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Ferrante M, Leite BMM, Fontes LBC, Santos Moreira A, Nascimento de Almeida ÉM, Brodskyn CI, Lima IDS, dos Santos WLC, Pacheco LV, Cardoso da Silva V, dos Anjos JP, Guarieiro LLN, Landoni F, de Menezes JPB, Fraga DBM, Santos Júnior ADF, Veras PST. Pharmacokinetics, Dose-Proportionality, and Tolerability of Intravenous Tanespimycin (17-AAG) in Single and Multiple Doses in Dogs: A Potential Novel Treatment for Canine Visceral Leishmaniasis. Pharmaceuticals (Basel) 2024; 17:767. [PMID: 38931434 PMCID: PMC11206245 DOI: 10.3390/ph17060767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024] Open
Abstract
In the New World, dogs are considered the main reservoir of visceral leishmaniasis (VL). Due to inefficacies in existing treatments and the lack of an efficient vaccine, dog culling is one of the main strategies used to control disease, making the development of new therapeutic interventions mandatory. We previously showed that Tanespimycin (17-AAG), a Hsp90 inhibitor, demonstrated potential for use in leishmaniasis treatment. The present study aimed to test the safety of 17-AAG in dogs by evaluating plasma pharmacokinetics, dose-proportionality, and the tolerability of 17-AAG in response to a dose-escalation protocol and multiple administrations at a single dose in healthy dogs. Two protocols were used: Study A: four dogs received variable intravenous (IV) doses (50, 100, 150, 200, or 250 mg/m2) of 17-AAG or a placebo (n = 4/dose level), using a cross-over design with a 7-day "wash-out" period; Study B: nine dogs received three IV doses of 150 mg/m2 of 17-AAG administered at 48 h intervals. 17-AAG concentrations were determined by a validated high-performance liquid chromatographic (HPLC) method: linearity (R2 = 0.9964), intra-day precision with a coefficient of variation (CV) ≤ 8%, inter-day precision (CV ≤ 20%), and detection and quantification limits of 12.5 and 25 ng/mL, respectively. In Study A, 17-AAG was generally well tolerated. However, increased levels of liver enzymes-alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT)-and bloody diarrhea were observed in all four dogs receiving the highest dosage of 250 mg/m2. After single doses of 17-AAG (50-250 mg/m2), maximum plasma concentrations (Cmax) ranged between 1405 ± 686 and 9439 ± 991 ng/mL, and the area under the curve (AUC) plotting plasma concentration against time ranged between 1483 ± 694 and 11,902 ± 1962 AUC 0-8 h μg/mL × h, respectively. Cmax and AUC parameters were dose-proportionate between the 50 and 200 mg/m2 doses. Regarding Study B, 17-AAG was found to be well tolerated at multiple doses of 150 mg/m2. Increased levels of liver enzymes-ALT (28.57 ± 4.29 to 173.33 ± 49.56 U/L), AST (27.85 ± 3.80 to 248.20 ± 85.80 U/L), and GGT (1.60 ± 0.06 to 12.70 ± 0.50 U/L)-and bloody diarrhea were observed in only 3/9 of these dogs. After the administration of multiple doses, Cmax and AUC 0-48 h were 5254 ± 2784 μg/mL and 6850 ± 469 μg/mL × h in plasma and 736 ± 294 μg/mL and 7382 ± 1357 μg/mL × h in tissue transudate, respectively. In conclusion, our results demonstrate the potential of 17-AAG in the treatment of CVL, using a regimen of three doses at 150 mg/m2, since it presents the maintenance of high concentrations in subcutaneous interstitial fluid, low toxicity, and reversible hepatotoxicity.
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Affiliation(s)
- Marcos Ferrante
- Laboratory of Physiology and Pharmacology, Department of Veterinary Medicine, Federal University of Lavras, Lavras 37200-000, Minas Gerais, Brazil;
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Bruna Martins Macedo Leite
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Lívia Brito Coelho Fontes
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Alice Santos Moreira
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Élder Muller Nascimento de Almeida
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Claudia Ida Brodskyn
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Isadora dos Santos Lima
- Laboratory of Structural and Molecular Pathology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (I.d.S.L.); (W.L.C.d.S.)
| | - Washington Luís Conrado dos Santos
- Laboratory of Structural and Molecular Pathology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (I.d.S.L.); (W.L.C.d.S.)
- Department of Pathology and Forensic Medicine, Bahia Medical School, Federal University of Bahia, Salvador 40110-906, Bahia, Brazil
| | - Luciano Vasconcellos Pacheco
- Department of Life Sciences, State University of Bahia, Salvador 41150-000, Bahia, Brazil; (L.V.P.); (V.C.d.S.); (A.d.F.S.J.)
| | - Vagner Cardoso da Silva
- Department of Life Sciences, State University of Bahia, Salvador 41150-000, Bahia, Brazil; (L.V.P.); (V.C.d.S.); (A.d.F.S.J.)
| | - Jeancarlo Pereira dos Anjos
- Integrated Campus of Manufacturing and Technology, SENAI CIMATEC University Center, Salvador 41650-010, Bahia, Brazil; (J.P.d.A.); (L.L.N.G.)
| | - Lílian Lefol Nani Guarieiro
- Integrated Campus of Manufacturing and Technology, SENAI CIMATEC University Center, Salvador 41650-010, Bahia, Brazil; (J.P.d.A.); (L.L.N.G.)
| | - Fabiana Landoni
- Department of Pharmacology, Faculty of Veterinary Science, National University of La Plata, Buenos Aires 1900, Argentina;
| | - Juliana P. B. de Menezes
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
| | - Deborah Bittencourt Mothé Fraga
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
- Department of Preventive Veterinary Medicine and Animal Production, School of Veterinary Medicine and Animal Science, Federal University of Bahia, Salvador 40170-110, Bahia, Brazil
- National Institute of Science and Technology of Tropical Diseases (INCT-DT), National Council for Scientific Research and Development (CNPq)
| | - Aníbal de Freitas Santos Júnior
- Department of Life Sciences, State University of Bahia, Salvador 41150-000, Bahia, Brazil; (L.V.P.); (V.C.d.S.); (A.d.F.S.J.)
| | - Patrícia Sampaio Tavares Veras
- Laboratory of Host-Parasite Interaction and Epidemiology, Gonçalo Moniz Institute, Fiocruz-Bahia, Salvador 40296-710, Bahia, Brazil; (B.M.M.L.); (L.B.C.F.); (A.S.M.); (É.M.N.d.A.); (C.I.B.); (J.P.B.d.M.); (D.B.M.F.)
