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Clark RL. Safety of Treating Malaria with Artemisinin-Based Combination Therapy in the First Trimester of Pregnancy. Reprod Toxicol 2022; 111:204-210. [PMID: 35667524 DOI: 10.1016/j.reprotox.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
There have been recent calls for the use of artemisinin-based combination therapies (ACTs) for uncomplicated malaria in the first trimester of pregnancy. Nevertheless, the 2021 WHO Guidelines for Malaria reaffirmed their position that there is not adequate clinical safety data on artemisinins to support that usage. The WHO's position is consistent with several issues with the existing clinical data. First, first trimester safety results from multiple ACTs were lumped in a meta-analysis which does not demonstrate that each of the included ACTs is equally safe. Second, safety results from all periods of the first trimester were lumped in the meta-analysis which does not demonstrate the same level of safety for all subperiods, particularly gestational Weeks 6 to 8 which is likely to be the most sensitive period. Third, even if there is evidence of a lack of an effect on miscarriage for a particular ACT, it does not follow then there are no developmental effects for any ACT. In monkeys, artesunate caused marked embryonal anemia leading to embryo death but the long-term consequences of lower levels of embryonal anemia are not known. Fourth, there have been advances in the sensitivity and usage of rapid diagnostic tests that will lead to diagnoses of malaria earlier in gestation which is less well studied and more likely sensitive to artemisinins. Any clinical studies of the safety of ACTs in the first trimester need to evaluate the results of treatment with individual ACTs during different 1- to 2-week periods of the first trimester.
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2
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Asano K, Takahashi Y, Ueno M, Fukuda T, Otani M, Kitamoto S, Tomigahara Y. Lack of human relevance for rat developmental toxicity of flumioxazin is revealed by comparative heme synthesis assay using embryonic erythroid cells derived from human and rat pluripotent stem cells. J Toxicol Sci 2022; 47:125-138. [DOI: 10.2131/jts.47.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Koji Asano
- Environmental Health Science Laboratory, Sumitomo Chemical Co., Ltd
| | | | - Manako Ueno
- Bioscience Research Laboratory, Sumitomo Chemical Co., Ltd
| | - Takako Fukuda
- Bioscience Research Laboratory, Sumitomo Chemical Co., Ltd
| | - Mitsuhiro Otani
- Environmental Health Science Laboratory, Sumitomo Chemical Co., Ltd
| | - Sachiko Kitamoto
- Environmental Health Science Laboratory, Sumitomo Chemical Co., Ltd
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Aghahowa S, Ozolua R, Bafor E, Obarisiagbon P, Isah A. Toxicological effect of Artemisinin-Based Combination Therapies plus Paracetamol in malaria patients. Toxicol Rep 2021; 8:1930-1936. [PMID: 34926171 PMCID: PMC8649067 DOI: 10.1016/j.toxrep.2021.11.007] [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: 06/24/2021] [Revised: 10/27/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Following the paucity of safety reports in the use of Artemisinin-Based Combination Therapies (ACTs) plus paracetamol, the study assessed safety potential of artemether-lumefantrine (ALP), artesunate-amodiaquine (AAP), artesunate-mefloquine (AMP), artesunate-sulphadoxine-pyrimethamine (ASPP) and dihydroartemisinin-piperaquine (DHPP) combination with paracetamol in malaria patients. METHODS ACTs and paracetamol were administered concomitantly in conventional doses/regimen to randomly selected patients. Blood samples were collected from the ante-cubital vein before and after completion of therapies. Toxicity markers such as weights, glucose, lipids, renal electrolytes, liver enzymes and haematological indices were assessed using standard protocols. RESULTS The total numbers of participants were 57 patients. Male to female ratio was 1:1.1. Mean body weight and ages were 59.19 ± 1.39 kg and 42.86 ± 1.32 years respectively. The mean temperatures prior to and after therapy were 37.49 ± 1.02 °C and 37.50 ± 0.17 °C respectively. Mean parasitaemia before the commencement of therapy was 6282 ± 21.01 parasites/μl. Out of thirty-seven toxicological indices evaluated, twenty-four were significantly altered by ACTs plus paracetamol (P < 0.05). Increased serum toxicity markers due to the drug combinations were glucose (AAP, AMP), urea (ALP, ASPP), bicarbonate ion (ALP, AAP, AMP, ASPP), chloride ion (ALP, AAP, AMP), creatinine (ALP, AAP, AMP, ASPP), alkaline phosphatase (ALP, AAP), aspartate aminotransferase and alanine aminotransferase (ALP, AAP, AMP, ASPP, DHPP), total protein (AMP, DHPP) and albumin (AMP, DHPP). Decreased serum toxicity markers due to the drugs were glucose (ALP, ASPP, DHPP), urea (AMP), bicarbonate ion (DHPP), chloride ion (ASPP, DHPP), creatinine (DHPP), alkaline phosphatase (AMP, ASPP, DHPP), total protein (ALP, AAP, and ASPP) and albumin (ALP, AAP, ASPP). Altered haematological indices were white blood cells, red blood cells, mean cell haemoglobin and platelets. CONCLUSION Since ACTs plus paracetamol altered human system, discrete selection is essential in managing uncomplicated malaria most especially in patients with co-morbid conditions.
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Affiliation(s)
- S.E. Aghahowa
- Department of Pharmacology and Toxicology, University of Benin, Benin City, Nigeria
| | - R.I. Ozolua
- Department of Pharmacology and Toxicology, University of Benin, Benin City, Nigeria
| | - E.E. Bafor
- Department of Pharmacology and Toxicology, University of Benin, Benin City, Nigeria
| | - P. Obarisiagbon
- Department of Pharmacology and Toxicology, University of Benin, Benin City, Nigeria
| | - A.O. Isah
- College of Medicine, University of Benin, Benin City, Nigeria
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4
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A rapid spectrophotometric method to identify inhibitors of human erythropoiesis. J Pharmacol Toxicol Methods 2021; 113:107134. [PMID: 34798285 DOI: 10.1016/j.vascn.2021.107134] [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: 07/15/2021] [Revised: 11/05/2021] [Accepted: 11/12/2021] [Indexed: 11/22/2022]
Abstract
Erythropoiesis is a complex physiological process by which erythroid progenitors proliferate and differentiate into nonnucleated red blood cells. Several methods can be used to monitor in vitro the differentiation of erythroid precursors, and hence the toxic effects of drugs, chemicals, or pollutants. One of the most commonly available assay of erythropoiesis is the microscopic observation of differentiated cells after benzidine staining, which forms a blue complex with hemoglobin. However, this method is laborious and does not provide accurate results since it heavily relies on the reader's interpretation. Moreover, benzidine is a carcinogen and a highly reactive molecule which forces the reader to microscopically count differentiated and non-differentiated cells within a short time frame (5 min). Here we have developed a simple, inexpensive, in-vitro spectrophotometric assay to measure erythroid differentiation using K562 cell line as a model. Materials needed included 96-well round-bottomed microplates and a microplate reader. Remarkably, carcinogenic benzidine was replaced by its isomeric tetramethyl derivative, the 3,3', 5,5'- tetramethylbenzidine (TMB), which presents several advantages: it is cheap, not mutagenic and a ready-to-use chromogenic substrate. A small volume (50 μl) of TMB added to the samples forms a blue complex in 15 min, and the reaction can be easily stopped and stabilized by the addition of H2SO4. The yellow precipitate is then solubilized, and the absorbance is measured at 450 nm. In addition, the suitability of the assay to determine the effects of compounds on erythroid differentiation was further tested with known inhibitors (artemisinin derivatives) of K562 differentiation. Overall, the reported methodology permits to measure in an accurate and reproducible manner the K562 differentiation and can be used for medium throughput screenings (MTS) of compounds or environmental toxics with potential erythro-toxicity and ability to inhibit erythroid differentiation.
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Charlie-Silva I, Feitosa NM, Fukushima HCS, Borra RC, Foglio MA, Xavier RMP, de Melo Hoyos DC, de Oliveira Sousa IM, de Souza GG, Bailone RL, de Andrade Belo MA, Correia SAM, Junior JDC, Pierezan F, Malafaia G. Effects of nanocapsules of poly-ε-caprolactone containing artemisinin on zebrafish early-life stages and adults. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 756:143851. [PMID: 33257061 DOI: 10.1016/j.scitotenv.2020.143851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
Artemisinin extracted from Artemisia annua L. plants has a range of properties that qualifies it to treat several diseases, such as malaria and cancer. However, it has short half-life, which requires making continuous use of it, which has motivated the association of artemisinin (ART) with polymeric nanoparticles to increase its therapeutic efficiency. However, the ecotoxicological safety of this association has been questioned, given the scarcity of studies in this area. Thus, in this work the toxicity of Poly (ε-Caprolactone) nanocapsules added with ART (ART-NANO) in zebrafish (Danio rerio), embryos and adults was studied. Different endpoints were analyzed in organisms exposed to ART-NANO, including those predictive of embryotoxicity and histopatoxicity. Embryotoxicity was analyzed based on Organization for Economic Co-operation and Development (OECD) test guideline (236) for fish embryo acute toxicity applied to zebrafish (Danio rerio) at 96 hpf under five nominal logarithmic concentrations (0.125 to 2.0 mg/ L). Our results demonstrate, mainly, that fertilized eggs presented increased coagulation, lack of heart rate, vitelline sac displacement and lack of somite formation. On the other hand, adult individuals (exposed to the same concentrations and evaluated after 24 and 96 h of exposure) have shown increased pericarditis. Therefore, the treatment based on ART, poly (ε-caprolactone) nanocapsules and on their combination at different concentrations have shown toxic effects on zebrafish embryos and adult individuals.
