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Alcântara JA, de Araújo FSA, da Costa Paz A, Alencar RM, de Albuquerque Caldas BY, Godoy RSM, Lacerda MVG, de Melo GC, Monteiro WM, de Souza Sampaio V, Secundino NFC, Duarte APM, Santana RAG, Pimenta PFP. Effect of fluralaner on the biology, survival, and reproductive fitness of the neotropical malaria vector Anopheles aquasalis. Malar J 2023; 22:337. [PMID: 37936198 PMCID: PMC10631211 DOI: 10.1186/s12936-023-04767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Reducing mosquito abundance or interfering with its ability to support the parasite cycle can help to interrupt malaria in areas of significant risk of malaria transmission. Fluralaner is a safe and effective drug for veterinary use indicated for the treatment against fleas and ticks which acts as an antagonist of chloride ion channels mediated by γ-aminobutyric acid (GABA), preventing the entry of these ions into the postsynaptic neuron, leading to hyperexcitability of the postsynaptic neuron of the central nervous system of arthropods. Fluralaner demonstrated insecticidal activity against different insect species. METHODS The study aimed to evaluate the effects of fluralaner on the biology, survival, and reproductive fitness of Anopheles aquasalis. The following lethal concentrations (LC) were determined for An. aquasalis: LC5 = 0.511 µM; LC25 = 1.625 µM; LC50 = 3.237 µM. RESULTS A significant decrease (P < 0.001) was evident in the number of eggs, larvae, and pupae in the group exposed to a sublethal dose of fluralaner when compared to a control group (without the drug). Using blood from dogs after administration of fluralaner, it was observed that the drug causes 100% mortality in An. aquasalis in less than 24 h after feeding; this effect remains even after 90 days in all samples. DISCUSSION Fluralaner showed the same result for up to 60 days, and after that, there was a slight reduction in its effect, evidenced by a decrease in the percentage of dead females; however, still significant when compared to the control group. CONCLUSION Fluralaner affects the biology and reduction of survival in An. aquasalis in a lasting and prolonged period, and its fecundity with lower dosages, is a strong candidate for controlling disease vectors.
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Affiliation(s)
- João Arthur Alcântara
- Programa de Pós-graduação em Medicina Tropical-Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (PPGM-UEA/FMT-HVD), Manaus, Brazil
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil
| | - Francys Sayara Andrade de Araújo
- Programa de Pós-graduação em Medicina Tropical-Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (PPGM-UEA/FMT-HVD), Manaus, Brazil
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil
| | - Andréia da Costa Paz
- Programa de Pós-graduação em Medicina Tropical-Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (PPGM-UEA/FMT-HVD), Manaus, Brazil
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil
| | - Rodrigo Maciel Alencar
- Programa de Pós-graduação em Medicina Tropical-Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (PPGM-UEA/FMT-HVD), Manaus, Brazil
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil
| | | | - Raquel Soares Maia Godoy
- Programa de Pós-Graduação Em Ciências da Saúde, FIOCRUZ-Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
- Instituto René Rachou-Fundação Oswaldo Cruz-(IRR-Fiocruz Minas), Belo Horizonte, Brazil
| | - Marcus Vinicius Guimarães Lacerda
- Programa de Pós-graduação em Medicina Tropical-Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (PPGM-UEA/FMT-HVD), Manaus, Brazil
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil
- Instituto Leônidas e Maria Deane - Fundação Oswaldo Cruz - (ILMD - Fiocruz Amazônia), Manaus, Brazil
- University of Texas Medical Branch (UTMB), Galveston, USA
| | - Gisely Cardoso de Melo
- Programa de Pós-graduação em Medicina Tropical-Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (PPGM-UEA/FMT-HVD), Manaus, Brazil
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-graduação em Medicina Tropical-Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (PPGM-UEA/FMT-HVD), Manaus, Brazil
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil
| | - Vanderson de Souza Sampaio
- Programa de Pós-graduação em Medicina Tropical-Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (PPGM-UEA/FMT-HVD), Manaus, Brazil
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil
| | - Nágila Francinete Costa Secundino
- Programa de Pós-graduação em Medicina Tropical-Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (PPGM-UEA/FMT-HVD), Manaus, Brazil
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil
- Programa de Pós-Graduação Em Ciências da Saúde, FIOCRUZ-Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
- Instituto René Rachou-Fundação Oswaldo Cruz-(IRR-Fiocruz Minas), Belo Horizonte, Brazil
| | - Ana Paula Marques Duarte
- Programa de Pós-graduação em Medicina Tropical-Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (PPGM-UEA/FMT-HVD), Manaus, Brazil
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil
- Instituto René Rachou-Fundação Oswaldo Cruz-(IRR-Fiocruz Minas), Belo Horizonte, Brazil
| | - Rosa Amélia Gonçalves Santana
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil
- Instituto Leônidas e Maria Deane - Fundação Oswaldo Cruz - (ILMD - Fiocruz Amazônia), Manaus, Brazil
| | - Paulo Filemon Paolucci Pimenta
- Programa de Pós-graduação em Medicina Tropical-Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (PPGM-UEA/FMT-HVD), Manaus, Brazil.
