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Liu T, Zheng D, Wang J, Li X, Yu S, Liu Z, Zheng F, Zhao C, Yang X, Wang Y. Dihydroartemisinin suppresses the susceptibility of Anopheles stephensi to Plasmodium yoelii by activating the Toll signaling pathway. Parasit Vectors 2024; 17:414. [PMID: 39363238 PMCID: PMC11451267 DOI: 10.1186/s13071-024-06497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 09/18/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Malaria is a serious public health concern. Artemisinin and its derivatives are first-line drugs for the treatment of Plasmodium falciparum malaria. In mammals, artemisinin exhibits potent anti-inflammatory and immunoregulatory properties. However, it is unclear whether artemisinin plays a regulatory role in the innate immunity of mosquitoes, thereby affecting the development of Plasmodium in Anopheles when artemisinin and its metabolites enter mosquitoes. This study aims to determine the effect of dihydroartemisinin (DHA), a first-generation semisynthetic derivative of artemisinin, on innate immunity and malaria vector competence of Anopheles stephensi. METHODS Anopheles stephensi was fed Plasmodium-infected mice treated with DHA via gavage, Plasmodium-infected blood containing DHA in vitro, or DHA-containing sugar, followed by Plasmodium yoelii infection. The engorged female mosquitoes were separated and dissected 8 and 17 days after infection. Plasmodium oocysts and sporozoites were counted and compared between the control and DHA-treated groups. Additionally, total RNA and proteins were extracted from engorged mosquitoes 24 and 72 h post infection (hpi). Real-time polymerase chain reaction (PCR) and western blotting were performed to detect the transcriptional levels and protein expression of immune molecules in mosquitoes. Finally, the Toll signaling pathway was inhibited via RNA interference and the infection density was analyzed to confirm the role of the Toll signaling pathway in the effect of DHA on the vector competence of mosquitoes. RESULTS DHA treatment via different approaches significantly reduced the number of Plasmodium oocysts and sporozoites in mosquitoes. The transcriptional levels of anti-Plasmodium immune genes (including TEP1, LRIM1, and APL1C), Toll pathway genes (including Tube, MyD88, and Rel1), and the effector defensin 1 were upregulated by DHA treatment at 24 and 72 hpi. TEP1 and Rel1 protein expression was significantly induced under DHA treatment. However, Rel1 knockdown in DHA-treated mosquitoes abrogated DHA-mediated refractoriness to Plasmodium infection. CONCLUSIONS DHA treatment effectively inhibited the development of P. yoelii in A. stephensi by upregulating mosquitoes' Toll signaling pathway, thereby influencing the susceptibility of Anopheles to Plasmodium.
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Affiliation(s)
- Tingting Liu
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, No. 30 Gaotanyan St, Shapingba Dis, Chongqing, 400038, China
| | - Dan Zheng
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, No. 30 Gaotanyan St, Shapingba Dis, Chongqing, 400038, China
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, 550025, China
| | - Jing Wang
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, No. 30 Gaotanyan St, Shapingba Dis, Chongqing, 400038, China
| | - Xin Li
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, No. 30 Gaotanyan St, Shapingba Dis, Chongqing, 400038, China
| | - Shasha Yu
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, No. 30 Gaotanyan St, Shapingba Dis, Chongqing, 400038, China
| | - Zhilong Liu
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, No. 30 Gaotanyan St, Shapingba Dis, Chongqing, 400038, China
| | - Feifei Zheng
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, No. 30 Gaotanyan St, Shapingba Dis, Chongqing, 400038, China
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, 550025, China
| | - Caizhi Zhao
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, No. 30 Gaotanyan St, Shapingba Dis, Chongqing, 400038, China
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, 550025, China
| | - Xuesen Yang
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, No. 30 Gaotanyan St, Shapingba Dis, Chongqing, 400038, China
| | - Ying Wang
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, No. 30 Gaotanyan St, Shapingba Dis, Chongqing, 400038, China.