- National Institute of Science and Technology of Tropical Diseases (INCT-DT), National Council for Scientific Research and Development (CNPq)
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Cano M, Ruiz-Postigo JA, Macharia P, Ampem Amoako Y, Odame Phillips R, Kinyeru E, Carrion C. Evaluating the World Health Organization's SkinNTDs App as a Training Tool for Skin Neglected Tropical Diseases in Ghana and Kenya: Cross-Sectional Study. J Med Internet Res 2024; 26:e51628. [PMID: 38687587 PMCID: PMC11094592 DOI: 10.2196/51628] [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: 08/06/2023] [Revised: 02/27/2024] [Accepted: 03/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, primarily impoverished populations in low- and middle-income countries. Skin NTDs, a significant subgroup, manifest primarily as skin lesions and require extensive diagnosis and treatment resources, including trained personnel and financial backing. The World Health Organization has introduced the SkinNTDs app, a mobile health tool designed to train and be used as a decision support tool for frontline health care workers. As most digital health guidelines prioritize the thorough evaluation of mobile health interventions, it is essential to conduct a rigorous and validated assessment of this app. OBJECTIVE This study aims to assess the usability and user experience of World Health Organization SkinNTDs app (version 3) as a capacity-building tool and decision-support tool for frontline health care workers. METHODS A cross-sectional study was conducted in Ghana and Kenya. Frontline health care workers dealing with skin NTDs were recruited through snowball sampling. They used the SkinNTDs app for at least 5 days before completing a web-based survey containing demographic variables and the user version of the Mobile Application Rating Scale (uMARS), a validated scale for assessing health apps. A smaller group of participants took part in semistructured interviews and one focus group. Quantitative data were analyzed using SPSS with a 95% CI and P≤.05 for statistical significance and qualitative data using ATLAS.ti to identify attributes, cluster themes, and code various dimensions that were explored. RESULTS Overall, 60 participants participated in the quantitative phase and 17 in the qualitative phase. The SkinNTDs app scored highly on the uMARS questionnaire, with an app quality mean score of 4.02 (SD 0.47) of 5, a subjective quality score of 3.82 (SD 0.61) of 5, and a perceived impact of 4.47 (SD 0.56) of 5. There was no significant association between the app quality mean score and any of the categorical variables examined, according to Pearson correlation analysis; app quality mean score vs age (P=.37), sex (P=.70), type of health worker (P=.35), country (P=.94), work context (P=.17), frequency of dealing with skin NTDs (P=.09), and dermatology experience (P=.63). Qualitative results echoed the quantitative outcomes, highlighting the ease of use, the offline functionality, and the potential utility for frontline health care workers in remote and resource-constrained settings. Areas for improvement were identified, such as enhancing the signs and symptoms section. CONCLUSIONS The SkinNTDs app demonstrates notable usability and user-friendliness. The results indicate that the app could play a crucial role in improving capacity building of frontline health care workers dealing with skin NTDs. It could be improved in the future by including new features such as epidemiological context and direct contact with experts. The possibility of using the app as a diagnostic tool should be considered. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/39393.
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Affiliation(s)
- Mireia Cano
- eHealth Lab Research Group, eHealth Center, School of Health Sciences, Universitat de Catalunya, Barcelona, Spain
- Innovation, Digital Transformation and Health Economics Research Group, Research Institut Germans Trias i Pujol, Badalona, Spain
| | - José A Ruiz-Postigo
- Prevention, Treatment and Care Unit, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | - Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Carme Carrion
- eHealth Lab Research Group, eHealth Center, School of Health Sciences, Universitat de Catalunya, Barcelona, Spain
- School of Health Sciences, Universitat de Girona, Girona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion, Barcelona, Spain
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Millsapps EM, Underwood EC, Barr KL. Development and Application of Treatment for Chikungunya Fever. Res Rep Trop Med 2022; 13:55-66. [PMID: 36561535 PMCID: PMC9767026 DOI: 10.2147/rrtm.s370046] [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: 09/01/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
The development and application of treatment for Chikungunya fever (CHIKF) remains complicated as there is no current standard treatment and many barriers to research exist. Chikungunya virus (CHIKV) causes serious global health implications due to its socioeconomic impact and high morbidity rates. In research, treatment through natural and pharmaceutical techniques is being evaluated for their efficacy and effectiveness. Natural treatment options, such as homeopathy and physiotherapy, give patients a variety of options for how to best manage acute and chronic symptoms. Some of the most used pharmaceutical therapies for CHIKV include non-steroidal anti-inflammatory drugs (NSAIDS), methotrexate (MTX), chloroquine, and ribavirin. Currently, there is no commercially available vaccine for chikungunya, but vaccine development is crucial for this virus. Potential treatments need further research until they can become a standard part of treatment. The barriers to research for this complicated virus create challenges in the efficacy and equitability of its research. The rising need for increased research to fully understand chikungunya in order to develop more effective treatment options is vital in protecting endemic populations globally.
