1
|
Kümpornsin K, Loesbanluechai D, de Cozar C, Kotanan N, Chotivanich K, White NJ, Wilairat P, Gomez-Lorenzo MG, Gamo FJ, Sanz LM, Lee MCS, Chookajorn T. Lumefantrine attenuates Plasmodium falciparum artemisinin resistance during the early ring stage. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2021; 17:186-190. [PMID: 34673330 PMCID: PMC8528645 DOI: 10.1016/j.ijpddr.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022]
Abstract
Emerging artemisinin resistance in Plasmodium falciparum malaria has the potential to become a global public health crisis. In Southeast Asia, this phenomenon clinically manifests in the form of delayed parasite clearance following artemisinin treatment. Reduced artemisinin susceptibility is limited to the early ring stage window, which is sufficient to allow parasites to survive the short half-life of artemisinin exposure. A screen of known clinically-implemented antimalarial drugs was performed to identify a drug capable of enhancing the killing activity of artemisinins during this critical resistance window. As a result, lumefantrine was found to increase the killing activity of artemisinin against an artemisinin-resistant clinical isolate harboring the C580Y kelch13 mutation. Isobologram analysis revealed synergism during the early ring stage resistance window, when lumefantrine was combined with artemether, an artemisinin derivative clinically partnered with lumefantrine. These findings suggest that lumefantrine should be clinically explored as a partner drug in artemisinin-based combination therapies to control emerging artemisinin resistance. Artemisinin booster compound screening targeting the early ring resistance window in Plasmodium falciparum was performed. Lumefantrine improves the activity of artesunate against the parasite during the resistance window. Artemether and lumefantrine are synergistic during the early ring stage resistance window.
Collapse
Affiliation(s)
| | - Duangkamon Loesbanluechai
- Genomics and Evolutionary Medicine Unit (GEM), Centre of Excellence in Malaria Research, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Molecular Medicine Program, Multidisciplinary Unit, Faculty of Science, Mahidol University, Bangkok, Thailand
| | | | - Namfon Kotanan
- Genomics and Evolutionary Medicine Unit (GEM), Centre of Excellence in Malaria Research, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kesinee Chotivanich
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Prapon Wilairat
- Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok, Thailand
| | | | | | | | - Marcus C S Lee
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK.
| | - Thanat Chookajorn
- Genomics and Evolutionary Medicine Unit (GEM), Centre of Excellence in Malaria Research, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
2
|
Erhunse N, Sahal D. Protecting future antimalarials from the trap of resistance: Lessons from artemisinin-based combination therapy (ACT) failures. J Pharm Anal 2021; 11:541-554. [PMID: 34765267 PMCID: PMC8572664 DOI: 10.1016/j.jpha.2020.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/19/2020] [Accepted: 07/19/2020] [Indexed: 11/01/2022] Open
Abstract
Having faced increased clinical treatment failures with dihydroartemisinin-piperaquine (DHA-PPQ), Cambodia swapped the first line artemisinin-based combination therapy (ACT) from DHA-PPQ to artesunate-mefloquine given that parasites resistant to piperaquine are susceptible to mefloquine. However, triple mutants have now emerged, suggesting that drug rotations may not be adequate to keep resistance at bay. There is, therefore, an urgent need for alternative treatment strategies to tackle resistance and prevent its spread. A proper understanding of all contributors to artemisinin resistance may help us identify novel strategies to keep artemisinins effective until new drugs become available for their replacement. This review highlights the role of the key players in artemisinin resistance, the current strategies to deal with it and suggests ways of protecting future antimalarial drugs from bowing to resistance as their predecessors did.
Collapse
Affiliation(s)
- Nekpen Erhunse
- Malaria Drug Discovery Research Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, 110067, India
- Department of Biochemistry, Faculty of Life Sciences, University of Benin, Benin City, Edo-State, Nigeria
| | - Dinkar Sahal
- Malaria Drug Discovery Research Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, 110067, India
| |
Collapse
|
3
|
Efforts Made to Eliminate Drug-Resistant Malaria and Its Challenges. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5539544. [PMID: 34497848 PMCID: PMC8421183 DOI: 10.1155/2021/5539544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/09/2021] [Indexed: 01/01/2023]
Abstract
Since 2000, a good deal of progress has been made in malaria control. However, there is still an unacceptably high burden of the disease and numerous challenges limiting advancement towards its elimination and ultimate eradication. Among the challenges is the antimalarial drug resistance, which has been documented for almost all antimalarial drugs in current use. As a result, the malaria research community is working on the modification of existing treatments as well as the discovery and development of new drugs to counter the resistance challenges. To this effect, many products are in the pipeline and expected to be marketed soon. In addition to drug and vaccine development, mass drug administration (MDA) is under scientific scrutiny as an important strategy for effective utilization of the developed products. This review discusses the challenges related to malaria elimination, ongoing approaches to tackle the impact of drug-resistant malaria, and upcoming antimalarial drugs.
Collapse
|
4
|
Varo R, Bassat Q. Arterolane-based combinations for the treatment of uncomplicated falciparum malaria in Kenyan children. THE LANCET. INFECTIOUS DISEASES 2021; 21:1338-1339. [PMID: 34111411 DOI: 10.1016/s1473-3099(21)00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Rosauro Varo
- Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Quique Bassat
- Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona 08036, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ICREA, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.
| |
Collapse
|
5
|
Alagbonsi AI, Salman TM, Sulaiman SO, Adedini KA, Kebu S. Possible mechanisms of the hypoglycaemic effect of artesunate: Gender implication. Metabol Open 2021; 10:100087. [PMID: 33778463 PMCID: PMC7985403 DOI: 10.1016/j.metop.2021.100087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023] Open
Abstract
Background We investigated the mechanism of artesunate’s glucose-modulating effect especially with gender implication. Methods Twenty-five (25) male and 25 female rats were separately and blindly allocated into five identical groups (n = 5/group). Group I (control) received 0.2 ml/kg distilled water. Groups II and III both received 2.90 mg/kg artesunate on day one, but 1.45 mg/kg from day two till day five and day fifteen respectively. Groups IV and V both received 8.70 mg/kg artesunate on day one, but 4.35 mg/kg artesunate from day two till day five and day fifteen respectively. Results In male rats, glucose was reduced by both doses of artesunate at 5 days but increased by high dose at 15 days. Artesunate increased glycogen concentration at short duration which normalised at long duration in both genders. Artesunate increased G6P concentration only in male rats at 15 days but reduced G6Pase activity in male and female rats (except in those that received low and high doses of artesunate for 15 days). Artesunate increased insulin only in male rats treated with low dose artesunate for 5 days. Artesunate increased cortisol concentration in male but reduced it in female rats. Artesunate decreased glucagon concentration except in female rats treated with high dose for 5 days. Artesunate increased oestrogen concentration in male rats that received low dose artesunate for 5 days but reduced it in female rats that received high dose for 15 days. Conclusions Artesunate reduces plasma glucose by reducing plasma glucagon concentrations and inhibiting liver glycogenolysis via inhibition of G6Pase activity in both sexes. Increase in insulin concentration contributed to the reduction in blood glucose caused by artesunate in male but not female rats; and artesunate-induced increase in G6P, a substrate for G6PD, could enhance NADPH generation and antioxidant enzyme activation in male rats. Reducing glucagon concentration and inhibiting G6Pase activity in both genders. . Increasing plasma insulin in male but not in female. Increasing G6P, a substrate for G6PD, in male rats.
