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Santos A, Brito M, Silva E, Rocha F, Oliveira A, Dávila R, Gama H, Albuquerque J, Paiva M, Baía-Silva D, Sampaio V, Balieiro P, Rufatto R, Grewal Daumerie P, Peterka C, Edilson Lima F, Monteiro W, Arcanjo A, Silva R, Batista Pereira D, Lacerda M, Murta F. Perspectives of healthcare professionals on training for quantitative G6PD testing during implementation of tafenoquine in Brazil (QualiTRuST Study). PLoS Negl Trop Dis 2024; 18:e0012197. [PMID: 38837977 PMCID: PMC11152287 DOI: 10.1371/journal.pntd.0012197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Effective radical cure of Plasmodium vivax malaria is essential for malaria elimination in Brazil. P. vivax radical cure requires administration of a schizonticide, such as chloroquine, plus an 8-aminoquinoline. However, 8-aminoquinolines cause hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, requiring prior screening to exclude those at risk. Brazil is pioneering the implementation of tafenoquine, a single-dose 8-aminoquinoline indicated for P. vivax patients with >70% of normal G6PD activity. Tafenoquine implementation in Manaus and Porto Velho, two municipalities located in the western Brazilian Amazon, included comprehensive training of healthcare professionals (HCPs) on point-of-care quantitative G6PD testing and a new treatment algorithm for P. vivax radical cure incorporating tafenoquine. Training was initially provided to higher-level facilities (phase one) and later adapted for primary care units (phase two). This study analyzed HCP experiences during training and implementation and identified barriers and facilitators. In-depth interviews and focus discussion groups were conducted 30 days after each training for a purposive random sample of 115 HCPs. Thematic analysis was employed using MAXQDA software, analyzing data through inductive and deductive coding. Analysis showed that following the initial training for higher-level facilities, some HCPs did not feel confident performing quantitative G6PD testing and prescribing the tafenoquine regimen. Modifications to the training in phase two resulted in an improvement in understanding the implementation process of the G6PD test and tafenoquine, as well as in the knowledge acquired by HCPs. Additionally, knowledge gaps were addressed through in situ training, peer communication via a messaging app, and educational materials. Training supported effective deployment of the new tools in Manaus and Porto Velho and increased awareness of the need for pharmacovigilance. A training approach for nationwide implementation of these tools was devised. Implementing quantitative G6PD testing and tafenoquine represents a significant shift in P. vivax malaria case management. Consistent engagement with HCPs is needed to overcome challenges in fully integrating these tools within the Brazilian health system.
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Affiliation(s)
- Alicia Santos
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Marcelo Brito
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Evellyn Silva
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Felipe Rocha
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Ana Oliveira
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Rafaela Dávila
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Hiran Gama
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Mena Paiva
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Djane Baía-Silva
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Vanderson Sampaio
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Patrícia Balieiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Rosilene Rufatto
- Centro de Pesquisa em Medicina Tropical de Rondônia (CEPEM), Porto Velho, Brazil
| | | | | | | | - Wuelton Monteiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
| | - Ana Arcanjo
- Fundação de Vigilância em Saúde, Manaus, Brazil
| | | | | | - Marcus Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
- University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Felipe Murta
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
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2
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Webster R, Mitchell H, Peters JM, Heunis J, O'Neill B, Gower J, Lynch S, Jennings H, Amante FH, Llewellyn S, Marquart L, Potter AJ, Birrell GW, Edstein MD, Shanks GD, McCarthy JS, Barber BE. Transmission Blocking Activity of Low-dose Tafenoquine in Healthy Volunteers Experimentally Infected With Plasmodium falciparum. Clin Infect Dis 2023; 76:506-512. [PMID: 35731843 DOI: 10.1093/cid/ciac503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Blocking the transmission of parasites from humans to mosquitoes is a key component of malaria control. Tafenoquine exhibits activity against all stages of the malaria parasite and may have utility as a transmission blocking agent. We aimed to characterize the transmission blocking activity of low-dose tafenoquine. METHODS Healthy adults were inoculated with Plasmodium falciparum 3D7-infected erythrocytes on day 0. Piperaquine was administered on days 9 and 11 to clear asexual parasitemia while allowing gametocyte development. A single 50-mg oral dose of tafenoquine was administered on day 25. Transmission was determined by enriched membrane feeding assays predose and at 1, 4, and 7 days postdose. Artemether-lumefantrine was administered following the final assay. Outcomes were the reduction in mosquito infection and gametocytemia after tafenoquine and safety parameters. RESULTS Six participants were enrolled, and all were infective to mosquitoes before tafenoquine, with a median 86% (range, 22-98) of mosquitoes positive for oocysts and 57% (range, 4-92) positive for sporozoites. By day 4 after tafenoquine, the oocyst and sporozoite positivity rate had reduced by a median 35% (interquartile range [IQR]: 16-46) and 52% (IQR: 40-62), respectively, and by day 7, 81% (IQR 36-92) and 77% (IQR 52-98), respectively. The decline in gametocyte density after tafenoquine was not significant. No significant participant safety concerns were identified. CONCLUSIONS Low-dose tafenoquine (50 mg) reduces P. falciparum transmission to mosquitoes, with a delay in effect.