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2
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Omorou R, Bin Sa'id I, Delves M, Severini C, Kouakou YI, Bienvenu AL, Picot S. Protocols for Plasmodium gametocyte production in vitro: an integrative review and analysis. Parasit Vectors 2022; 15:451. [PMID: 36471426 PMCID: PMC9720971 DOI: 10.1186/s13071-022-05566-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The production of Plasmodium gametocytes in vitro is a real challenge. Many protocols have been described, but few have resulted in the production of viable and infectious gametocytes in sufficient quantities to conduct research on-but not limited to-transmission-blocking drug and vaccine development. The aim of this review was to identify and discuss gametocyte production protocols that have been developed over the last two decades. METHODS We analyzed the original gametocyte production protocols published from 2000 onwards based on a literature search and a thorough review. A systematic review was performed of relevant articles identified in the PubMed, Web of Sciences and ScienceDirect databases. RESULTS A total 23 studies on the production of Plasmodium gametocytes were identified, 19 involving in vitro Plasmodium falciparum, one involving Plasmodium knowlesi and three involving ex vivo Plasmodium vivax. Of the in vitro studies, 90% used environmental stressors to trigger gametocytogenesis. Mature gametocytemia of up to 4% was reported. CONCLUSIONS Several biological parameters contribute to an optimal production in vitro of viable and infectious mature gametocytes. The knowledge gained from this systematic review on the molecular mechanisms involved in gametocytogenesis enables reproducible gametocyte protocols with transgenic parasite lines to be set up. This review highlights the need for additional gametocyte production protocols for Plasmodium species other than P. falciparum.
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Affiliation(s)
- Roukayatou Omorou
- Malaria Research Unit, UMR 5246 CNRS-INSA-CPE-University Lyon1, University of Lyon, 69100, Villeurbanne, France.
| | - Ibrahim Bin Sa'id
- Malaria Research Unit, UMR 5246 CNRS-INSA-CPE-University Lyon1, University of Lyon, 69100, Villeurbanne, France.,Institut Agama Islam Negeri (IAIN) Kediri, 64127, Kota Kediri, Jawa Timur, Indonesia
| | - Michael Delves
- Department of Infection Biology, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1A 7HT, UK
| | - Carlo Severini
- Dipartimento Di Malattie Infettive, Istituto Superiore Di Sanità, Rome, Italy
| | - Yobouet Ines Kouakou
- Malaria Research Unit, UMR 5246 CNRS-INSA-CPE-University Lyon1, University of Lyon, 69100, Villeurbanne, France
| | - Anne-Lise Bienvenu
- Malaria Research Unit, UMR 5246 CNRS-INSA-CPE-University Lyon1, University of Lyon, 69100, Villeurbanne, France.,Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Stephane Picot
- Malaria Research Unit, UMR 5246 CNRS-INSA-CPE-University Lyon1, University of Lyon, 69100, Villeurbanne, France.,Institut de Parasitologie Et Mycologie Médicale, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
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3
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Portugaliza HP, Natama HM, Guetens P, Rovira-Vallbona E, Somé AM, Millogo A, Ouédraogo DF, Valéa I, Sorgho H, Tinto H, van Hong N, Sitoe A, Varo R, Bassat Q, Cortés A, Rosanas-Urgell A. Plasmodium falciparum sexual conversion rates can be affected by artemisinin-based treatment in naturally infected malaria patients. EBioMedicine 2022; 83:104198. [PMID: 35961203 PMCID: PMC9385555 DOI: 10.1016/j.ebiom.2022.104198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 10/25/2022] Open
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4
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Pembet Singana B, Casimiro PN, Matondo Diassivi B, Kobawila SC, Youndouka JM, Basco LK, Ringwald P, Briolant S, Ndounga M. Prevalence of malaria among febrile patients and assessment of efficacy of artemether-lumefantrine and artesunate-amodiaquine for uncomplicated malaria in Dolisie, Republic of the Congo. Malar J 2022; 21:137. [PMID: 35501861 PMCID: PMC9063077 DOI: 10.1186/s12936-022-04143-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/28/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In the Republic of the Congo, malaria represents a major public health problem affecting all age groups. A regular surveillance of the current efficacy of first-line anti-malarial drugs is required in the face of possible emergence and spread of artemisinin-resistant