Collapse
Affiliation(s)
- Abdullateef Isiaka Alagbonsi
- Department of Clinical Biology (Physiology unit), School of Medicine and Pharmacy, University of Rwanda College of Medicine and Health Sciences, Huye, Rwanda
| | - Toyin Mohammad Salman
- Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria
| | - Sheu Oluwadare Sulaiman
- Department of Physiology, Kampala International University Western Campus, Ishaka Bushenyi, Uganda.,Department of Cell Biology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kafayat Anike Adedini
- Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria
| | - Susan Kebu
- Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria
| |
Collapse
|
6
|
van der Pluijm RW, Amaratunga C, Dhorda M, Dondorp AM. Triple Artemisinin-Based Combination Therapies for Malaria - A New Paradigm? Trends Parasitol 2020; 37:15-24. [PMID: 33060063 DOI: 10.1016/j.pt.2020.09.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 01/31/2023]
Abstract
Recent gains in the fight against malaria are threatened by the emergence and spread of artemisinin and partner drug resistance in Plasmodium falciparum in the Greater Mekong Subregion (GMS). When artemisinins are combined with a single partner drug, all recommended artemisinin-based combination therapies have shown reduced efficacy in some countries in the GMS at some point. Novel drugs are not available for the near future. Triple artemisinin-based combination therapies, combining artemisinins with two currently available partner drugs, will provide one of the last remaining safe and effective treatments for falciparum malaria that can be deployed rapidly in the GMS, whereas their deployment beyond the GMS could delay or prevent the global emergence and spread of resistance to currently available drugs.
Collapse
Affiliation(s)
- Rob W van der Pluijm
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chanaki Amaratunga
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mehul Dhorda
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; WorldWide Antimalarial Resistance Network - Asia-Pacific Regional Centre, Bangkok, Thailand
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| |
Collapse
|
7
|
Dokunmu TM, Adjekukor CU, Yakubu OF, Bello AO, Adekoya JO, Akinola O, Amoo EO, Adebayo AH. Asymptomatic malaria infections and Pfmdr1 mutations in an endemic area of Nigeria. Malar J 2019; 18:218. [PMID: 31248414 PMCID: PMC6598231 DOI: 10.1186/s12936-019-2833-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/09/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Malaria eradication globally is yet to be achieved and transmission is sustained in many endemic countries. Plasmodium falciparum continues to develop resistance to currently available anti-malarial drugs, posing great problems for malaria elimination. This study evaluates the frequencies of asymptomatic infection and multidrug resistance-1 (mdr-1) gene mutations in parasite isolates, which form the basis for understanding persistently high incidence in South West, Nigeria. METHODS A total of 535 individuals aged from 6 months were screened during the epidemiological survey evaluating asymptomatic transmission. Parasite prevalence was determined by histidine-rich protein II rapid detection kit (RDT) in healthy individuals. Plasmodium falciparum mdr-1 gene mutations were detected by polymerase chain reaction (PCR) followed by restriction enzyme digest and electrophoresis to determine polymorphism in parasite isolates. Sequencing was done to confirm polymorphism. Proportions were compared using Chi-square test at p value < 0.05. RESULTS Malaria parasites were detected by RDT in 204 (38.1%) individuals. Asymptomatic infection was detected in 117 (57.3%) and symptomatic malaria confirmed in 87 individuals (42.6%). Overall, individuals with detectable malaria by RDT was significantly higher in individuals with symptoms, 87 of 197 (44.2%), than asymptomatic persons; 117 of 338 (34.6%), p = 0.02. In a sub-set of 75 isolates, 18(24%) and 14 (18.6%) individuals had Pfmdr1 86Y and 1246Y mutations. CONCLUSIONS There is still high malaria transmission rate in Nigeria with higher incidence of asymptomatic infections. These parasites harbour mutations on Pfmdr1 which contribute to artemisinin partner drug resistance; surveillance strategies to reduce the spread of drug resistance in endemic areas are needed to eliminate the reservoir of malaria parasites that can mitigate the eradication of malaria in Nigeria.
Collapse
Affiliation(s)
| | | | - Omolara F Yakubu
- Department of Biochemistry, Covenant University, Ota, 23401, Nigeria
| | - Adetutu O Bello
- Department of Biological Sciences, Covenant University, Ota, 23401, Nigeria
| | - Jarat O Adekoya
- Department of Biological Sciences, Covenant University, Ota, 23401, Nigeria
| | - Olugbenga Akinola
- Department of Pharmacology and Therapeutics, University of Ilorin, Ilorin, 24003, Nigeria
| | - Emmanuel O Amoo
- Demography and Social Statistics Unit, Department of Economics and Development Studies, Covenant University, Ota, 23401, Nigeria
| | - Abiodun H Adebayo
- Department of Biochemistry, Covenant University, Ota, 23401, Nigeria.