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Affiliation(s)
- Ives Charlie-Silva
- Pharmacology Department, Biomedical Sciences Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Natália Martins Feitosa
- Integrated Translational Biosciences Laboratory (LIBT), Biodiversity and Sustainability Institute (NUPEM), Federal University of Rio de Janeiro (UFRJ)- Macaé, RJ, Brazil
| | | | - Ricardo Carneiro Borra
- Department of Genetics and Evolution, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Mary Ann Foglio
- Pharmaceutical Sciences School, State University of Campinas, Campinas, SP, Brazil
| | | | | | | | | | - Ricardo Lacava Bailone
- Ministry of Agriculture, Livestock and Supply, São Carlos, SP, Brazil; São Paulo State University, Botucatu, SP, Brazil
| | - Marco Antonio de Andrade Belo
- Ministry of Agriculture, Livestock and Supply, São Carlos, SP, Brazil; São Paulo State University, Botucatu, SP, Brazil
| | | | | | | | - Guilherme Malafaia
- Biological Sciences Department, Goiano Federal Institute, Urutaí, GO, Brazil.
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Kawamura S, Otani M, Miyamoto T, Abe J, Ihara R, Inawaka K, Fantel AG. Different effects of an N-phenylimide herbicide on heme biosynthesis between human and rat erythroid cells. Reprod Toxicol 2021; 99:27-38. [PMID: 33249232 DOI: 10.1016/j.reprotox.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/28/2020] [Accepted: 11/22/2020] [Indexed: 01/10/2023]
Abstract
Rat developmental toxicity including embryolethality and teratogenicity (mainly ventricular septal defects and wavy ribs) were produced by S-53482, an N-phenylimide herbicide that inhibits protoporphyrinogen oxidase (PPO) common to chlorophyll and heme biosynthesis. The sequence of key biological events in the mode of action has been elucidated as follows: inhibition of PPO interferes with normal heme synthesis, which causes loss of blood cells leading to fetal anemia, embryolethality and the development of malformations. In this study we investigated whether the rat is a relevant model for the assessment of the human hazard of the herbicide. To study effects on heme biosynthesis, human erythroleukemia, human cord blood, and rat erythroleukemia cells were treated with the herbicide during red cell differentiation. Protoporphyrin IX, a marker of PPO inhibition, and heme were determined. We investigated whether synchronous maturation of primitive erythropoiesis, which can contribute to massive losses of embryonic blood, occurs in rats. The population of primitive erythroblasts was observed on gestational days 11 through 14. Heme production was suppressed in rat erythroid cells. In contrast, heme reduction was not seen in both human erythroid cells when PPO was inhibited. Rats underwent synchronous maturation in primitive erythropoiesis. Our results combined with epidemiological findings that patients with deficient PPO are not anemic led us to conclude that human erythroblasts are resistant to the herbicide. It is suggested that the rat would be an inappropriate model for assessing the developmental toxicity of S-53482 in humans as rats are specifically sensitive to PPO inhibition by the herbicide.
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Affiliation(s)
- Satoshi Kawamura
- Environmental Health Science Laboratory, Sumitomo Chemical Co., Ltd., 1-98, Kasugade-naka 3-chome, Konohana-ku, Osaka, 554-8558, Japan.
| | - Mitsuhiro Otani
- Environmental Health Science Laboratory, Sumitomo Chemical Co., Ltd., 1-98, Kasugade-naka 3-chome, Konohana-ku, Osaka, 554-8558, Japan
| | - Taiki Miyamoto
- Environmental Health Science Laboratory, Sumitomo Chemical Co., Ltd., 1-98, Kasugade-naka 3-chome, Konohana-ku, Osaka, 554-8558, Japan
| | - Jun Abe
- Environmental Health Science Laboratory, Sumitomo Chemical Co., Ltd., 1-98, Kasugade-naka 3-chome, Konohana-ku, Osaka, 554-8558, Japan
| | - Ryo Ihara
- Environmental Health Science Laboratory, Sumitomo Chemical Co., Ltd., 1-98, Kasugade-naka 3-chome, Konohana-ku, Osaka, 554-8558, Japan
| | - Kunifumi Inawaka
- Environmental Health Science Laboratory, Sumitomo Chemical Co., Ltd., 1-98, Kasugade-naka 3-chome, Konohana-ku, Osaka, 554-8558, Japan
| | - Alan G Fantel
- Department of Pediatrics, University of Washington, 1959 NE Pacific St. Box 366320, Seattle, WA 98195-6320, USA
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Clark RL. Teratogen update: Malaria in pregnancy and the use of antimalarial drugs in the first trimester. Birth Defects Res 2020; 112:1403-1449. [PMID: 33079495 DOI: 10.1002/bdr2.1798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 02/04/2023]
Abstract
Malaria is a particular problem in pregnancy because of enhanced sensitivity, the possibility of placental malaria, and adverse effects on pregnancy outcome. Artemisinin-containing combination therapies (ACTs) are the most effective antimalarials known. WHO recommends 7-day quinine therapy for uncomplicated Plasmodium falciparum malaria in the first trimester despite the superior tolerability and efficacy of 3-day ACT regimens because artemisinins caused embryolethality and/or cardiovascular malformations at relatively low doses in rats, rabbits, and monkeys. The developmental toxicity of artesunate, artemether, and DHA were similar in rats but artesunate was embryotoxic at lower doses in rabbits (5 mg/kg/day) than artemether (no effect level = 25 mg/kg/day). In clinical studies in Africa, treatment with artemether-lumefantrine in the first trimester was observed to be highly efficacious and the miscarriage rate (≤3.1%) was similar to no antimalarial treatment (2.6%). When data from the first-trimester use of largely artesunate-based therapies in Thailand were pooled together, there was no difference in miscarriage rate compared to quinine. However, individually, artesunate-mefloquine was associated with a higher miscarriage rate (15/71 = 21%) compared to other artemisinin-based therapies including 7-day artesunate + clindamycin (2/50 = 4%) and quinine (92/842 = 11%). Thus, appropriate statistical comparisons of individual ACT groups are needed prior to assuming that they all have the same risk for developmental toxicity. Current limitations in the assessment of the safety of ACTs in the first trimester are a lack of exposures early in gestation (gestational weeks 6-7), limited postnatal evaluation for cardiovascular malformations, and the pooling of all ACTs for the assessment of risk.
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Affiliation(s)
- Robert L Clark
- Artemis Pharmaceutical Research, Saint Augustine, Florida, USA
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8
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D'Alessandro S, Menegola E, Parapini S, Taramelli D, Basilico N. Safety of Artemisinin Derivatives in the First Trimester of Pregnancy: A Controversial Story. Molecules 2020; 25:molecules25153505. [PMID: 32752056 PMCID: PMC7435965 DOI: 10.3390/molecules25153505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/31/2022] Open
Abstract
Artemisinin combination therapy (ACT) is recommended by the World Health Organization (WHO) as first line treatment for uncomplicated malaria both in adults and children. During pregnancy, ACT is considered safe only in the second and third trimester, since animal studies have demonstrated that artemisinin derivatives can cause foetal death and congenital malformation within a narrow time window in early embryogenesis. During this period, artemisinin derivatives induce defective embryonic erythropoiesis and vasculogenesis/angiogenesis in experimental models. However, clinical data on the safety profile of ACT in pregnant women have not shown an increased risk of miscarriage, stillbirth, or congenital malformation, nor low birth weight, associated with exposure to artemisinins in the first trimester. Although further studies are needed, the evidence collected up to now is prompting the WHO towards a change in the guidelines for the treatment of uncomplicated malaria, allowing the use of ACT also in the first trimester of pregnancy.