Plasmodium falciparum strains in Africa. The purpose of this study was to determine the prevalence of malaria among febrile patients of all ages and assess the efficacy of artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) in Congolese children. METHODS Febrile patients of all ages were initially screened for malaria by both rapid diagnostic test (RDT) and microscopy. Patients less than 12 years of age, with parasitaemia ≥ 1000 asexual parasites of P. falciparum/µL of blood, without any signs of severity, were enrolled in a therapeutic efficacy study and treated after obtaining their parents' (or legal guardian's) informed consent in two health centres in Dolisie. The patients were followed for 28 days in accordance with the 2009 World Health Organization standard protocol. If parasitaemia reappeared on or after day 7, the genetic profiles (genes expressing merozoite surface protein-1 [msp1], merozoite surface protein-2 [msp2], and glutamine-rich protein [glurp]) of pre-treatment and post-treatment isolates were compared by nested polymerase chain reaction (PCR) followed by capillary electrophoresis to make a distinction between recrudescence and re-infection. The clinical and parasitological outcome was analysed by the per-protocol method and Kaplan-Meier survival curves. RESULTS A total of 994 febrile patients of all ages were screened by RDT and microscopy. Of 994 patients, 323 (32.5%) presented a positive RDT, and 266 (26.8%) were microscopy-positive. Based on microscopy as the reference diagnostic method, the sensitivity and the specificity of the RDT were 98.9 and 91.8%, respectively. The Cohen's kappa coefficient was 0.86. A total of 121 children aged less than 12 years (61 in AL treatment group and 60 in ASAQ treatment group) were included in therapeutic efficacy study. Before PCR correction, the proportions of adequate clinical and parasitological response were 96.6% for AL and 86.0% for ASAQ in the per-protocol population (P < 0.05). The PCR-corrected efficacy rates were 98.2% and 94.2% for AL and ASAQ, respectively (P > 0.05). Both treatments were well tolerated. CONCLUSIONS AL and ASAQ remain highly effective for the first-line treatment of uncomplicated P. falciparum malaria in Dolisie. Despite high efficacy of first- and second-line treatment, there is a continuing need to scale up effective malaria preventive interventions and vector control strategies in the country. TRIAL REGISTRATION NUMBER ACTRN12616001422415.
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Affiliation(s)
- Brice Pembet Singana
- grid.442828.00000 0001 0943 7362Faculté des Sciences et Techniques, Université Marien Ngouabi, BP 69 Brazzaville, Republic of the Congo
| | - Prisca Nadine Casimiro
- Institut National de Recherche en Sciences de la Santé, Brazzaville, Republic of the Congo
| | | | - Simon Charles Kobawila
- grid.442828.00000 0001 0943 7362Faculté des Sciences et Techniques, Université Marien Ngouabi, BP 69 Brazzaville, Republic of the Congo
| | - Jean-Mermoz Youndouka
- Programme National de Lutte Contre le Paludisme, Direction Générale de l’Epidémiologie de la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - Leonardo K. Basco
- Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France ,grid.483853.10000 0004 0519 5986IHU-Méditerranée Infection, Marseille, France
| | - Pascal Ringwald
- grid.3575.40000000121633745Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Sébastien Briolant
- Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France ,grid.483853.10000 0004 0519 5986IHU-Méditerranée Infection, Marseille, France ,grid.418221.cUnité de Parasitologie Entomologie, Département de Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France
| | - Mathieu Ndounga
- Programme National de Lutte Contre le Paludisme, Direction Générale de l’Epidémiologie de la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
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Thommen BT, Passecker A, Buser T, Hitz E, Voss TS, Brancucci NMB. Revisiting the Effect of Pharmaceuticals on Transmission Stage Formation in the Malaria Parasite Plasmodium falciparum. Front Cell Infect Microbiol 2022; 12:802341. [PMID: 35223540 PMCID: PMC8873190 DOI: 10.3389/fcimb.2022.802341] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/21/2022] [Indexed: 12/27/2022] Open
Abstract