| |
Collapse
|
8
|
Takahashi E, Nonaka D, Iwagami M, Phoutnalong V, Chanthakoumane K, Kobayashi J, Pongvongsa T, Kounnavong S, Hongvanthong B, Brey PT, Kano S. Patients' adherence to artemisinin-based combination therapy and healthcare workers' perception and practice in Savannakhet province, Lao PDR. Trop Med Health 2018; 46:44. [PMID: 30607137 PMCID: PMC6303952 DOI: 10.1186/s41182-018-0125-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/28/2018] [Indexed: 11/15/2022] Open
Abstract
Background Artemisinin resistance in Plasmodium falciparum has been spreading across Southeast Asia. Patients’ adherence to artemisinin-based combination therapy (ACT) is critical to avoid expanding this resistance. The objectives of this research were to examine patients’ adherence to ACT for the treatment of uncomplicated malaria and to examine the healthcare workers’ perception of medication adherence and their dispensing practices for malaria patients in Savannakhet province, Lao PDR. Methods A prospective observational study of patients and a descriptive study of healthcare workers were conducted in Xepon, Phin, and Nong districts. In the patient study, patients aged 18 years old or older who were prescribed artemether-lumefantrine (AL) at six healthcare facilities between October 2016 and August 2017 were examined. Patient interviews and tablet counts were conducted on the first day of treatment (day 0) and the follow-up day (around day 3). In the healthcare workers study, a self-administered questionnaire survey was conducted. Results Of the 54 patients examined, 51 (94.4%) were adherent to the AL regimen. The other three patients stopped medication because they felt better, even though the importance of completing the regimen was explained to all patients when it was prescribed. Among 152 healthcare workers who had ever instructed a malaria patient, 74.3% reported that they occasionally saw a malaria patient who adhered poorly to medication instructions. The healthcare workers perceived the major reasons for poor adherence to be illiteracy and poor understanding of medication instructions by patients. In practice, 27.6% of the healthcare workers did not regularly explain the importance of completing the regimen to patients, and 32.2% did not often or always confirm the patients’ understanding of medication instructions. Conclusions Patient adherence to AL was high. The healthcare workers perceived that poor adherence was attributable to the patients, i.e., their poor understanding and illiteracy, which appeared to be related to linguistic differences. However, poor adherence also appeared to be attributable to the healthcare workers, who should tell patients of the importance of completing the AL regimen regardless of their improvement in physical condition and also confirm the patients’ understanding of the instructions. Electronic supplementary material The online version of this article (10.1186/s41182-018-0125-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Emiri Takahashi
- 1Department of Global Health, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan.,SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic
| | - Daisuke Nonaka
- 1Department of Global Health, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan.,SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic
| | - Moritoshi Iwagami
- SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,3Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, 162-8655 Japan.,4Institut Pasteur du Laos, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Vilay Phoutnalong
- 1Department of Global Health, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan.,SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,5Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Ketmany Chanthakoumane
- 6Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Jun Kobayashi
- 1Department of Global Health, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan.,SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic
| | - Tiengkham Pongvongsa
- SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Savannakhet Provincial Health Department, Savannakhet, Lao People's Democratic Republic.,8Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sengchanh Kounnavong
- 6Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Bouasy Hongvanthong
- SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,5Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Paul T Brey
- SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,4Institut Pasteur du Laos, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Shigeyuki Kano
- SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,3Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, 162-8655 Japan
| |
Collapse
|
9
|
Grigg MJ, William T, Piera KA, Rajahram GS, Jelip J, Aziz A, Menon J, Marfurt J, Price RN, Auburn S, Barber BE, Yeo TW, Anstey NM. Plasmodium falciparum artemisinin resistance monitoring in Sabah, Malaysia: in vivo therapeutic efficacy and kelch13 molecular marker surveillance. Malar J 2018; 17:463. [PMID: 30526613 PMCID: PMC6287347 DOI: 10.1186/s12936-018-2593-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/23/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Spreading Plasmodium falciparum artemisinin drug resistance threatens global malaria public health gains. Limited data exist to define the extent of P. falciparum artemisinin resistance southeast of the Greater Mekong region in Malaysia. METHODS A clinical efficacy study of oral artesunate (total target dose 12 mg/kg) daily for 3 days was conducted in patients with uncomplicated falciparum malaria and a parasite count < 100,000/µL admitted to 3 adjacent district hospitals in Sabah, East Malaysia. On day 3 and 4 all patients were administered split dose mefloquine (total dose 25 mg/kg) and followed for 28 days. Twenty-one kelch13 polymorphisms associated with P. falciparum artemisinin resistance were also evaluated in P. falciparum isolates collected from patients presenting to health facilities predominantly within the tertiary referral area of western Sabah between 2012 and 2016. RESULTS In total, 49 patients were enrolled and treated with oral artesunate. 90% (44/49) of patients had cleared their parasitaemia by 48 h and 100% (49/49) within 72 h. The geometric mean parasite count at presentation was 9463/µL (95% CI 6757-13,254), with a median time to 50% parasite clearance of 4.3 h (IQR 2.0-8.4). There were 3/45 (7%) patients with a parasite clearance slope half-life of ≥ 5 h. All 278 P. falciparum isolates evaluated were wild-type for kelch13 markers. CONCLUSION There is no suspected or confirmed evidence of endemic artemisinin-resistant P. falciparum in this pre-elimination setting in Sabah, Malaysia. Current guidelines recommending first-line treatment with ACT remain appropriate for uncomplicated malaria in Sabah, Malaysia. Ongoing surveillance is needed southeast of the Greater Mekong sub-region.
Collapse
Affiliation(s)
- Matthew J Grigg
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia.
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Jesselton Medical Centre, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
| | - Kim A Piera
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Giri S Rajahram
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
- Sabah Department of Health, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
| | - Jenarun Jelip
- Vector Disease Sector, Disease Control Division, Ministry of Health, Kuala Lumpur, Malaysia
| | - Ammar Aziz
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia
| | - Jayaram Menon
- Clinical Research Centre, Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
- Sabah Department of Health, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia
| | - Bridget E Barber
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Tsin W Yeo
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| |
Collapse
|
10
|
Ebenebe JC, Ntadom G, Ambe J, Wammanda R, Jiya N, Finomo F, Emechebe G, Mokuolu O, Akano K, Agomo C, Folarin OA, Oguche S, Useh F, Oyibo W, Aderoyeje T, Abdulkadir M, Ezeigwe NM, Happi C, Sowunmi A. Efficacy of Artemisinin-Based Combination Treatments of Uncomplicated Falciparum Malaria in Under-Five-Year-Old Nigerian Children Ten Years Following Adoption as First-Line Antimalarials. Am J Trop Med Hyg 2018; 99:649-664. [PMID: 29943725 PMCID: PMC6169162 DOI: 10.4269/ajtmh.18-0115] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/08/2018] [Indexed: 11/07/2022] Open
Abstract
The efficacies of 3-day regimens of artemether-lumefantrine (AL), artesunate-amodiaquine (AA), and dihydroartemisinin-piperaquine (DHP) were evaluated in 910 children < 5 years old with uncomplicated malaria from six geographical areas of Nigeria. Parasite positivity 1 day and Kaplan-Meier estimated risk of persistent parasitemia 3 days after therapy initiation were both significantly higher, and geometric mean parasite reduction ratio 1 day after treatment initiation (PRRD1) was significantly lower in AL-treated children than in AA- and DHP-treated children. No history of fever, temperature > 38°C, enrollment parasitemia > 75,000 μL-1, and PRRD1 < 5,000 independently predicted persistent parasitemia 1 day after treatment initiation. Parasite clearance was significantly faster and risk of reappearance of asexual parasitemia after initial clearance was significantly lower in DHP-treated children. Overall, day 42 polymerase chain reaction-corrected efficacy was 98.3% (95% confidence interval [CI]: 96.1-100) and was similar for all treatments. In a non-compartment model, declines of parasitemias were monoexponential with mean terminal elimination half-life of 1.3 hours and unimodal frequency distribution of half-lives. All treatments were well tolerated. In summary, all three treatments evaluated remain efficacious treatments of uncomplicated malaria in young Nigerian children, but DHP appears more efficacious than AL or AA.