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Affiliation(s)
- Rebecca Webster
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Hayley Mitchell
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jenny M Peters
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Juanita Heunis
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Brighid O'Neill
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jeremy Gower
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Sean Lynch
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Helen Jennings
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Fiona H Amante
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | | | - Adam J Potter
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Geoffrey W Birrell
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Michael D Edstein
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - G Dennis Shanks
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - James S McCarthy
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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3
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Abstract
IMPORTANCE Malaria is caused by protozoa parasites of the genus Plasmodium and is diagnosed in approximately 2000 people in the US each year who have returned from visiting regions with endemic malaria. The mortality rate from malaria is approximately 0.3% in the US and 0.26% worldwide. OBSERVATIONS In the US, most malaria is diagnosed in people who traveled to an endemic region. More than 80% of people diagnosed with malaria in the US acquired the infection in Africa. Of the approximately 2000 people diagnosed with malaria in the US in 2017, an estimated 82.4% were adults and about 78.6% were Black or African American. Among US residents diagnosed with malaria, 71.7% had not taken malaria chemoprophylaxis during travel. In 2017 in the US, P falciparum was the species diagnosed in approximately 79% of patients, whereas P vivax was diagnosed in an estimated 11.2% of patients. In 2017 in the US, severe malaria, defined as vital organ involvement including shock, pulmonary edema, significant bleeding, seizures, impaired consciousness, and laboratory abnormalities such as kidney impairment, acidosis, anemia, or high parasitemia, occurred in approximately 14% of patients, and an estimated 0.3% of those receiving a diagnosis of malaria in the US died. P falciparum has developed resistance to chloroquine in most regions of the world, including Africa. First-line therapy for P falciparum malaria in the US is combination therapy that includes artemisinin. If P falciparum was acquired in a known chloroquine-sensitive region such as Haiti, chloroquine remains an alternative option. When artemisinin-based combination therapies are not available, atovaquone-proguanil or quinine plus clindamycin is used for chloroquine-resistant malaria. P vivax, P ovale, P malariae, and P knowlesi are typically chloroquine sensitive, and treatment with either artemisinin-based combination therapy or chloroquine for regions with chloroquine-susceptible infections for uncomplicated malaria is recommended. For severe malaria, intravenous artesunate is first-line therapy. Treatment of mild malaria due to a chloroquine-resistant parasite consists of a combination therapy that includes artemisinin or chloroquine for chloroquine-sensitive malaria. P vivax and P ovale require additional therapy with an 8-aminoquinoline to eradicate the liver stage. Several options exist for chemoprophylaxis and selection should be based on patient characteristics and preferences. CONCLUSIONS AND RELEVANCE Approximately 2000 cases of malaria are diagnosed each year in the US, most commonly in travelers returning from visiting endemic areas. Prevention and treatment of malaria depend on the species and the drug sensitivity of parasites from the region of acquisition. Intravenous artesunate is first-line therapy for severe malaria.