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Affiliation(s)
- Sarah D'Alessandro
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, 20133 Milan, Italy
| | - Elena Menegola
- Dipartimento di Scienze e Politiche Ambientali, Università degli Studi di Milano, 20133 Milan, Italy
| | - Silvia Parapini
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milan, Italy
| | - Donatella Taramelli
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy
| | - Nicoletta Basilico
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, 20133 Milan, Italy
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Luo Y, Guo Q, Zhang L, Zhuan Q, Meng L, Fu X, Hou Y. Dihydroartemisinin exposure impairs porcine ovarian granulosa cells by activating PERK-eIF2α-ATF4 through endoplasmic reticulum stress. Toxicol Appl Pharmacol 2020; 403:115159. [PMID: 32721431 DOI: 10.1016/j.taap.2020.115159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 12/16/2022]
Abstract
Dihydroartemisinin (DHA) is an artemisinin derivative commonly used in malaria therapy, and a growing number of studies have focused on the potent anticancer activity of DHA. However, the reproductive toxicity of anticancer drugs is a major concern for young female cancer patients. Previous studies have suggested that DHA can cause embryonic damage and affect oocyte maturation. Here, we explored the side effects of DHA exposure on ovarian somatic cells. We exposed porcine granulosa cells to 5 μM and 40 μM DHA for 24 h or 48 h in vitro. DHA inhibited granulosa cell viability in a dose-dependent manner and, in the 48 h treatment group, DHA enhanced the apoptotic rate. We observed that the levels of intracellular calcium, mitochondrial calcium, and ATP concentration were elevated with DHA treatment. In granulosa cells exposed to DHA, the mRNA levels of endoplasmic reticulum stress-related genes GRP78 and ATF4 were increased. Furthermore, analysis of the unfolded protein response signaling pathway showed that the protein levels of P-PERK, P-eIF2α, and ATF4 were upregulated by DHA exposure. These results demonstrate that in granulosa cells, DHA exposure induces endoplasmic reticulum stress that then activates the PERK/eIF2α/ATF4 signaling pathway, thus providing insight into the mechanism underlying DHA-induced reproductive toxicity, and giving reference to DHA use in females.
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Affiliation(s)
- Yan Luo
- State Key Laboratory for Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing 100193, China
| | - Qing Guo
- State Key Laboratory for Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing 100193, China
| | - Luyao Zhang
- State Key Laboratory for Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing 100193, China
| | - Qingrui Zhuan
- Key Laboratory of Animal Genetics, Breeding and Reproduction, Ministry of Agriculture and National Engineering Laboratory for Animal Breeding, College of Animal Science and Technology, China Agricultural University, Beijing 100193, China
| | - Lin Meng
- State Key Laboratory for Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing 100193, China
| | - Xiangwei Fu
- Key Laboratory of Animal Genetics, Breeding and Reproduction, Ministry of Agriculture and National Engineering Laboratory for Animal Breeding, College of Animal Science and Technology, China Agricultural University, Beijing 100193, China
| | - Yunpeng Hou
- State Key Laboratory for Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing 100193, China.
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Jeong H, Latif A, Kong CS, Seo Y, Lee YJ, Dalal SR, Cassera MB, Kingston DGI. Isolation and characterization of antiplasmodial constituents from the marine sponge Coscinoderma sp. ACTA ACUST UNITED AC 2020; 74:313-318. [PMID: 31393837 DOI: 10.1515/znc-2019-0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/18/2019] [Indexed: 12/26/2022]
Abstract
Six known compounds, namely two halisulfates 1 and 2 and four epidioxy sterols 3-6, were isolated from the marine sponge Coscinoderma sp. The structures of these compounds were confirmed by nuclear magnetic resonance (1H and 13C NMR) spectroscopy, and their antiplasmodial activities were determined against the chloroquine-resistant Dd2 strain of Plasmodium falciparum. The epidioxy steroids 3-6 all showed moderate to weak antiplasmodial activity, with IC50 values of 2.7 μM for (24S)-5α,8α-epidioxy-24-methylcholesta-6-en-3β-ol (3), 11.6 μM for 5α,8α-epidioxycholesta-6,24(28)-dien-3β-o1 (4), 2.33 μM for 5α,8α-epidioxy-24-methylcholesta-6,9(11)-24(28)-trien-3β-ol (5), and between 12 and 24 μM for 5α,8α-epidioxycholesta-6-en-3β-ol (6). In contrast, halisulfate 2 (1) was inactive, and halisulfate 1 (2) had an of IC50 value of about 24 μM.
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Affiliation(s)
- Huijeong Jeong
- Division of Marine Bioscience, Korea Maritime and Ocean University, Busan 49112, Republic of Korea
| | - Abdul Latif
- Department of Chemistry, University of Malakand, Chakdara, Dir Lower, KP, Pakistan
| | - Chang-Suk Kong
- Department of Food and Nutrition, College of Medical and Life Sciences, Silla University, Busan 46958, Republic of Korea
| | - Youngwan Seo
- Division of Marine Bioscience, Korea Maritime and Ocean University, Busan 49112, Republic of Korea
| | - Yeon-Ju Lee
- Marine Natural Product Chemistry Laboratory, Korea Institute of Ocean Science and Technology, Ansan 15627, Republic of Korea
| | - Seema R Dalal
- Department of Biochemistry and Molecular Biology, Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, Athens, GA 30602, USA
| | - Maria B Cassera
- Department of Biochemistry and Molecular Biology, Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, Athens, GA 30602, USA
| | - David G I Kingston
- Department of Chemistry, Virginia Tech Center for Drug Discovery, M/C 0212, Virginia Tech, Blacksburg, VA 24061, USA
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11
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Toxicity and related mechanisms of dihydroartemisinin on porcine oocyte maturation in vitro. Toxicol Appl Pharmacol 2018; 341:8-15. [DOI: 10.1016/j.taap.2018.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/29/2017] [Accepted: 01/04/2018] [Indexed: 11/19/2022]
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12
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Clark RL, Edwards TL, Longo M, Kinney J, Walker DK, Rhodes J, Clode SA, Rückle T, Wells T, Andenmatten N, Huber AC. Improved safety margin for embryotoxicity in rats for the new endoperoxide artefenomel (OZ439) as compared to artesunate. Birth Defects Res 2017; 110:553-578. [DOI: 10.1002/bdr2.1170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | - Jon Rhodes
- Covance Laboratories Ltd, Reproduction Toxicology; Harrogate North Yorkshire United Kingdom
| | - Sally A. Clode
- Covance Laboratories Ltd, Reproduction Toxicology; Harrogate North Yorkshire United Kingdom
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Zyad A, Tilaoui M, Jaafari A, Oukerrou MA, Mouse HA. More insights into the pharmacological effects of artemisinin. Phytother Res 2017; 32:216-229. [PMID: 29193409 DOI: 10.1002/ptr.5958] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 12/23/2022]
Abstract
Artemisinin is one of the most widely prescribed drugs against malaria and has recently received increased attention because of its other potential biological effects. The aim of this review is to summarize recent discoveries of the pharmaceutical effects of artemisinin in basic science along with its mechanistic action, as well as the intriguing results of recent clinical studies, with a focus on its antitumor activity. Scientific evidence indicates that artemisinin exerts its biological activity by generating reactive oxygen species that damage the DNA, mitochondrial depolarization, and cell death. In the present article review, scientific evidence suggests that artemisinin is a potential therapeutic agent for various diseases. Thus, this review is expected to encourage interested scientists to conduct further preclinical and clinical studies to evaluate these biological activities.
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Affiliation(s)
- Abdelmajid Zyad
- Laboratory of Biological Engineering, Team of Natural Substances and Cellular and Molecular Immuno-pharmacology, Immuno-biology of Cancer Cells, Sultan Moulay Slimane University, Faculty of Science and Technology, Beni-Mellal, Morocco
| | - Mounir Tilaoui
- Laboratory of Biological Engineering, Team of Natural Substances and Cellular and Molecular Immuno-pharmacology, Immuno-biology of Cancer Cells, Sultan Moulay Slimane University, Faculty of Science and Technology, Beni-Mellal, Morocco
| | - Abdeslam Jaafari
- Laboratory of Biological Engineering, Team of Natural Substances and Cellular and Molecular Immuno-pharmacology, Immuno-biology of Cancer Cells, Sultan Moulay Slimane University, Faculty of Science and Technology, Beni-Mellal, Morocco
| | - Moulay Ali Oukerrou
- Laboratory of Biological Engineering, Team of Natural Substances and Cellular and Molecular Immuno-pharmacology, Immuno-biology of Cancer Cells, Sultan Moulay Slimane University, Faculty of Science and Technology, Beni-Mellal, Morocco
| | - Hassan Ait Mouse
- Laboratory of Biological Engineering, Team of Natural Substances and Cellular and Molecular Immuno-pharmacology, Immuno-biology of Cancer Cells, Sultan Moulay Slimane University, Faculty of Science and Technology, Beni-Mellal, Morocco
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Gomes C, Boareto AC, Dalsenter PR. Clinical and non-clinical safety of artemisinin derivatives in pregnancy. Reprod Toxicol 2016; 65:194-203. [PMID: 27506918 DOI: 10.1016/j.reprotox.2016.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
Abstract
Malaria in pregnancy is a clinically wasting infectious disease, where drug therapy has to be promptly initiated. Currently, the treatment of this infection depends on the use of artemisinin derivatives. The World Health Organization does not recommend the use of these drugs in the first trimester of pregnancy due to non-clinical findings that have shown embryolethality and teratogenic effects. Nevertheless, until now, this toxicity has not been proved in humans. Artemisinin derivatives mechanisms of embryotoxicity are related to depletion of circulating embryonic primitive erythroblasts. Species differences in this sensitive period for toxicity and the presence of malaria infection, which could reduce drug distribution to the fetus, are significant to the risk assessment of artemisinin derivatives treatment to pregnant women. In this review we aimed to assess the results of non-clinical and clinical studies with artemisinin derivatives, their mechanisms of embryotoxicity and discuss the safety of their use during pregnancy.
