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Masaku J, Gachohi JM, Sinkeet A, Maghanga M, Wakesho F, Omondi W, Monnier N, Steinmann P, Reigl LS, Lange IL, Winkler AS, Njenga SM, Amuyunzu-Nyamongo M. Community preferred drug delivery approaches for pilot roll-out of a potential novel paediatric schistosomiasis treatment option in two endemic counties of Kenya: A mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003221. [PMID: 38820456 PMCID: PMC11142487 DOI: 10.1371/journal.pgph.0003221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/22/2024] [Indexed: 06/02/2024]
Abstract
Treating preschool age children (PSAC) for schistosomiasis has remained a challenge due to lack of a pediatric formulation. In response to this unmet need, the Paediatric Praziquantel Consortium has developed a potential novel paediatric treatment option. In advance to its roll-out to follow regulatory response, we conducted a social science study to gather information on preferred drug delivery approaches to inform implementation. A cross-sectional study was conducted in eight villages in two purposively selected Kenyan counties. A questionnaire was administered on 690 parents/guardians of PSAC at household level. Preferred drug delivery approaches were analyzed using frequencies and proportions. We conducted key informant interviews with 17 opinion leaders and 28 healthcare workers, and 12 focus group discussions with parents/guardians of PSAC and 7 with community health volunteers (CHVs). Thematic analysis was performed on the qualitative data. Majority of the 690 respondents were women 594 (86.1%) with a mean age of 34.1 (SD = 11.3, min-max = 18-86). Community-based mass drug administration (cMDA) was the most preferred drug delivery method by 598 participants (86.7%), followed by health facility/fixed points by 398 participants (57.7%). Similarly, in the qualitative data participants indicated they prefer cMDA since the CHVs who would distribute the medication are familiar with households with PSAC and are trusted to explain the drug effects. Health facilities/fixed points were the second most preferred drug delivery approach, but some health workers we interviewed expressed concern about potential understaffing and overcrowding of facilities. Appropriate timing of the drug distribution, not to interfere with farming activities, was considered critical, irrespective of the approach used. All profiles of study participants preferred cMDA over the other delivery approaches due to the convenience of receiving drugs at home and providing explanations about the new drug. For positive outcomes, adequate planning, proper timings and community involvement are highly recommended.
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Affiliation(s)
- Janet Masaku
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
| | - John M. Gachohi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
| | - Alice Sinkeet
- African Institute for Health and Development (AIHD), Nairobi, Kenya
| | - Mary Maghanga
- African Institute for Health and Development (AIHD), Nairobi, Kenya
| | - Florence Wakesho
- Division of Vector Borne and Neglected Tropical Diseases (DVB/NTDs), Ministry of Health (MoH), Nairobi, Kenya
| | - Wyckliff Omondi
- Division of Vector Borne and Neglected Tropical Diseases (DVB/NTDs), Ministry of Health (MoH), Nairobi, Kenya
| | - Nora Monnier
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Peter Steinmann
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Lisa Sophie Reigl
- Department of Neurology, Center for Global Health, Technical University of Munich (TUM), Munich, Germany
| | - Isabelle L. Lange
- Department of Neurology, Center for Global Health, Technical University of Munich (TUM), Munich, Germany
| | - Andrea S. Winkler
- Department of Neurology, Center for Global Health, Technical University of Munich (TUM), Munich, Germany
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sammy M. Njenga
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Mary Amuyunzu-Nyamongo
- Division of Vector Borne and Neglected Tropical Diseases (DVB/NTDs), Ministry of Health (MoH), Nairobi, Kenya
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Makanga M, Beattie P, Jajkowicz D, Nyirenda T, Tanner M, Hankins C. Impact with equity: EDCTP and equitable research partnerships. Lancet Glob Health 2024; 12:e552-e554. [PMID: 38485420 DOI: 10.1016/s2214-109x(24)00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Michael Makanga
- Global Health EDCTP3 Joint Undertaking, 1060 Brussels, Belgium.
| | | | | | | | - Marcel Tanner
- EDCTP Association, Swiss Academies of Arts and Sciences, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Catherine Hankins
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands
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Marchant JS. Progress interrogating TRPMPZQ as the target of praziquantel. PLoS Negl Trop Dis 2024; 18:e0011929. [PMID: 38358948 PMCID: PMC10868838 DOI: 10.1371/journal.pntd.0011929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
The drug praziquantel (PZQ) has served as the long-standing drug therapy for treatment of infections caused by parasitic flatworms. These encompass diseases caused by parasitic blood, lung, and liver flukes, as well as various tapeworm infections. Despite a history of clinical usage spanning over 4 decades, the parasite target of PZQ has long resisted identification. However, a flatworm transient receptor potential ion channel from the melastatin subfamily (TRPMPZQ) was recently identified as a target for PZQ action. Here, recent experimental progress interrogating TRPMPZQ is evaluated, encompassing biochemical, pharmacological, genetic, and comparative phylogenetic data that highlight the properties of this ion channel. Various lines of evidence that support TRPMPZQ being the therapeutic target of PZQ are presented, together with additional priorities for further research into the mechanism of action of this important clinical drug.