Collapse
Affiliation(s)
- Joy C. Ebenebe
- Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nigeria
| | - Godwin Ntadom
- National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
| | - Jose Ambe
- Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | | | - Nma Jiya
- Department of Paediatrics, Uthman Dan Fodio University, Sokoto, Nigeria
| | - Finomo Finomo
- Department of Paediatrics, Federal Medical Centre, Yenagoa, Nigeria
| | - George Emechebe
- Department of Paediatrics, Imo State University Teaching Hospital, Orlu, Nigeria
| | - Olugbenga Mokuolu
- Department of Paediatrics and Child Health, University of Ilorin, Ilorin, Nigeria
| | - Kazeem Akano
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Chimere Agomo
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
| | - Onikepe A. Folarin
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Stephen Oguche
- Department of Paediatrics, University of Jos, Jos, Nigeria
| | - Francis Useh
- Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
| | - Wellington Oyibo
- Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
| | - Temitope Aderoyeje
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Mohammed Abdulkadir
- Department of Paediatrics and Child Health, University of Ilorin, Ilorin, Nigeria
| | - Nnenna M. Ezeigwe
- National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
| | - Christian Happi
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Akintunde Sowunmi
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - for the Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nigeria
- National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
- Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
- Department of Paediatrics, Uthman Dan Fodio University, Sokoto, Nigeria
- Department of Paediatrics, Federal Medical Centre, Yenagoa, Nigeria
- Department of Paediatrics, Imo State University Teaching Hospital, Orlu, Nigeria
- Department of Paediatrics and Child Health, University of Ilorin, Ilorin, Nigeria
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
- Department of Paediatrics, University of Jos, Jos, Nigeria
- Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
- Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
11
|
Fitness Loss under Amino Acid Starvation in Artemisinin-Resistant Plasmodium falciparum Isolates from Cambodia. Sci Rep 2018; 8:12622. [PMID: 30135481 PMCID: PMC6105667 DOI: 10.1038/s41598-018-30593-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/31/2018] [Indexed: 11/09/2022] Open
Abstract
Artemisinin is the most rapidly effective drug for Plasmodium falciparum malaria treatment currently in clinical use. Emerging artemisinin-resistant parasites pose a great global health risk. At present, the level of artemisinin resistance is still relatively low with evidence pointing towards a trade-off between artemisinin resistance and fitness loss. Here we show that artemisinin-resistant P. falciparum isolates from Cambodia manifested fitness loss, showing fewer progenies during the intra-erythrocytic developmental cycle. The loss in fitness was exacerbated under the condition of low exogenous amino acid supply. The resistant parasites failed to undergo maturation, whereas their drug-sensitive counterparts were able to complete the erythrocytic cycle under conditions of amino acid deprivation. The artemisinin-resistant phenotype was not stable, and loss of the phenotype was associated with changes in the expression of a putative target, Exp1, a membrane glutathione transferase. Analysis of SNPs in haemoglobin processing genes revealed associations with parasite clearance times, suggesting changes in haemoglobin catabolism may contribute to artemisinin resistance. These findings on fitness and protein homeostasis could provide clues on how to contain emerging artemisinin-resistant parasites.
Collapse
|
12
|
A Thioredoxin Homologous Protein of Plasmodium falciparum Participates in Erythrocyte Invasion. Infect Immun 2018; 86:IAI.00289-18. [PMID: 29844242 PMCID: PMC6056854 DOI: 10.1128/iai.00289-18] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/18/2018] [Indexed: 12/30/2022] Open
Abstract
Invasion of erythrocytes by merozoites is required in the life cycle of malarial parasites. Proteins derived from the invasive merozoites are essential ligands for erythrocyte recognition and penetration. Invasion of erythrocytes by merozoites is required in the life cycle of malarial parasites. Proteins derived from the invasive merozoites are essential ligands for erythrocyte recognition and penetration. In this study, we report a novel protein that possesses a Trx domain-like structure of the thioredoxin family and is expressed on the surface of merozoites of the malaria parasite Plasmodium falciparum. This protein, namely, PfTrx-mero protein, displayed a mutated sequence character at the Trx domain, but with a specific binding activity to human erythrocytes. Specific antibodies to the protein inhibited merozoite invasion into human erythrocytes. Immunization with a homologous protein of Plasmodium berghei strain ANKA also showed significant protection against lethal infection in mice. These results suggested that the novel PfTrx-like-mero protein expressed on the surface of merozoites is an important ligand participating in erythrocyte invasion and a potential vaccine candidate.
Collapse
|
13
|
Tun KM, Jeeyapant A, Myint AH, Kyaw ZT, Dhorda M, Mukaka M, Cheah PY, Imwong M, Hlaing T, Kyaw TH, Ashley EA, Dondorp A, White NJ, Day NPJ, Smithuis F. Effectiveness and safety of 3 and 5 day courses of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in an area of emerging artemisinin resistance in Myanmar. Malar J 2018; 17:258. [PMID: 29996844 PMCID: PMC6042398 DOI: 10.1186/s12936-018-2404-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Artemisinin resistance in Plasmodium falciparum has emerged and spread in Southeast Asia. In areas where resistance is established longer courses of artemisinin-based combination therapy have improved cure rates. METHODS The standard 3-day course of artemether-lumefantrine (AL) was compared with an extended 5-day regimen for the treatment of uncomplicated falciparum malaria in Kayin state in South-East Myanmar, an area of emerging artemisinin resistance. Late parasite clearance dynamics were described by microscopy and quantitative ultra-sensitive PCR. Patients were followed up for 42 days. RESULTS Of 154 patients recruited (105 adults and 49 children < 14 years) 78 were randomized to 3 days and 76 to 5 days AL. Mutations in the P. falciparum kelch13 propeller gene (k13) were found in 46% (70/152) of infections, with F446I the most prevalent propeller mutation (29%; 20/70). Both regimens were well-tolerated. Parasite clearance profiles were biphasic with a slower submicroscopic phase which was similar in k13 wild-type and mutant infections. The cure rates were 100% (70/70) and 97% (68/70) in the 3- and 5-day arms respectively. Genotyping of the two recurrences was unsuccessful. CONCLUSION Despite a high prevalence of k13 mutations, the current first-line treatment, AL, was still highly effective in this area of South-East Myanmar. The extended 5 day regimen was very well tolerated, and would be an option to prolong the useful therapeutic life of AL. Trial registration NCT02020330. Registered 24 December 2013, https://clinicaltrials.gov/NCT02020330.
Collapse
Affiliation(s)
- Kyaw Myo Tun
- Defence Services Medical Academy, Yangon, Myanmar.
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Atthanee Jeeyapant
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Aung Hpone Myint
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Medical Action Myanmar, Yangon, Myanmar
| | - Zwe Thiha Kyaw
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Medical Action Myanmar, Yangon, Myanmar
| | - Mehul Dhorda
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Worldwide Antimalarial Resistance Network (WWARN), Asia Regional Centre, Bangkok, Thailand
| | - Mavuto Mukaka
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phaik Yeong Cheah
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mallika Imwong
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thaung Hlaing
- Department of Health, Ministry of Health and Sports, Naypyidaw, Myanmar
| | - Thar Htun Kyaw
- Department of Health, Ministry of Health and Sports, Naypyidaw, Myanmar
| | - Elizabeth A Ashley
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Arjen Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas P J Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Frank Smithuis
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Medical Action Myanmar, Yangon, Myanmar
| |
Collapse
|
14
|
Amiri M, Nourian A, Khoshkam M, Ramazani A. Apigenin inhibits growth of the Plasmodium berghei and disrupts some metabolic pathways in mice. Phytother Res 2018; 32:1795-1802. [PMID: 29748995 DOI: 10.1002/ptr.6113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 01/20/2023]
Abstract
Due to the challenges in the control, prevention, and eradication of parasitic diseases like malaria, there is an urgent need to discover new therapeutic agents. Plant-derived medicines may open new ways in the field of antiplasmodial therapy. This study is aimed to investigate the toxicity and in vivo antiplasmodial activity of apigenin, a dietary flavonoid. Apigenin cytotoxicity was investigated on Huh7 cell line, brine shrimp (Artemia salina) larva, and human red blood cells. In vivo toxicity of apigenin was assessed by metabolomics approaches. Apigenin exhibited significant suppression of parasitemia in a dose-dependent manner; it suppressed Plasmodium berghei growth by 69.74%, 50.3%, and 49.23% at concentrations of 70, 35, and 15 mg/kg/day, respectively. The IC50 value for apigenin after 24 hr exposure to Huh7 cells was 225 μg/ml. Apigenin did not show noticeable toxicity on A. salina and also on the membrane integrity of red blood cells. After 24 hr exposure of mice to apigenin, alterations were seen in the metabolism of glucocorticoids and mineralocorticoids, bile acid metabolism (alternative pathway), sulfur metabolism, bile acid metabolism, metabolism of estrogens and androgens, cholesterol catabolism, and biosynthesis of cholesterol. These findings indicate that apigenin has potential in vivo antiplasmodial activity against P. berghei infected mice with high selectivity against malaria, but it can disrupt some metabolic pathways in mice.