Malaria parasites rely on specialized stages, called gametocytes, to ensure human-to-human transmission. The formation of these sexual precursor cells is initiated by commitment of blood stage parasites to the sexual differentiation pathway. Plasmodium falciparum, the most virulent of six parasite species infecting humans, employs nutrient sensing to control the rate at which sexual commitment is initiated, and the presence of stress-inducing factors, including antimalarial drugs, has been linked to increased gametocyte production in vitro and in vivo. These observations suggest that therapeutic interventions may promote gametocytogenesis and malaria transmission. Here, we engineered a P. falciparum reporter line to quantify sexual commitment rates after exposure to antimalarials and other pharmaceuticals commonly prescribed in malaria-endemic regions. Our data reveal that some of the tested drugs indeed have the capacity to elevate sexual commitment rates in vitro. Importantly, however, these effects are only observed at drug concentrations that inhibit parasite survival and only rarely result in a net increase of gametocyte production. Using a drug-resistant parasite reporter line, we further show that the gametocytogenesis-promoting effect of drugs is linked to general stress responses rather than to compound-specific activities. Altogether, we did not observe evidence for mechanistic links between the regulation of sexual commitment and the activity of commonly used pharmaceuticals in vitro. Our data hence does not support scenarios in which currently applied therapeutic interventions would promote the spread of drug-resistant parasites or malaria transmission in general.
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Affiliation(s)
- Basil T. Thommen
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Armin Passecker
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Tamara Buser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Eva Hitz
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Till S. Voss
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- *Correspondence: Till S. Voss, ; Nicolas M. B. Brancucci,
| | - Nicolas M. B. Brancucci
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- *Correspondence: Till S. Voss, ; Nicolas M. B. Brancucci,
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Shibeshi W, Alemkere G, Mulu A, Engidawork E. Efficacy and safety of artemisinin-based combination therapies for the treatment of uncomplicated malaria in pediatrics: a systematic review and meta-analysis. BMC Infect Dis 2021; 21:326. [PMID: 33827422 PMCID: PMC8028735 DOI: 10.1186/s12879-021-06018-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/26/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Malaria is a major cause of morbidity and mortality in pediatrics in malaria endemic areas. Artemisinin-based combination therapies (ACTs) are the drugs of choice for malaria management particularly across malaria-endemic countries. This systematic review and meta-analysis was performed to assess efficacy and safety of ACTs for uncomplicated malaria in pediatric populations. METHODS A body of evidence was searched for published ACT trials until March 06, 2020. The search was focused on efficacy and safety studies of ACTs for uncomplicated malaria in pediatrics. PubMed library was searched using best adapted search terms after multiple trials. References were exported to the endnote library and then to Covidence for screening. Data was extracted using the Covidence platform. The per-protocol analysis report for the efficacy and the intention-to-treat analysis for the safety were synthesized. Met-analysis was carried using Open Meta-Analyst software. Random effects model was applied and the heterogeneity of studies was evaluated using I2 statistic. RESULTS Nineteen studies were included in the final analysis. Overall, crude, PCR-corrected P. falciparum malaria treatment success rate was 96.3 and 93.9% for day 28 and 42, respectively. In the subgroup analysis, PCR-corrected adequate clinical and parasitological response (ACPR) of dihydroartemisinin-piperaquine (DP) was 99.6% (95% CI: 99.1 to 100%, I2 = 0%; 4 studies) at day 28 and 99.6% (95% CI of 99 to 100%, I2 = 0%; 3 studies) at day 42. Nine studies reported ACT related adverse drug reactions (ADR) (8.3%, 356/4304). The reported drug related adverse reactions ranged from 1.8% in DP (two studies) to 23.3% in artesunate-pyronaridine (AP). Gastrointestinal symptoms were the most common ACT related adverse effects, and all ADRs were reported to resolve spontaneously. CONCLUSION ACTs demonstrated a high crude efficacy and tolerability against P. falciparum. The high treatment success and tolerability with low heterogeneity conferred by DP has implication for policy makers who plan the use of ACTs for uncomplicated falciparum malaria treatment in pediatrics.
