidence that human genetic polymorphism and acquired immunity after repeated exposure to parasites can modulate the risk of P. vivax infection and disease in predictable ways. One-fifth of the hosts account for 80% or more of the community-wide vivax malaria burden and contribute disproportionally to onward transmission, representing a priority target of more intensive interventions to achieve malaria elimination. Importantly, high-risk individuals eventually develop clinical immunity, even in areas with very low or residual malaria transmission, and may constitute a large but silent parasite reservoir.
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Affiliation(s)
- Rodrigo M. Corder
- Department of Epidemiology and Biostatistics, University of California, Berkeley School of Public Health, Berkeley, California, United States of America
| | - Ana Paula Arez
- Global Health and Tropical Medicine (GHTM), institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
| | - Marcelo U. Ferreira
- Global Health and Tropical Medicine (GHTM), institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- * E-mail: ,
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11
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Chamchoy K, Sudsumrit S, Thita T, Krudsood S, Patrapuvich R, Boonyuen U. Cytochrome P450 2D6 (CYP2D6) and glucose-6-phosphate dehydrogenase (G6PD) genetic variations in Thai vivax malaria patients: Implications for 8-aminoquinoline radical cure. PLoS Negl Trop Dis 2022; 16:e0010986. [PMID: 36508454 PMCID: PMC9779666 DOI: 10.1371/journal.pntd.0010986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/22/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Primaquine and tafenoquine are the only licensed drugs that effectively kill the hypnozoite stage and are used to prevent Plasmodium vivax malaria relapse. However, both primaquine and tafenoquine can cause acute hemolysis in glucose-6-phosphate dehydrogenase (G6PD)-deficient people with varying degrees of severity depending on G6PD variants. Additionally, primaquine efficacy against malaria parasites was decreased in individuals with impaired cytochrome P450 2D6 (CYP2D6) activity due to genetic polymorphisms. This study aimed to characterize G6PD and CYP2D6 genetic variations in vivax malaria patients from Yala province, a malaria-endemic area along the Thai-Malaysian border, and determine the biochemical properties of identified G6PD variants. METHODOLOGY/PRINCIPLE FINDINGS Multiplexed high-resolution melting assay and DNA sequencing detected five G6PD variants, including G6PD Kaiping, G6PD Vanua Lava, G6PD Coimbra, G6PD Mahidol, and G6PD Kerala-Kalyan. Biochemical and structural characterization revealed that G6PD Coimbra markedly reduced catalytic activity and structural stability, indicating a high susceptibility to drug-induced hemolysis. While Kerala-Kalyan had minor effects, it is possible to develop mild adverse effects when receiving radical treatment. CYP2D6 genotyping was performed using long-range PCR and DNA sequencing, and the phenotypes were predicted using the combination of allelic variants. Decreased and no-function alleles were detected at frequencies of 53.4% and 14.2%, respectively. The most common alleles were CYP2D6*36+*10 (25.6%), *10 (23.9%), and *1 (22.2%). Additionally, 51.1% of the intermediate metabolizers showed CYP2D6*10/*36+*10 as the predominant genotype (15.9%). CONCLUSIONS/SIGNIFICANCE Our findings provide insights about genetic variations of G6PD and CYP2D6 in 88 vivax malaria patients from Yala, which may influence the safety and effectiveness of radical treatment. Optimization of 8-aminoquinoline administration may be required for safe and effective treatment in the studied population, which could be a significant challenge in achieving the goal of eliminating malaria.
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Affiliation(s)
- Kamonwan Chamchoy
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Sirapapha Sudsumrit
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thanyapit Thita
- Drug Research Unit for Malaria (DRUM), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Srivicha Krudsood
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rapatbhorn Patrapuvich
- Drug Research Unit for Malaria (DRUM), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Usa Boonyuen
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- * E-mail: ,
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12
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Birrell GW, Van Breda K, Barber B, Webster R, McCarthy JS, Shanks GD, Edstein MD. Quantification of Tafenoquine and 5,6-Orthoquinone Tafenoquine by UHPLC-MS/MS in Blood, Plasma, and Urine, and Application to a Pharmacokinetic Study. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27238186. [PMID: 36500278 PMCID: PMC9737280 DOI: 10.3390/molecules27238186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
Analytical methods for the quantification of the new 8-aminoquinoline antimalarial tafenoquine (TQ) in human blood, plasma and urine, and the 5,6-orthoquinone tafenoquine metabolite (5,6-OQTQ) in human plasma and urine have been validated. The procedure involved acetonitrile extraction of samples followed by ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS). Chromatography was performed using a Waters Atlantis T3 column with a gradient of 0.1% formic acid and acetonitrile at a flow rate of 0.5 mL per minute for blood and plasma. Urine analysis was the same but with methanol containing 0.1% formic acid replacing acetonitrile mobile phase. The calibration range for TQ and 5,6-OQTQ in plasma was 1 to 1200 ng/mL, and in urine was 10 to 1000 ng/mL. Blood calibration range for TQ was 1 to 1200 ng/mL. Blood could not be validated for 5,6-OQTQ due to significant signal suppression. The inter-assay precision (coefficient of variation %) was 9.9% for TQ at 1 ng/mL in blood (n = 14) and 8.2% for TQ and 7.1% for 5,6-OQTQ at 1 ng/mL in plasma (n = 14). For urine, the inter-assay precision was 8.2% for TQ and 6.4% for 5,6-OQTQ at 10 ng/mL (n = 14). TQ and 5,6-OQTQ are stable in blood, plasma and urine for at least three months at both -80 °C and -20 °C. Once validated, the analytical methods were applied to samples collected from healthy volunteers who were experimentally infected with Plasmodium falciparum to evaluate the blood stage antimalarial activity of TQ and to determine the therapeutic dose estimates for TQ, the full details of which will be published elsewhere. In this study, the measurement of TQ and 5,6-OQTQ concentrations in samples from one of the four cohorts of participants is reported. Interestingly, TQ urine concentrations were proportional to parasite recrudescence times post dosing To our knowledge, this is the first description of a fully validated method for the measurement of TQ and 5,6-OQTQ quantification in urine.
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Affiliation(s)
- Geoffrey W. Birrell
- Drug Evaluation, Australian Defence Force Malaria and Infectious Disease Institute, Brisbane 4051, Australia
- Correspondence:
| | - Karin Van Breda
- Drug Evaluation, Australian Defence Force Malaria and Infectious Disease Institute, Brisbane 4051, Australia
| | - Bridget Barber
- Clinical Malaria Group, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Rebecca Webster
- Clinical Malaria Group, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - James S. McCarthy
- Clinical Malaria Group, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
- Department of Infectious Diseases, University of Melbourne, Melbourne 3010, Australia
| | - G. Dennis Shanks
- Drug Evaluation, Australian Defence Force Malaria and Infectious Disease Institute, Brisbane 4051, Australia
| | - Michael D. Edstein
- Drug Evaluation, Australian Defence Force Malaria and Infectious Disease Institute, Brisbane 4051, Australia
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13
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Olvany JM, Williams SM, Zimmerman PA. Global perspectives on CYP2D6 associations with primaquine metabolism and Plasmodium vivax radical cure. Front Pharmacol 2022; 13:752314. [PMID: 36457706 PMCID: PMC9705595 DOI: 10.3389/fphar.2022.752314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/27/2022] [Indexed: 07/30/2023] Open
Abstract
Clinical trial and individual patient treatment outcomes have produced accumulating evidence that effective primaquine (PQ) treatment of Plasmodium vivax and P. ovale liver stage hypnozoites is associated with genetic variation in the human cytochrome P450 gene, CYP2D6. Successful PQ treatment of individual and population-wide infections by the Plasmodium species that generate these dormant liver stage forms is likely to be necessary to reach elimination of malaria caused by these parasites globally. Optimizing safe and effective PQ treatment will require coordination of efforts between the malaria and pharmacogenomics research communities.
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Affiliation(s)
- Jasmine M. Olvany
- The Center for Global Health and Diseases, Pathology Department, Case Western Reserve University, Cleveland, OH, United States
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Scott M. Williams
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Peter A. Zimmerman
- The Center for Global Health and Diseases, Pathology Department, Case Western Reserve University, Cleveland, OH, United States
- Master of Public Health Program, Case Western Reserve University, Cleveland, OH, United States
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14
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Cui L, Sattabongkot J, Aung PL, Brashear A, Cao Y, Kaewkungwal J, Khamsiriwatchara A, Kyaw MP, Lawpoolsri S, Menezes L, Miao J, Nguitragool W, Parker D, Phuanukoonnon S, Roobsoong W, Siddiqui F, Soe MT, Sriwichai P, Yang Z, Zhao Y, Zhong D. Multidisciplinary Investigations of Sustained Malaria Transmission in the Greater Mekong Subregion. Am J Trop Med Hyg 2022; 107:138-151. [PMID: 36228909 DOI: 10.4269/ajtmh.21-1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/28/2022] [Indexed: 11/07/2022] Open
Abstract
In the course of malaria elimination in the Greater Mekong Subregion (GMS), malaria epidemiology has experienced drastic spatiotemporal changes with residual transmission concentrated along international borders and the rising predominance of Plasmodium vivax. The emergence of Plasmodium falciparum parasites resistant to artemisinin and partner drugs renders artemisinin-based combination therapies less effective while the potential spread of multidrug-resistant parasites elicits concern. Vector behavioral changes and insecticide resistance have reduced the effectiveness of core vector control measures. In recognition of these problems, the Southeast Asian International Center of Excellence for Malaria Research (ICEMR) has been conducting multidisciplinary research to determine how human migration, antimalarial drug resistance, vector behavior, and insecticide resistance sustain malaria transmission at international borders. These efforts allow us to comprehensively understand the ecology of border malaria transmission and develop population genomics tools to identify and track parasite introduction. In addition to employing in vivo, in vitro, and molecular approaches to monitor the emergence and spread of drug-resistant parasites, we also use genomic and genetic methods to reveal novel mechanisms of antimalarial drug resistance of parasites. We also use omics and population genetics approaches to study insecticide resistance in malaria vectors and identify changes in mosquito community structure, vectorial potential, and seasonal dynamics. Collectively, the scientific findings from the ICEMR research activities offer a systematic view of the factors sustaining residual malaria transmission and identify potential solutions to these problems to accelerate malaria elimination in the GMS.