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Affiliation(s)
- Johanna P Daily
- Department of Medicine (Infectious Diseases), Albert Einstein College of Medicine, Bronx, New York
| | - Aurelia Minuti
- D. Samuel Gottesman Library, Albert Einstein College of Medicine, Bronx, New York
| | - Nazia Khan
- Department of Medicine (Infectious Diseases), Albert Einstein College of Medicine, Bronx, New York
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4
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Suh J, Kim JH, Kim JD, Kim C, Choi JY, Lee J, Yeom JS. Cost-Benefit Analysis of Tafenoquine for Radical Cure of Plasmodium vivax Malaria in Korea. J Korean Med Sci 2022; 37:e212. [PMID: 35818703 PMCID: PMC9274106 DOI: 10.3346/jkms.2022.37.e212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/10/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Plasmodium vivax malaria has a persistent liver stage that causes relapse, and introducing tafenoquine to suppress relapse could aid in disease eradication. Therefore, we assessed the impact of tafenoquine introduction on P. vivax malaria incidence and performed a cost-benefit analysis from the payer's perspective. METHODS We expanded the previously developed P. vivax malaria dynamic transmission model and calibrated it to weekly civilian malaria incidences in 2014-2018. Primaquine and tafenoquine scenarios were considered by assuming different relapse probabilities, and relapse and total P. vivax malaria cases were predicted over the next decade for each scenario. We then estimated the number of cases prevented by replacing primaquine with tafenoquine. The cost and benefit of introducing tafenoquine were obtained using medical expenditure from a nationwide database, and a cost-benefit analysis was conducted. A probabilistic sensitivity analysis was performed to assess the economic feasibility robustness of tafenoquine introduction under uncertainties of model parameters, costs, and benefits. RESULTS Under 0.04 primaquine relapse probability, the introduction of tafenoquine with relapse probability of 0.01 prevented 129 (12.27%) and 35 (77.78%) total and relapse cases, respectively, over the next decade. However, under the same relapse probability as primaquine, introducing tafenoquine had no additional preventative effect. The 14-day primaquine treatment cost was $3.71. The tafenoquine and the glucose-6-phosphate dehydrogenase rapid diagnostic testing cost $57.37 and $7.76, totaling $65.13. The average medical expenditure per malaria patient was estimated at $1444.79. The cost-benefit analysis results provided an incremental benefit-cost ratio (IBCR) from 0 to 3.21 as the tafenoquine relapse probability decreased from 0.04 to 0.01. The probabilistic sensitivity analysis showed an IBCR > 1, indicating that tafenoquine is beneficial, with a probability of 69.1%. CONCLUSION Tafenoquine could reduce P. vivax malaria incidence and medical costs and bring greater benefits than primaquine.
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Affiliation(s)
- Jiyeon Suh
- School of Mathematics and Computing (Computational Science and Engineering), Yonsei University, Seoul, Korea
| | - Jung Ho Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Dae Kim
- Department of General Surgery, Bestian Woosong Hospital, Daejeon, Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeehyun Lee
- School of Mathematics and Computing, Yonsei University, Seoul, Korea.
| | - Joon-Sup Yeom
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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5
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Dong Y, Sonawane Y, Maher SP, Zeeman AM, Chaumeau V, Vantaux A, Cooper CA, Chiu FCK, Ryan E, McLaren J, Chen G, Wittlin S, Witkowski B, Nosten F, Sriraghavan K, Kyle DE, Kocken CHM, Charman SA, Vennerstrom JL. Metabolic, Pharmacokinetic, and Activity Profile of the Liver Stage Antimalarial (RC-12). ACS OMEGA 2022; 7:12401-12411. [PMID: 35449901 PMCID: PMC9016807 DOI: 10.1021/acsomega.2c01099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
The catechol derivative RC-12 (WR 27653) (1) is one of the few non-8-aminoquinolines with good activity against hypnozoites in the gold-standard Plasmodium cynomolgi-rhesus monkey (Macaca mulatta) model, but in a small clinical trial, it had no efficacy against Plasmodium vivax hypnozoites. In an attempt to better understand the pharmacokinetic and pharmacodynamic profile of 1 and to identify potential active metabolites, we now describe the phase I metabolism, rat pharmacokinetics, and in vitro liver-stage activity of 1 and its metabolites. Compound 1 had a distinct metabolic profile in human vs monkey liver microsomes, and the data suggested that the O-desmethyl, combined O-desmethyl/N-desethyl, and N,N-didesethyl metabolites (or a combination thereof) could potentially account for the superior liver stage antimalarial efficacy of 1 in rhesus monkeys vs that seen in humans. Indeed, the rate of metabolism was considerably lower in human liver microsomes in comparison to rhesus monkey microsomes, as was the formation of the combined O-desmethyl/N-desethyl metabolite, which was the only metabolite tested that had any activity against liver-stage P. vivax; however, it was not consistently active against liver-stage P. cynomolgi. As 1 and all but one of its identified Phase I metabolites had no in vitro activity against P. vivax or P. cynomolgi liver-stage malaria parasites, we suggest that there may be additional unidentified active metabolites of 1 or that the exposure of 1 achieved in the reported unsuccessful clinical trial of this drug candidate was insufficient to kill the P. vivax hypnozoites.