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Affiliation(s)
- Workineh Shibeshi
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Getachew Alemkere
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Mulu
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Ippolito MM, Moser KA, Kabuya JBB, Cunningham C, Juliano JJ. Antimalarial Drug Resistance and Implications for the WHO Global Technical Strategy. CURR EPIDEMIOL REP 2021; 8:46-62. [PMID: 33747712 PMCID: PMC7955901 DOI: 10.1007/s40471-021-00266-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Five years have passed since the World Health Organization released its Global Technical Strategy for Malaria (GTS). In that time, progress against malaria has plateaued. This review focuses on the implications of antimalarial drug resistance for the GTS and how interim progress in parasite genomics and antimalarial pharmacology offer a bulwark against it. RECENT FINDINGS For the first time, drug resistance-conferring genes have been identified and validated before their global expansion in malaria parasite populations. More efficient methods for their detection and elaboration have been developed, although low-density infections and polyclonality remain a nuisance to be solved. Clinical trials of alternative regimens for multidrug-resistant malaria have delivered promising results. New agents continue down the development pipeline, while a nascent infrastructure in sub-Saharan Africa for conducting phase I trials and trials of transmission-blocking agents has come to fruition after years of preparation. SUMMARY These and other developments can help inform the GTS as the world looks ahead to the next two decades of its implementation. To remain ahead of the threat that drug resistance poses, wider application of genomic-based surveillance and optimization of existing and forthcoming antimalarial drugs are essential.
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Affiliation(s)
- Matthew M. Ippolito
- Divisions of Clinical Pharmacology and Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
- The Johns Hopkins Malaria Research Institute, Johns Hopkins University School of Public Health, Baltimore, MD USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Kara A. Moser
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC USA
| | | | - Clark Cunningham
- School of Medicine, University of North Carolina, Chapel Hill, NC USA
| | - Jonathan J. Juliano
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, CB#7030, 130 Mason Farm Rd, Chapel Hill, NC 27599 USA
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina, Chapel Hill, NC USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
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8
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Portugaliza HP, Miyazaki S, Geurten FJ, Pell C, Rosanas-Urgell A, Janse CJ, Cortés A. Artemisinin exposure at the ring or trophozoite stage impacts Plasmodium falciparum sexual conversion differently. eLife 2020; 9:60058. [PMID: 33084568 PMCID: PMC7577739 DOI: 10.7554/elife.60058] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022] Open
Abstract
Malaria transmission is dependent on the formation of gametocytes in the human blood. The sexual conversion rate, the proportion of asexual parasites that convert into gametocytes at each multiplication cycle, is variable and reflects the relative parasite investment between transmission and maintaining the infection. The impact of environmental factors such as drugs on sexual conversion rates is not well understood. We developed a robust assay using gametocyte-reporter parasite lines to accurately measure the impact of drugs on sexual conversion rates, independently from their gametocytocidal activity. We found that exposure to subcurative doses of the frontline antimalarial drug dihydroartemisinin (DHA) at the trophozoite stage resulted in a ~ fourfold increase in sexual conversion. In contrast, no increase was observed when ring stages were exposed or in cultures in which sexual conversion was stimulated by choline depletion. Our results reveal a complex relationship between antimalarial drugs and sexual conversion, with potential public health implications.