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Affiliation(s)
- Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | | | - Awtum Brashear
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Yaming Cao
- Department of Immunology, China Medical University, Shenyang, China
| | | | | | | | | | - Lynette Menezes
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jun Miao
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Wang Nguitragool
- Mahidol Vivax Research Unit, Mahidol University, Bangkok, Thailand
| | - Daniel Parker
- Department of Epidemiology, University of California at Irvine, Irvine, California
| | | | | | - Faiza Siddiqui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Myat Thu Soe
- Myanmar Health Network Organization, Yangon, Myanmar
| | - Patchara Sriwichai
- Department of Medical Entomology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Yan Zhao
- Department of Immunology, China Medical University, Shenyang, China
| | - Daibin Zhong
- Program in Public Health, University of California at Irvine, Irvine, California
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15
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Choi S, Choi H, Park SY, Kwak YG, Song JE, Shin SY, Baek JH, Shin HI, Cho SH, Lee SE, Kwon JR, Park S, Kim M, Oh HS, Kim YC, Kim MJ, Yeom JS. Association between CYP2D6 phenotype and recurrence of Plasmodium vivax infection in south Korean patients. Malar J 2022; 21:289. [PMID: 36217154 PMCID: PMC9552356 DOI: 10.1186/s12936-022-04311-6] [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] [Received: 04/06/2022] [Accepted: 09/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Primaquine is activated by CYP2D6 in the hepatocytes. In Korea, primaquine is the only hypnozoitocidal agent used for patients with vivax malaria. Thus, patients with poor CYP2D6 activity could have an increased risk of primaquine failure and subsequent relapse. The study sought to identify the association between CYP2D6 phenotype and recurrence of malaria in Korean patients. Methods A total of 102 patients with vivax malaria were prospectively enrolled from eight institutions in Korea. An additional 38 blood samples from patients with recurred vivax malaria were provided by the Korea Disease Control and Prevention Agency. Malaria recurrence was defined as more than one episode of vivax malaria in the same or consecutive years. CYP2D6 star alleles, phenotypes, and activity scores were examined. Results Genotyping for CYP2D6 was successful in 101 of the prospectively enrolled patients and 38 samples from the Korea Disease Control and Prevention Agency, of which 91 were included in the no-recurrence group and 48 were included in the recurrence group. Reduced CYP2D6 activity (intermediate metabolizer) phenotype was more common in the recurrence group than in the no-recurrence group (OR, 2.33 (95% CI, 1.14–4.77); p = 0.02). Patients with lower CYP2D6 activity had a higher probability of recurrence (p = 0.029). Conclusion This study suggests that CYP2D6 polymorphism may affect primaquine efficacy and thus Plasmodium vivax recurrence in Korea. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04311-6.
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Affiliation(s)
- Sungim Choi
- Division of Infectious Diseases, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Heun Choi
- Department of Infectious Diseases, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Seong Yeon Park
- Division of Infectious Diseases, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Yee Gyung Kwak
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Je Eun Song
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - So Youn Shin
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Hyun-Il Shin
- Division of Vectors and Parasitic Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency, Chungcheongbuk-do, Republic of Korea
| | - Shin-Hyung Cho
- Division of Vectors and Parasitic Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency, Chungcheongbuk-do, Republic of Korea
| | - Sang-Eun Lee
- Division of Vectors and Parasitic Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency, Chungcheongbuk-do, Republic of Korea
| | - Jeong-Ran Kwon
- Division of Zoonotic and Vector borne Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Chungcheongbuk-do, Republic of Korea
| | - Sookkyung Park
- Division of Zoonotic and Vector borne Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Chungcheongbuk-do, Republic of Korea
| | - Miyoung Kim
- Division of Zoonotic and Vector borne Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Chungcheongbuk-do, Republic of Korea
| | - Hong Sang Oh
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yong Chan Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Joon-Sup Yeom
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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16
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Park YA, Park KH, Yoon HY, Yee J, Gwak HS. Effects of CYP2D6 genotypes on Plasmodium vivax recurrence after primaquine treatment: A meta-analysis. Travel Med Infect Dis 2022; 48:102333. [PMID: 35452835 DOI: 10.1016/j.tmaid.2022.102333] [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: 11/04/2021] [Revised: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To elucidate the relationship between CYP2D6 polymorphisms and Plasmodium vivax recurrence in patients receiving primaquine-based treatment through systematic review and meta-analysis. METHODS We searched the PubMed, EMBASE, Cochrane Library, and Web of Science databases for eligible studies published up to August of 2021. We included studies investigating the associations between CYP2D6 polymorphisms and P. vivax recurrence. We evaluated the pooled odds ratio (OR) and 95% confidence interval (CI). RESULTS Data from nine studies, including 970 patients, were analyzed. We found that CYP2D6 poor metabolizers (PMs), intermediate metabolizers (IMs), or normal metabolizers slow (NM-Ss) were associated with a 1.8-fold (95% CI, 1.34-2.45; P = 0.0001) higher recurrence of P. vivax than normal metabolizers fast (NM-Fs), extensive metabolizers (EMs), or ultrarapid metabolizer (UMs). Subgroup analysis showed that studies on both Brazilian and Southeast or East Asian individuals had similar results to the main results. Sensitivity analysis by sequentially excluding individual studies also showed robust results (OR range: 1.63-2.01). CONCLUSIONS This meta-analysis confirmed that CYP2D6 PMs, IMs, or NM-Ss increased the risk of P. vivax recurrence compared to NM-Fs, EMs, or UMs. The results of this study could be used to predict P. vivax recurrence and suggest CYP2D6 genotype-based primaquine dosing.
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Affiliation(s)
- Yoon-A Park
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea
| | - Ki Hyun Park
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea
| | - Ha Young Yoon
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea
| | - Jeong Yee
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea.
| | - Hye Sun Gwak
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea.
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17
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Llanos-Cuentas A, Manrrique P, Rosas-Aguirre A, Herrera S, Hsiang MS. Tafenoquine for the treatment of Plasmodium vivax malaria. Expert Opin Pharmacother 2022; 23:759-768. [PMID: 35379070 DOI: 10.1080/14656566.2022.2058394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Plasmodium vivax malaria causes significant disease burden worldwide, especially in Latin America, Southeast Asia, and Oceania. P. vivax is characterized by the production of liver hypnozoites that cause clinical relapses upon periodic activation. Primaquine, an 8-aminoquinoline drug, has been the standard of care for decades to treat liver-stage P. vivax malaria; however, it requires long treatment regimens (one to two weeks) that lead to poor adherence and thus clinical relapses. Tafenoquine (TFQ), a newly available and efficacious single-dose 8-aminoquinoline, aims to address this challenge. Safe administration is possible when paired with the use of glucose-6-phosphate dehydrogenase (G6PD) diagnostics to prevent 8-aminoquinoline-induced hemolysis in patients with underlying G6PD deficiency (G6PDd). AREAS COVERED In this review, the authors present the recent literature regarding the pharmacology, efficacy, safety, and tolerability of TFQ and highlight regional differences in these areas. The authors also discuss the potential for TFQ, complemented with primaquine PQ and effective screening for G6PDd, to improve P. vivax clinical management and facilitate targeted mass drug administration in communities to decrease transmission. EXPERT OPINION Clinical studies show therapeutic efficacy of TFQ as well as a good performance in terms of safety and tolerability. Additional research regarding the effectiveness and safety TFQ in malaria elimination strategies such as targeted or mass drug administration are needed.
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Affiliation(s)
| | - Paulo Manrrique
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, PA, USA
| | - Angel Rosas-Aguirre
- Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sonia Herrera
- Department of Epidemiology, Division of Infectious Diseases and Global Health, Department of Pediatrics, Division of Pediatric Infectious Diseases, University of California San Francisco, San Francisco, CA, United States
| | - Michelle S Hsiang
- Department of Epidemiology, Division of Infectious Diseases and Global Health, Department of Pediatrics, Division of Pediatric Infectious Diseases, University of California San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, CA, USA.,Department of PediatricsUniversity of California San Francisco (UCSF), San Francisco, CA, USA
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Chamma-Siqueira NN, Negreiros SC, Ballard SB, Farias S, Silva SP, Chenet SM, Santos EJM, Pereira de Sena LW, Póvoa da Costa F, Cardoso-Mello AGN, Marchesini PB, Peterka CRL, Viana GMR, Macedo de Oliveira A. Higher-Dose Primaquine to Prevent Relapse of Plasmodium vivax Malaria. N Engl J Med 2022; 386:1244-1253. [PMID: 35353962 PMCID: PMC9132489 DOI: 10.1056/nejmoa2104226] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In most of the Americas, the recommended treatment to prevent relapse of Plasmodium vivax malaria is primaquine at a total dose of 3.5 mg per kilogram of body weight, despite evidence of only moderate efficacy. METHODS In this trial conducted in Brazil, we evaluated three primaquine regimens to prevent relapse of P. vivax malaria in children at least 5 years of age and in adults with microscopy-confirmed P. vivax monoinfection. All the patients received directly observed chloroquine for 3 days (total dose, 25 mg per kilogram). Group 1 received a total primaquine dose of 3.5 mg per kilogram (0.5 mg per kilogram per day) over 7 days with unobserved administration; group 2 received the same regimen as group 1 but with observed administration; and group 3 received a total primaquine dose of 7.0 mg per kilogram over 14 days (also 0.5 mg per kilogram per day) with observed administration. We monitored the patients for 168 days. RESULTS We enrolled 63 patients in group 1, 96 in group 2, and 95 in group 3. The median age of the patients was 22.4 years (range, 5.4 to 79.8). By day 28, three P. vivax recurrences were observed: 2 in group 1 and 1 in group 2. By day 168, a total of 70 recurrences had occurred: 24 in group 1, 34 in group 2, and 12 in group 3. No serious adverse events were noted. On day 168, the percentage of patients without recurrence was 58% (95% confidence interval [CI], 44 to 70) in group 1, 59% (95% CI, 47 to 69) in group 2, and 86% (95% CI, 76 to 92) in group 3. Survival analysis showed a difference in the day 168 recurrence-free percentage of 27 percentage points (97.5% CI, 10 to 44; P<0.001) between group 1 and group 3 and a difference of 27 percentage points (97.5% CI, 12 to 42; P<0.001) between group 2 and group 3. CONCLUSIONS The administration of primaquine at a total dose of 7.0 mg per kilogram had higher efficacy in preventing relapse of P. vivax malaria than a total dose of 3.5 mg per kilogram through day 168. (Supported by the U.S. Agency for International Development; ClinicalTrials.gov number, NCT03610399.).
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Affiliation(s)
- Nathália N Chamma-Siqueira
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Suiane C Negreiros
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Sarah-Blythe Ballard
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Sâmela Farias
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Sandro P Silva
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Stella M Chenet
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Eduardo J M Santos
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Luann W Pereira de Sena
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Flávia Póvoa da Costa
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Amanda G N Cardoso-Mello
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Paola B Marchesini
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Cássio R L Peterka
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Giselle M R Viana
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Alexandre Macedo de Oliveira
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
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19
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Cardoso JLM, Salazar YEAR, Almeida ACG, Barbosa LRA, Silva EL, Rodrigues MGA, Rodrigues-Soares F, Sampaio VS, Siqueira AM, Lacerda MVG, Monteiro WM, Melo GC. Influence of CYP2D6, CYP3A4 and CYP2C19 Genotypes on Recurrence of Plasmodium vivax. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.845451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe influence of the CYPs (cytochrome P-450) in the success of antimalarial therapy remains uncertain. In this study, the association of CYP2D6, CYP2C19 and CYP3A4 polymorphisms and predicted phenotypes with malaria recurrence was investigated.MethodsAfter diagnosis of vivax malaria, individuals treated at a reference center in Manaus were followed up for 180 days. Patients were separated into two groups: a recurrence group and a non-recurrence group. Genotyping of CYP2D6, CYP2C19 and CYP3A4 was performed using a TaqMan™ assay and real-time PCR.FindingsThe frequencies of decreased-function and normal-function alleles and phenotypes for all CYPs were similar between the groups, except for the CYP2D6*2xN allele (p=0.047) and the CYP2D6 gUM phenotype (p=0.057), which were more frequent in individuals without recurrence. Despite this, the CYP2D6, CYP2C19 and CYP3A4 genotypes had no association with an increased risk of recurrence. CYPs polymorphisms also had no influence in parasite clearance, neither in the time nor the number of recurrence episodes. MAINConclusionThis prospective cohort study demonstrated that CYP2D6, CYP2C19 and CYP3A4 polymorphisms have no influence on malaria recurrence. Nonetheless, our findings suggest that the CYP2D6 predicted ultrarapid phenotype was less susceptible to recurrence, and that patients with the CYP2D6 gUM phenotype are less susceptible to primaquine failure. Additional investigation of pharmacogenetics and pharmacokinetics are needed before implementing CYP analysis to better orientate individualized radical treatment of vivax malaria in reference centers that treat patients with multiple recurrences.