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Affiliation(s)
- Erin M Millsapps
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL, USA
| | - Emma C Underwood
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL, USA
| | - Kelli L Barr
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL, USA,Correspondence: Kelli L Barr, Center for Global Health and Infectious Disease Research, University of South Florida, 3720 Spectrum Blvd. Suite 304, Tampa, FL, 33612, USA, Tel +1 813 974 4480, Fax +1 813 974 4962, Email
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Frej A, Cano M, Ruiz-Postigo JA, Macharia P, Phillips RO, Amoako YA, Carrion C. Assessing the Quality of the World Health Organization's Skin NTDs App as a Training Tool in Ghana and Kenya: Protocol for a Cross-sectional Study. JMIR Res Protoc 2022; 11:e39393. [PMID: 36480252 PMCID: PMC9782345 DOI: 10.2196/39393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/28/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, the majority of them belonging to impoverished populations in low- and middle-income countries (LMICs). Skin NTDs are a subgroup of NTDs that manifest primarily as skin lesions. The diagnosis and treatment of skin NTDs entail considerable resources, including trained personnel and financial backing. Many interventions are being launched and evaluated, particularly mobile health (mHealth) interventions, such as Skin NTDs App, a training and decision support tool offered by the World Health Organization (WHO) for frontline health workers (FHWs). As most digital health guidelines prioritize the thorough evaluation of mHealth interventions, it is essential to conduct a rigorous and validated assessment of Skin NTDs App. OBJECTIVE We aim to assess the quality of version 3 of Skin NTDs App, developed for the WHO by Universal Doctor and Netherlands Leprosy Relief as a training and decision support tool for FHWs. METHODS A cross-sectional study will be conducted in 2 LMICs: Ghana and Kenya. We will use snowball sampling recruitment to select 48 participants from the target population of all FHWs dealing with skin NTDs. The sample group of FHWs will be asked to download and use Skin NTDs App for at least 5 days before answering a web-based survey containing demographic variables and the user Mobile App Rating Scale (uMARS) questionnaire. A semistructured interview will then be conducted. Quantitative and qualitative data will be analyzed using SPSS (version 25; SPSS Inc), with statistical significance for all tests set at a 95% CI and P≤.05 considered significant. Data derived from the semistructured interviews will be clustered in themes and coded to enable analysis of various dimensions using ATLAS.ti. RESULTS The estimated completion date of the study is in the third quarter of 2022. The results are expected to show that Skin NTDs App version 3 has a good reported user experience, as assessed using the uMARS scale. No differences are expected to be found, except for those related to experience in dermatology and the use of mobile technology that could influence the final score. Semistructured interviews are expected to complete the results obtained on the uMARS scale. Moreover, they will be the previous step before assessing other aspects of the app, such as its efficiency and how it should be disseminated or implemented. CONCLUSIONS This study is the first step in a qualitative and quantitative assessment of Skin NTDs App as a training and support tool for FHWs diagnosing and managing skin NTDs. Our results will serve to improve future versions of the App. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/39393.
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Affiliation(s)
- Asmae Frej
- School of Health Sciences, Universitat de Girona, Girona, Spain
| | - Mireia Cano
- eHealth Lab Research Group, eHealth Center & School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - José A Ruiz-Postigo
- Prevention, Treatment and Care Unit, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneve, Switzerland
| | | | | | - Yaw Ampem Amoako
- Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Carme Carrion
- School of Health Sciences, Universitat de Girona, Girona, Spain
- eHealth Lab Research Group, eHealth Center & School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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Factors associated with variation in single-dose albendazole pharmacokinetics: A systematic review and modelling analysis. PLoS Negl Trop Dis 2022; 16:e0010497. [DOI: 10.1371/journal.pntd.0010497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/14/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Background
Albendazole is an orally administered anti-parasitic medication with widespread usage in a variety of both programmatic and clinical contexts. Previous work has shown that the drug’s pharmacologically active metabolite, albendazole sulfoxide, is characterised by substantial inter-individual pharmacokinetic variation. This variation might have implications for the efficacy of albendazole treatment, but current understanding of the factors associated with this variation remains incomplete.
Methodology/Principal findings
We carried out a systematic review to identify references containing temporally disaggregated data on the plasma concentration of albendazole and/or (its pharmacologically-active metabolite) albendazole sulfoxide following a single oral dose. These data were then integrated into a mathematical modelling framework to infer albendazole sulfoxide pharmacokinetic parameters and relate them to characteristics of the groups being treated. These characteristics included age, weight, sex, dosage, infection status, and whether patients had received a fatty meal prior to treatment or other drugs alongside albendazole. Our results highlight a number of factors systematically associated with albendazole sulfoxide pharmacokinetic variation including age, existing parasitic infection and receipt of a fatty meal. Age was significantly associated with variation in albendazole sulfoxide systemic availability and peak plasma concentration achieved; as well as the clearance rate (related to the half-life) after adjusting for variation in dosage due to differences in body weight between children and adults. Receipt of a fatty meal prior to treatment was associated with increased albendazole sulfoxide systemic availability (and by extension, peak plasma concentration and total albendazole sulfoxide exposure following the dose). Parasitic infection (particularly echinococcosis) was associated with altered pharmacokinetic parameters, with infected populations displaying distinct characteristics to uninfected ones.
Conclusions/Significance
These results highlight the extensive inter-individual variation that characterises albendazole sulfoxide pharmacokinetics and provide insight into some of the factors associated with this variation.
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Zaidi AK, Dehgani-Mobaraki P. The mechanisms of action of ivermectin against SARS-CoV-2-an extensive review. J Antibiot (Tokyo) 2022; 75:60-71. [PMID: 34931048 PMCID: PMC8688140 DOI: 10.1038/s41429-021-00491-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022]
Abstract
Considering the urgency of the ongoing COVID-19 pandemic, detection of new mutant strains and potential re-emergence of novel coronaviruses, repurposing of drugs such as ivermectin could be worthy of attention. This review article aims to discuss the probable mechanisms of action of ivermectin against SARS-CoV-2 by summarizing the available literature over the years. A schematic of the key cellular and biomolecular interactions between ivermectin, host cell, and SARS-CoV-2 in COVID-19 pathogenesis and prevention of complications has been proposed.