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Affiliation(s)
- Yuxiang Dong
- College
of Pharmacy, University of Nebraska Medical
Center, 986125 Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Yogesh Sonawane
- College
of Pharmacy, University of Nebraska Medical
Center, 986125 Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Steven P. Maher
- Center
for Tropical and Emerging Global Diseases, University of Georgia, 370 Coverdell
Center, 500 D.W. Brooks Drive, Athens, Georgia 30602, United States
| | - Anne-Marie Zeeman
- Department
of Parasitology, Biomedical Primate Research
Centre, P.O. Box 3306, 2280 GH Rijswijk, The Netherlands
| | - Victor Chaumeau
- Shoklo
Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit,
Faculty of Tropical Medicine, Mahidol University, 68/30 Bantung Road, Mae Sot, Tak 63110, Thailand
- Centre for
Tropical Medicine and Global Health, Nuffield Department of Medicine
Research building, University of Oxford
Old Road Campus, Oxford OX3 7DQ, U.K.
| | - Amélie Vantaux
- Malaria
Molecular Epidemiology Unit, Institut Pasteur
du Cambodge, 5 Boulevard Monivong, P.O. Box 983, Phnom
Penh 120 210, Cambodia
| | - Caitlin A. Cooper
- Center
for Tropical and Emerging Global Diseases, University of Georgia, 370 Coverdell
Center, 500 D.W. Brooks Drive, Athens, Georgia 30602, United States
| | - Francis C. K. Chiu
- Centre
for Drug Candidate Optimisation, Monash Institute of Pharmaceutical
Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Eileen Ryan
- Centre
for Drug Candidate Optimisation, Monash Institute of Pharmaceutical
Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Jenna McLaren
- Centre
for Drug Candidate Optimisation, Monash Institute of Pharmaceutical
Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Gong Chen
- Centre
for Drug Candidate Optimisation, Monash Institute of Pharmaceutical
Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Sergio Wittlin
- Department
of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4002 Basel, Switzerland
| | - Benoît Witkowski
- Malaria
Molecular Epidemiology Unit, Institut Pasteur
du Cambodge, 5 Boulevard Monivong, P.O. Box 983, Phnom
Penh 120 210, Cambodia
| | - François Nosten
- Shoklo
Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit,
Faculty of Tropical Medicine, Mahidol University, 68/30 Bantung Road, Mae Sot, Tak 63110, Thailand
- Centre for
Tropical Medicine and Global Health, Nuffield Department of Medicine
Research building, University of Oxford
Old Road Campus, Oxford OX3 7DQ, U.K.
| | - Kamaraj Sriraghavan
- College
of Pharmacy, University of Nebraska Medical
Center, 986125 Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Dennis E. Kyle
- Center
for Tropical and Emerging Global Diseases, University of Georgia, 370 Coverdell
Center, 500 D.W. Brooks Drive, Athens, Georgia 30602, United States
| | - Clemens H. M. Kocken
- Department
of Parasitology, Biomedical Primate Research
Centre, P.O. Box 3306, 2280 GH Rijswijk, The Netherlands
| | - Susan A. Charman
- Centre
for Drug Candidate Optimisation, Monash Institute of Pharmaceutical
Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Jonathan L. Vennerstrom
- College
of Pharmacy, University of Nebraska Medical
Center, 986125 Nebraska Medical Center, Omaha, Nebraska 68198, United States
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6
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Marcos LA, Leung A, Kirkman L, Wormser GP. Use of tafenoquine to treat a patient with relapsing babesiosis with clinical and molecular evidence of resistance to azithromycin and atovaquone. IDCases 2022; 27:e01460. [PMID: 35242564 PMCID: PMC8885462 DOI: 10.1016/j.idcr.2022.e01460] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 02/20/2022] [Accepted: 02/20/2022] [Indexed: 11/23/2022] Open
Abstract
Tafenoquine is a highly effective treatment for Babesia microti infections in animal models. An immunocompromised patient infected by a strain of B. microti that was at least partially resistant to both azithromycin and atovaquone was treated with tafenoquine. Systematic clinical studies using tafenoquine for treating other patients with babesiosis should be considered.