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20
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Nain M, Mohan M, Sharma A. Effects of Host Genetic Polymorphisms on the Efficacy of the Radical Cure Malaria Drug Primaquine. Am J Trop Med Hyg 2022; 106:764-767. [PMID: 35008050 PMCID: PMC8922494 DOI: 10.4269/ajtmh.21-1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/24/2021] [Indexed: 11/07/2022] Open
Abstract
Malaria is a major cause of death in low-income countries. Malaria relapses are caused by Plasmodium vivax-induced latent liver stage hypnozoites, and relapses contribute significantly to the total disease burden. The goal of malaria elimination is threatened in countries where P. vivax is endemic and relapses remain a key aspect of concern. Targeting of the hypnozoites is crucial for radical cure and this is achieved by primaquine (PQ). In addition to its anti-hypnozoite effects, PQ also possesses gametocidal activity against all malaria causing Plasmodium species and is hence a useful tool to curtail malaria transmission. It is well known that host glucose-6-phosphate dehydrogenase (G6PD) deficiency is associated with hemolysis after treatment with PQ. Multiple other host polymorphisms impact on PQ metabolism, potentially affecting drug efficacy. Being a prodrug, PQ requires host factors cytochrome P450 2D6 (CYP2D6), cytochrome P450 NADPH: oxidoreductase (CPR) and monoamine oxidase (MAO) for its metabolism and conversion to active form. The efficacy of PQ in the host is therefore dependent on genetic polymorphisms of these three host genes. The efficacy of PQ is important for clearing reservoirs of P. vivax infection. Here, we have analyzed the known spectrum of genetic polymorphisms for host genes that enable PQ metabolism. It is vital to delineate the polymorphisms that determine the ultimate efficacy of PQ for formulating better malaria elimination strategies in countries with severe malaria burden. Thus population-based studies of these gene variants will provide new insights into the role of host genetics on PQ treatment outcomes.
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Affiliation(s)
- Minu Nain
- National Institute of Malaria Research, New Delhi, India
| | - Mradul Mohan
- National Institute of Malaria Research, New Delhi, India
| | - Amit Sharma
- National Institute of Malaria Research, New Delhi, India;,Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi, India,Address correspondence to Amit Sharma, National Institute of Malaria Research, Group Leader, Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, Sector 8, Dwarka, New Delhi, Delhi 110077, India. E-mail:
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21
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Chan ER, Mehlotra RK, Pirani KA, Ratsimbasoa AC, Williams SM, Gaedigk A, Zimmerman PA. CYP2D6 gene resequencing in the Malagasy, a population at the crossroads between Asia and Africa: a pilot study. Pharmacogenomics 2022; 23:315-325. [PMID: 35230160 PMCID: PMC8965795 DOI: 10.2217/pgs-2021-0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Plasmodium vivax malaria is endemic in Madagascar, where populations have genetic inheritance from Southeast Asia and East Africa. Primaquine, a drug of choice for vivax malaria, is metabolized principally via CYP2D6. CYP2D6 variation was characterized by locus-specific gene sequencing and was compared with TaqMan™ genotype data. Materials & methods: Long-range PCR amplicons were generated from 96 Malagasy samples and subjected to next-generation sequencing. Results: The authors observed high concordance between TaqMan™-based CYP2D6 genotype calls and the base calls from sequencing. In addition, there are new variants and haplotypes present in the Malagasy. Conclusion: Sequencing unique admixed populations provides more detailed and accurate insights regarding CYP2D6 variability, which may help optimize primaquine treatment across human genetic diversity.
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Affiliation(s)
- E Ricky Chan
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH 44106, USA.,Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Rajeev K Mehlotra
- Center for Global Health & Diseases, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Karim A Pirani
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, MO 64108, USA
| | - Arsene C Ratsimbasoa
- University of Fianarantsoa, Fianarantsoa, Madagascar.,CNARP (Centre National d'Application de Recherche Pharmaceutique), Antananarivo, Madagascar
| | - Scott M Williams
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH 44106, USA.,Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, MO 64108, USA
| | - Peter A Zimmerman
- Center for Global Health & Diseases, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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22
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Fasinu PS, Chaurasiya ND, Dhammika Nanayakkara NP, Wang Y, Bandara Herath HMT, Avula B, McChesney JD, Jollow D, Walker LA, Tekwani BL. Comparative pharmacokinetics and tissue distribution of primaquine enantiomers in mice. Malar J 2022; 21:33. [PMID: 35123453 PMCID: PMC8817607 DOI: 10.1186/s12936-022-04054-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Primaquine (PQ) has been used for the radical cure of relapsing Plasmodium vivax malaria for more than 60 years. PQ is also recommended for prophylaxis and prevention of transmission of Plasmodium falciparum. However, clinical utility of PQ has been limited due to toxicity in individuals with genetic deficiencies in glucose 6-phosphate dehydrogenase (G6PD). PQ is currently approved for clinical use as a racemic mixture. Recent studies in animals as well as humans have established differential pharmacological and toxicological properties of the two enantiomers of PQ. This has been attributed to differential metabolism and pharmacokinetics of individual PQ enantiomers. The aim of the current study is to evaluate the comparative pharmacokinetics (PK), tissue distribution and metabolic profiles of the individual enantiomers in mice.
Methods
Two groups of 21 male Albino ND4 Swiss mice were dosed orally with 45 mg/kg of S-(+)-PQ and R-(−)PQ respectively. Each of the enantiomers was comprised of a 50:50 mixture of 12C- and 13C- stable isotope labelled species (at 6 carbons on the benzene ring of the quinoline core). Three mice were euthanized from each group at different time points (at 0, 0.5, 1, 2, 4, 8, 24 h) and blood was collected by terminal cardiac bleed. Liver, spleen, lungs, kidneys and brain were removed, extracted and analysed using UPLC/MS. The metabolites were profiled by tandem mass (MS/MS) fragmentation profile and fragments with 12C–13C twin peaks. Non-compartmental analysis was performed using the Phoenix WinNonLin PK software module.
Results
The plasma AUC0-last (µg h/mL) (1.6 vs. 0.6), T1/2 (h) (1.9 vs. 0.45), and Tmax (h) (1 vs. 0.5) were greater for SPQ as compared to RPQ. Generally, the concentration of SPQ was higher in all tissues. At Tmax, (0.5–1 h in all tissues), the level of SPQ was 3 times that of RPQ in the liver. Measured Cmax of SPQ and RPQ in the liver were about 100 and 40 times the Cmax values in plasma, respectively. Similar observations were recorded in other tissues where the concentration of SPQ was higher compared to RPQ (2× in the spleen, 6× in the kidneys, and 49× in the lungs) than in the plasma. CPQ, the major metabolite, was preferentially generated from RPQ, with higher levels in all tissues (> 10× in the liver, and 3.5× in the plasma) than from SPQ. The PQ-o-quinone was preferentially formed from the SPQ (> 4× compared to RPQ), with higher concentrations in the liver.
Conclusion
These studies show that in mice, PQ enantiomers are differentially biodistributed and metabolized, which may contribute to differential pharmacologic and toxicity profiles of PQ enantiomers. The findings on higher levels of PQ-o-quinone in liver and RBCs compared to plasma and preferential generation of this metabolite from SPQ are consistent with the higher anti-malarial efficacy of SPQ observed in the mouse causal prophylaxis test, and higher haemolytic toxicity in the humanized mouse model of G6PD deficiency. Potential relevance of these findings to clinical use of racemic PQ and other 8-aminoquinolines vis-à-vis need for further clinical evaluation of individual enantiomers are discussed.
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23
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Choi S, Choi H, Park SY, Kwak YG, Song JE, Shin SY, Baek JH, Shin HI, Oh HS, Kim YC, Yeom JS, Han JH, Kim MJ. Four Times of Relapse of Plasmodium vivax Malaria Despite Primaquine Treatment in a Patient with Impaired Cytochrome P450 2D6 Function. THE KOREAN JOURNAL OF PARASITOLOGY 2022; 60:39-43. [PMID: 35247953 PMCID: PMC8898651 DOI: 10.3347/kjp.2022.60.1.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
Plasmodium vivax exhibits dormant liver-stage parasites, called hypnozoites, which can cause relapse of malaria. The only drug currently used for eliminating hypnozoites is primaquine. The antimalarial properties of primaquine are dependent on the production of oxidized metabolites by the cytochrome P450 isoenzyme 2D6 (CYP2D6). Reduced primaquine metabolism may be related to P. vivax relapses. We describe a case of 4 episodes of recurrence of vivax malaria in a patient with decreased CYP2D6 function. The patient was 52-year-old male with body weight of 52 kg. He received total gastrectomy and splenectomy 7 months before the first episode and was under chemotherapy for the gastric cancer. The first episode occurred in March 2019 and each episode had intervals of 34, 41, and 97 days, respectively. At the first and second episodes, primaquine was administered as 15 mg for 14 days. The primaquine dose was increased with 30 mg for 14 days at the third and fourth episodes. Seven gene sequences of P. vivax were analyzed and revealed totally identical for all the 4 samples. The CYP2D6 genotype was analyzed and intermediate metabolizer phenotype with decreased function was identified.
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Affiliation(s)
- Sungim Choi
- Department of Infectious Diseases, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Heun Choi
- Department of Infectious Diseases, National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea
| | - Seong Yeon Park
- Department of Infectious Diseases, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Ilsan 10380, Korea
| | - Je Eun Song
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Ilsan 10380, Korea
| | - So Youn Shin
- Department of Infectious Diseases, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Hyun-Il Shin
- Division of Vectors and Parasitic Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency, Chungbuk 28159, Korea
| | - Hong Sang Oh
- Division of Infectious Disease, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam 13574, Korea
| | - Yong Chan Kim
- Department of Internal Medicine, Division of Infectious Disease, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine, Division of Infectious Disease, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea
| | - Jin-Hee Han
- Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon 24341, Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
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24
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Tafenoquine exposure assessment, safety, and relapse prevention efficacy in children with Plasmodium vivax malaria: open-label, single-arm, non-comparative, multicentre, pharmacokinetic bridging, phase 2 trial. THE LANCET CHILD & ADOLESCENT HEALTH 2022; 6:86-95. [PMID: 34871570 DOI: 10.1016/s2352-4642(21)00328-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022]
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25
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White NJ, Watson JA, Baird JK. Methaemoglobinaemia and the radical curative efficacy of 8-aminoquinoline antimalarials. Br J Clin Pharmacol 2022; 88:2657-2664. [PMID: 34997616 PMCID: PMC7612727 DOI: 10.1111/bcp.15219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/18/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022] Open
Abstract
Methaemoglobin results from the oxidation of ferrous to ferric iron in the centre of the haem moeity of haemoglobin. The production of dose-dependent methaemoglobinaemia by 8-aminoquinoline antimalarial drugs appears to be associated with, but is not directly linked to, therapeutic efficacy against latent Plasmodium vivax and P. ovale malarias (radical cure). Iatrogenic methaemoglobinaemia may be a useful pharmacodynamic measure in 8-aminoquinoline drug and dose optimization.