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Affiliation(s)
- Asiya Kamber Zaidi
- Association "Naso Sano" Onlus, Umbria Regional Registry of Volunteer Activities, Corciano, Italy.
| | - Puya Dehgani-Mobaraki
- Association "Naso Sano" Onlus, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
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Zaidi AK, Dehgani-Mobaraki P. RETRACTED ARTICLE: The mechanisms of action of Ivermectin against SARS-CoV-2: An evidence-based clinical review article. J Antibiot (Tokyo) 2022; 75:122. [PMID: 34127807 PMCID: PMC8203399 DOI: 10.1038/s41429-021-00430-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Asiya Kamber Zaidi
- Member, Association "Naso Sano" Onlus, Umbria Regional Registry of volunteer activities, Corciano, Italy.
- Mahatma Gandhi Memorial Medical College, Indore, India.
| | - Puya Dehgani-Mobaraki
- President, Association "Naso Sano" Onlus, Umbria Regional Registry of volunteer activities, Corciano, Italy
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Roseboom IC, Thijssen B, Rosing H, Alves F, Mondal D, Teunissen MBM, Beijnen JH, Dorlo TPC. Development and validation of an HPLC-MS/MS method for the quantification of the anti-leishmanial drug miltefosine in human skin tissue. J Pharm Biomed Anal 2022; 207:114402. [PMID: 34634528 DOI: 10.1016/j.jpba.2021.114402] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
Miltefosine is the only oral drug approved for the treatment of various clinical presentations of the neglected parasitic disease leishmaniasis. In cutaneous leishmaniasis and post-kala-azar dermal leishmaniasis, Leishmania parasites reside and multiply in the dermis of the skin. As miltefosine is orally administered and this drug is currently studied for the treatment of these skin-related types of leishmaniasis, there is an urgent need for an accurate assay to determine actual miltefosine levels in human skin tissue to further optimize treatment regimens through target-site pharmacokinetic studies. We describe here the development and validation of a sensitive method to quantify miltefosine in 4-mm human skin biopsies utilizing high-performance liquid chromatography coupled to tandem mass spectrometry. After the skin tissues were homogenized overnight by enzymatic digestion using collagenase A, the skin homogenates were further processed by protein precipitation and phenyl-bonded solid phase extraction. Final extracts were injected onto a Gemini C18 column using alkaline eluent for separation and elution. Detection was performed by positive ion electrospray ionization followed by a quadrupole - linear ion trap mass spectrometer, using deuterated miltefosine as an internal standard. The method was validated over a linear calibration range of 4-1000 ng/mL (r2 ≥ 0.9996) using miltefosine spiked digestion solution for calibration and quality control samples. Validation parameters were all within internationally accepted criteria, including intra- and inter-assay accuracies and precisions within± 15% and ≤ 15% (within± 20% and ≤ 20% at the lower limit of quantitation). There was no significant matrix effect of the human skin tissue matrix and the recovery for miltefosine, and internal standard were comparable. Miltefosine in human skin tissue homogenates was stable during the homogenization incubation (37 °C,± 16 h) and after a minimum of 10 days of storage at - 20 °C after the homogenization process. With our assay we could successfully detect miltefosine in skin biopsies from patients with post-kala azar dermal leishmaniasis who were treated with this drug in Bangladesh.
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Affiliation(s)
- Ignace C Roseboom
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Bas Thijssen
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hilde Rosing
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Fabiana Alves
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Dinesh Mondal
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marcel B M Teunissen
- Department of Dermatology, Amsterdam University Medical Centers, location AMC, University of Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Thomas P C Dorlo
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1082-1093. [DOI: 10.1093/jac/dkac020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/05/2022] [Indexed: 11/14/2022] Open
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10
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Kip AE, Blesson S, Alves F, Wasunna M, Kimutai R, Menza P, Mengesha B, Beijnen JH, Hailu A, Diro E, Dorlo TPC. Low antileishmanial drug exposure in HIV-positive visceral leishmaniasis patients on antiretrovirals: an Ethiopian cohort study. J Antimicrob Chemother 2021; 76:1258-1268. [PMID: 33677546 PMCID: PMC8050768 DOI: 10.1093/jac/dkab013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/05/2021] [Indexed: 01/02/2023] Open
Abstract
Background Despite high HIV co-infection prevalence in Ethiopian visceral leishmaniasis (VL) patients, the adequacy of antileishmanial drug exposure in this population and effect of HIV-VL co-morbidity on pharmacokinetics of antileishmanial and antiretroviral (ARV) drugs is still unknown. Methods HIV-VL co-infected patients received the recommended liposomal amphotericin B (LAmB) monotherapy (total dose 40 mg/kg over 24 days) or combination therapy of LAmB (total dose 30 mg/kg over 11 days) plus 28 days 100 mg/day miltefosine, with possibility to extend treatment for another cycle. Miltefosine, total amphotericin B and ARV concentrations were determined in dried blood spots or plasma using LC–MS/MS. Results Median (IQR) amphotericin B Cmax on Day 1 was 24.6 μg/mL (17.0–34.9 μg/mL), which increased to 40.9 (25.4–53.1) and 33.2 (29.0–46.6) μg/mL on the last day of combination and monotherapy, respectively. Day 28 miltefosine concentration was 18.7 (15.4–22.5) μg/mL. Miltefosine exposure correlated with amphotericin B accumulation. ARV concentrations were generally stable during antileishmanial treatment, although efavirenz Cmin was below the 1 μg/mL therapeutic target for many patients. Conclusions This study demonstrates that antileishmanial drug exposure was low in this cohort of HIV co-infected VL patients. Amphotericin B Cmax was 2-fold lower than previously observed in non-VL patients. Miltefosine exposure in HIV-VL co-infected patients was 35% lower compared with adult VL patients in Eastern Africa, only partially explained by a 19% lower dose, possibly warranting a dose adjustment. Adequate drug exposure in these HIV-VL co-infected patients is especially important given the high proportion of relapses.