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Affiliation(s)
- Harvie P Portugaliza
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Global Health, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Shinya Miyazaki
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Fiona Ja Geurten
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Christopher Pell
- Department of Global Health, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Netherlands
| | - Anna Rosanas-Urgell
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris J Janse
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Alfred Cortés
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,ICREA, Barcelona, Spain
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Ippolito MM, Pringle JC, Siame M, Katowa B, Aydemir O, Oluoch PO, Huang L, Aweeka FT, Bailey JA, Juliano JJ, Meshnick SR, Shapiro TA, Moss WJ, Thuma PE. Therapeutic Efficacy of Artemether-Lumefantrine for Uncomplicated Falciparum Malaria in Northern Zambia. Am J Trop Med Hyg 2020; 103:2224-2232. [PMID: 33078701 DOI: 10.4269/ajtmh.20-0852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Artemether-lumefantrine (AL) is a first-line agent for uncomplicated malaria caused by Plasmodium falciparum. The WHO recommends periodic therapeutic efficacy studies of antimalarial drugs for the detection of malaria parasite drug resistance and to inform national malaria treatment policies. We conducted a therapeutic efficacy study of AL in a high malaria transmission region of northern Zambia from December 2014 to July 2015. One hundred children of ages 6 to 59 months presenting to a rural health clinic with uncomplicated falciparum malaria were admitted for treatment with AL (standard 6-dose regimen) and followed weekly for 5 weeks. Parasite counts were taken every 6 hours during treatment to assess parasite clearance. Recurrent episodes during follow-up (n = 14) were genotyped to distinguish recrudescence from reinfection and to identify drug resistance single nucleotide polymorphisms (SNPs) and multidrug resistance protein 1 (mdr1) copy number variation. Day 7 lumefantrine concentrations were measured for correspondence with posttreatment reinfection. All children who completed the parasite clearance portion of the study (n = 94) were microscopy-negative by 72 hours. The median parasite elimination half-life was 2.7 hours (interquartile range: 2.1-3.3). Genotype-corrected therapeutic efficacy was 98.8% (95% CI: 97.6-100). Purported artemisinin and lumefantrine drug resistance SNPs in atp6, 3D7_1451200, and mdr1 were detected but did not correlate with parasite recurrence, nor did day 7 lumefantrine concentrations. In summary, AL was highly effective for the treatment of uncomplicated falciparum malaria in northern Zambia during the study period. The high incidence of recurrent parasitemia was consistent with reinfection due to high, perennial malaria transmission.
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Affiliation(s)
- Matthew M Ippolito
- The Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia C Pringle
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Mwiche Siame
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | | | - Ozkan Aydemir
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island
| | - Peter O Oluoch
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island
| | - Liusheng Huang
- Department of Clinical Pharmacology, University of California San Francisco School of Pharmacy, San Francisco, California
| | - Francesca T Aweeka
- Department of Clinical Pharmacology, University of California San Francisco School of Pharmacy, San Francisco, California
| | - Jeffrey A Bailey
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island
| | - Jonathan J Juliano
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Steven R Meshnick
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Theresa A Shapiro
- The Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William J Moss
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,The Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Philip E Thuma
- Macha Research Trust, Macha, Zambia.,The Johns Hopkins Malaria Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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10
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Stepniewska K, Humphreys GS, Gonçalves BP, Craig E, Gosling R, Guerin PJ, Price RN, Barnes KI, Raman J, Smit MR, D’Alessandro U, Stone WJR, Bjorkman A, Samuels AM, Arroyo-Arroyo MI, Bastiaens GJH, Brown JM, Dicko A, El-Sayed BB, Elzaki SEG, Eziefula AC, Kariuki S, Kwambai TK, Maestre AE, Martensson A, Mosha D, Mwaiswelo RO, Ngasala BE, Okebe J, Roh ME, Sawa P, Tiono AB, Chen I, Drakeley CJ, Bousema T. Efficacy of Single-Dose Primaquine With Artemisinin Combination Therapy on Plasmodium falciparum Gametocytes and Transmission: An Individual Patient Meta-Analysis. J Infect Dis 2020; 225:1215-1226. [PMID: 32778875 PMCID: PMC8974839 DOI: 10.1093/infdis/jiaa498] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/06/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Since the World Health Organization recommended single low-dose (0.25 mg/kg) primaquine (PQ) in combination with artemisinin-based combination therapies (ACTs) in areas of low transmission or artemisinin-resistant Plasmodium falciparum, several single-site studies have been conducted to assess efficacy. METHODS An individual patient meta-analysis to assess gametocytocidal and transmission-blocking efficacy of PQ in combination with different ACTs was conducted. Random effects logistic regression was used to quantify PQ effect on (1) gametocyte carriage in the first 2 weeks post treatment; and (2) the probability of infecting at least 1 mosquito or of a mosquito becoming infected. RESULTS In 2574 participants from 14 studies, PQ reduced PCR-determined gametocyte carriage on days 7 and 14, most apparently in patients presenting with gametocytemia on day 0 (odds ratio [OR], 0.22; 95% confidence interval [CI], .17-.28 and OR, 0.12; 95% CI, .08-.16, respectively). Rate of decline in gametocyte carriage was faster when PQ was combined with artemether-lumefantrine (AL) compared to dihydroartemisinin-piperaquine (DP) (P = .010 for day 7). Addition of 0.25 mg/kg PQ was associated with near complete prevention of transmission to mosquitoes. CONCLUSIONS Transmission blocking is achieved with 0.25 mg/kg PQ. Gametocyte persistence and infectivity are lower when PQ is combined with AL compared to DP.