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Affiliation(s)
- Nicholas J White
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - James A Watson
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - J Kevin Baird
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
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26
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Measurements of 5,6 orthoquinone, surrogate for presumed active primaquine metabolite 5-hydroxyprimaquine, in the urine of Cambodian adults. Antimicrob Agents Chemother 2022; 66:e0182121. [DOI: 10.1128/aac.01821-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The active metabolites of primaquine, in particular 5-hydroxyprimaquine, likely responsible for clearance of dormant hypnozoites, are produced through the hepatic CYP450 2D6 (CYP2D6) enzymatic pathway. With the inherent instability of 5-hydroxyprimaquine, a stable surrogate, 5,6 orthoquinone, can now be detected and measured in the urine as part of primaquine pharmacokinetic studies. This study performed CYP450 2D6 genotyping and primaquine pharmacokinetic testing, to include urine 5,6 orthoquinone, in 27 healthy adult Cambodians, as a preliminary step to prepare for future clinical studies assessing primaquine efficacy for
Plasmodium vivax
infections. The CYP2D6 *10 reduced activity allele was found in 57% of volunteers, and the CYP2D6 genotypes were dominated by *1/*10 (33%) and *10/*10 (30%). Predicted phenotypes were evenly split between Normal Metabolizer (NM) and Intermediate Metabolizer (IM) except one volunteer with a gene duplication and unclear phenotype, classifying as either IM or NM. Median plasma PQ area under the curve (AUC) was lower in the NM group (460 hr*ng/mL) compared to the IM group (561 hr*ng/mL), although not statistically significant. Similar to what has been found in the US study, no 5,6 orthoquinone was detected in the plasma. The urine creatinine-corrected 5,6 orthoquinone AUC in the NM group was almost three times higher than in the IM group, with peak measurements (T
max
) at 4 hours. Although there is variation among individuals, future studies examining the relationship between the levels of urine 5,6 orthoquinone and primaquine radical cure efficacy could result in a metabolism biomarker predictive of radical cure.
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27
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Pernaute-Lau L, Camara M, Nóbrega de Sousa T, Morris U, Ferreira MU, Gil JP. An update on pharmacogenetic factors influencing the metabolism and toxicity of artemisinin-based combination therapy in the treatment of malaria. Expert Opin Drug Metab Toxicol 2022; 18:39-59. [PMID: 35285373 DOI: 10.1080/17425255.2022.2049235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Artemisinin-based combination therapies (ACTs) are recommended first-line antimalarials for uncomplicated Plasmodium falciparum malaria. Pharmacokinetic/pharmacodynamic variation associated with ACT drugs and their effect is documented. It is accepted to an extent that inter-individual variation is genetically driven, and should be explored for optimized antimalarial use. AREAS COVERED We provide an update on the pharmacogenetics of ACT antimalarial disposition. Beyond presently used antimalarials, we also refer to information available for the most notable next-generation drugs under development. The bibliographic approach was based on multiple Boolean searches on PubMed covering all recent publications since our previous review. EXPERT OPINION The last 10 years have witnessed an increase in our knowledge of ACT pharmacogenetics, including the first clear examples of its contribution as an exacerbating factor for drug-drug interactions. This knowledge gap is still large and is likely to widen as a new wave of antimalarial drug is looming, with few studies addressing their pharmacogenetics. Clinically useful pharmacogenetic markers are still not available, in particular, from an individual precision medicine perspective. A better understanding of the genetic makeup of target populations can be valuable for aiding decisions on mass drug administration implementation concerning region-specific antimalarial drug and dosage options.
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Affiliation(s)
- Leyre Pernaute-Lau
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Solna, Sweden.,Faculty of Sciences, BioISI - Biosystems & Integrative Sciences Institute, University of Lisbon, Lisbon, 1749-016, Portugal
| | - Mahamadou Camara
- Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, Malaria Research and Training Center, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Taís Nóbrega de Sousa
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Brasil
| | - Ulrika Morris
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Solna, Sweden
| | - Marcelo Urbano Ferreira
- Faculty of Sciences, BioISI - Biosystems & Integrative Sciences Institute, University of Lisbon, Lisbon, 1749-016, Portugal.,Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - José Pedro Gil
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Solna, Sweden.,Faculty of Sciences, BioISI - Biosystems & Integrative Sciences Institute, University of Lisbon, Lisbon, 1749-016, Portugal.,Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Portugal
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28
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Watson JA, Commons RJ, Tarning J, Simpson JA, Llanos Cuentas A, Lacerda MVG, Green JA, Koh GCKW, Chu CS, Nosten FH, Price RN, Day NPJ, White NJ. The clinical pharmacology of tafenoquine in the radical cure of Plasmodium vivax malaria: An individual patient data meta-analysis. eLife 2022; 11:83433. [PMID: 36472067 PMCID: PMC9725750 DOI: 10.7554/elife.83433] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Tafenoquine is a newly licensed antimalarial drug for the radical cure of Plasmodium vivax malaria. The mechanism of action and optimal dosing are uncertain. We pooled individual data from 1102 patients and 72 healthy volunteers studied in the pre-registration trials. We show that tafenoquine dose is the primary determinant of efficacy. Under an Emax model, we estimate the currently recommended 300 mg dose in a 60 kg adult (5 mg/kg) results in 70% of the maximal obtainable hypnozoiticidal effect. Increasing the dose to 7.5 mg/kg (i.e. 450 mg) would result in 90% reduction in the risk of P. vivax recurrence. After adjustment for dose, the tafenoquine terminal elimination half-life, and day 7 methaemoglobin concentration, but not the parent compound exposure, were also associated with recurrence. These results suggest that the production of oxidative metabolites is central to tafenoquine's hypnozoiticidal efficacy. Clinical trials of higher tafenoquine doses are needed to characterise their efficacy, safety and tolerability.
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Affiliation(s)
- James A Watson
- Oxford University Clinical Research Unit, Hospital for Tropical DiseasesHo Chi Minh CityViet Nam,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom,WorldWide Antimalarial Resistance NetworkOxfordUnited Kingdom
| | - Robert J Commons
- WorldWide Antimalarial Resistance NetworkOxfordUnited Kingdom,Global Health Division, Menzies School of Health Research, Charles Darwin UniversityDarwinAustralia
| | - Joel Tarning
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom,Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of MelbourneMelbourneAustralia
| | - Alejandro Llanos Cuentas
- Unit of Leishmaniasis and Malaria, Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano HerediaLimaPeru
| | | | - Justin A Green
- Formerly Senior Director, Global Health, GlaxoSmithKlineBrentfordUnited Kingdom
| | - Gavin CKW Koh
- Department of Infectious Diseases, Northwick Park HospitalHarrowUnited Kingdom
| | - Cindy S Chu
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom,Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityMae SotThailand
| | - François H Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom,Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityMae SotThailand
| | - Richard N Price
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom,WorldWide Antimalarial Resistance NetworkOxfordUnited Kingdom,Global Health Division, Menzies School of Health Research, Charles Darwin UniversityDarwinAustralia
| | - Nicholas PJ Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom,Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom,Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
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Stone W, Mahamar A, Sanogo K, Sinaba Y, Niambele SM, Sacko A, Keita S, Youssouf A, Diallo M, Soumare HM, Kaur H, Lanke K, ter Heine R, Bradley J, Issiaka D, Diawara H, Traore SF, Bousema T, Drakeley C, Dicko A. Pyronaridine–artesunate or dihydroartemisinin–piperaquine combined with single low-dose primaquine to prevent Plasmodium falciparum malaria transmission in Ouélessébougou, Mali: a four-arm, single-blind, phase 2/3, randomised trial. THE LANCET MICROBE 2022; 3:e41-e51. [PMID: 35028628 PMCID: PMC8721154 DOI: 10.1016/s2666-5247(21)00192-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- William Stone
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
- Correspondence to: Dr William Stone, Department of Infection Biology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Almahamoudou Mahamar
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Koualy Sanogo
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Youssouf Sinaba
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sidi M Niambele
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Adama Sacko
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekouba Keita
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Ahamadou Youssouf
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Makonon Diallo
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Harouna M Soumare
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Harparkash Kaur
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kjerstin Lanke
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, Netherlands
| | - Rob ter Heine
- Department of Pharmacy and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, Netherlands
| | - John Bradley
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Djibrilla Issiaka
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Halimatou Diawara
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekou F Traore
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Teun Bousema
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, Netherlands
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Alassane Dicko
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
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Stewart AGA, Zimmerman PA, McCarthy JS. Genetic Variation of G6PD and CYP2D6: Clinical Implications on the Use of Primaquine for Elimination of Plasmodium vivax. Front Pharmacol 2021; 12:784909. [PMID: 34899347 PMCID: PMC8661410 DOI: 10.3389/fphar.2021.784909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/05/2021] [Indexed: 12/03/2022] Open
Abstract
Primaquine, an 8-aminoquinoline, is the only medication approved by the World Health Organization to treat the hypnozoite stage of Plasmodium vivax and P. ovale malaria. Relapse, triggered by activation of dormant hypnozoites in the liver, can occur weeks to years after primary infection, and provides the predominant source of transmission in endemic settings. Hence, primaquine is essential for individual treatment and P. vivax elimination efforts. However, primaquine use is limited by the risk of life-threatening acute hemolytic anemia in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals. More recently, studies have demonstrated decreased efficacy of primaquine due to cytochrome P450 2D6 (CYP2D6) polymorphisms conferring an impaired metabolizer phenotype. Failure of standard primaquine therapy has occurred in individuals with decreased or absent CYP2D6 activity. Both G6PD and CYP2D6 are highly polymorphic genes, with considerable geographic and interethnic variability, adding complexity to primaquine use. Innovative strategies are required to overcome the dual challenge of G6PD deficiency and impaired primaquine metabolism. Further understanding of the pharmacogenetics of primaquine is key to utilizing its full potential. Accurate CYP2D6 genotype-phenotype translation may optimize primaquine dosing strategies for impaired metabolizers and expand its use in a safe, efficacious manner. At an individual level the current challenges with G6PD diagnostics and CYP2D6 testing limit clinical implementation of pharmacogenetics. However, further characterisation of the overlap and spectrum of G6PD and CYP2D6 activity may optimize primaquine use at a population level and facilitate region-specific dosing strategies for mass drug administration. This precision public health approach merits further investigation for P. vivax elimination.