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Affiliation(s)
- Luis A Marcos
- Department of Medicine (Division of Infectious Diseases) and Department of Microbiology and Immunology, Stony Brook University, USA
| | - Annie Leung
- Department of Medicine (Division of Infectious Diseases) and Department of Microbiology and Immunology, Weill Cornell Medical College, New York, NY, USA
| | - Laura Kirkman
- Department of Medicine (Division of Infectious Diseases) and Department of Microbiology and Immunology, Weill Cornell Medical College, New York, NY, USA
| | - Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, NY, USA
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7
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Al Fayez N, Böttger R, Rouhollahi E, Cullis PR, Witzigmann D, Li SD. Improved Liver Delivery of Primaquine by Phospholipid-Free Small Unilamellar Vesicles with Reduced Hemolytic Toxicity. Mol Pharm 2021; 19:1778-1785. [PMID: 34546758 DOI: 10.1021/acs.molpharmaceut.1c00520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hemolytic toxicity caused by primaquine (PQ) is a high-risk condition that hampers the wide use of PQ to treat liver-stage malaria. This study demonstrated that phospholipid-free small unilamellar vesicles (PFSUVs) composed of Tween80 and cholesterol could encapsulate and deliver PQ to the hepatocytes with reduced exposure to the red blood cells (RBCs). Nonionic surfactant (Tween80) and cholesterol-forming SUVs with a mean diameter of 50 nm were fabricated for delivering PQ. Drug release/retention, drug uptake by RBCs, pharmacokinetics, and liver uptake of PFSUVs-PQ were evaluated in in vitro and in vivo models in comparison to free drugs. Additionally, the stress effect on RBCs induced by free PQ and PFSUVs-PQ was evaluated by examining RBC morphology. PFSUVs provided >95% encapsulation efficiency for PQ at a drug-to-lipid ratio of 1:20 (w/w) and stably retained the drug in the presence of serum. When incubated with RBCs, PQ uptake in the PFSUVs group was reduced by 4- to 8-folds compared to free PQ. As a result, free PQ induced significant RBC morphology changes, while PFSUVs-PQ showed no such adverse effect. Intravenously (i.v.) delivered PFSUVs-PQ produced a comparable plasma profile as free PQ, given i.v. and orally, while the liver uptake was increased by 4.8 and 1.6-folds, respectively, in mice. Within the liver, PFSUVs selectively targeted the hepatocytes, with no significant blood or liver toxicity in mice. PFSUVs effectively targeted PQ to the liver and reduced RBC uptake compared to free PQ, leading to reduced RBC toxicity. PFSUVs exhibited potential in improving the efficacy of PQ for treating liver-stage malaria.
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Affiliation(s)
- Nojoud Al Fayez
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Roland Böttger
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Elham Rouhollahi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Pieter R Cullis
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada.,NanoMedicines Innovation Network (NMIN), University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Dominik Witzigmann
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada.,NanoMedicines Innovation Network (NMIN), University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Shyh-Dar Li
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada.,NanoMedicines Innovation Network (NMIN), University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
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8
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Markus MB. Safety and Efficacy of Tafenoquine for Plasmodium vivax Malaria Prophylaxis and Radical Cure: Overview and Perspectives. Ther Clin Risk Manag 2021; 17:989-999. [PMID: 34526770 PMCID: PMC8435617 DOI: 10.2147/tcrm.s269336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
This article is inter alia a brief, first-stop guide to possible adverse events (AEs) associated with tafenoquine (TQ) intake. Safety and efficacy findings for TQ in Plasmodium vivax malaria prophylaxis and radical cure are summarized and some of the latest TQ-related studies (published in 2020 and 2021) are highlighted. In addition, little-known biological and other matters concerning malaria parasites and 8-aminoquinoline (8-AQ) drug action are discussed and some correct terminology pertinent to malaria is explained.