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Affiliation(s)
- Caroline Gomes
- Department of Pharmacology, Federal University of Paraná, Curitiba, PR, Brazil.
| | - Ana Cláudia Boareto
- Department of Pharmacology, Federal University of Paraná, Curitiba, PR, Brazil.
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15
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Jain SA, Awale M, Pathak S, Vanage G, Patravale VB, Sharma S. Teratogenicity of Artemether–Clindamycin Nanostructured Lipid Carriers in Rats. Int J Toxicol 2016; 35:420-8. [DOI: 10.1177/1091581816652605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Currently, artemisinin-based combination therapy is considered the best option in the treatment of malaria. However, toxicity of artemisinins limits their use in pregnancy. In the absence of sufficient toxicity data, the World Health Organization recommends that artemisinins are not to be used in the first trimester of pregnancy and can be used only in second and third trimesters, when other treatments are not available. We have recently observed that drugs loaded in nanolipid carriers are selectively taken up in Plasmodium-infected erythrocytes with a concomitant reduction in the dose required to cure animals. Thus, 20% of the therapeutic dose of artemether–clindamycin (ARM-CP) loaded in nanostructured lipid carriers (NLCs; mean particle size 55 ± 10 nm) resulted in complete parasite clearance and 100% survival of infected mice. Here, we investigate the teratogenicity of this formulation in rodents (dosing on alternate days from 6th day to 18th day of gestation; 12-15 animals/group). The teratogenicity of drug-free NLCs and artesunate–clindamycin (ARS-CP) solution was also evaluated. We found that the therapeutic dose of ARS-CP caused fetal resorptions (87.5% resorptions in 8 litters), suggesting its unsuitability for use in pregnancy. Artesunate–clindamycin NLCs at therapeutic doses also resulted in ∼90% fetal resorptions in 10 litters examined. However, postimplantation losses or fetal malformations were not observed at the dose of ARM-CP NLCs that was required for complete parasite clearance in preclinical trials (ie, 20% of the therapeutic dose). Our data suggest that the NLCs loaded with 20% of the therapeutic dose of ARM-CP may have potential in treating malaria during pregnancy.
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Affiliation(s)
- Soniya A. Jain
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai, Maharashtra, India
| | - Madhavi Awale
- National Centre for Preclinical Reproductive and Genetic Toxicology, National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Sulabha Pathak
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, Maharashtra, India
| | - Geeta Vanage
- National Centre for Preclinical Reproductive and Genetic Toxicology, National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Vandana B. Patravale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai, Maharashtra, India
| | - Shobhona Sharma
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, Maharashtra, India
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Abdolmaleki Z, Arab HA, Amanpour S, Muhammadnejad S. Anti-angiogenic effects of ethanolic extract of Artemisia sieberi compared to its active substance, artemisinin. REVISTA BRASILEIRA DE FARMACOGNOSIA-BRAZILIAN JOURNAL OF PHARMACOGNOSY 2016. [DOI: 10.1016/j.bjp.2015.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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17
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Kawamura S, Yoshioka T, Mito N, Kishimoto N, Nakaoka M, Fantel AG. Mechanism of Developmental Effects in Rats Caused by an N-Phenylimide Herbicide: Transient Fetal Anemia and Sequelae during Mid-to-Late Gestation. ACTA ACUST UNITED AC 2016; 107:45-59. [PMID: 26865470 DOI: 10.1002/bdrb.21172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/20/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Rat developmental toxicity including embryolethality and teratogenicity (mainly ventricular septal defects [VSDs] and wavy ribs) was produced by an N-phenylimide herbicide that inhibits protoporphyrinogen oxidase (PPO) common to chlorophyll and heme biosynthesis. Major characteristics of the developmental toxicity included species difference between rats and rabbits, compound-specific difference among structurally similar herbicides, and sensitive period. Protoporphyrin accumulation in treated fetuses closely correlated with the major characteristics. Iron deposits in erythroblastic mitochondria and degeneration of erythroblasts were observed in treated rat fetuses. In this study we investigated fetal anemia and subsequent developmental effects in rats, and inhibition of PPO in rats, rabbits, and humans by the herbicides in vitro. METHODS Fetuses were treated on gestational day (GD) 12 and removed on GDs 13 through 20. All litters were examined externally. One half of litters were examined for blood and skeletal development, and the other half for interventricular foramen closure. Effects on PPO were determined in mitochondria from embryos and adult livers. RESULTS Fetal anemia in rats was evident on GDs 13 through 16. Subsequently, enlarged heart, delayed closure of the foramen, reduced serum protein, and retarded rib ossification were observed. In vitro PPO inhibition exhibited species- and compound-specific differences corresponding to the developmental toxicity. CONCLUSION We propose that developmental toxicity results from PPO inhibition in primitive erythroblasts, causing transient fetal anemia followed by death. Compensatory enlargement of the fetal heart results in failure of interventricular foramen closure and VSD. Reduced serum protein leads to delayed ossification and wavy ribs.
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Affiliation(s)
- Satoshi Kawamura
- Environmental Health Science Laboratory, Sumitomo Chemical Co. Ltd, Konohana-ku, Osaka, Japan
| | - Takafumi Yoshioka
- Environmental Health Science Laboratory, Sumitomo Chemical Co. Ltd, Konohana-ku, Osaka, Japan
| | - Nobuaki Mito
- Intellectual Property Department, Sumitomo Chemical Co. Ltd, Chuo-ku, Tokyo, Japan
| | - Noriyuki Kishimoto
- Environmental Health Science Laboratory, Sumitomo Chemical Co. Ltd, Konohana-ku, Osaka, Japan
| | - Masanao Nakaoka
- Environmental Health Science Laboratory, Sumitomo Chemical Co. Ltd, Konohana-ku, Osaka, Japan
| | - Alan G Fantel
- Department of Pediatrics, University of Washington, Seattle, Washington
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18
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Yang R, Yan S, Zhu X, Li CY, Liu Z, Xiong JW. Antimalarial drug artemisinin depletes erythrocytes by activating apoptotic pathways in zebrafish. Exp Hematol 2015; 43:331-41.e8. [PMID: 25584867 DOI: 10.1016/j.exphem.2014.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/02/2014] [Accepted: 11/11/2014] [Indexed: 11/15/2022]
Abstract
Despite its extraordinary efficacy, administration of the major antimalarial drug artemisinin leads to anemia, and the underlying cellular and molecular mechanisms are not well understood. Here, we report the effects of artemisinin on erythroid development and apoptosis in zebrafish and human cells. By performing a small-molecule screen with zebrafish embryos, we found that artemisinin treatment depleted red blood cells and slightly decreased definitive hematopoietic stem cells, but had no effect on primitive hematopoietic progenitors. RNA-Seq revealed that artemisinin suppressed a cluster of genes in the heme biosynthesis and globin synthesis pathways. Furthermore, artemisinin induced apoptosis in erythrocytes in zebrafish embryos, as assessed by terminal deoxynucleotidyl transferase dUTP nick end labeling assay, and preferentially acted on differentiated erythrocytes by elevating caspase 8 and caspase 9 activity in differentiated human K562 cells. Consistently, artemisinin suppressed the ectopic expression of erythroid genes in jak2aV581F-injected embryos, a zebrafish model for human polycythemia vera in which the bone marrow makes too many red blood cells. Taken together, our data suggested that artemisinin, in addition to killing parasites, has a direct action on differentiated erythrocytes other than definitive hematopoietic stem cells and causes erythroid apoptosis by interfering with the heme biosynthesis pathway in zebrafish and human cells.
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Affiliation(s)
- Ran Yang
- Beijing Key Laboratory of Cardiometabolic Molecular Medicine, Institute of Molecular Medicine, Peking University, Beijing, China
| | - Shouyu Yan
- Beijing Key Laboratory of Cardiometabolic Molecular Medicine, Institute of Molecular Medicine, Peking University, Beijing, China
| | - Xiaojun Zhu
- Beijing Key Laboratory of Cardiometabolic Molecular Medicine, Institute of Molecular Medicine, Peking University, Beijing, China
| | - Chuan-Yun Li
- Beijing Key Laboratory of Cardiometabolic Molecular Medicine, Institute of Molecular Medicine, Peking University, Beijing, China
| | - Zhenming Liu
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China.
| | - Jing-Wei Xiong
- Beijing Key Laboratory of Cardiometabolic Molecular Medicine, Institute of Molecular Medicine, Peking University, Beijing, China.