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Affiliation(s)
| | - Peter A Zimmerman
- The Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, United States
| | - James S McCarthy
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Peter Doherty Institute of Infection and Immunity, Melbourne, VIC, Australia
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Dong Y, Huang H, Deng Y, Xu Y, Chen M, Liu Y, Zhang C. Prediction of the CYP2D6 enzymatic activity based on investigating of the CYP2D6 genotypes around the vivax malaria patients in Yunnan Province, China. Malar J 2021; 20:448. [PMID: 34823523 PMCID: PMC8620920 DOI: 10.1186/s12936-021-03988-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background In recent years, the incidence rate of vivax malaria recurrence still had 3.1% in Yunnan Province population after eradication therapy using primaquine (PQ). In order to understand the specific failure reasons for preventing vivax malaria relapses, a preliminary exploration on the CYP2D6 enzyme activity was carried out in the vivax malaria patients in Yunnan Province population by analysing mutational polymorphism in the coding region of CYP2D6 gene. Methods Blood samples were collected from vivax malaria patients with suspected relapse (SR) and non-relapsed (NR) malaria in Yunnan Province. The DNA fragments containing 9 exons regions of human CYP2D6 gene were amplified by performing PCR and sequenced. The sequencing results were aligned by using DNAStar 11.0 to obtain the coding DNA sequence (CDS) of CYP2D6 gene. DnaSP 6.11.01 software was used to identify mutant polymorphisms and haplotypes of the CDS chain. The waterfall function of GenVisR package in R was utilized to visualize the mutational landscape. The alleles of CYP2D6 gene were identified according to the criteria prescribed by Human Cytochrome P450 (CYP) Allele Nomenclature Committee Database and the CYP2D6 enzyme activity was predicted based on diploid genotype. Results A total of 320 maternal CDS chains, including 63 from SR group and 257 from NR group, were obtained. Twelve mutant loci, including c.31 (rs769259), c.100 (rs1065852), c.271 (rs28371703), c.281 (rs28371704), c.294 (rs28371705), c.297 (rs200269944), c.336 (rs1081003), c.408 (rs1058164), c.505 (rs5030865), c.801 (rs28371718), c.886 (rs16947), and c.1,457 (rs1135840) were observed on the 640 CDS chains (including 320 maternal and 320 paternal chains). The high-frequency mutation at rs1135840 (0.703) and low-frequency mutation, such as rs28371703, were detected only in the SR group. The frequency of mutant rs1058164 and rs1135840 were significantly increased in the SR group (\documentclass[12pt]{minimal}
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\begin{document}$${x}^{2}$$\end{document}x2= 4.468, 5.889, P < 0.05), as opposed to the NR group. Of the 23 haplotypes (from Hap_1 to Hap_23), the nomenclatures of 11 allelic forms could be found: Hap_3 was non-mutant, Hap_2 accounted for the highest frequency (36.9%, 236/640), and Hap_9 had the most complex sequence structure, containing 7 loci mutations. Allele *10 was the most frequent among these genotypes (0.423). Among the allele *10 standard named genotypes, *1/*10, *1/*1 and *2/*10 were significantly more frequent in the NR group (\documentclass[12pt]{minimal}
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\begin{document}$${x}^{2}$$\end{document}x2= 3.911, P < 0.05) and all showed uncompromised enzyme activity; the impaired genotype *10/*39 was more frequent in the SR group (\documentclass[12pt]{minimal}
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\begin{document}$${x}^{2}$$\end{document}x2= 10.050, P < 0.05), and genotype *4/*4was detected only in the SR group. Conclusion In the patients receiving PQ dosage in Yunnan Province population, both rs1135840 single nucleotide polymorphism and *10 allele form was common in the CYP2D6 gene. Low-frequency mutation sites, such as rs28371703, were only presented in patients with vivax malaria relapse. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03988-5.
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Affiliation(s)
- Ying Dong
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China.
| | - Herong Huang
- Department of Basic Medical Sciences, Clinical College of Anhui Medical University, Hefei, 230031, China
| | - Yan Deng
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Yanchun Xu
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Mengni Chen
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Yan Liu
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Canglin Zhang
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China
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Woon SA, Manning L, Moore BR. Antimalarials for children with Plasmodium vivax infection: Current status, challenges, and research priorities. Parasitol Int 2021; 87:102512. [PMID: 34785369 DOI: 10.1016/j.parint.2021.102512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
The aim of this narrative review is to summarise efficacy and pharmacokinetic data for Plasmodium vivax in children. The burden of P. vivax malaria in children continues to remain a significant public health issue, and the need for improved treatment regimens for this vulnerable population is critical. Relapse after re-activation of dormant liver-stage hypnozoites poses additional challenges for treatment, elimination, and control strategies for P. vivax. Whilst it is recognised that paediatric pharmacology may be significantly influenced by anatomical and physiological changes of childhood, dosing regimens often continue to be extrapolated from adult data, highlighting the need for antimalarial dosing in children to be evaluated in early phase clinical trials. This will ensure that globally recommended treatment regimens do not result in suboptimal dosing in children. Furthermore, the development of affordable paediatric formulations to enhance treatment acceptability and widespread G6PD testing to facilitate use of anti-hypnozoite treatment such as primaquine and tafenoquine, should be further prioritised. As the world prepares for malaria elimination, a renewed focus on P. vivax malaria provides an ideal opportunity to harness momentum and ensure that all populations, including children have access to safe, efficacious, and correctly dosed antimalarial therapies.
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Affiliation(s)
- Sze-Ann Woon
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Laurens Manning
- Medical School, University of Western Australia, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Brioni R Moore
- Medical School, University of Western Australia, Perth, Western Australia, Australia; Curtin Medical School, Curtin University, Perth, Western Australia, Australia; Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.
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Tayipto Y, Liu Z, Mueller I, Longley RJ. Serology for Plasmodium vivax surveillance: A novel approach to accelerate towards elimination. Parasitol Int 2021; 87:102492. [PMID: 34728377 DOI: 10.1016/j.parint.2021.102492] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/30/2021] [Accepted: 10/28/2021] [Indexed: 01/13/2023]
Abstract
Plasmodium vivax is the most widespread causative agent of human malaria in the world. Despite the ongoing implementation of malaria control programs, the rate of case reduction has declined over the last 5 years. Hence, surveillance of malaria transmission should be in place to identify and monitor areas that require intensified malaria control interventions. Serological tools may offer additional insights into transmission intensity over parasite and entomological measures, especially as transmission levels decline. Antibodies can be detected in the host system for months to even years after parasite infections have been cleared from the blood, enabling malaria exposure history to be captured. Because the Plasmodium parasite expresses more than 5000 proteins, it is important to a) understand antibody longevity following infection and b) measure antibodies to more than one antigen in order to accurately inform on the exposure and/or immune status of populations. This review summarises current practices for surveillance of P. vivax malaria, the current state of research into serological exposure markers and their potential role for accelerating malaria elimination, and discusses further studies that need to be undertaken to see such technology implemented in malaria-endemic areas.
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Affiliation(s)
- Yanie Tayipto
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia; Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Zoe Liu
- The Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia; School of Medicine, Centre for Molecular and Medical Research, Deakin University, Geelong, Australia
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia; Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Rhea J Longley
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia; Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia.
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Abstract
J. Kevin Baird and colleagues, examine and discuss the estimated global burden of vivax malaria and it's biological, clinical, and public health complexity.
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Affiliation(s)
- Katherine E. Battle
- Institute for Disease Modeling, Seattle, Washington, United States of America
| | - J. Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia
- Nuffield Department of Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Baird JK. Basic Research of Plasmodium vivax Biology Enabling Its Management as a Clinical and Public Health Problem. Front Cell Infect Microbiol 2021; 11:696598. [PMID: 34540716 PMCID: PMC8447957 DOI: 10.3389/fcimb.2021.696598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/22/2021] [Indexed: 12/20/2022] Open
Abstract
The emerging understanding of Plasmodium vivax as an infection seated in extravascular spaces of its human host carries fundamentally important implications for its management as a complex clinical and public health problem. This progress begins to reverse decades of neglected research borne of the false dogma of P. vivax as an intrinsically benign and inconsequential parasite. This Review provides real world context for the on-going laboratory explorations of the molecular and cellular events in the life of this parasite. Chemotherapies against the latent reservoir impose extraordinarily complex and difficult problems of science and medicine, but great strides in studies of the biology of hepatic P. vivax promise solutions. Fundamental assumptions regarding the interpretation of parasitaemia in epidemiology, clinical medicine, and public health are being revisited and reassessed in light of new studies of P. vivax cellular/molecular biology and pathogenesis. By examining these long overlooked complexities of P. vivax malaria, we open multiple new avenues to vaccination, chemoprevention, countermeasures against transmission, epidemiology, diagnosis, chemotherapy, and clinical management. This Review expresses how clarity of vision of biology and pathogenesis may rationally and radically transform the multiple means by which we may combat this insidiously harmful infection.
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Affiliation(s)
- J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Determinants of primaquine and carboxyprimaquine exposures in children and adults with Plasmodium vivax malaria. Antimicrob Agents Chemother 2021; 65:e0130221. [PMID: 34398667 DOI: 10.1128/aac.01302-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Primaquine is the only widely available drug for radical cure of Plasmodium vivax malaria. There is uncertainty whether the pharmacokinetic properties of primaquine are altered significantly in childhood or not. Methods Glucose-6-phosphate dehydrogenase normal patients with uncomplicated P. vivax malaria were randomized to receive either chloroquine (25mg base/kg) or dihydroartemisinin-piperaquine (dihydroartemisinin 7mg/kg and piperaquine 55mg/kg) plus primaquine; given either as 0.5 mg base/kg/day for 14 days or 1 mg/kg/day for 7 days. Pre-dose day 7 venous plasma concentrations of chloroquine, desethylchloroquine, piperaquine, primaquine and carboxyprimaquine were measured. Methemoglobin levels were measured on day 7. Results Day 7 primaquine and carboxyprimaquine concentrations were available for 641 patients. After adjustment for the primaquine mg/kg daily dose, day of sampling, partner drug, and fever clearance, there was a significant non-linear relationship between age and trough primaquine and carboxyprimaquine concentrations, and day methemoglobin levels. Compared to adults 30 years of age, children 5 years of age had trough primaquine concentrations 0.53 (95% CI: 0.39- 0.73) fold lower, trough carboxyprimaquine concentrations 0.45 (95% CI: 0.35- 0.55) fold lower, and day 7 methemoglobin levels 0.87 (95% CI: 0.58-1.27) fold lower. Increasing concentrations of piperaquine and chloroquine and poor metabolizer CYP 2D6 alleles were associated with higher day 7 primaquine and carboxyprimaquine concentrations. Higher blood methemoglobin concentrations were associated with a lower risk of recurrence. Conclusion Young children have lower primaquine and carboxyprimaquine exposures, and lower levels of methemoglobinemia, than adults. Young children may need higher weight adjusted primaquine doses than adults.