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Affiliation(s)
- Kasia Stepniewska
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom,Infectious Diseases Data Observatory, Oxford, United Kingdom,Kasia Stepniewska, PhD, WorldWide Antimalarial Resistance Network (WWARN), Centre for Tropical Medicine and Global Health, Churchill Hospital, CCVTM, University of Oxford, Old Road, Oxford OX3 7LE, UK
| | - Georgina S Humphreys
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom,Infectious Diseases Data Observatory, Oxford, United Kingdom,Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Bronner P Gonçalves
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elaine Craig
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom,Infectious Diseases Data Observatory, Oxford, United Kingdom
| | - Roly Gosling
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA,Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, California, USA
| | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom,Infectious Diseases Data Observatory, Oxford, United Kingdom
| | - Ric N Price
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom,Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Norther Territory, Australia,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Karen I Barnes
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,University of Cape Town/Medical Research Council Collaborating Centre for Optimising Antimalarial Therapy, University of Cape Town, Cape Town, South Africa,Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jaishree Raman
- University of Cape Town/Medical Research Council Collaborating Centre for Optimising Antimalarial Therapy, University of Cape Town, Cape Town, South Africa,Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa,Wits Research Institute for Malaria, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Menno R Smit
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Umberto D’Alessandro
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Will J R Stone
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anders Bjorkman
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Aaron M Samuels
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Maria I Arroyo-Arroyo
- Grupo Salud y Comunidad, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
| | - Guido J H Bastiaens
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands,Department of Microbiology and Immunology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Joelle M Brown
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Alassane Dicko
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Badria B El-Sayed
- Tropical Medicine Research Institute, National Centre for Research, Khartoum, Sudan
| | - Salah-Eldin G Elzaki
- Tropical Medicine Research Institute, National Centre for Research, Khartoum, Sudan
| | - Alice C Eziefula
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | - Titus K Kwambai
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom,Kenya Medical Research Institute, Kisian, Kenya
| | - Amanda E Maestre
- Grupo Salud y Comunidad, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
| | - Andreas Martensson
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Dominic Mosha
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, Tanzania,Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Richard O Mwaiswelo
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Billy E Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joseph Okebe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Michelle E Roh
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA,Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, California, USA
| | - Patrick Sawa
- Human Health Division, International Centre for Insect Physiology and Ecology, Mbita Point, Kenya
| | - Alfred B Tiono
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Ingrid Chen
- Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, California, USA
| | - Chris J Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Teun Bousema
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands,Correspondence: Teun Bousema, PhD, Department of Medical Microbiology, Radboud Institute for Health Science, Radboudumc, PO Box 9101, 6500 HB Nijmegen, The Netherlands ()
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11
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Schinkel M, Panday RN, Nanayakkara P. Blood Culture Results Before and After Antimicrobial Administration. Ann Intern Med 2020; 172:439. [PMID: 32176903 DOI: 10.7326/l19-0794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Michiel Schinkel
- Center of Experimental and Molecular Medicine, Amsterdam UMC, Academic Medical Center, and Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands (M.S.)
| | - Rishi Nannan Panday
- Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands (R.N.P., P.N.)
| | - Prabath Nanayakkara
- Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands (R.N.P., P.N.)