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Affiliation(s)
- Anke E Kip
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Fabiana Alves
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | | | | | - Peninah Menza
- Drugs for Neglected Diseases initiative, Nairobi, Kenya
| | - Bewketu Mengesha
- Leishmaniasis Research and Treatment Center, University of Gondar, Gondar, Ethiopia
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, The Netherlands.,Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Asrat Hailu
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ermias Diro
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Thomas P C Dorlo
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, The Netherlands
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11
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Verrest L, Wasunna M, Kokwaro G, Aman R, Musa AM, Khalil EAG, Mudawi M, Younis BM, Hailu A, Hurissa Z, Hailu W, Tesfaye S, Makonnen E, Mekonnen Y, Huitema ADR, Beijnen JH, Kshirsagar SA, Chakravarty J, Rai M, Sundar S, Alves F, Dorlo TPC. Geographical Variability in Paromomycin Pharmacokinetics Does Not Explain Efficacy Differences between Eastern African and Indian Visceral Leishmaniasis Patients. Clin Pharmacokinet 2021; 60:1463-1473. [PMID: 34105063 PMCID: PMC8585822 DOI: 10.1007/s40262-021-01036-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/09/2022]
Abstract
Introduction Intramuscular paromomycin monotherapy to treat visceral leishmaniasis (VL) has been shown to be effective for Indian patients, while a similar regimen resulted in lower efficacy in Eastern Africa, which could be related to differences in paromomycin pharmacokinetics. Methods Pharmacokinetic data were available from two randomized controlled trials in VL patients from Eastern Africa and India. African patients received intramuscular paromomycin monotherapy (20 mg/kg for 21 days) or combination therapy (15 mg/kg for 17 days) with sodium stibogluconate. Indian patients received paromomycin monotherapy (15 mg/kg for 21 days). A population pharmacokinetic model was developed for paromomycin in Eastern African and Indian VL patients. Results Seventy-four African patients (388 observations) and 528 Indian patients (1321 observations) were included in this pharmacokinetic analysis. A one-compartment model with first-order kinetics of absorption and elimination best described paromomycin in plasma. Bioavailability (relative standard error) was 1.17 (5.18%) times higher in Kenyan and Sudanese patients, and 2.46 (24.5%) times higher in Ethiopian patients, compared with Indian patients. Ethiopian patients had an approximately fourfold slower absorption rate constant of 0.446 h–1 (18.2%). Area under the plasma concentration-time curve for 24 h at steady-state (AUCτ,SS) for 15 mg/kg/day (median [interquartile range]) was higher in Kenya and Sudan (172.7 µg·h/mL [145.9–214.3]) and Ethiopia (230.1 µg·h/mL [146.3–591.2]) compared with India (97.26 µg·h/mL [80.83–123.4]). Conclusion The developed model provides detailed insight into the pharmacokinetic differences among Eastern African countries and India, however the resulting differences in paromomycin exposure do not seem to explain the geographical differences in paromomycin efficacy in the treatment of VL patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40262-021-01036-8.
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Affiliation(s)
- Luka Verrest
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90440, 1006 BK, Amsterdam, The Netherlands.
| | - Monique Wasunna
- Drugs for Neglected Diseases initiative (DNDi) Africa, Nairobi, Kenya
| | - Gilbert Kokwaro
- KEMRI Wellcome Trust Programme, Nairobi, Kenya.,African Centre for Clinical Trials, Nairobi, Kenya
| | - Rashid Aman
- African Centre for Clinical Trials, Nairobi, Kenya
| | - Ahmed M Musa
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | - Mahmoud Mudawi
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Northern Border University, Arar, Saudi Arabia
| | - Brima M Younis
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Asrat Hailu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zewdu Hurissa
- College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Workagegnehu Hailu
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samson Tesfaye
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyasu Makonnen
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yalemtsehay Mekonnen
- College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alwin D R Huitema
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90440, 1006 BK, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90440, 1006 BK, Amsterdam, The Netherlands
| | - Smita A Kshirsagar
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Jaya Chakravarty
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Madhukar Rai
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Thomas P C Dorlo
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90440, 1006 BK, Amsterdam, The Netherlands.