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de Pina-Costa A, Silvino ACR, Dos Santos EM, Pedro RS, Moreira J, Umana GL, da Silva ADT, da Rosa Santos OHL, de Deus Henriques KM, Daniel-Ribeiro CT, Brasil P, Sousa TN, Siqueira AM. Increased primaquine total dose prevents Plasmodium vivax relapses in patients with impaired CYP2D6 activity: report of three cases. Malar J 2021; 20:341. [PMID: 34391426 PMCID: PMC8364036 DOI: 10.1186/s12936-021-03869-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background The relapsing nature of Plasmodium vivax infection is a major barrier to its control and elimination. Factors such as adequate dosing, adherence, drug quality, and pharmacogenetics can impact the effectiveness of radical cure of P. vivax and need to be adequately evaluated. CYP2D6 pathway mediates the activation of primaquine (primaquine) into an active metabolite(s) in hepatocytes, and impaired activity has been linked to a higher risk of relapse. Cases presentation Three patients diagnosed with P. vivax malaria presented repeated relapses after being initially treated with chloroquine (25 mg/kg) and primaquine (3.5 mg/kg in 14 days) at a non-endemic travel clinic. Recurring episodes were subsequently treated with a higher dose of primaquine (7 mg/kg in 14 days), which prevented further relapses in two patients. However, one patient still presented two episodes after a higher primaquine dose and was prescribed 300 mg of chloroquine weekly to prevent further episodes. Impaired CYP2D6 function was observed in all of them. Conclusion Lack of response to primaquine was associated with impaired CYP2D6 activity in three patients presenting multiple relapses followed in a non-endemic setting. Higher primaquine dosage was safe and effectively prevented relapses in two patients and should be further investigated as an option in Latin America. It is crucial to investigate the factors associated with unsuccessful radical cures and alternative therapeutic options.
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Affiliation(s)
- Anielle de Pina-Costa
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Centro de Pesquisa Diagnóstico e Treinamento em Malária-Fiocruz, Rio de Janeiro, Brazil.,Centro Universitário Serra Dos Órgãos (UNIFESO), Teresópolis, RJ, Brazil
| | | | - Edwiges Motta Dos Santos
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Renata Saraiva Pedro
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Assessoria Clínica-Instituto em Tecnologia em Imunobiológicos-Fiocruz, Rio de Janeiro, Brazil
| | - José Moreira
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Programa de Pós-Graduação Em Pesquisa Clínica, INI Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Gabriela Liseth Umana
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Ana Danielle Tavares da Silva
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Otília Helena Lupi da Rosa Santos
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Centro de Pesquisa Diagnóstico e Treinamento em Malária-Fiocruz, Rio de Janeiro, Brazil
| | - Karina Medeiros de Deus Henriques
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Programa de Pós-Graduação Em Pesquisa Clínica, INI Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Cláudio Tadeu Daniel-Ribeiro
- Centro de Pesquisa Diagnóstico e Treinamento em Malária-Fiocruz, Rio de Janeiro, Brazil.,Laboratório de Pesquisa Em Malária, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Patrícia Brasil
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Centro de Pesquisa Diagnóstico e Treinamento em Malária-Fiocruz, Rio de Janeiro, Brazil.,Programa de Pós-Graduação Em Pesquisa Clínica, INI Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | | | - André M Siqueira
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil. .,Centro de Pesquisa Diagnóstico e Treinamento em Malária-Fiocruz, Rio de Janeiro, Brazil. .,Programa de Pós-Graduação Em Pesquisa Clínica, INI Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil.
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Salles PF, Perce-da-Silva DS, Rossi AD, Raposo LR, Ramirez Ramirez AD, Pereira Bastos OM, Pratt-Riccio LR, Cassiano GC, Baptista ARS, Cardoso CC, Banic DM, Machado RLD. CYP2D6 Allele Frequency in Five Malaria Vivax Endemic Areas From Brazilian Amazon Region. Front Pharmacol 2021; 12:542342. [PMID: 34366834 PMCID: PMC8343396 DOI: 10.3389/fphar.2021.542342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/07/2021] [Indexed: 12/29/2022] Open
Abstract
Genetic variability was linked with individual responses to treatment and susceptibility to malaria by Plasmodium vivax. Polymorphisms in the CYP2D6 gene may modulate enzyme level and activity, thereby affecting individual responses to pharmacological treatment. The aim of the study was to investigate whether or not CYP2D6 single nucleotide polymorphisms rs1065852, rs38920-97, rs16947 and rs28371725 are unequally distributed in malaria by Plasmodium vivax individuals from the Brazilian Amazon region. The blood samples were collected from 220 unrelated Plasmodium vivax patients from five different endemic areas. Genotyping was performed using SNaPshot® and real-time polymerase chain reaction methods. In all five areas, the rs1065852 (CYP2D6*10, C.100C > T), rs3892097 (CYP2D6*4, 1846C > T) and rs16947 (CYP2D6*2, C.2850G > A), as a homozygous genotype, showed the lowest frequencies. The rs28371725 (CYP2D6*41, 2988G > A) homozygous genotype was not detected, while the allele A was found in a single patient from Macapá region. No deviations from Hardy-Weinberg equilibrium were found, although a borderline p-value was observed (p = 0.048) for the SNP rs3892097 in Goianésia do Pará, Pará state. No significant associations were detected in these frequencies among the five studied areas. For the SNP rs3892097, a higher frequency was observed for the C/T heterozygous genotype in the Plácido de Castro and Macapá, Acre and Amapá states, respectively. The distribution of the CYP2D6 alleles investigated in the different areas of the Brazilian Amazon is not homogeneous. Further investigations are necessary in order to determine which alleles might be informative to assure optimal drug dosing recommendations based on experimental pharmacogenetics.
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Affiliation(s)
- Paula Ferreira Salles
- Centro de Investigação de Microrganismos, Universidade Federal Fluminense, Niterói, Brazil
| | | | - Atila Duque Rossi
- Laboratório de Virologia Molecular, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luisa Riehl Raposo
- Laboratório de Imunologia Clínica, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | | | - Gustavo Capatti Cassiano
- Saúde Global e Medicina Tropical, Instituto de Higiene e Medicina Tropical, Universidade de Lisboa, Lisbon, Portugal
| | | | - Cynthia Chester Cardoso
- Laboratório de Virologia Molecular, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dalma Maria Banic
- Laboratório de Imunologia Clínica, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Kulkeaw K, Pengsart W. Progress and Challenges in the Use of a Liver-on-a-Chip for Hepatotropic Infectious Diseases. MICROMACHINES 2021; 12:mi12070842. [PMID: 34357252 PMCID: PMC8306537 DOI: 10.3390/mi12070842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 12/16/2022]
Abstract
The liver is a target organ of life-threatening pathogens and prominently contributes to the variation in drug responses and drug-induced liver injury among patients. Currently available drugs significantly decrease the morbidity and mortality of liver-dwelling pathogens worldwide; however, emerging clinical evidence reveals the importance of host factors in the design of safe and effective therapies for individuals, known as personalized medicine. Given the primary adherence of cells in conventional two-dimensional culture, the use of these one-size-fit-to-all models in preclinical drug development can lead to substantial failures in assessing therapeutic safety and efficacy. Advances in stem cell biology, bioengineering and material sciences allow us to develop a more physiologically relevant model that is capable of recapitulating the human liver. This report reviews the current use of liver-on-a-chip models of hepatotropic infectious diseases in the context of precision medicine including hepatitis virus and malaria parasites, assesses patient-specific responses to antiviral drugs, and designs personalized therapeutic treatments to address the need for a personalized liver-like model. Second, most organs-on-chips lack a monitoring system for cell functions in real time; thus, the review discusses recent advances and challenges in combining liver-on-a-chip technology with biosensors for assessing hepatocyte viability and functions. Prospectively, the biosensor-integrated liver-on-a-chip device would provide novel biological insights that could accelerate the development of novel therapeutic compounds.
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Affiliation(s)
- Kasem Kulkeaw
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Correspondence: ; Tel.: +66-2-419-6468 (ext. 96484)
| | - Worakamol Pengsart
- Faculty of Graduate Studies, Mahidol University, Nakhon Pathom 73170, Thailand;
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Satyagraha AW, Sadhewa A, Panggalo LV, Subekti D, Elyazar I, Soebianto S, Mahpud N, Harahap AR, Baird JK. Genotypes and phenotypes of G6PD deficiency among Indonesian females across diagnostic thresholds of G6PD activity guiding safe primaquine therapy of latent malaria. PLoS Negl Trop Dis 2021; 15:e0009610. [PMID: 34270547 PMCID: PMC8318249 DOI: 10.1371/journal.pntd.0009610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/28/2021] [Accepted: 06/30/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Plasmodium vivax occurs as a latent infection of liver and a patent infection of red blood cells. Radical cure requires both blood schizontocidal and hypnozoitocidal chemotherapies. The hypnozoitocidal therapies available are primaquine and tafenoquine, 8-aminoquinoline drugs that can provoke threatening acute hemolytic anemia in patients having an X-linked G6PD-deficiency. Heterozygous females may screen as G6PD-normal prior to radical cure and go on to experience hemolytic crisis. METHODS & FINDINGS This study examined G6PD phenotypes in 1928 female subjects living in malarious Sumba Island in eastern Indonesia to ascertain the prevalence of females vulnerable to diagnostic misclassification as G6PD-normal. All 367 (19%) females having <80% G6PD normal activity were genotyped. Among those, 103 (28%) were G6PD wild type, 251 (68·4%) were heterozygous, three (0·8%) were compound heterozygotes, and ten (2·7%) were homozygous deficient. The variants Vanua Lava, Viangchan, Coimbra, Chatham, and Kaiping occurred among them. Below the 70% of normal G6PD activity threshold, just 18 (8%) were G6PD-normal and 214 (92%) were G6PD-deficient. Among the 31 females with <30% G6PD normal activity were all ten homozygotes, all three compound heterozygotes, and just 18 were heterozygotes (7% of those). CONCLUSIONS In this population, most G6PD heterozygosity in females occurred between 30% and 70% of normal (69·3%; 183/264). The prevalence of females at risk of G6PD misclassification as normal by qualitative screening was 9·5% (183/1928). Qualitative G6PD screening prior to 8-aminoquinoline therapies against P. vivax may leave one in ten females at risk of hemolytic crisis, which may be remedied by point-of-care quantitative tests.