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Abstract
INTRODUCTION Chemotherapy of malaria has become a rapidly changing field. Less than two decades ago, treatment regimens were increasingly bound to fail due to emerging drug resistance against 4-aminoquinolines and sulfa compounds. By now, artemisinin-based combination therapies (ACTs) constitute the standard of care for uncomplicated falciparum malaria and are increasingly also taken into consideration for the treatment of non-falciparum malaria. AREAS COVERED This narrative review provides an overview of the state-of-art antimalarial drug therapy, highlights the global portfolio of current Phase III/IV clinical trials and summarizes current developments. EXPERT OPINION Malaria chemotherapy remains a dynamic field, with novel drugs and drug combinations continuing to emerge in order to outpace the development of large-scale drug resistance against the currently most important drug class, the artemisinin derivatives. More randomized controlled studies are urgently needed especially for the treatment of malaria in first trimester pregnant women. ACTs should be used for the treatment of imported malaria more consequently. Gaining sufficient efficacy and safety information on ACT use for non-falciparum species including Plasmodium ovale and malariae should be a research priority. Continuous investment into malaria drug development is a vital factor to combat artemisinin resistance and successfully improve malaria control toward the ultimate goal of elimination.
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Affiliation(s)
- Benjamin J Visser
- University of Amsterdam, Academic Medical Centre, Center of Tropical Medicine and Travel Medicine, Division of Infectious Diseases , Amsterdam , The Netherlands
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20
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Posobiec LM, Clark RL, Bushdid PB, Laffan SB, Wang KF, White TEK. Dihydroartemisinin (DHA) Treatment Causes an Arrest of Cell Division and Apoptosis in Rat Embryonic Erythroblasts in Whole Embryo Culture. ACTA ACUST UNITED AC 2014; 98:445-58. [DOI: 10.1002/bdrb.21088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/14/2013] [Indexed: 12/25/2022]
Affiliation(s)
| | | | - Paul B. Bushdid
- Safety Assessment; GlaxoSmithKline; King of Prussia Pennsylvania
| | - Susan B. Laffan
- Safety Assessment; GlaxoSmithKline; King of Prussia Pennsylvania
| | - Kai-Fen Wang
- Safety Assessment; GlaxoSmithKline; King of Prussia Pennsylvania
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21
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Hwang BS, Rho JR. Four new cyclic peroxides from the Marine Sponge Plakortis simplex. JOURNAL OF THE KOREAN MAGNETIC RESONANCE SOCIETY 2013. [DOI: 10.6564/jkmrs.2013.17.1.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Boareto A, Müller J, Lourenço E, Lombardi N, Lourenço A, Rabitto I, de Morais R, Rios F, Dalsenter P. Effects of the combined artesunate and mefloquine antimalarial drugs on rat embryos. Hum Exp Toxicol 2013; 32:930-41. [DOI: 10.1177/0960327113475678] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Artemisinins combination therapy (ACT) is the first choice therapy for falciparum malaria. Data on the safety of ACTs in pregnancy are limited and controversial and the use is not recommended on the first trimester. To evaluate the effects of isolated and combined artesunate (AS)/mefloquine (MQ) on embryo rats, pregnant rats were treated orally with AS (15 and 40 mg/kg body weight (bwt)/day), MQ (30 and 80 mg/kg bwt/day) and AS/MQ (15/30 and 40/80 mg/kg bwt/day) on days 9–11 post coitum (pc). The dams were euthanized on day 12 pc and gestational and embryos histological parameters were evaluated. Embryolethality and histopathological anomalies were significant when AS was given alone or combined with MQ. Combination of AS and MQ did not enhance their toxicity compared to their separate administrations; on the other side, there was a reduction in the toxic effects of the AS when combined with MQ. Isolated MQ did not induce developmental toxicity.
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Affiliation(s)
- A.C. Boareto
- Department of Pharmacology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - J.C. Müller
- Department of Pharmacology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - E.L.B. Lourenço
- Department of Pharmacology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - N. Lombardi
- Department of Pharmacology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - A.C. Lourenço
- Department of Pharmacology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - I. Rabitto
- Department of Pharmacology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - R.N. de Morais
- Department of Physiology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - F.S. Rios
- Department of Cell Biology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - P.R. Dalsenter
- Department of Pharmacology, Federal University of Paraná, Curitiba, Paraná, Brazil
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23
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Piperaquine phosphate: Reproduction studies. Reprod Toxicol 2012; 34:584-97. [DOI: 10.1016/j.reprotox.2012.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/24/2012] [Accepted: 09/11/2012] [Indexed: 11/17/2022]
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24
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Boareto AC, Müller JC, de Araujo SL, Lourenço AC, Lourenço ELB, Gomes C, Minatovicz B, Lombardi N, Paumgartten FR, Dalsenter PR. Study on the developmental toxicity of combined artesunate and mefloquine antimalarial drugs on rats. Reprod Toxicol 2012; 34:658-64. [PMID: 23069110 DOI: 10.1016/j.reprotox.2012.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 09/27/2012] [Accepted: 10/02/2012] [Indexed: 10/27/2022]
Abstract
Antimalarial drug combinations containing artemisinins (ACTs) have become first choice therapies for Plasmodium falciparum malaria. Data on safety of ACTs in pregnancy are limited and no previous study has been conducted on the developmental toxicity of artesunate-mefloquine combinations on the first trimester of gestation. To evaluate the developmental toxicity of an artesunate/mefloquine combination, pregnant rats were treated orally with artesunate (15 and 40 mg/kg bwt/day), mefloquine (30 and 80 mg/kg bwt/day) and artesunate/mefloquine (15/30 and 40/80 mg/kg bwt/day) on gestation days 9-11. Dams were C-sectioned on day 20, and their uteri and fetuses removed and examined for soft tissue and skeleton abnormalities. Artesunate increased embryolethality and the incidence of limb long bone malformations on the absence of overt maternal toxicity. Mefloquine (80 mg/kg bwt/day) was maternally toxic and enhanced fetal variations. Combination of artesunate and mefloquine did not enhance their toxicity compared to the toxicity observed after its separate administration. Embryotoxicity of artesunate was apparently attenuated when it is co-administered with mefloquine.
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Affiliation(s)
- Ana Cláudia Boareto
- Department of Pharmacology, Federal University of Paraná, CEP 81531-990 Curitiba, PR, Brazil.
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25
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Finaurini S, Basilico N, Corbett Y, D’Alessandro S, Parapini S, Olliaro P, Haynes RK, Taramelli D. Dihydroartemisinin inhibits the human erythroid cell differentiation by altering the cell cycle. Toxicology 2012; 300:57-66. [DOI: 10.1016/j.tox.2012.05.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/26/2012] [Accepted: 05/26/2012] [Indexed: 11/16/2022]
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26
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Copple IM, Mercer AE, Firman J, Donegan G, Herpers B, Wong MH, Chadwick J, Bringela AD, Cristiano MLS, van de Water B, Ward SA, O'Neill PM, Park BK. Examination of the cytotoxic and embryotoxic potential and underlying mechanisms of next-generation synthetic trioxolane and tetraoxane antimalarials. Mol Med 2012; 18:1045-55. [PMID: 22669474 DOI: 10.2119/molmed.2012.00154] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 05/22/2012] [Indexed: 11/06/2022] Open
Abstract
Semisynthetic artemisinin-based therapies are the first-line treatment for P. falciparum malaria, but next-generation synthetic drug candidates are urgently required to improve availability and respond to the emergence of artemisinin-resistant parasites. Artemisinins are embryotoxic in animal models and induce apoptosis in sensitive mammalian cells. Understanding the cytotoxic propensities of antimalarial drug candidates is crucial to their successful development and utilization. Here, we demonstrate that, similarly to the model artemisinin artesunate (ARS), a synthetic tetraoxane drug candidate (RKA182) and a trioxolane equivalent (FBEG100) induce embryotoxicity and depletion of primitive erythroblasts in a rodent model. We also show that RKA182, FBEG100 and ARS are cytotoxic toward a panel of established and primary human cell lines, with caspase-dependent apoptosis and caspase-independent necrosis underlying the induction of cell death. Although the toxic effects of RKA182 and FBEG100 proceed more rapidly and are relatively less cell-selective than that of ARS, all three compounds are shown to be dependent upon heme, iron and oxidative stress for their ability to induce cell death. However, in contrast to previously studied artemisinins, the toxicity of RKA182 and FBEG100 is shown to be independent of general chemical decomposition. Although tetraoxanes and trioxolanes have shown promise as next-generation antimalarials, the data described here indicate that adverse effects associated with artemisinins, including embryotoxicity, cannot be ruled out with these novel compounds, and a full understanding of their toxicological actions will be central to the continuing design and development of safe and effective drug candidates which could prove important in the fight against malaria.
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Affiliation(s)
- Ian M Copple
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, The University of Liverpool, Sherrington Buildings, Ashton Street, Liverpool, United Kingdom.