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12
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Carrion C, Robles N, Sola-Morales O, Aymerich M, Ruiz Postigo JA. Mobile Health Strategies to Tackle Skin Neglected Tropical Diseases With Recommendations From Innovative Experiences: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e22478. [PMID: 33382382 PMCID: PMC7808891 DOI: 10.2196/22478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/28/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022] Open
Abstract
Background Neglected tropical diseases (NTDs) represent a diverse group of 20 communicable diseases that occur in tropical and subtropical areas in 149 countries, affecting over 1 billion people and costing developing economies billions of dollars every year. Within these diseases, those that present lesions on the skin surface are classified as skin NTDs (sNTDs). Mobile health interventions are currently being used worldwide to manage skin diseases and can be a good strategy in the epidemiological and clinical management of sNTDs. Objective We aimed to analyze existing evidence about mobile health interventions to control and manage sNTDs in low- and middle-income countries (LMICs) and make recommendations for what should be considered in future interventions. Methods A systematic review was conducted of the MEDLINE, Embase, and Scopus databases over 10 years up to April 30, 2020. All types of clinical studies were considered. Data were synthesized into evidence tables. Apps were selected through a comprehensive systematic search in the Google Play Store and Apple App Store conducted between March 20 and April 15, 2020. Results From 133 potentially relevant publications, 13 studies met our criteria (9.8%). These analyzed eight different interventions (three SMS text messaging interventions and five app interventions). Six of the 13 (46%) studies were community-based cross-sectional studies intended to epidemiologically map a specific disease, mainly lymphatic filariasis, but also cutaneous leishmaniasis, leprosy, and NTDs, as well as sNTDs in general. Most of the studies were considered to have a high (5/13, 39%) or moderate (4/13, 31%) risk of bias. Fifteen apps were identified in the Google Play Store, of which three were also in the Apple App Store. Most of the apps (11/15, 73%) were targeted at health care professionals, with only four targeted at patients. The apps focused on scabies (3/15, 20%), lymphatic filariasis (3/15, 20%), cutaneous leishmaniasis (1/15, 7%), leprosy (1/15, 7%), yaws and Buruli ulcer (1/15, 7%), tropical diseases including more than one sNTDs (3/15, 20%), and NTDs including sNTDs (2/15, 13%). Only 1 (7%) app focused on the clinical management of sNTDs. Conclusions All mobile health interventions that were identified face technological, legal, final user, and organizational issues. There was a remarkable heterogeneity among studies, and the majority had methodological limitations that leave considerable room for improvement. Based on existing evidence, eight recommendations have been made for future interventions.
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Affiliation(s)
- Carme Carrion
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain.,Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Noemí Robles
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain.,Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | | | - Marta Aymerich
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Jose Antonio Ruiz Postigo
- Prevention, Treatment and Care Unit, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneve, Switzerland
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13
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Borborema SET, Osso JA, de Andrade HF, do Nascimento N. Pharmacokinetics of neutron-irradiated meglumine antimoniate in Leishmania amazonensis-infected BALB/c mice. J Venom Anim Toxins Incl Trop Dis 2019; 25:e144618. [PMID: 31130998 PMCID: PMC6521709 DOI: 10.1590/1678-9199-jvatitd-1446-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/17/2018] [Indexed: 11/21/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) is a parasitic disease caused by the protozoan Leishmania spp. Pentavalent antimonial agents have been used as an effective therapy, despite their side effects and resistant cases. Their pharmacokinetics remain largely unexplored. This study aimed to investigate the pharmacokinetic profile of meglumine antimoniate in a murine model of cutaneous leishmaniasis using a radiotracer approach. Methods Meglumine antimoniate was neutron-irradiated inside a nuclear reactor and was administered once intraperitoneally to uninfected and L. amazonensis-infected BALB/c mice. Different organs and tissues were collected and the total antimony was measured. Results Higher antimony levels were found in infected than uninfected footpad (0.29% IA vs. 0.14% IA, p = 0.0057) and maintained the concentration. The animals accumulated and retained antimony in the liver, which cleared slowly. The kidney and intestinal uptake data support the hypothesis that antimony has two elimination pathways, first through renal excretion, followed by biliary excretion. Both processes demonstrated a biphasic elimination profile classified as fast and slow. In the blood, antimony followed a biexponential open model. Infected mice showed a lower maximum concentration (6.2% IA/mL vs. 11.8% IA/mL, p = 0.0001), a 2.5-fold smaller area under the curve, a 2.7-fold reduction in the mean residence time, and a 2.5-fold higher clearance rate when compared to the uninfected mice. Conclusions neutron-irradiated meglumine antimoniate concentrates in infected footpad, while the infection affects antimony pharmacokinetics.
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Affiliation(s)
- Samanta Etel Treiger Borborema
- Center for Biotechnology, Nuclear and Energy Research Institute, São Paulo, SP, Brazil.,Center for Parasitology and Mycology, Adolfo Lutz Institute, São Paulo, SP, Brazil
| | - João Alberto Osso
- Center for Radiopharmacy, Nuclear and Energy Research Institute, São Paulo, SP, Brazil
| | - Heitor Franco de Andrade
- Laboratory of Protozoology, São Paulo Tropical Medicine Institute, University of São Paulo (IMTSP/USP) São Paulo, SP, Brazil
| | - Nanci do Nascimento
- Center for Biotechnology, Nuclear and Energy Research Institute, São Paulo, SP, Brazil
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14
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Kip AE, Schellens JHM, Beijnen JH, Dorlo TPC. Clinical Pharmacokinetics of Systemically Administered Antileishmanial Drugs. Clin Pharmacokinet 2019; 57:151-176. [PMID: 28756612 PMCID: PMC5784002 DOI: 10.1007/s40262-017-0570-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This review describes the pharmacokinetic properties of the systemically administered antileishmanial drugs pentavalent antimony, paromomycin, pentamidine, miltefosine and amphotericin B (AMB), including their absorption, distribution, metabolism and excretion and potential drug–drug interactions. This overview provides an understanding of their clinical pharmacokinetics, which could assist in rationalising and optimising treatment regimens, especially in combining multiple antileishmanial drugs in an attempt to increase efficacy and shorten treatment duration. Pentavalent antimony pharmacokinetics are characterised by rapid renal excretion of unchanged drug and a long terminal half-life, potentially due to intracellular conversion to trivalent antimony. Pentamidine is the only antileishmanial drug metabolised by cytochrome P450 enzymes. Paromomycin is excreted by the kidneys unchanged and is eliminated fastest of all antileishmanial drugs. Miltefosine pharmacokinetics are characterized by a long terminal half-life and extensive accumulation during treatment. AMB pharmacokinetics differ per drug formulation, with a fast renal and faecal excretion of AMB deoxylate but a much slower clearance of liposomal AMB resulting in an approximately ten-fold higher exposure. AMB and pentamidine pharmacokinetics have never been evaluated in leishmaniasis patients. Studies linking exposure to effect would be required to define target exposure levels in dose optimisation but have only been performed for miltefosine. Limited research has been conducted on exposure at the drug’s site of action, such as skin exposure in cutaneous leishmaniasis patients after systemic administration. Pharmacokinetic data on special patient populations such as HIV co-infected patients are mostly lacking. More research in these areas will help improve clinical outcomes by informed dosing and combination of drugs.