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Affiliation(s)
- Miles B Markus
- School of Animal, Plant and Environmental Sciences, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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9
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Tisnerat C, Dassonville-Klimpt A, Gosselet F, Sonnet P. Antimalarial drug discovery: from quinine to the most recent promising clinical drug candidates. Curr Med Chem 2021; 29:3326-3365. [PMID: 34344287 DOI: 10.2174/0929867328666210803152419] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022]
Abstract
Malaria is a tropical threatening disease caused by Plasmodium parasites, resulting in 409,000 deaths in 2019. The delay of mortality and morbidity has been compounded by the widespread of drug resistant parasites from Southeast Asia since two decades. The emergence of artemisinin-resistant Plasmodium in Africa, where most cases are accounted, highlights the urgent need for new medicines. In this effort, the World Health Organization and Medicines for Malaria Venture joined to define clear goals for novel therapies and characterized the target candidate profile. This ongoing search for new treatments is based on imperative labor in medicinal chemistry which is summarized here with particular attention to hit-to-lead optimizations, key properties, and modes of action of these novel antimalarial drugs. This review, after presenting the current antimalarial chemotherapy, from quinine to the latest marketed drugs, focuses in particular on recent advances of the most promising antimalarial candidates in clinical and preclinical phases.
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Affiliation(s)
- Camille Tisnerat
- AGIR UR4294, UFR de Pharmacie, Université de Picardie Jules Verne, Amiens. France
| | | | | | - Pascal Sonnet
- AGIR UR4294, UFR de Pharmacie, Université de Picardie Jules Verne, Amiens. France
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Costescu Strachinaru DI, Wauters A, Van Esbroeck M, Strachinaru M, Vanbrabant P, Soentjens P. A Cluster of Plasmodium ovale Infections in Belgian Military Personnel after Deployment in Kindu, Democratic Republic of Congo: A Retrospective Study. Trop Med Infect Dis 2021; 6:tropicalmed6030125. [PMID: 34287372 PMCID: PMC8293309 DOI: 10.3390/tropicalmed6030125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 01/28/2023] Open
Abstract
Plasmodium ovale malaria is often neglected due to its less severe course compared to Plasmodium falciparum. In 2011–2012, Belgian Armed Forces identified a cluster of P. ovale cases among military personnel after deployment in the Democratic Republic of Congo (DRC). In this retrospective, monocentric, observational study, clinical and biological features of soldiers diagnosed with P. ovale after deployment in DRC were reviewed. Species diagnosis was based on polymerase chain reaction (PCR) and/or thick blood smear. Medical records of 149 soldiers screened at the Queen Astrid Military Hospital after deployment were reviewed. Eight cases (seven P. ovale infections and one P. ovale—falciparum coinfection) were identified. All had positive thick smears, and seven were confirmed by PCR. Chemoprophylaxis was mefloquine in all subjects. Median time of disease onset was 101 days after return from the endemic region. Median delay between return and diagnosis was 103 days. All P. ovale bouts were uncomplicated. None had relapses after primaquine treatment. This military cohort highlights a hotspot of P. ovale in Eastern DRC. Non-specific symptoms, the less severe presentation, the lack of sensitive parasitological tools in the field and long delays between infection and symptoms probably lead to underestimation of P. ovale cases.
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Affiliation(s)
- Diana Isabela Costescu Strachinaru
- Center for Infectious Diseases, Queen Astrid Military Hospital, 1120 Brussels, Belgium; (P.V.); (P.S.)
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (A.W.); (M.V.E.)
- Correspondence:
| | - An Wauters
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (A.W.); (M.V.E.)
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (A.W.); (M.V.E.)
| | - Mihai Strachinaru
- Department of Cardiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands;
| | - Peter Vanbrabant
- Center for Infectious Diseases, Queen Astrid Military Hospital, 1120 Brussels, Belgium; (P.V.); (P.S.)