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27
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Rulisa S, Kaligirwa N, Agaba S, Karema C, Mens PF, de Vries PJ. Pharmacovigilance of artemether-lumefantrine in pregnant women followed until delivery in Rwanda. Malar J 2012; 11:225. [PMID: 22770264 PMCID: PMC3407697 DOI: 10.1186/1475-2875-11-225] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 07/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization presently recommends Artemisinin-based combination therapy (ACT) as first-line therapy for uncomplicated P. falciparum malaria. Many malaria-endemic countries, including Rwanda, have adopted these treatment guidelines. The Artemisinin derivative Artemether, in combination with lumefantrine, is currently used in Rwanda for malaria during the second and third trimesters of pregnancy. Safety data on the use of ACT in pregnancy are still limited though and more data are needed. METHODS In this pharmacovigilance study, the exposed group (pregnant women with malaria given artemether-lumefantrine), and a matched non-exposed group (pregnant women without malaria and no exposure to artemether-lumefantrine) were followed until delivery. Data were collected at public health centres all over Rwanda during acute malaria, routine antenatal visits, after hospital delivery or within 48 hours after home delivery. Information gathered from patients included routine antenatal and peri-partum data, pregnancy outcomes (abortions, stillbirths, at term delivery), congenital malformations and other adverse events through history taking and physical examination of both mothers and newborns. RESULTS The outcomes for the total sample of 2,050 women were for the treatment (n=1,072) and control groups (n=978) respectively: abortions: 1.3% and 0.4%; peri-natal mortality 3.7% and 2.8%; stillbirth 2.9% and 2.4%; neonatal death [less than or equal to]7 days after birth 0.5% and 0.4%; premature delivery 0.7% and 0.3%; congenital malformations 0.3% and 0.3%. A total of 129 obstetric adverse events in 127 subjects were reported (7.3% in the treatment group, 5.0% in the control group). In a multivariate regression model, obstetric complications were more frequent in the treatment group (OR (95% CI): 1.38 (0.95, 2.01)), and in primigravidae (OR (95% CI) 2.65 (1.71, 4.12) and at higher age (OR per year: 1.05 (1.01-1.09). CONCLUSIONS There were no specific safety concerns related to artemether-lumefantrine treatment for uncomplicated falciparum malaria in pregnancy. However, more obstetric complications were observed in the treatment group. These increased occurrence of complications could, however, be caused by the malaria episode itself, but further assessment is required.
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Affiliation(s)
- Stephen Rulisa
- National University of Rwanda, University Teaching Hospital of Kigali, BP 655, Kigali, Rwanda
- Center for Infection and Immunity Amsterdam, Center for Poverty Related Communicable Diseases (CPCD)Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Nadine Kaligirwa
- Rwanda Biomedical Centre, Center for Treatment and Research on AIDS, Malaria and TB (TRAC-PLUS), BP 2717, Kigali, Rwanda
| | - Steven Agaba
- Rwanda Biomedical Centre, Center for Treatment and Research on AIDS, Malaria and TB (TRAC-PLUS), BP 2717, Kigali, Rwanda
| | - Corine Karema
- Rwanda Biomedical Centre, Center for Treatment and Research on AIDS, Malaria and TB (TRAC-PLUS), BP 2717, Kigali, Rwanda
| | - Petra F Mens
- Center for Infection and Immunity Amsterdam, Center for Poverty Related Communicable Diseases (CPCD)Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Royal Tropical Institute/Koninklijk Instituutvoor de Tropen (KIT), KIT Biomedical Research, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands
| | - Peter J de Vries
- Center for Infection and Immunity Amsterdam, Center for Poverty Related Communicable Diseases (CPCD)Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Medical Center, Division of Infectious Diseases, Tropical Medicine and AIDS, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands
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28
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Abolaji AO, Eteng MU, Ebong PE, Brisibe EA, Dar A, Kabir N, Choudhary MI. A safety assessment of the antimalarial herb Artemisia annua during pregnancy in Wistar rats. Phytother Res 2012; 27:647-54. [PMID: 22736625 DOI: 10.1002/ptr.4760] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/17/2012] [Accepted: 05/20/2012] [Indexed: 11/11/2022]
Abstract
Artemisia annua is a Chinese antimalarial herb that has been used for more than 2000 years. The maternal and foetal safety of the ethanolic leaf extract of therapeutically active Artemisia annua (EAA), with previously determined artemisinin yield of 1.098% was evaluated in Wistar rats. Twenty pregnant rats, divided into four study groups of saline treated (control), and test groups administered orally with 100, 200 and 300 mg/kg body weights of EAA, respectively, from gestation days (GD) 8 to 19. Following overnight fast, animals were sacrificed on GD 20, and maternal blood was collected to evaluate biochemical and haematological markers. Foetuses were carefully removed, weighed, and observed for any possible malformation. Biochemical and haematological studies revealed that EAA did not result in maternal hepatotoxicity, haematotoxicity, and hyperlipidemia. While litter size significantly decreased (p < 0.05) at 100 mg/kg EAA, maternal estrogen levels decreased in all the EAA-treated groups. Non-viable (21%) and malformed (31%) foetuses were observed at the 300 mg/kg dose of EAA, which implies that although consumption of the leaf extract may not predispose users to hepatotoxicity, haematotoxicity, and hyperlipidemia, it should be taken with caution during pregnancy due to possible risk of embryotoxicity at concentrations higher than the therapeutic dose.
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Affiliation(s)
- Amos O Abolaji
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan.
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Kreeftmeijer-Vegter AR, van Genderen PJ, Visser LG, Bierman WFW, Clerinx J, van Veldhuizen CKW, de Vries PJ. Treatment outcome of intravenous artesunate in patients with severe malaria in the Netherlands and Belgium. Malar J 2012; 11:102. [PMID: 22462806 PMCID: PMC3364861 DOI: 10.1186/1475-2875-11-102] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/31/2012] [Indexed: 11/30/2022] Open
Abstract
Background Intravenous (IV) artesunate is the treatment of choice for severe malaria. In Europe, however, no GMP-manufactured product is available and treatment data in European travellers are scarce. Fortunately, artesunate became available in the Netherlands and Belgium through a named patient programme. This is the largest case series of artesunate treated patients with severe malaria in Europe. Methods Hospitalized patients treated with IV artesunate between November 2007 and December 2010 in the Netherlands and Belgium were retrospectively evaluated. Patient characteristics, treatment and clinical outcome were recorded on a standardized form and mortality, parasite clearance times and the occurrence of adverse events were evaluated. Results Of the 68 treated patients, including 55 with severe malaria, two patients died (2/55 = 3.6%). The mean time to 50% parasite clearance (PCT50), 90% and 99% were 4.4 hours (3.9 - 5.2), 14.8 hours (13.0 - 17.2), and 29.5 hours (25.9 - 34.4) respectively. Artesunate was well tolerated. However, an unusual form of haemolytic anaemia was observed in seven patients. The relationship with artesunate remains uncertain. Conclusions Data from the named patient programme demonstrate that IV artesunate is effective and well-tolerated in European travellers lacking immunity. However, increased attention needs to be paid to the possible development of haemolytic anaemia 2-3 weeks after start of treatment. Treatment of IV artesunate should be limited to the period that IV treatment is required and should be followed by a full oral course of an appropriate anti-malarial drug.
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D’Alessandro S, Basilico N, Corbett Y, Scaccabarozzi D, Omodeo-Salè F, Saresella M, Marventano I, Vaillant M, Olliaro P, Taramelli D. Hypoxia modulates the effect of dihydroartemisinin on endothelial cells. Biochem Pharmacol 2011; 82:476-84. [DOI: 10.1016/j.bcp.2011.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/30/2011] [Accepted: 06/02/2011] [Indexed: 02/03/2023]
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Sangaré LR, Weiss NS, Brentlinger PE, Richardson BA, Staedke SG, Kiwuwa MS, Stergachis A. Patterns of anti-malarial drug treatment among pregnant women in Uganda. Malar J 2011; 10:152. [PMID: 21645402 PMCID: PMC3118160 DOI: 10.1186/1475-2875-10-152] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 06/06/2011] [Indexed: 12/05/2022] Open
Abstract
Background Prompt use of an effective anti-malarial drug is essential for controlling malaria and its adverse effects in pregnancy. The World Health Organization recommends an artemisinin-based combination therapy as the first-line treatment of uncomplicated malaria in the second and third trimesters of pregnancy. The study objective was to determine the degree to which presumed episodes of uncomplicated symptomatic malaria in pregnancy were treated with a recommended anti-malarial regimen in a region of Uganda. Methods Utilizing a population-based random sample, we interviewed women living in Jinja, Uganda who had been pregnant in the past year. Results Self-reported malaria during the index pregnancy was reported among 67% (n = 334) of the 500 participants. Among the 637 self-reported episodes of malaria, an anti-malarial drug was used for treatment in 85% of the episodes. Use of a currently recommended treatment in the first trimester was uncommon (5.6%). A contraindicated anti-malarial drug (sulphadoxine-pyrimethamine and/or artemether-lumefantrine) was involved in 70% of first trimester episodes. Recommended anti-malarials were used according to the guidelines in only 30.1% of all second and third trimester episodes. Conclusions Self-reported malaria was extremely common in this population and adherence to treatment guidelines for the management of malaria in pregnancy was poor. Use of artemether-lumefantrine combined with non-recommended anti-malarials was common practice. Overuse of anti-malarial drugs, especially ones that are no longer recommended, undermines malaria control efforts by fueling the spread of drug resistance and delaying appropriate treatment of non-malarial febrile illnesses. Improved diagnostic capacity is essential to ultimately improving the management of malaria-like symptoms during pregnancy and appropriate use of currently available anti-malarials.