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Affiliation(s)
- Anke E Kip
- Department of Pharmacy and Pharmacology, Antoni van Leeuwenhoek Hospital/MC Slotervaart, Amsterdam, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Jan H M Schellens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacology, Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, Antoni van Leeuwenhoek Hospital/MC Slotervaart, Amsterdam, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacology, Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas P C Dorlo
- Department of Pharmacy and Pharmacology, Antoni van Leeuwenhoek Hospital/MC Slotervaart, Amsterdam, The Netherlands.
- Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
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15
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Souza Ribeiro Costa J, Medeiros M, Yamashiro-Kanashiro EH, Rocha MC, Cotrim PC, Stephano MA, Lancellotti M, Tavares GD, Oliveira-Nascimento L. Biodegradable nanocarriers coated with polymyxin B: Evaluation of leishmanicidal and antibacterial potential. PLoS Negl Trop Dis 2019; 13:e0007388. [PMID: 31042710 PMCID: PMC6513107 DOI: 10.1371/journal.pntd.0007388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 05/13/2019] [Accepted: 04/13/2019] [Indexed: 11/18/2022] Open
Abstract
Most treatments of leishmaniasis require hospitalization and present side effects or parasite resistance; innovations in drug formulation/reposition can overcome these barriers and must be pursued to increase therapeutic alternatives. Therefore, we tested polymyxin B (polB) potential to kill Leishmania amazonensis, adsorbed or not in PBCA nanoparticles (PBCAnp), which could augment polB internalization in infected macrophages. PBCAnps were fabricated by anionic polymerization and analyzed by Dynamic Light Scattering (size, ζ potential), Nanoparticle Tracking Analysis (size/concentration), vertical diffusion cell (release rate), drug incorporation (indirect method, protein determination) and in vitro cell viability. Nanoparticles coated with polB (PBCAnp-polB) presented an adequate size of 261.5 ± 25.9 nm, low PDI and ζ of 1.79 ± 0.17 mV (stable for 45 days, at least). The 50% drug release from PBCAnp-polB was 6-7 times slower than the free polB, which favors a prolonged and desired release profile. Concerning in vitro evaluations, polB alone reduced in vitro amastigote infection of macrophages (10 μg/mL) without complete parasite elimination, even at higher concentrations. This behavior limits its future application to adjuvant leishmanicidal therapy or antimicrobial coating of carriers. The nanocarrier PBCAnp also presented leishmanicidal effect and surpassed polB activity; however, no antimicrobial activity was detected. PolB maintained its activity against E. coli, Pseudomonas and Klebsiella, adding antimicrobial properties to the nanoparticles. Thus, this coated drug delivery system, described for the first time, demonstrated antileishmanial and antimicrobial properties. The bactericidal feature helps with concomitant prevention/treatment of secondary infections that worst ulcers induced by cutaneous L. amazonensis, ultimately ending in disfiguring or disabling lesions.
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Affiliation(s)
- Juliana Souza Ribeiro Costa
- Department of Biochemistry and Tissue Biology, Biology Institute, University of Campinas, Campinas, São Paulo, Brazil
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Marília Medeiros
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | | | - Mussya Cisotto Rocha
- Tropical Medicine Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Paulo Cesar Cotrim
- Tropical Medicine Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Marco Antonio Stephano
- School of Pharmaceutical Sciences, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Marcelo Lancellotti
- Department of Biochemistry and Tissue Biology, Biology Institute, University of Campinas, Campinas, São Paulo, Brazil
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | | | - Laura Oliveira-Nascimento
- Department of Biochemistry and Tissue Biology, Biology Institute, University of Campinas, Campinas, São Paulo, Brazil
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, São Paulo, Brazil
- * E-mail:
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16
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Jiménez-Antón MD, García-Calvo E, Gutiérrez C, Escribano MD, Kayali N, Luque-García JL, Olías-Molero AI, Corral MJ, Costi MP, Torrado JJ, Alunda JM. Pharmacokinetics and disposition of miltefosine in healthy mice and hamsters experimentally infected with Leishmania infantum. Eur J Pharm Sci 2018; 121:281-286. [PMID: 29883726 DOI: 10.1016/j.ejps.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 04/26/2018] [Accepted: 06/04/2018] [Indexed: 12/20/2022]
Abstract
Miltefosine is the only currently available oral drug for treatment of leishmaniasis. However, information on the pharmacokinetics (PK) of miltefosine is relatively scarce in animals. PK parameters and disposition of the molecule was determined in healthy NMRI mice and Syrian hamsters infected and treated with different miltefosine doses and regimens. Long half-life of the molecule was confirmed and differential pattern of accumulation of the drug was observed in analyzed organs in mice and hamster. Long treatment schedules produced miltefosine levels over IC50 value against L. infantum intracellular amastigotes for at least 24 days in spleen and liver of infected hamsters. The observed differential pattern of organ accumulation of the drug in mice and hamster supports the relevance of both species for translational research on chemotherapy of leishmaniasis.