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Affiliation(s)
| | | | | | - Decy Subekti
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Iqbal Elyazar
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Saraswati Soebianto
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Nunung Mahpud
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | | | - J. Kevin Baird
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Sudathip P, Saejeng A, Khantikul N, Thongrad T, Kitchakarn S, Sugaram R, Lertpiriyasuwat C, Areechokchai D, Gopinath D, Sintasath D, Ringwald P, Naowarat S, Pinyajeerapat N, Bustos MD, Shah JA. Progress and challenges of integrated drug efficacy surveillance for uncomplicated malaria in Thailand. Malar J 2021; 20:261. [PMID: 34107955 PMCID: PMC8188767 DOI: 10.1186/s12936-021-03791-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Integrated drug efficacy surveillance (iDES) was formally introduced nationally across Thailand in fiscal year 2018 (FY2018), building on a history of drug efficacy monitoring and interventions. According to the National Malaria Elimination Strategy for Thailand 2017–2026, diagnosis is microscopically confirmed, treatment is prescribed, and patients are followed up four times to ensure cure. Methods Routine patient data were extracted from the malaria information system for FY2018–FY2020. Treatment failure of first-line therapy was defined as confirmed parasite reappearance within 42 days for Plasmodium falciparum and 28 days for Plasmodium vivax. The primary outcome was the crude drug efficacy rate, estimated using Kaplan–Meier methods, at day 42 for P. falciparum treated with dihydroartemisinin–piperaquine plus primaquine, and day 28 for P. vivax treated with chloroquine plus primaquine; day 60 and day 90 efficacy were secondary outcomes for P. vivax. Results The proportion of patients with outcomes recorded at day 42 for P. falciparum malaria and at day 28 for P. vivax malaria has been increasing, with FY2020 follow-up rates of 61.5% and 57.2%, respectively. For P. falciparum malaria, day 42 efficacy in FY2018 was 92.4% (n = 249), in FY2019 93.3% (n = 379), and in FY2020 98.0% (n = 167). Plasmodium falciparum recurrences occurred disproportionally in Sisaket Province, with day 42 efficacy rates of 75.9% in FY2018 (n = 59) and 49.4% in FY2019 (n = 49), leading to an update in first-line therapy to pyronaridine–artesunate at the provincial level, rolled out in FY2020. For P. vivax malaria, day 28 efficacy (chloroquine efficacy) was 98.5% in FY2018 (n = 2048), 99.1% in FY2019 (n = 2206), and 99.9% in FY2020 (n = 2448), and day 90 efficacy (primaquine efficacy) was 94.8%, 96.3%, and 97.1%, respectively. Conclusions In Thailand, iDES provided operationally relevant data on drug efficacy, enabling the rapid amendment of treatment guidelines to improve patient outcomes and reduce the potential for the spread of drug-resistant parasites. A strong case-based surveillance system, integration with other health system processes, supporting biomarker collection and molecular analyses, and cross-border collaboration may maximize the potential of iDES in countries moving towards elimination.
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Affiliation(s)
- Prayuth Sudathip
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Aungkana Saejeng
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Thannikar Thongrad
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Suravadee Kitchakarn
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Rungniran Sugaram
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Cheewanan Lertpiriyasuwat
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Darin Areechokchai
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | | | - David Sintasath
- U.S. President's Malaria Initiative, Regional Development Mission for Asia, United States Agency for International Development, Bangkok, Thailand
| | | | - Sathapana Naowarat
- Inform Asia: USAID's Health Research Program, RTI International, Bangkok, Thailand
| | - Niparueradee Pinyajeerapat
- U.S. President's Malaria Initiative, Regional Development Mission for Asia, United States Agency for International Development, Bangkok, Thailand
| | | | - Jui A Shah
- Inform Asia: USAID's Health Research Program, RTI International, Bangkok, Thailand.
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Suarez-Kurtz G. Impact of CYP2D6 Genetic Variation on Radical Cure of Plasmodium vivax Malaria. Clin Pharmacol Ther 2021; 110:595-598. [PMID: 34042179 DOI: 10.1002/cpt.2313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/08/2021] [Indexed: 11/09/2022]
Abstract
Plasmodium vivax (P. vivax) is the most widespread human malaria parasite, with 2.5 billion people at risk of infection worldwide. P. vivax forms liver hypnozoites, which trigger further symptomatic episodes (relapses) weeks or months after the initial episode. Radical cure of vivax malaria requires hypnozoitocide therapy to prevent relapses. The two US Food and Drug Administration (FDA)-approved hypnozoiticides for human use, primaquine, and tafenoquine, are pro-drugs, that require in vivo conversion into metabolites with redox activity. This mini-review focuses on the association between CYP2D6-mediated hydroxylation and hypnozoitocide efficacy of primaquine and tafenoquine. Studies in murine models show that the antimalarial activity of primaquine and tafenoquine is abolished by CYP2D knock-out and partially restored by knock-in of humanized CYP2D6. Human studies explored the impact of CYP2D6 genetic variation and genotype-inferred CYP2D6 phenotype on anti-relapse efficacy. Most, but not all, studies with primaquine report higher rates of relapse in patients with decreased CYP2D6 activity (activity scores (AS) ≤ 1) compared to normal activity (AS ≥ 1.5). Potential factors for discordance among studies include risk of reinfection in endemic areas, adherence to primaquine-treatment, assignment of CYP2D6 phenotypes based on CYP2D6 polymorphism and choice of AS values for dichotomizing the study cohorts. Tafenoquine anti-relapse efficacy did not differ between patients with AS < 1 vs. AS ≥ 1.5 in 2 studies. Absence/small number of poor CYP2D6 metabolizers in AS ≤ 1 groups, combined with lesser dependence of tafenoquine on CYP2D6-mediated conversion into active redox metabolites may account for this result. Additional tafenoquine studies with larger representation of poor CYP2D6 metabolizers are warranted.
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Affiliation(s)
- Guilherme Suarez-Kurtz
- Coordenação de Pesquisa, Instituto Nacional de Câncer and Rede Nacional de Farmacogenômica, Rio de Janeiro, Brazil
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Population Pharmacokinetics of Primaquine in the Korean Population. Pharmaceutics 2021; 13:pharmaceutics13050652. [PMID: 34063671 PMCID: PMC8147617 DOI: 10.3390/pharmaceutics13050652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
While primaquine has long been used for malaria treatment, treatment failure is common. This study aims to develop a population pharmacokinetic model of primaquine and its metabolite, carboxyprimaquine, and examine factors influencing pharmacokinetic variability. The data was obtained from a clinical study in 24 Korean subjects randomly assigned to normal and obese groups. The participants received primaquine 15 mg daily for 4 days and blood samples were collected at day 4. Pharmacokinetic modeling was performed with NONMEM and using simulations; the influences of doses and covariates on drug exposure were examined. A minimal physiology-based pharmacokinetic model connected with a liver compartment comprehensively described the data, with CYP450 mediated clearance being positively correlated with the body weight and CYP2D6 activity score (p < 0.05). In the simulation, while the weight-normalized area under drug concentration for primaquine in the obese group decreased by 29% at the current recommended dose of 15 mg, it became similar to the normal weight group at a weight-normalized dose of 3.5 mg/kg. This study has demonstrated that the body weight and CYP2D6 activity score significantly influence the pharmacokinetics of primaquine. The developed model is expected to be used as a basis for optimal malaria treatment in Korean patients.
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Buyon LE, Elsworth B, Duraisingh MT. The molecular basis of antimalarial drug resistance in Plasmodium vivax. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2021; 16:23-37. [PMID: 33957488 PMCID: PMC8113647 DOI: 10.1016/j.ijpddr.2021.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
Plasmodium vivax is the most geographically widespread cause of human malaria and is responsible for the majority of cases outside of the African continent. While great progress has been made towards eliminating human malaria, drug resistant parasite strains pose a threat towards continued progress. Resistance has arisen to multiple antimalarials in P. vivax, including to chloroquine, which is currently the first line therapy for P. vivax in most regions. Despite its importance, an understanding of the molecular mechanisms of drug resistance in this species remains elusive, in large part due to the complex biology of P. vivax and the lack of in vitro culture. In this review, we will cover the extent and challenges of measuring clinical and in vitro drug resistance in P. vivax. We will consider the roles of candidate drug resistance genes. We will highlight the development of molecular approaches for studying P. vivax biology that provide the opportunity to validate the role of putative drug resistance mutations as well as identify novel mechanisms of drug resistance in this understudied parasite. Validated molecular determinants and markers of drug resistance are essential for the rapid and cost-effective monitoring of drug resistance in P. vivax, and will be useful for optimizing drug regimens and for informing drug policy in control and elimination settings. Drug resistance is emerging in Plasmodium vivax, an important cause of malaria. The complex biology of P. vivax and the limited range of research tools make it difficult to identify drug resistance. The molecular mechanisms of drug resistance in P. vivax remain elusive. This review highlights the extent of drug resistance, the putative mechanisms of resistance and new technologies for the study of P. vivax drug resistance.
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Affiliation(s)
- Lucas E Buyon
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, 02115, MA, USA
| | - Brendan Elsworth
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, 02115, MA, USA
| | - Manoj T Duraisingh
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, 02115, MA, USA.
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Mehlotra RK, Gaedigk A, Howes RE, Rakotomanga TA, Ratsimbasoa AC, Zimmerman PA. CYP2D6 Genetic Variation and Its Implication for Vivax Malaria Treatment in Madagascar. Front Pharmacol 2021; 12:654054. [PMID: 33959023 PMCID: PMC8093859 DOI: 10.3389/fphar.2021.654054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/01/2021] [Indexed: 12/19/2022] Open
Abstract
Plasmodium vivax is one of the five human malaria parasite species, which has a wide geographical distribution and can cause severe disease and fatal outcomes. It has the ability to relapse from dormant liver stages (hypnozoites), weeks to months after clearance of the acute blood-stage infection. An 8-aminoquinoline drug primaquine (PQ) can clear the hypnozoites, and thus can be used as an anti-relapse therapeutic agent. Recently, a number of studies have found that its efficacy is compromised by polymorphisms in the cytochrome P450 2D6 (CYP2D6) gene; decreased or absence of CYP2D6 activity contributes to PQ therapeutic failure. The present study sought to characterize CYP2D6 genetic variation in Madagascar, where populations originated from admixture between Asian and African populations, vivax malaria is endemic, and PQ can be deployed soon to achieve national malaria elimination. In a total of 211 samples collected from two health districts, CYP2D6 decreased function alleles CYP2D6*10, *17, *29, *36+*10, and *41 were observed at frequencies of 3.55-17.06%. In addition, nonfunctional alleles were observed, the most common of which were CYP2D6*4 (2.13%), *5 (1.66%), and the *4x2 gene duplication (1.42%). Given these frequencies, 34.6% of the individuals were predicted to be intermediate metabolizers (IM) with an enzyme activity score (AS) ≤ 1.0; both the IM phenotype and AS ≤ 1.0 have been found to be associated with PQ therapeutic failure. Furthermore, the allele and genotype frequency distributions add to the archaeological and genomic evidence of Malagasy populations constituting a unique, Asian-African admixed origin. The results from this exploratory study provide fresh insights about genomic characteristics that could affect the metabolism of PQ into its active state, and may enable optimization of PQ treatment across human genetic diversity, which is critical for achieving P. vivax elimination.