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Affiliation(s)
- Laura R Sangaré
- Department of Global Health, University of Washington, Seattle, WA, USA.
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Zhong YY, Zhang HF, Zhong JX, Bai L, Lu XH. Topical dihydroartemisinin inhibits suture-induced neovascularization in rat corneas through ERK1/2 and p38 pathways. Int J Ophthalmol 2011; 4:150-5. [PMID: 22553631 DOI: 10.3980/j.issn.2222-3959.2011.02.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 04/02/2011] [Indexed: 12/12/2022] Open
Abstract
AIM To determine if topical instillation of dihydroartemisinin (DHA) inhibits corneal neovascularization (NV) in rats and to investigate the role of the extracellular regulated kinases (ERK) 1/2 and p38 pathways in this process. METHODS Suture-induced corneal NV was produced in rats and the eyes were topically treated with different concentrations of DHA (20mg/L, 10mg/L or 5mg/L) or normal saline 4 times a day for 7 days. The corneal NV was quantified as the proportion of NV area to the whole cornea. Western blot was used to determine the expressions of vascular endothelial growth factor (VEGF) and the phosphorylation status of VEGF receptor-2, ERK1/2 and p38 in the corneas. Immunofluorescent staining was used to determine the expressions of phospho-ERK1/2 and phospho-p38 in the corneal tissues from the eyes treated with 20 mg/L DHA (DHA group) or normal saline (control group). RESULTS The proportion of corneal NV area in the eyes treated with normal saline or DHA at dosages of 20mg/L, 10mg/L or 5mg/L was (23.74±3.00)%, (15.73±2.88)%, (19.53±2.42)%, and (23.38±2.79)%, respectively. In the eyes treated with 20mg/L or 10mg/L DHA, the corneal NV area was significantly reduced when compared to that in eyes with normal saline (P<0.05). Western blot analyses revealed that 20mg/L DHA significantly inhibited the expressions of VEGF and phospho-VEGFR-2. Both 20mg/L and 10mg/L DHA inhibited the expressions of phospho-ERK1/2 and phospho-p38. Immunofluorescent staining further demonstrated that 20mg/L DHA lowered the expression levels of phospho-ERK1/2 and phospho-p38 in the corneas with suture-induced NV. CONCLUSION Suture-induced NV in rat corneas was significantly inhibited by topical treatment with 20mg/L and 10mg/L DHA. The results suggest that the effects could be partially dependent on the DHA-mediated inhibitions of the ERK1/2 and p38 pathways.
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Affiliation(s)
- Yan-Yan Zhong
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
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Ji Y, Zhang YC, Pei LB, Shi LL, Yan JL, Ma XH. Anti-tumor effects of dihydroartemisinin on human osteosarcoma. Mol Cell Biochem 2011; 351:99-108. [PMID: 21234653 DOI: 10.1007/s11010-011-0716-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 01/04/2011] [Indexed: 11/25/2022]
Abstract
Dihydroartemisinin (DHA) exhibits antitumor activity against a wide spectrum of cancer cells. However, whether DHA has anti-tumor effect on human osteosarcoma cells remains unknown. This study aims to investigate the anti-tumor activity of DHA and the underlying mechanisms in human osteosarcoma cell lines with different p53 mutation statuses. Four human osteosarcoma cell lines were treated with different concentrations of DHA. Then, cell proliferation was determined by the CCK-8 viability assay; apoptosis and cell cycle progression were evaluated by flow cytometry; protein expression was analyzed by western blot assay; and NF-kB activity was examined by luciferase assay. The results demonstrated that DHA treatment could inhibit the proliferation of four osteosarcoma cell lines in a dose-dependent manner. P53 wild-type osteosarcoma cells were more sensitive to DHA. Moreover, the percentage of apoptotic cell and cell arrest in G₂/M phase was increased upon DHA treatment in a dose-dependent manner. Mechanistically, DHA activated caspase-3, caspase-8, and caspase-9; upregulated the expression of Bax, FAS, and cyclin D1; downregulated the expression of Bcl-2, Cdc25B, and cyclin B1; and inhibited the activity of NF-кB. In conclusion, DHA has significant anticancer effects against human osteosarcoma cells, which include induction of apoptosis and cell cycle arrest. The p53 gene may play a certain role in the DHA-induced human osteosarcoma apoptosis and cell cycle arrest. DHA is a novel anti-osteosarcoma drug candidate that merits further study.
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Affiliation(s)
- Ye Ji
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng St., Nangang District, Harbin, Heilongjiang 150001, China
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Finaurini S, Ronzoni L, Colancecco A, Cattaneo A, Cappellini MD, Ward SA, Taramelli D. Selective toxicity of dihydroartemisinin on human CD34+ erythroid cell differentiation. Toxicology 2010; 276:128-34. [DOI: 10.1016/j.tox.2010.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 07/24/2010] [Accepted: 07/26/2010] [Indexed: 11/25/2022]
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Fattorusso C, Persico M, Calcinai B, Cerrano C, Parapini S, Taramelli D, Novellino E, Romano A, Scala F, Fattorusso E, Taglialatela-Scafati O. Manadoperoxides A-D from the Indonesian sponge Plakortis cfr. simplex. Further insights on the structure-activity relationships of simple 1,2-dioxane antimalarials. JOURNAL OF NATURAL PRODUCTS 2010; 73:1138-1145. [PMID: 20521782 DOI: 10.1021/np100196b] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The new endoperoxyketal polyketides manadoperoxides A-D (2-5) have been isolated from the Indonesian sponge Plakortis cfr. simplex and their stereostructures established by means of spectroscopic data and semisynthetic transformations. Manadoperoxides were assayed in vitro against D10 and W2 strains of Plasmodium falciparum and showed moderate antimalarial activity compared to that of plakortin (1) and peroxyplakoric B(3) ester (9), the latter differing from manadoperoxide B only by minor structural details. This unexpected difference in the antimalarial activity has been rationalized on the basis of our recently published model for the interaction of 1,2-dioxanes with heme and production of C-centered radicals toxic to the parasite. For the manadoperoxides, either the endoperoxide linkage is inaccessible to the heme iron or the O1 radical cannot evolve to produce a C-centered radical.
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Affiliation(s)
- Caterina Fattorusso
- Dipartimento di Chimica delle Sostanze Naturali, Universita di Napoli "Federico II", Via D. Montesano, 49, I-80131, Napoli, Italy
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Investigation of reproductive toxicity of piperaquine in mice. Reprod Toxicol 2010; 29:206-13. [DOI: 10.1016/j.reprotox.2009.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 10/19/2009] [Accepted: 10/28/2009] [Indexed: 11/20/2022]
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Zhang X, Liu J, Qiao H, Liu H, Ni J, Zhang W, Shi Y. Formulation optimization of dihydroartemisinin nanostructured lipid carrier using response surface methodology. POWDER TECHNOL 2010. [DOI: 10.1016/j.powtec.2009.09.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Severe embryotoxicity of artemisinin derivatives in experimental animals, but possibly safe in pregnant women. Molecules 2009; 15:40-57. [PMID: 20110870 PMCID: PMC6256922 DOI: 10.3390/molecules15010040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 12/22/2009] [Accepted: 12/24/2009] [Indexed: 11/16/2022] Open
Abstract
Preclinical studies in rodents have demonstrated that artemisinins, especially injectable artesunate, can induce fetal death and congenital malformations at a low dose range. The embryotoxicity can be induced in those animals only within a narrow window in early embryogenesis. Evidence was presented that the mechanism by which embryotoxicity of artemisinins occurs seems to be limited to fetal erythropoiesis and vasculogenesis/ angiogenesis on the very earliest developing red blood cells, causing severe anemia in the embryos with higher drug peak concentrations. However, this embryotoxicity has not been convincingly observed in clinical trials from 1,837 pregnant women, including 176 patients in the first trimester exposed to an artemisinin agent or artemisinin-based combination therapy (ACT) from 1989 to 2009. In the rodent, the sensitive early red cells are produced synchronously over one day with single or multiple exposures to the drug can result in a high proportion of cell deaths. In contrast, primates required a longer period of treatment of 12 days to induce such embryonic loss. In humans only limited information is available about this stage of red cell development; however, it is known to take place over a longer time period, and it may well be that a limited period of treatment of 2 to 3 days for malaria would not produce serious toxic effects. In addition, current oral intake, the most commonly used route of administration in pregnant women with an ACT, results in lower peak concentration and shorter exposure time of artemisinins that demonstrated that such a concentration–course profile is unlikely to induce the embryotoxicity. When relating the animal and human toxicity of artemisinins, the different drug sensitive period and pharmacokinetic profiles as reviewed in the present report may provide a great margin of safety in the pregnant women.