Collapse
Affiliation(s)
- Mahdi Amiri
- Department of Medical Parasitology and Mycology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Abbasali Nourian
- Department of Medical Parasitology and Mycology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Maryam Khoshkam
- Chemistry Group, Faculty of Basic Sciences, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Ali Ramazani
- Cancer Gene Therapy Research Center, Zanjan University of Medical Sciences, Zanjan, Iran.,Department of Pharmaceutical Biotechnology, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
15
|
Bosson-Vanga H, Franetich JF, Soulard V, Sossau D, Tefit M, Kane B, Vaillant JC, Borrmann S, Müller O, Dereuddre-Bosquet N, Le Grand R, Silvie O, Mazier D. Differential activity of methylene blue against erythrocytic and hepatic stages of Plasmodium. Malar J 2018; 17:143. [PMID: 29615050 PMCID: PMC5883292 DOI: 10.1186/s12936-018-2300-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/26/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In the context of malaria elimination/eradication, drugs that are effective against the different developmental stages of the parasite are highly desirable. The oldest synthetic anti-malarial drug, the thiazine dye methylene blue (MB), is known for its activity against Plasmodium blood stages, including gametocytes. The aim of the present study was to investigate a possible effect of MB against malaria parasite liver stages. METHODS MB activity was investigated using both in vitro and in vivo models. In vitro assays consisted of testing MB activity on Plasmodium falciparum, Plasmodium cynomolgi and Plasmodium yoelii parasites in human, simian or murine primary hepatocytes, respectively. MB in vivo activity was evaluated using intravital imaging in BALB/c mice infected with a transgenic bioluminescent P. yoelii parasite line. The transmission-blocking activity of MB was also addressed using mosquitoes fed on MB-treated mice. RESULTS MB shows no activity on Plasmodium liver stages, including hypnozoites, in vitro in primary hepatocytes. In BALB/c mice, MB has moderate effect on P. yoelii hepatic development but is highly effective against blood stage growth. MB is active against gametocytes and abrogates parasite transmission from mice to mosquitoes. CONCLUSION While confirming activity of MB against both sexual and asexual blood stages, the results indicate that MB has only little activity on the development of the hepatic stages of malaria parasites.
Collapse
Affiliation(s)
- Henriette Bosson-Vanga
- Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses, U1135, ERL8255, CIMI-Paris, F-75013, PARIS, France. .,Département de Parasitologie-Mycologie, UFR des Sciences Pharmaceutiques et Biologiques, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire.
| | - Jean-François Franetich
- Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses, U1135, ERL8255, CIMI-Paris, F-75013, PARIS, France
| | - Valérie Soulard
- Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses, U1135, ERL8255, CIMI-Paris, F-75013, PARIS, France
| | - Daniel Sossau
- Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses, U1135, ERL8255, CIMI-Paris, F-75013, PARIS, France.,Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Maurel Tefit
- Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses, U1135, ERL8255, CIMI-Paris, F-75013, PARIS, France
| | - Bocar Kane
- UPMC, UMS28, 105 Bd de l'hôpital, 75013, Paris, France
| | - Jean-Christophe Vaillant
- Service de Chirurgie Digestive, Hépato-Bilio-Pancréatique et Transplantation Hépatique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 83 Bd de l'hôpital, 75013, Paris, France
| | - Steffen Borrmann
- German Center for Infection Research (DZIF), Tübingen, Germany.,Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Olaf Müller
- Institute of Public Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
| | - Nathalie Dereuddre-Bosquet
- CEA, INSERM U1184, Immunology of Viral Infections and Autoimmune Diseases, Université Paris Sud 11, Fontenay-aux-Roses, France
| | - Roger Le Grand
- CEA, INSERM U1184, Immunology of Viral Infections and Autoimmune Diseases, Université Paris Sud 11, Fontenay-aux-Roses, France
| | - Olivier Silvie
- Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses, U1135, ERL8255, CIMI-Paris, F-75013, PARIS, France
| | - Dominique Mazier
- Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses, U1135, ERL8255, CIMI-Paris, F-75013, PARIS, France. .,Service de Parasitologie-Mycologie, Centre National de Référence du Paludisme, AP-HP, Groupe Hospitalier Pitié Salpêtrière, 83 Bd de l'hôpital, 75013, PARIS, France.
| |
Collapse
|
16
|
Using Yeast Synthetic Lethality To Inform Drug Combination for Malaria. Antimicrob Agents Chemother 2018; 62:AAC.01533-17. [PMID: 29358287 PMCID: PMC5913926 DOI: 10.1128/aac.01533-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/30/2017] [Indexed: 11/28/2022] Open
Abstract
Combinatorial chemotherapy is necessary for the treatment of malaria. However, finding a suitable partner drug for a new candidate is challenging. Here we develop an algorithm that identifies all of the gene pairs of Plasmodium falciparum that possess orthologues in yeast that have a synthetic lethal interaction but are absent in humans. This suggests new options for drug combinations, particularly for inhibitors of targets such as P. falciparum calcineurin, cation ATPase 4, or phosphatidylinositol 4-kinase.
Collapse
|
17
|
Sugiarto SR, Moore BR, Makani J, Davis TME. Artemisinin Therapy for Malaria in Hemoglobinopathies: A Systematic Review. Clin Infect Dis 2018; 66:799-804. [PMID: 29370347 DOI: 10.1093/cid/cix785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/20/2017] [Indexed: 01/07/2023] Open
Abstract
Artemisinin derivatives are widely used antimalarial drugs. There is some evidence from in vitro, animal and clinical studies that hemoglobinopathies may alter their disposition and antimalarial activity. This review assesses relevant data in α-thalassemia, sickle cell disease (SCD), β-thalassemia and hemoglobin E. There is no convincing evidence that the disposition of artemisinin drugs is affected by hemoglobinopathies. Although in vitro studies indicate that Plasmodium falciparum cultured in thalassemic erythrocytes is relatively resistant to the artemisinin derivatives, mean 50% inhibitory concentrations (IC50s) are much lower than in vivo plasma concentrations after recommended treatment doses. Since IC50s are not increased in P. falciparum cultures using SCD erythrocytes, delayed post-treatment parasite clearance in SCD may reflect hyposplenism. As there have been no clinical studies suggesting that hemoglobinopathies significantly attenuate the efficacy of artemisinin combination therapy (ACT) in uncomplicated malaria, recommended artemisinin doses as part of ACT remain appropriate in this patient group.