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Affiliation(s)
- Jonathan S. Marchant
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
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Park SK, Sprague DJ, Rohr CM, Chulkov EG, Petrow I, Kumar S, Marchant JS. The anthelmintic meclonazepam activates a schistosome transient receptor potential channel. J Biol Chem 2024; 300:105528. [PMID: 38043794 PMCID: PMC10788528 DOI: 10.1016/j.jbc.2023.105528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023] Open
Abstract
Parasitic flatworms cause various clinical and veterinary infections that impart a huge burden worldwide. The most clinically impactful infection is schistosomiasis, a neglected tropical disease caused by parasitic blood flukes. Schistosomiasis is treated with praziquantel (PZQ), an old drug introduced over 40 years ago. New drugs are urgently needed, as while PZQ is broadly effective it suffers from several limitations including poor efficacy against juvenile worms, which may prevent it from being completely curative. An old compound that retains efficacy against juvenile worms is the benzodiazepine meclonazepam (MCLZ). However, host side effects caused by benzodiazepines preclude development of MCLZ as a drug and MCLZ lacks an identified parasite target to catalyze rational drug design for engineering out human host activity. Here, we identify a transient receptor potential ion channel of the melastatin subfamily, named TRPMMCLZ, as a parasite target of MCLZ. MCLZ potently activates Schistosoma mansoni TRPMMCLZ through engagement of a binding pocket within the voltage-sensor-like domain of the ion channel to cause worm paralysis, tissue depolarization, and surface damage. TRPMMCLZ reproduces all known features of MCLZ action on schistosomes, including a lower activity versus Schistosoma japonicum, which is explained by a polymorphism within this voltage-sensor-like domain-binding pocket. TRPMMCLZ is distinct from the TRP channel targeted by PZQ (TRPMPZQ), with both anthelmintic chemotypes targeting unique parasite TRPM paralogs. This advances TRPMMCLZ as a novel druggable target that could circumvent any target-based resistance emerging in response to current mass drug administration campaigns centered on PZQ.
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Affiliation(s)
- Sang-Kyu Park
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daniel J Sprague
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Program in Chemical Biology, Department of Biochemistry, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Claudia M Rohr
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Evgeny G Chulkov
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ian Petrow
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sushil Kumar
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan S Marchant
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Friedrich L, Park SK, Ballard P, Ho Baeurle TH, Maillard D, Bödding M, Keiser J, Marchant JS, Spangenberg T. Metabolism of (R)-Praziquantel versus the Activation of a Parasite Transient Receptor Potential Melastatin Ion Channel. ChemMedChem 2023; 18:e202300140. [PMID: 37272317 PMCID: PMC10530395 DOI: 10.1002/cmdc.202300140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/06/2023]
Abstract
Praziquantel (PZQ) is an essential anthelmintic drug recently established to be an activator of a Transient Receptor Potential Melastatin (TRPMPZQ ) ion channel in trematode worms. Bioinformatic, mutagenesis and drug metabolism work indicate that the cyclohexyl ring of PZQ is a key pharmacophore for activation of trematode TRPMPZQ , as well as serving as the primary site of oxidative metabolism which results in PZQ being a short-lived drug. Based on our recent findings, the hydrophobic cleft in schistosome TRPMPZQ defined by three hydrophobic residues surrounding the cyclohexyl ring has little tolerance for polarity. Here we evaluate the in vitro and in vivo activities of PZQ analogues with improved metabolic stability relative to the challenge of maintaining activity on the channel. Finally, an estimation of the respective contribution to the overall activity of both the parent and the main metabolite of PZQ in humans is reported.
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Affiliation(s)
- Lukas Friedrich
- Global Research & Development, Merck Healthcare KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
| | - Sang-Kyu Park
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee WI, 53226, USA
| | | | | | - David Maillard
- Central Process Development-Downstream Processing Services, Merck Electronics KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
| | - Matthias Bödding
- Merck Healthcare KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Kreuzstr. 2, 4123, Allschwil, Switzerland
- Helminth Drug Development Unit, University of Basel, Basel, Switzerland
| | - Jonathan S Marchant
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee WI, 53226, USA
| | - Thomas Spangenberg
- Global Health Institute of Merck, Ares Trading S.A., a subsidiary of Merck KGaA, Darmstadt Germany, 1262, Eysins, Switzerland
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Yang GJ, Zhou XN. A new formulation of praziquantel to achieve schistosomiasis elimination. THE LANCET. INFECTIOUS DISEASES 2023; 23:774-776. [PMID: 36893783 DOI: 10.1016/s1473-3099(23)00059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Guo-Jing Yang
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Tropical Medicine, The First Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases at Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, NHC Key Laboratory on Parasite and Vector Biology, Shanghai, China; School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Hainan Center of Tropical Diseases Research, Haikou, China.
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