- General Internal Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Patrick Soentjens
- Center for Infectious Diseases, Queen Astrid Military Hospital, 1120 Brussels, Belgium; (P.V.); (P.S.)
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (A.W.); (M.V.E.)
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Fesler MC, Stricker RB. Pre-Exposure Prophylaxis for COVID-19 in Pregnant Women. Int J Gen Med 2021; 14:279-284. [PMID: 33542646 PMCID: PMC7851576 DOI: 10.2147/ijgm.s295627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
Pregnant women are at higher risk for developing severe complications of COVID-19 including preterm delivery, respiratory failure, and death. Although vaccines to prevent COVID-19 are being developed, pregnant women are not included in the current COVID-19 vaccine trials and initially this population may not be eligible for COVID-19 vaccines due to lack of safety testing in pregnancy. As an alternate approach, we discuss the concept of pre-exposure prophylaxis (PrEP) using medications that are approved for use in pregnant women to prevent gestational problems and severe illness in this high-risk population. In particular, the use of hydroxychloroquine PrEP affords a safe and readily available means to avoid COVID-19 complications in pregnancy.
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Affiliation(s)
- Melissa C Fesler
- Alan E. Beer Medical Center for Reproductive Immunology, Los Gatos, CA, USA.,Union Square Medical Associates, San Francisco, CA, USA
| | - Raphael B Stricker
- Alan E. Beer Medical Center for Reproductive Immunology, Los Gatos, CA, USA.,Union Square Medical Associates, San Francisco, CA, USA
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Collins KA, Abd-Rahman AN, Marquart L, Ballard E, Gobeau N, Griffin P, Chalon S, Möhrle JJ, McCarthy JS. Antimalarial activity of artefenomel against asexual parasites and transmissible gametocytes during experimental blood-stage Plasmodium vivax infection. J Infect Dis 2020; 225:1062-1069. [PMID: 32479608 PMCID: PMC8922009 DOI: 10.1093/infdis/jiaa287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Interventions that effectively target Plasmodium vivax are critical for the future control and elimination of malaria. We conducted a P. vivax volunteer infection study to characterize the antimalarial activity of artefenomel, a new drug candidate. Methods Eight healthy, malaria-naive participants were intravenously inoculated with blood-stage P. vivax and subsequently received a single oral 200-mg dose of artefenomel. Blood samples were collected to monitor the development and clearance of parasitemia, and plasma artefenomel concentration. Mosquito feeding assays were conducted before artefenomel dosing to investigate parasite transmissibility. Results Initial parasite clearance occurred in all participants after artefenomel administration (log10 parasite reduction ratio over 48 hours, 1.67; parasite clearance half-life, 8.67 hours). Recrudescence occurred in 7 participants 11–14 days after dosing. A minimum inhibitory concentration of 0.62 ng/mL and minimum parasiticidal concentration that achieves 90% of maximum effect of 0.83 ng/mL were estimated, and a single 300-mg dose was predicted to clear 109 parasites per milliliter with 95% certainty. Gametocytemia developed in all participants and was cleared 4–8 days after dosing. At peak gametocytemia, 75% of participants were infectious to mosquitoes. Conclusions The in vivo antimalarial activity of artefenomel supports its further clinical development as a treatment for P. vivax malaria. Clinical Trials Registration NCT02573857.
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Affiliation(s)
| | | | - Louise Marquart
- QIMR Berghofer Medical Research Institute, Herston QLD, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Herston QLD, Australia
| | - Nathalie Gobeau
- Medicine for Malaria Venture, Route de Pré-Bois, Meyrin, Switzerland
| | - Paul Griffin
- QIMR Berghofer Medical Research Institute, Herston QLD, Australia.,The University of Queensland, Brisbane QLD, Australia.,Department of Medicine and Infectious Diseases, Mater Hospital and Mater Research, Raymond Terrace, South Brisbane QLD, Australia
| | - Stephan Chalon
- Medicine for Malaria Venture, Route de Pré-Bois, Meyrin, Switzerland
| | - Jörg J Möhrle
- Medicine for Malaria Venture, Route de Pré-Bois, Meyrin, Switzerland
| | - James S McCarthy
- QIMR Berghofer Medical Research Institute, Herston QLD, Australia.,The University of Queensland, Brisbane QLD, Australia
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