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Abstract
Artemisinin, a sesquiterpene lactone derived from the sweet wormwood plant Artemisia annua, and its bioactive derivatives exhibit potent anticancer effects in a variety of human cancer cell model systems. The pleiotropic response in cancer cells includes growth inhibition by cell cycle arrest, apoptosis, inhibition of angiogenesis, disruption of cell migration, and modulation of nuclear receptor responsiveness. These effects of artemisinin and its derivatives result from perturbations of many cellular signalling pathways. This review provides a comprehensive discussion of these cellular responses, and considers the ramifications for the potential development of artemisinin-based compounds in anticancer therapeutic and preventative strategies.
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Li Q, Si Y, Xie L, Zhang J, Weina P. Severe embryolethality of artesunate related to pharmacokinetics following intravenous and intramuscular doses in pregnant rats. ACTA ACUST UNITED AC 2009; 86:385-93. [DOI: 10.1002/bdrb.20207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Evaluation of the developmental toxicity of artemether during different phases of rat pregnancy. Food Chem Toxicol 2009; 47:1437-41. [DOI: 10.1016/j.fct.2009.03.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 03/04/2009] [Accepted: 03/23/2009] [Indexed: 11/22/2022]
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Schmuck G, Klaus AM, Krötlinger F, Langewische FW. Developmental and reproductive toxicity studies on artemisone. ACTA ACUST UNITED AC 2009; 86:131-43. [PMID: 19306395 DOI: 10.1002/bdrb.20192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In order to justify clinical studies in women of child-bearing age with artemisone, a new artimisinin derivative, studies to assess fertility and early embryonic development in rats, developmental toxicity in rats and rabbits, and peri-post natal development in rats were performed. METHODS AND RESULTS In the study on fertility and early embryonic development (dose levels 0-5-20-80 mg/kg bw/day), doses inducing clinical and organ toxicity were used. Only in severe toxicity conditions, a reduction of the number of estruses, a prolonged time to insemination, decreased numbers of corpora lutea, implantation sites, and viable fetuses were found. Two developmental toxicity studies were performed in rats (dose levels 0-1-2 mg/kg bw/day) and rabbits (dose levels 0-2.5-5.0-7.5 mg/kg bw/day). It was shown that rats were about 5 times more sensitive than rabbits. In rats, artemisone induced total litter loss (late resorptions) at 2 mg/kg body weight and above with an increased incidence of a common vascular variation and retarded ossification at this dose. In rabbits, maternal toxicity, abortion and a slightly increased incidence of cardiac ventricular septal defects was observed at 7.5 mg/kg body weight. In a pre- and postnatal developmental toxicity study in rats (dose levels 0-1-2-4 mg/kg bw/day), 4 mg/kg body weight artemisone induced clinical symptoms and affected postnatal survival, body weight gain in the F1 pups, and motor activity. CONCLUSIONS In summary, artemisone was shown to be embryo- and fetotoxic and induced cardiac ventricular septal defects and retarded ossification in dosages where total litter loss and abortions were observed. However, no effect on reproductive and developmental parameters below severe toxic dosages could be observed.
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Affiliation(s)
- G Schmuck
- Bayer Healthcare AG, Pharma Research Center, Wuppertal, Germany.
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Clark RL, Arima A, Makori N, Nakata Y, Bernard F, Gristwood W, Harrell A, White TEK, Wier PJ. Artesunate: developmental toxicity and toxicokinetics in monkeys. ACTA ACUST UNITED AC 2009; 83:418-34. [PMID: 18702116 DOI: 10.1002/bdrb.20163] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The developmental toxicity, toxicokinetics, and hematological effects of the antimalarial drug, artesunate, were previously studied in rats and rabbits and have now been studied in cynomolgus monkeys. METHODS Groups of up to 15 pregnant females were dosed on Gestation Days (GD) 20-50 or for 3-7-day intervals. RESULTS At 30 mg/kg/day, 6 embryos died between GD30 and GD40. Histologic examination of 3 live embryos (GD26-GD36) revealed a marked reduction in embryonic erythroblasts and cardiomyopathy. At 12 mg/kg/day, 6 embryos died between GD30 and GD45. Four surviving fetuses examined on GD100 had no malformations, but long bone lengths were slightly decreased. At the developmental no-adverse-effect-level (4 mg/kg/day), maternal plasma AUC was 3.68 ng.h/mL for artesunate and 6.93 ng.h/ml for its active metabolite, dihydroartemisinin (DHA). No developmental toxicity occurred with administration of 12 mg/kg/day for 3 or 7 days, GD29-31 or GD27-33 (maternal plasma AUC of 9.84 ng.h/mL artesunate and 16.4 ng.h/mL DHA). Exposures at embryotoxic doses were substantially lower than human therapeutic exposures. However, differences in monkey and human Vss for artesunate (0.5 L/kg vs. 0.18 L/kg) confound relying solely on AUC for assessing human risk. Decreases in reticulocyte count occur at therapeutic doses in humans. Changes to reticulocyte counts at embryotoxic doses in monkeys (> or =12 mg/kg/day) were variable and generally minor. CONCLUSIONS Artesunate was embryolethal at > or =12 mg/kg/day when dosed for at least 12 days at the beginning of organogenesis, but not when dosed for 3 or 7 days, indicating that developmental toxicity of artesunate is dependent upon duration of dosing in cynomologus monkeys.
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Affiliation(s)
- Robert L Clark
- GlaxoSmithKline, Upper Merion, Pennsylvania 19406-0939, USA
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Dellicour S, ter Kuile FO, Stergachis A. Pregnancy exposure registries for assessing antimalarial drug safety in pregnancy in malaria-endemic countries. PLoS Med 2008; 5:e187. [PMID: 18788893 PMCID: PMC2531138 DOI: 10.1371/journal.pmed.0050187] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Feiko ter Kuile and colleagues argue that there is an urgent need to develop targeted pharmacovigilance systems to assess the safety of antimalarials in early pregnancy.
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Toovey S, Bustamante LY, Uhlemann AC, East JM, Krishna S. Effect of Artemisinins and Amino Alcohol Partner Antimalarials on Mammalian Sarcoendoplasmic Reticulum Calcium Adenosine Triphosphatase Activity. Basic Clin Pharmacol Toxicol 2008; 103:209-13. [DOI: 10.1111/j.1742-7843.2008.00256.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Krishna S, Bustamante L, Haynes RK, Staines HM. Artemisinins: their growing importance in medicine. Trends Pharmacol Sci 2008; 29:520-7. [PMID: 18752857 PMCID: PMC2758403 DOI: 10.1016/j.tips.2008.07.004] [Citation(s) in RCA: 213] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 07/11/2008] [Accepted: 07/16/2008] [Indexed: 11/30/2022]
Abstract
Artemisinins are derived from extracts of sweet wormwood (Artemisia annua) and are well established for the treatment of malaria, including highly drug-resistant strains. Their efficacy also extends to phylogenetically unrelated parasitic infections such as schistosomiasis. More recently, they have also shown potent and broad anticancer properties in cell lines and animal models. In this review, we discuss recent advances in defining the role of artemisinins in medicine, with particular focus on their controversial mechanisms of action. This safe and cheap drug class that saves lives at risk from malaria can also have important potential in oncology.
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Affiliation(s)
- Sanjeev Krishna
- Centre for Infection, Division of Cellular and Molecular Medicine, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
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Li Q, Si Y, Smith KS, Zeng Q, Weina PJ. Embryotoxicity of artesunate in animal species related to drug tissue distribution and toxicokinetic profiles. ACTA ACUST UNITED AC 2008; 83:435-45. [DOI: 10.1002/bdrb.20164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Clark RL, Lerman SA, Cox EM, Gristwood WE, White TE. Developmental toxicity of artesunate in the rat: comparison to other artemisinins, comparison of embryotoxicity and kinetics by oral and intravenous routes, and relationship to maternal reticulocyte count. ACTA ACUST UNITED AC 2008; 83:397-406. [DOI: 10.1002/bdrb.20165] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Longo M, Zanoncelli S, Della Torre P, Rosa F, Giusti A, Colombo P, Brughera M, Mazué G, Olliaro P. Investigations of the effects of the antimalarial drug dihydroartemisinin (DHA) using the Frog Embryo Teratogenesis Assay-Xenopus (FETAX). Reprod Toxicol 2008; 25:433-41. [DOI: 10.1016/j.reprotox.2008.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 01/16/2008] [Accepted: 02/22/2008] [Indexed: 11/24/2022]
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Abstract
Nicholas White and colleagues discuss why it is so important to conduct clinical trials of malaria treatments in pregnancy.
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Affiliation(s)
- Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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