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12
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de Boer JG, Busula AO, Ten Berge J, van Dijk TS, Takken W. Does artemether-lumefantrine administration affect mosquito olfactory behaviour and fitness? Malar J 2019; 18:28. [PMID: 30691446 PMCID: PMC6350316 DOI: 10.1186/s12936-019-2646-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 01/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Artemisinin-based combination therapy (ACT) is the recommended treatment against uncomplicated Plasmodium falciparum infections, and ACT is widely used. It has been shown that gametocytes may be present after ACT and transmission to mosquitoes is still possible. Artemether–lumefantrine (AL) is a broadly used artemisinin-based combination medicine. Here, it is tested whether AL influences behaviour and fitness of Anopheles mosquitoes, which are the main vectors of P. falciparum. Results Dual-choice olfactometer and screenhouse experiments showed that skin odour of healthy human individuals obtained before, during and after AL-administration was equally attractive to Anopheles coluzzii and Anopheles gambiae sensu stricto, apart from a small (but significant) increase in mosquito response to skin odour collected 3 weeks after AL-administration. Anopheles coluzzii females fed on parasite-free blood supplemented with AL or on control-blood had similar survival, time until oviposition and number of eggs produced. Conclusions Based on the results, AL does not appear to influence malaria transmission through modification of vector mosquito olfactory behaviour or fitness. Extending these studies to Plasmodium-infected individuals and malaria mosquitoes with parasites are needed to further support this conclusion. Electronic supplementary material The online version of this article (10.1186/s12936-019-2646-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jetske G de Boer
- Laboratory of Entomology, Wageningen University & Research, Droevendaalsesteeg 1, 6708 PB, Wageningen, The Netherlands. .,Netherlands Institute of Ecology, Droevendaalsesteeg 10, 6708 PB, Wageningen, The Netherlands.
| | - Annette O Busula
- Laboratory of Entomology, Wageningen University & Research, Droevendaalsesteeg 1, 6708 PB, Wageningen, The Netherlands.,International Centre of Insect Physiology and Ecology, P.O BOX 30772-00100 GPO, Nairobi, Kenya.,Kaimosi Friends University College, P.O BOX 385-50309, Kaimosi, Kenya
| | - Jet Ten Berge
- Laboratory of Entomology, Wageningen University & Research, Droevendaalsesteeg 1, 6708 PB, Wageningen, The Netherlands
| | - Tessa S van Dijk
- Laboratory of Entomology, Wageningen University & Research, Droevendaalsesteeg 1, 6708 PB, Wageningen, The Netherlands
| | - Willem Takken
- Laboratory of Entomology, Wageningen University & Research, Droevendaalsesteeg 1, 6708 PB, Wageningen, The Netherlands
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13
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Pinto RDM, Sampaio VDS, de Melo GC, Alecrim MDGC, Mattos K, Perdomo RT, Cordeiro SDC, Parente AFA, de Carvalho LR, Mendes RP, Lacerda MVG, Monteiro WM, Weber SS. Overview of artemisinin effectiveness during outset years of its implementation in the western Brazilian Amazon. Mem Inst Oswaldo Cruz 2019; 114:e190075. [PMID: 31038549 PMCID: PMC6489370 DOI: 10.1590/0074-02760190075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/27/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND METHODS FINDINGS MAIN CONCLUSIONS
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Affiliation(s)
| | - Vanderson de Souza Sampaio
- Fundação de Vigilância em Saúde, Brasil; Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brazil
| | - Gisely Cardoso de Melo
- Universidade do Estado do Amazonas, Brazil; Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brazil
| | | | | | | | | | | | | | | | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brazil; Fundação Oswaldo Cruz-Fiocruz, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brazil
| | - Simone Schneider Weber
- Universidade Federal de Mato Grosso do Sul, Brazil; Universidade Federal do Amazonas, Brazil
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