Collapse
Affiliation(s)
- Sri Riyati Sugiarto
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Brioni R Moore
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,School of Pharmacy, Curtin University, Perth, Western Australia, Australia
| | - Julie Makani
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Timothy M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
18
|
Kaur H, Allan EL, Mamadu I, Hall Z, Green MD, Swamidos I, Dwivedi P, Culzoni MJ, Fernandez FM, Garcia G, Hergott D, Monti F. Prevalence of substandard and falsified artemisinin-based combination antimalarial medicines on Bioko Island, Equatorial Guinea. BMJ Glob Health 2017; 2:e000409. [PMID: 29082025 PMCID: PMC5652615 DOI: 10.1136/bmjgh-2017-000409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 01/15/2023] Open
Abstract
Introduction Poor-quality artemisinin-containing antimalarials (ACAs), including falsified and substandard formulations, pose serious health concerns in malaria endemic countries. They can harm patients, contribute to the rise in drug resistance and increase the public’s mistrust of health systems. Systematic assessment of drug quality is needed to gain knowledge on the prevalence of the problem, to provide Ministries of Health with evidence on which local regulators can take action. Methods We used three sampling approaches to purchase 677 ACAs from 278 outlets on Bioko Island, Equatorial Guinea as follows: convenience survey using mystery client (n=16 outlets, 31 samples), full island-wide survey using mystery client (n=174 outlets, 368 samples) and randomised survey using an overt sampling approach (n=88 outlets, 278 samples). The stated active pharmaceutical ingredients (SAPIs) were assessed using high-performance liquid chromatography and confirmed by mass spectrometry at three independent laboratories. Results Content analysis showed 91.0% of ACAs were of acceptable quality, 1.6% were substandard and 7.4% falsified. No degraded medicines were detected. The prevalence of medicines without the SAPIs was higher for ACAs purchased in the convenience survey compared with the estimates obtained using the full island-wide survey-mystery client and randomised-overt sampling approaches. Comparable results were obtained for full island survey-mystery client and randomised overt. However, the availability of purchased artesunate monotherapies differed substantially according to the sampling approach used (convenience, 45.2%; full island-wide survey-mystery client, 32.6%; random-overt sampling approach, 21.9%). Of concern is that 37.1% (n=62) of these were falsified. Conclusion Falsified ACAs were found on Bioko Island, with the prevalence ranging between 6.1% and 16.1%, depending on the sampling method used. These findings underscore the vital need for national authorities to track the scale of ineffective medicines that jeopardise treatment of life-threatening diseases and value of a representative sampling approach to obtain/measure the true prevalence of poor-quality medicines.
Collapse
Affiliation(s)
- Harparkash Kaur
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Louise Allan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Ibrahim Mamadu
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Zoe Hall
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael D Green
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isabel Swamidos
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Prabha Dwivedi
- Division of laboratory Sciences, Organic Analytical Toxicology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Julia Culzoni
- Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, and Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Santa Fe, Argentina
| | - Facundo M Fernandez
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Guillermo Garcia
- Bioko Island Malaria Control Project, Medical Care Development International, Malabo, Equatorial Guinea
| | - Dianna Hergott
- Bioko Island Malaria Control Project, Medical Care Development International, Malabo, Equatorial Guinea
| | - Feliciano Monti
- Bioko Island Malaria Control Project, Medical Care Development International, Malabo, Equatorial Guinea
| |
Collapse
|
19
|
Phyo AP, von Seidlein L. Challenges to replace ACT as first-line drug. Malar J 2017; 16:296. [PMID: 28738892 PMCID: PMC5525298 DOI: 10.1186/s12936-017-1942-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/15/2017] [Indexed: 01/15/2023] Open
Abstract
The spread of artemisinin and partner drug resistance through Asia requires changes in first-line therapy. The traditional modus has been the replacement of one first-line anti-malarial regimen with another. The number of anti-malarial drug candidates currently in development may have given false confidence in the expectation that resistance to artemisinin-based combination therapy (ACT) can be solved with a switch to the next anti-malarial drug regimen. A number of promising anti-malarial drug regimens did not succeed in becoming first-line drugs due to safety concerns or rapid development of resistance. Currently promising candidates for inclusion in first-line regimens, such as KAE 609, KAF 156, OZ 439, and OZ 277, have already triggered safety concerns or fears that point mutations could render the drugs inefficacious. An additional challenge for a new first-line drug is finding an appropriate partner drug. There is hope that none of the above-mentioned concerns will be substantiated in larger, upcoming trials. Meanwhile, combining already licensed anti-malarials may be a promising stop-gap measure. Practitioners in Vietnam have empirically started to add mefloquine to the current dihydroartemisinin-piperaquine. Practitioners in Africa could do worse than empirically combine already licensed co-artemether and amodiaquine when treatment with ACT no longer clears Plasmodium falciparum. Both combinations are currently undergoing trials.
Collapse
Affiliation(s)
- Aung Pyae Phyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| |
Collapse
|
20
|
Thu AM, Phyo AP, Landier J, Parker DM, Nosten FH. Combating multidrug-resistant Plasmodium falciparum malaria. FEBS J 2017; 284:2569-2578. [PMID: 28580606 PMCID: PMC5575457 DOI: 10.1111/febs.14127] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/09/2017] [Accepted: 06/01/2017] [Indexed: 01/05/2023]
Abstract
Over the past 50 years, Plasmodium falciparum has developed resistance against all antimalarial drugs used against it: chloroquine, sulphadoxine-pyrimethamine, quinine, piperaquine and mefloquine. More recently, resistance to the artemisinin derivatives and the resulting failure of artemisinin-based combination therapy (ACT) are threatening all major gains made in malaria control. Each time resistance has developed progressively, with delayed clearance of parasites first emerging only in a few regions, increasing in prevalence and geographic range, and then ultimately resulting in the complete failure of that antimalarial. Drawing from this repeated historical chain of events, this article presents context-specific approaches for combating drug-resistant P. falciparum malaria. The approaches begin with a context of drug-sensitive parasites and focus on the prevention of the emergence of drug resistance. Next, the approaches address a scenario in which resistance has emerged and is increasing in prevalence and geographic extent, with interventions focused on disrupting transmission through vector control, early diagnosis and treatment, and the use of new combination therapies. Elimination is also presented as an approach for addressing the imminent failure of all available antimalarials. The final drug resistance context presented is one in which all available antimalarials have failed; leaving only personal protection and the use of new antimalarials (or new combinations of antimalarials) as a viable strategy for dealing with complete resistance. All effective strategies and contexts require a multipronged, holistic approach.