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Affiliation(s)
- M Dolores Jiménez-Antón
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Estefanía García-Calvo
- C.A.I. Espectrometría de Masas, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, Avda. Complutense s/n, 28040 Madrid, Spain
| | - Cristina Gutiérrez
- C.A.I. Espectrometría de Masas, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, Avda. Complutense s/n, 28040 Madrid, Spain
| | - Mª D Escribano
- CSI Analítica SL, C. Santiago Grisolía, 2, 28760 Madrid, Spain
| | - Nour Kayali
- C.A.I. Espectrometría de Masas, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, Avda. Complutense s/n, 28040 Madrid, Spain
| | - José L Luque-García
- C.A.I. Espectrometría de Masas, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, Avda. Complutense s/n, 28040 Madrid, Spain; Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, Avda. Complutense s/n, 28040 Madrid, Spain
| | - Ana Isabel Olías-Molero
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - María J Corral
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Maria P Costi
- Department of Life Science, University of Modena and Reggio Emilia, Via Campi 103, 41125 Modena, Italy
| | - Juan J Torrado
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad Complutense de Madrid, Avda. Complutense s/n, 28040 Madrid, Spain
| | - José Mª Alunda
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain.
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17
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Muñoz J, Ballester MR, Antonijoan RM, Gich I, Rodríguez M, Colli E, Gold S, Krolewiecki AJ. Safety and pharmacokinetic profile of fixed-dose ivermectin with an innovative 18mg tablet in healthy adult volunteers. PLoS Negl Trop Dis 2018; 12:e0006020. [PMID: 29346388 PMCID: PMC5773004 DOI: 10.1371/journal.pntd.0006020] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/06/2017] [Indexed: 11/19/2022] Open
Abstract
Ivermectin is a pivotal drug for the control of onchocerciasis and lymphatic filariasis, which is increasingly identified as a useful drug for the control of other Neglected Tropical Diseases. Its role in the treatment of soil transmitted helminthiasis through improved efficacy against Trichuris trichiura in combination with other anthelmintics might accelerate the progress towards breaking transmission. Ivermectin is a derivative of Avermectin B1, and consists of an 80:20 mixture of the equipotent homologous 22,23 dehydro B1a and B1b. Pharmacokinetic characteristics and safety profile of ivermectin allow to explore innovative uses to further expand its utilization through mass drug administration campaigns to improve coverage rates. We conducted a phase I clinical trial with 54 healthy adult volunteers who sequentially received 2 experimental treatments using a new 18 mg ivermectin tablet in a fixed-dose strategy of 18 and 36 mg single dose regimens, compared to the standard, weight based 150–200 μg/kg, regimen. Volunteers were recruited in 3 groups based on body weight. Plasma concentrations of ivermectin were measured through HPLC up to 168 hours post treatment. Safety data showed no significant differences between groups and no serious adverse events: headache was the most frequent adverse event in all treatment groups, none of them severe. Pharmacokinetic parameters showed a half-life between 81 and 91 h in the different treatment groups. When comparing the systemic bioavailability (AUC0t and Cmax) of the reference product (WA-ref) with the other two study groups using fixed doses, we observed an overall increase in AUC0t and Cmax for the two experimental treatments of 18 mg and 36 mg. Body mass index (BMI) and weight were associated with t1/2 and V/F, probably reflecting the high liposolubility of IVM with longer retention times proportional to the presence of more adipose tissue. Systemic exposure to ivermectin (AUC0t or Cmax) was not associated with BMI or weight in our study. These findings contribute to further understand the pharmacokinetic characteristics of ivermectin, highlighting its safety across different dosing regimens. They also correlate with known pharmacokinetic parameters showing stable levels of AUC and Cmax across a wide range of body weights, which justifies the strategy of fix dosing from a pharmacokinetic perspective. TRIAL REGISTRATION ClinicalTrials.gov NCT03173742.
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Affiliation(s)
- Jose Muñoz
- Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona. Barcelona, Spain
| | - Maria Rosa Ballester
- CIM-Sant Pau. IIB Sant Pau. Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau. Barcelona, Spain
| | - Rosa Maria Antonijoan
- CIM-Sant Pau. IIB Sant Pau. Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau. Barcelona, Spain
- Pharmacology and Therapeutics Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Ignasi Gich
- CIM-Sant Pau. IIB Sant Pau. Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau. Barcelona, Spain
- Pharmacology and Therapeutics Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Montse Rodríguez
- CIM-Sant Pau. IIB Sant Pau. Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau. Barcelona, Spain
| | | | - Silvia Gold
- Fundacion Mundo Sano, Buenos Aires, Argentina
| | - Alejandro J. Krolewiecki
- Instituto de Investigaciones en Enfermedades Tropicales, Universidad Nacional de Salta/CONICET, Oran, Argentina
- * E-mail:
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18
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Hong ST. Albendazole and Praziquantel: Review and Safety Monitoring in Korea. Infect Chemother 2018; 50:1-10. [PMID: 29637747 PMCID: PMC5895825 DOI: 10.3947/ic.2018.50.1.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Indexed: 01/04/2023] Open
Abstract
Albendazole (ADZ) and praziquantel (PZQT) have been used as anthelmintics for over 30 years. Worldwide, hundreds of millions tablets are administered to people and livestock every year. ADZ is poorly orally absorbed (<5%), and its uptake is enhanced by high-fat meals, while PZQT is well absorbed (>75%) and uptake is enhanced by carbohydrate-rich meals. Both ADZ and PZQT are safe, but not recommended for children <2 years or for women in the first trimester of pregnancy. Serious adverse events occur following high dose and prolonged administration of these drugs for treatment of echinococcosis or neurocysticercosis, especially in patients with poor liver function. The adverse events may be induced by the drugs, or by the dead worms themselves. The Korea Institute of Drug Safety & Risk Management monitors drug-related adverse events in Korea, and its database included 256 probable or possible ADZ-associated events and 108 PZQT-associated events between 2006 and 2015. Such low incidence rates in Korea are due to the low single dose treatments of ADZ, and the short-term use of PZQT. The number of serious adverse events due to drug interaction induced by ADZ and PZQT were six and two, respectively. We conclude that ADZ and PZQT are generally safe drugs, but they must be used with caution in people with poor liver function or those being comedicated for gastroesophageal reflux disease.
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Affiliation(s)
- Sung Tae Hong
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul, Korea.
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