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Affiliation(s)
- Rajeev K Mehlotra
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Kansas City, Kanas City, MO, United States
| | - Rosalind E Howes
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom.,Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Tovonahary A Rakotomanga
- The National Malaria Control Program, Ministry of Health, Antananarivo, Madagascar.,University of Fianarantsoa, Fianarantsoa, Madagascar
| | - Arsene C Ratsimbasoa
- The National Malaria Control Program, Ministry of Health, Antananarivo, Madagascar.,University of Fianarantsoa, Fianarantsoa, Madagascar
| | - Peter A Zimmerman
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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Nekkab N, Lana R, Lacerda M, Obadia T, Siqueira A, Monteiro W, Villela D, Mueller I, White M. Estimated impact of tafenoquine for Plasmodium vivax control and elimination in Brazil: A modelling study. PLoS Med 2021; 18:e1003535. [PMID: 33891582 PMCID: PMC8064585 DOI: 10.1371/journal.pmed.1003535] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite recent intensification of control measures, Plasmodium vivax poses a major challenge for malaria elimination efforts. Liver-stage hypnozoite parasites that cause relapsing infections can be cleared with primaquine; however, poor treatment adherence undermines drug effectiveness. Tafenoquine, a new single-dose treatment, offers an alternative option for preventing relapses and reducing transmission. In 2018, over 237,000 cases of malaria were reported to the Brazilian health system, of which 91.5% were due to P. vivax. METHODS AND FINDINGS We evaluated the impact of introducing tafenoquine into case management practices on population-level transmission dynamics using a mathematical model of P. vivax transmission. The model was calibrated to reflect the transmission dynamics of P. vivax endemic settings in Brazil in 2018, informed by nationwide malaria case reporting data. Parameters for treatment pathways with chloroquine, primaquine, and tafenoquine with glucose-6-phosphate dehydrogenase deficiency (G6PDd) testing were informed by clinical trial data and the literature. We assumed 71.3% efficacy for primaquine and tafenoquine, a 66.7% adherence rate to the 7-day primaquine regimen, a mean 5.5% G6PDd prevalence, and 8.1% low metaboliser prevalence. The introduction of tafenoquine is predicted to improve effective hypnozoite clearance among P. vivax cases and reduce population-level transmission over time, with heterogeneous levels of impact across different transmission settings. According to the model, while achieving elimination in only few settings in Brazil, tafenoquine rollout in 2021 is estimated to improve the mean effective radical cure rate from 42% (95% uncertainty interval [UI] 41%-44%) to 62% (95% UI 54%-68%) among clinical cases, leading to a predicted 38% (95% UI 7%-99%) reduction in transmission and over 214,000 cumulative averted cases between 2021 and 2025. Higher impact is predicted in settings with low transmission, low pre-existing primaquine adherence, and a high proportion of cases in working-aged males. High-transmission settings with a high proportion of cases in children would benefit from a safe high-efficacy tafenoquine dose for children. Our methodological limitations include not accounting for the role of imported cases from outside the transmission setting, relying on reported clinical cases as a measurement of community-level transmission, and implementing treatment efficacy as a binary condition. CONCLUSIONS In our modelling study, we predicted that, provided there is concurrent rollout of G6PDd diagnostics, tafenoquine has the potential to reduce P. vivax transmission by improving effective radical cure through increased adherence and increased protection from new infections. While tafenoquine alone may not be sufficient for P. vivax elimination, its introduction will improve case management, prevent a substantial number of cases, and bring countries closer to achieving malaria elimination goals.
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Affiliation(s)
- Narimane Nekkab
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Raquel Lana
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcus Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Thomas Obadia
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - André Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Wuelton Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Daniel Villela
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ivo Mueller
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
- Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael White
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
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Popovici J, Tebben K, Witkowski B, Serre D. Primaquine for Plasmodium vivax radical cure: What we do not know and why it matters. Int J Parasitol Drugs Drug Resist 2021; 15:36-42. [PMID: 33529838 PMCID: PMC7851417 DOI: 10.1016/j.ijpddr.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
Plasmodium vivax radical cure requires the administration of a blood schizonticide for killing blood-stage parasites and the addition of a drug able to kill hypnozoites, the dormant parasite stages residing in the liver of infected patients. All drugs used clinically for killing hypnozoites are 8-aminoquinolines and among them, primaquine has been at the forefront of P. vivax case management for decades. We discuss here the possible factors that could lead to the emergence and selection of P. vivax primaquine resistant parasites and emphasize on how a better understanding of the mechanisms underlying primaquine treatment and hypnozoite biology is needed to prevent this catastrophic scenario from happening.
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Affiliation(s)
- Jean Popovici
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Malaria Translational Research Unit, Institut Pasteur, Paris & Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
| | - Kieran Tebben
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA
| | - Benoit Witkowski
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Malaria Translational Research Unit, Institut Pasteur, Paris & Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - David Serre
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA
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Huang H, Dong Y, Xu Y, Deng Y, Zhang C, Liu S, Chen M, Liu Y. The association of CYP2D6 gene polymorphisms in the full-length coding region with higher recurrence rate of vivax malaria in Yunnan Province, China. Malar J 2021; 20:160. [PMID: 33743705 PMCID: PMC7981985 DOI: 10.1186/s12936-021-03685-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/05/2021] [Indexed: 11/12/2022] Open
Abstract
Background Accumulating evidence suggest that compromised CYP2D6 enzyme activity caused by gene mutation could contribute to primaquine failure for the radical cure of vivax malaria. The current study aims to preliminarily reveal the association between the recurrence of vivax malaria in Yunnan Province and CYP2D6 gene mutation by analysing polymorphisms in the entire coding region of human CYP2D6 gene. Methods Blood samples were collected from patients with vivax malaria, who received "chloroquine and 8-day course of primaquine therapy" in Yunnan Province. The suspected relapsed cases were determined by epidemiological approaches and gene sequence alignment. PCR was conducted to amplify the CYP2D6 gene in the human genome, and the amplified products were then sequenced to compare with the non-mutation “reference” sequence, so as to ensure correct sequencing results and to determine 9 exon regions. Subsequently, the DNA sequences of 9 exons were spliced into the coding DNA sequence (CDS), which, by default, is known as maternal CDS. The paternal CDS was obtained by adjusting the bases according to the sequencing peaks. The mutation loci, haplotypes (star alleles), genotypes and odds ratios (OR) of all the CDSs were analysed. Results Of the119 maternal CDS chains in total with 1491 bp in length, 12 mutation sites in the 238 maternal and paternal CDS chains were detected. The c.408G > C mutation was most frequently detected in both suspected relapsed group (SR) and non-relapsed group (NR), reaching 85.2% (75/88) and 76.0% (114/150), respectively. The c.886C > T mutation was most closely related to the recurrence of vivax malaria (OR = 2.167, 95% CI 1.104–4.252, P < 0.05). Among the 23 haplotypes (Hap_1 ~ Hap_23), Hap_3 was non-mutant, and the sequence structure of Hap_9 was the most complicated one. Five star alleles, including *1, *2, *4, *10 and *39, were confirmed by comparison, and CYP2D6*10 allele accounted for the largest percentage (45.4%, 108/238). The frequency of CYP2D6*2 allele in the SR group was significantly higher than that in the NR group (Χ2 = 16.177, P < 0.05). Of the defined 24 genotypes, 8 genotypes, including *4/*4, *4/*o, *2/*39, *39/*m, *39/*x, *1/*r, *1/*n, and *v/*10, were detected only in the SR group. Conclusion Mutation of CYP2D6*10 allele accounts for the highest proportion of vivax malaria cases in Yunnan Province. The mutations of c. 886C > T and CYP2D6*2 allele, which correspond to impaired PQ metabolizer phenotype, are most closely related to the relapse of vivax malaria. In addition, the genotype *4/*4 with null CYP2D6 enzyme function was only detected in the SR group. These results reveal the risk of defected CYP2D6 enzyme activity that diminishes the therapeutic effect of primaquine on vivax malaria. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03685-3.
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Affiliation(s)
- Herong Huang
- School of Basic Medical Sciences, Dali University, Dali, 667000, China
| | - Ying Dong
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China.
| | - Yanchun Xu
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Yan Deng
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Canglin Zhang
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Shuping Liu
- School of Basic Medical Sciences, Dali University, Dali, 667000, China
| | - Mengni Chen
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Yan Liu
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Centre of Malaria Research, Pu'er, 665000, China
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49
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Bancone G, Chu CS. G6PD Variants and Haemolytic Sensitivity to Primaquine and Other Drugs. Front Pharmacol 2021; 12:638885. [PMID: 33790795 PMCID: PMC8005603 DOI: 10.3389/fphar.2021.638885] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/01/2021] [Indexed: 02/04/2023] Open
Abstract
Restrictions on the cultivation and ingestion of fava beans were first reported as early as the fifth century BC. Not until the late 19th century were clinical descriptions of fava-induced disease reported and soon after characterised as “favism” in the early 20th century. It is now well known that favism as well as drug-induced haemolysis is caused by a deficiency of the glucose-6-phosphate dehydrogenase (G6PD) enzyme, one of the most common enzyme deficiency in humans. Interest about the interaction between G6PD deficiency and therapeutics has increased recently because mass treatment with oxidative 8-aminoquinolines is necessary for malaria elimination. Historically, assessments of haemolytic risk have focused on the clinical outcomes (e.g., haemolysis) associated with either a simplified phenotypic G6PD characterisation (deficient or normal) or an ill-fitting classification of G6PD genetic variants. It is increasingly apparent that detailed knowledge of both aspects is required for a complete understanding of haemolytic risk. While more attention has been devoted recently to better phenotypic characterisation of G6PD activity (including the development of new point-of care tests), the classification of G6PD variants should be revised to be clinically useful in malaria eliminating countries and in populations with prevalent G6PD deficiency. The scope of this work is to summarize available literature on drug-induced haemolysis among individuals with different G6PD variants and to highlight knowledge gaps that could be filled with further clinical and laboratory research.
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Affiliation(s)
- Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Cindy S Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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50
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Ferreira MU, Nobrega de Sousa T, Rangel GW, Johansen IC, Corder RM, Ladeia-Andrade S, Gil JP. Monitoring Plasmodium vivax resistance to antimalarials: Persisting challenges and future directions. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2020; 15:9-24. [PMID: 33360105 PMCID: PMC7770540 DOI: 10.1016/j.ijpddr.2020.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022]
Abstract
Emerging antimalarial drug resistance may undermine current efforts to control and eliminate Plasmodium vivax, the most geographically widespread yet neglected human malaria parasite. Endemic countries are expected to assess regularly the therapeutic efficacy of antimalarial drugs in use in order to adjust their malaria treatment policies, but proper funding and trained human resources are often lacking to execute relatively complex and expensive clinical studies, ideally complemented by ex vivo assays of drug resistance. Here we review the challenges for assessing in vivo P. vivax responses to commonly used antimalarials, especially chloroquine and primaquine, in the presence of confounding factors such as variable drug absorption, metabolism and interaction, and the risk of new infections following successful radical cure. We introduce a simple modeling approach to quantify the relative contribution of relapses and new infections to recurring parasitemias in clinical studies of hypnozoitocides. Finally, we examine recent methodological advances that may render ex vivo assays more practical and widely used to confirm P. vivax drug resistance phenotypes in endemic settings and review current approaches to the development of robust genetic markers for monitoring chloroquine resistance in P. vivax populations. Plasmodium vivax resistance to chloroquine may undermine malaria elimination efforts. Plasmodium vivax resistance to schizontocides has been mostly monitored in therapeutic efficacy studies. In vivo studies to determine the anti-relapse efficacy of primaquine are challenging to design and execute. Ex vivo assays to determine Plasmodium vivax resistance to schizontocides remain limited to research settings. Robust molecular markers to monitor Plasmodium vivax drug resistance are currently lacking.
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Affiliation(s)
- Marcelo U Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil; Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal.
| | - Tais Nobrega de Sousa
- Molecular Biology and Malaria Immunology Research Group, René Rachou Institute, Fiocruz, Belo Horizonte, Brazil
| | - Gabriel W Rangel
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA, USA
| | - Igor C Johansen
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rodrigo M Corder
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Simone Ladeia-Andrade
- Laboratory of Parasitic Diseases, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - José Pedro Gil
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Solna, Sweden
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