Collapse
Affiliation(s)
- Aung Myint Thu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aung Pyae Phyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Daniel M Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
| |
Collapse
|
21
|
Mukherjee A, Bopp S, Magistrado P, Wong W, Daniels R, Demas A, Schaffner S, Amaratunga C, Lim P, Dhorda M, Miotto O, Woodrow C, Ashley EA, Dondorp AM, White NJ, Wirth D, Fairhurst R, Volkman SK. Artemisinin resistance without pfkelch13 mutations in Plasmodium falciparum isolates from Cambodia. Malar J 2017; 16:195. [PMID: 28494763 PMCID: PMC5427620 DOI: 10.1186/s12936-017-1845-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 04/29/2017] [Indexed: 12/31/2022] Open
Abstract
Background Artemisinin resistance is associated with delayed parasite clearance half-life in vivo and correlates with ring-stage survival under dihydroartemisinin in vitro. Both phenotypes are associated with mutations in the PF3D7_1343700 pfkelch13 gene. Recent spread of artemisinin resistance and emerging piperaquine resistance in Southeast Asia show that artemisinin combination therapy, such as dihydroartemisinin–piperaquine, are losing clinical effectiveness, prompting investigation of drug resistance mechanisms and development of strategies to surmount emerging anti-malarial resistance. Methods Sixty-eight parasites isolates with in vivo clearance data were obtained from two Tracking Resistance to Artemisinin Collaboration study sites in Cambodia, culture-adapted, and genotyped for pfkelch13 and other mutations including pfmdr1 copy number; and the RSA0–3h survival rates and response to antimalarial drugs in vitro were measured for 36 of these isolates. Results Among these 36 parasites one isolate demonstrated increased ring-stage survival for a PfKelch13 mutation (D584V, RSA0–3h = 8%), previously associated with slow clearance but not yet tested in vitro. Several parasites exhibited increased ring-stage survival, yet lack pfkelch13 mutations, and one isolate showed evidence for piperaquine resistance. Conclusions This study of 68 culture-adapted Plasmodium falciparum clinical isolates from Cambodia with known clearance values, associated the D584V PfKelch13 mutation with increased ring-stage survival and identified parasites that lack pfkelch13 mutations yet exhibit increased ring-stage survival. These data suggest mutations other than those found in pfkelch13 may be involved in conferring artemisinin resistance in P. falciparum. Piperaquine resistance was also detected among the same Cambodian samples, consistent with reports of emerging piperaquine resistance in the field. These culture-adapted parasites permit further investigation of mechanisms of both artemisinin and piperaquine resistance and development of strategies to prevent or overcome anti-malarial resistance. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1845-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Angana Mukherjee
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, I-704, Boston, MA, 02115, USA
| | - Selina Bopp
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, I-704, Boston, MA, 02115, USA
| | - Pamela Magistrado
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, I-704, Boston, MA, 02115, USA
| | - Wesley Wong
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, I-704, Boston, MA, 02115, USA
| | - Rachel Daniels
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, I-704, Boston, MA, 02115, USA.,Infectious Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Allison Demas
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, I-704, Boston, MA, 02115, USA
| | - Stephen Schaffner
- Infectious Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Chanaki Amaratunga
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Pharath Lim
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Mehul Dhorda
- Asia Regional Centre, Worldwide Antimalarial Resistance Network, Bangkok, Thailand.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Olivo Miotto
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Genomics and Global Health, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.,Wellcome Trust Sanger Institute, Hinxton, UK
| | - Charles Woodrow
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Elizabeth A Ashley
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Arjen M Dondorp
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicholas J White
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Dyann Wirth
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, I-704, Boston, MA, 02115, USA.,Infectious Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Rick Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Sarah K Volkman
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, I-704, Boston, MA, 02115, USA. .,Infectious Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA. .,School of Nursing and Health Sciences, Simmons College, Boston, MA, USA.
| |
Collapse
|
22
|
How to Contain Artemisinin- and Multidrug-Resistant Falciparum Malaria. Trends Parasitol 2017; 33:353-363. [DOI: 10.1016/j.pt.2017.01.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 11/18/2016] [Accepted: 01/05/2017] [Indexed: 11/20/2022]
|
23
|
Imwong M, Suwannasin K, Kunasol C, Sutawong K, Mayxay M, Rekol H, Smithuis FM, Hlaing TM, Tun KM, van der Pluijm RW, Tripura R, Miotto O, Menard D, Dhorda M, Day NPJ, White NJ, Dondorp AM. The spread of artemisinin-resistant Plasmodium falciparum in the Greater Mekong subregion: a molecular epidemiology observational study. THE LANCET. INFECTIOUS DISEASES 2017; 17:491-497. [PMID: 28161569 PMCID: PMC5406483 DOI: 10.1016/s1473-3099(17)30048-8] [Citation(s) in RCA: 323] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/05/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Evidence suggests that the PfKelch13 mutations that confer artemisinin resistance in falciparum malaria have multiple independent origins across the Greater Mekong subregion, which has motivated a regional malaria elimination agenda. We aimed to use molecular genotyping to assess antimalarial drug resistance selection and spread in the Greater Mekong subregion. METHODS In this observational study, we tested Plasmodium falciparum isolates from Myanmar, northeastern Thailand, southern Laos, and western Cambodia for PfKelch13 mutations and for Pfplasmepsin2 gene amplification (indicating piperaquine resistance). We collected blood spots from patients with microscopy or rapid test confirmed uncomplicated falciparum malaria. We used microsatellite genotyping to assess genetic relatedness. FINDINGS As part of studies on the epidemiology of artemisinin-resistant malaria between Jan 1, 2008, and Dec 31, 2015, we collected 434 isolates. In 2014-15, a single long PfKelch13 C580Y haplotype (-50 to +31·5 kb) lineage, which emerged in western Cambodia in 2008, was detected in 65 of 88 isolates from northeastern Thailand, 86 of 111 isolates from southern Laos, and 14 of 14 isolates from western Cambodia, signifying a hard transnational selective sweep. Pfplasmepsin2 amplification occurred only within this lineage, and by 2015 these closely related parasites were found in ten of the 14 isolates from Cambodia and 15 of 15 isolates from northeastern Thailand. C580Y mutated parasites from Myanmar had a different genetic origin. INTERPRETATION Our results suggest that the dominant artemisinin-resistant P falciparum C580Y lineage probably arose in western Cambodia and then spread to Thailand and Laos, outcompeting other parasites and acquiring piperaquine resistance. The emergence and spread of fit artemisinin-resistant P falciparum parasite lineages, which then acquire partner drug resistance across the Greater Mekong subregion, threatens regional malaria control and elimination goals. Elimination of falciparum malaria from this region should be accelerated while available antimalarial drugs still remain effective. FUNDING The Wellcome Trust and the Bill and Melinda Gates Foundation.
Collapse
Affiliation(s)
- Mallika Imwong
- Department of Molecular Tropical Medicine and Genetics, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Kanokon Suwannasin
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chanon Kunasol
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kreepol Sutawong
- Buntharik Hospital, Amphoe Buntharik, Ubon Ratchathani, Thailand
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Laos; Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Laos
| | - Huy Rekol
- National Centre for Parasitology, Entomology, and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Frank M Smithuis
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Medical Action Myanmar, Yangon, Myanmar
| | | | - Kyaw M Tun
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Defence Services Medical Research Centre, Naypyitaw, Myanmar
| | - Rob W van der Pluijm
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Olivo Miotto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Wellcome Trust Sanger Institute, Hinxton, UK
| | - Didier Menard
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Mehul Dhorda
- Worldwide Antimalarial Resistance Network (WWARN), Bangkok, Thailand
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
24
|
Hemming-Schroeder E, Lo E. Evidence of a hard selective sweep for artemisinin resistant Plasmodium falciparum. THE LANCET. INFECTIOUS DISEASES 2017; 17:462-463. [PMID: 28161568 DOI: 10.1016/s1473-3099(17)30056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 06/06/2023]
Affiliation(s)
| | - Eugenia Lo
- University of California at Irvine, Irvine, CA 92697, USA
| |
Collapse
|
25
|
Gil JP, Krishna S. pfmdr1 (Plasmodium falciparum multidrug drug resistance gene 1): a pivotal factor in malaria resistance to artemisinin combination therapies. Expert Rev Anti Infect Ther 2017; 15:527-543. [DOI: 10.1080/14787210.2017.1313703] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J. Pedro Gil
- Physiology and Pharmacology Department, Karolinska Institutet, Stockholm, Sweden
| | - S. Krishna
- St George’s University Hospital, Institute for Infection and Immunity, London, United Kingdom
| |
Collapse
|
26
|
Thanh NV, Thuy-Nhien N, Tuyen NTK, Tong NT, Nha-Ca NT, Dong LT, Quang HH, Farrar J, Thwaites G, White NJ, Wolbers M, Hien TT. Rapid decline in the susceptibility of Plasmodium falciparum to dihydroartemisinin-piperaquine in the south of Vietnam. Malar J 2017; 16:27. [PMID: 28086775 PMCID: PMC5237149 DOI: 10.1186/s12936-017-1680-8] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/04/2017] [Indexed: 12/03/2022] Open
Abstract
Background Artemisinin resistant Plasmodium falciparum has emerged in the countries of the Greater Mekong sub-region posing a serious threat to global malaria elimination efforts. The relationship of artemisinin resistance to treatment failure has been unclear. Methods In annual studies conducted in three malaria endemic provinces in the south of Vietnam (Binh Phuoc, Ninh Thuan and Gia Lai) between 2011 and 2015, 489 patients with uncomplicated P. falciparum malaria were enrolled in detailed clinical, parasitological and molecular therapeutic response assessments with 42 days follow up. Patients received the national recommended first-line treatment dihydroartemisinin-piperaquine for three days. Results Over the 5 years the proportion of patients with detectable parasitaemia on day 3 rose steadily from 38 to 57% (P < 0.001). In Binh Phuoc province, the parasite clearance half-life increased from 3.75 h in 2011 to 6.60 h in 2015 (P < 0.001), while treatment failures rose from 0% in 2012 and 2013, to 7% in 2014 and 26% in 2015 (P < 0.001). Recrudescence was associated with in vitro evidence of artemisinin and piperaquine resistance. In the treatment failures cases of 2015, all 14 parasite isolates carried the C580Y Pfkelch 13 gene, marker of artemisinin resistance and 93% (13/14) of them carried exoE415G mutations, markers of piperaquine resistance. Conclusions In the south of Vietnam recent emergence of piperaquine resistant P. falciparum strains has accelerated the reduced response to artemisinin and has led to treatment failure rates of up to 26% to dihydroartemisinin-piperaquine, Vietnam’s current first-line ACT. Alternative treatments are urgently needed. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1680-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ngo Viet Thanh
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Thuy-Nhien
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam.
| | - Nguyen Thi Kim Tuyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Thanh Tong
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Thuy Nha-Ca
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Le Thanh Dong
- Institute of Malariology, Parasitology, and Entomology, Ho Chi Minh City, Vietnam
| | - Huynh Hong Quang
- Institute of Malariology, Parasitology, and Entomology, Qui Nhon, Vietnam
| | - Jeremy Farrar
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Nicholas J White
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Marcel Wolbers
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| |
Collapse
|
27
|
Dondorp AM. New genetic marker for piperaquine resistance in Plasmodium falciparum. THE LANCET. INFECTIOUS DISEASES 2016; 17:119-121. [PMID: 27818096 DOI: 10.1016/s1473-3099(16)30414-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| |
Collapse
|
28
|
Ntege EH, Arisue N, Ito D, Hasegawa T, Palacpac NM, Egwang TG, Horii T, Takashima E, Tsuboi T. Identification of Plasmodium falciparum reticulocyte binding protein homologue 5-interacting protein, PfRipr, as a highly conserved blood-stage malaria vaccine candidate. Vaccine 2016; 34:5612-5622. [DOI: 10.1016/j.vaccine.2016.09.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/10/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
|
29
|
Mu TT, Sein AA, Kyi TT, Min M, Aung NM, Anstey NM, Kyaw MP, Soe C, Kyi MM, Hanson J. Malaria incidence in Myanmar 2005-2014: steady but fragile progress towards elimination. Malar J 2016; 15:503. [PMID: 27756394 PMCID: PMC5069869 DOI: 10.1186/s12936-016-1567-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/07/2016] [Indexed: 01/20/2023] Open
Abstract
Background There has been an impressive recent reduction in the global incidence of malaria, but the development of artemisinin resistance in the Greater Mekong Region threatens this progress. Increasing artemisinin resistance is particularly important in Myanmar, as it is the country in the Greater Mekong Region with the greatest malaria burden. If malaria is to be eliminated in the region, it is essential to define the spatial and temporal epidemiology of the disease in Myanmar to inform control strategies optimally. Results Between the years 2005 and 2014 there was an 81.1 % decline in the reported annual incidence of malaria in Myanmar (1341.8 cases per 100,000 population to 253.3 cases per 100,000 population). In the same period, there was a 93.5 % decline in reported annual mortality from malaria (3.79 deaths per 100,000 population to 0.25 deaths per 100,000 population) and a 87.2 % decline in the proportion of hospitalizations due to malaria (7.8 to 1.0 %). Chin State had the highest reported malaria incidence and mortality at the end of the study period, although socio-economic and geographical factors appear a more likely explanation for this finding than artemisinin resistance. The reduced malaria burden coincided with significant upscaling of disease control measures by the national government with support from international partners. These programmes included the training and deployment of over 40,000 community health care workers, the coverage of over 60 % of the at-risk population with insecticide-treated bed nets and significant efforts to improve access to artemesinin-based combination treatment. Beyond these malaria-specific programmes, increased general investment in the health sector, changing population demographics and deforestation are also likely to have contributed to the decline in malaria incidence seen over this time. Conclusions There has been a dramatic fall in the burden of malaria in Myanmar since 2005. However, with the rise of artemisinin resistance, continued political, financial and scientific commitment is required if the ambitious goal of malaria elimination in the country is to be realized.
Collapse
Affiliation(s)
- Thet Thet Mu
- Department of Public Health, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Aye Aye Sein
- Department of Public Health, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Tint Tint Kyi
- Department of Medical Care, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Myo Min
- Myanmar Medical Association, Yangon, Myanmar
| | | | | | | | - Chit Soe
- University of Medicine 1, Yangon, Myanmar
| | | | - Josh Hanson
- University of Medicine 2, Yangon, Myanmar. .,Menzies School of Health Research, Darwin, Australia. .,The Kirby Institute, Sydney, Australia.
| |
Collapse
|