- Departamento de Ensino e Pesquisa-Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (DENPE/FMT-HVD), Manaus, Brazil.
- Programa de Pós-Graduação Em Ciências da Saúde, FIOCRUZ-Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil.
- Instituto René Rachou-Fundação Oswaldo Cruz-(IRR-Fiocruz Minas), Belo Horizonte, Brazil.
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Chaccour C, Casellas A, Hammann F, Ruiz-Castillo P, Nicolas P, Montaña J, Mael M, Selvaraj P, Duthaler U, Mrema S, Kakolwa M, Lyimo I, Okumu F, Marathe A, Schürch R, Elobolobo E, Sacoor C, Saute F, Xia K, Jones C, Rist C, Maia M, Rabinovich NR. BOHEMIA: Broad One Health Endectocide-based Malaria Intervention in Africa-a phase III cluster-randomized, open-label, clinical trial to study the safety and efficacy of ivermectin mass drug administration to reduce malaria transmission in two African settings. Trials 2023; 24:128. [PMID: 36810194 PMCID: PMC9942013 DOI: 10.1186/s13063-023-07098-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/17/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Residual malaria transmission is the result of adaptive mosquito behavior that allows malaria vectors to thrive and sustain transmission in the presence of good access to bed nets or insecticide residual spraying. These behaviors include crepuscular and outdoor feeding as well as intermittent feeding upon livestock. Ivermectin is a broadly used antiparasitic drug that kills mosquitoes feeding on a treated subject for a dose-dependent period. Mass drug administration with ivermectin has been proposed as a complementary strategy to reduce malaria transmission. METHODS A cluster randomized, parallel arm, superiority trial conducted in two settings with distinct eco-epidemiological conditions in East and Southern Africa. There will be three groups: human intervention, consisting of a dose of ivermectin (400 mcg/kg) administered monthly for 3 months to all the eligible population in the cluster (>15 kg, non-pregnant and no medical contraindication); human and livestock intervention, consisting human treatment as above plus treatment of livestock in the area with a single dose of injectable ivermectin (200 mcg/kg) monthly for 3 months; and controls, consisting of a dose of albendazole (400 mg) monthly for 3 months. The main outcome measure will be malaria incidence in a cohort of children under five living in the core of each cluster followed prospectively with monthly RDTs DISCUSSION: The second site for the implementation of this protocol has changed from Tanzania to Kenya. This summary presents the Mozambique-specific protocol while the updated master protocol and the adapted Kenya-specific protocol undergo national approval in Kenya. BOHEMIA will be the first large-scale trial evaluating the impact of ivermectin-only mass drug administration to humans or humans and cattle on local malaria transmission TRIAL REGISTRATION: ClinicalTrials.gov NCT04966702 . Registered on July 19, 2021. Pan African Clinical Trials Registry PACTR202106695877303.
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Affiliation(s)
- Carlos Chaccour
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain. .,Universidda de Navarra, Pamplona, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain.
| | - Aina Casellas
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Felix Hammann
- grid.411656.10000 0004 0479 0855University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Paula Ruiz-Castillo
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Patricia Nicolas
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Julia Montaña
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Mary Mael
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Prashant Selvaraj
- grid.418309.70000 0000 8990 8592Bill and Melinda Gates Foundation, Seattle, USA
| | - Urs Duthaler
- grid.6612.30000 0004 1937 0642University Basel, Basel, Switzerland
| | - Sigilbert Mrema
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Ifakara, Tanzania
| | - Mwaka Kakolwa
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Ifakara, Tanzania
| | - Issa Lyimo
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Ifakara, Tanzania
| | - Fredros Okumu
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Ifakara, Tanzania
| | - Achla Marathe
- grid.27755.320000 0000 9136 933XUniversity of Virginia, Charlottesville, USA
| | - Roger Schürch
- grid.438526.e0000 0001 0694 4940Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Eldo Elobolobo
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Charfudin Sacoor
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Francisco Saute
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Kang Xia
- grid.438526.e0000 0001 0694 4940Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Caroline Jones
- grid.33058.3d0000 0001 0155 5938KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Cassidy Rist
- grid.438526.e0000 0001 0694 4940Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Marta Maia
- grid.33058.3d0000 0001 0155 5938KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - N. Regina Rabinovich
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain ,grid.38142.3c000000041936754XTH Chan Harvard School of Public Health, Boston, USA
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3
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Cobos-Campos R, Apiñaniz A, Parraza N, Cordero J, García S, Orruño E. Potential use of ivermectin for the treatment and prophylaxis of SARS-CoV-2 infection. Curr Res Transl Med 2021; 69:103309. [PMID: 34418758 PMCID: PMC8354804 DOI: 10.1016/j.retram.2021.103309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/30/2021] [Accepted: 08/07/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF THE STUDY Currently no treatment has been proven to be efficacious for patients with early symptoms of COVID-19. Although most patients present mild or moderate symptoms, up to 5-10% may have a poor disease progression, so there is an urgent need for effective drugs, which can be administered even before the onset of severe symptoms, i.e. when the course of the disease is modifiable. Recently, promising results of several studies on oral ivermectin have been published, which has prompted us to conduct the present review of the scientific literature. METHODS A narrative review has been carried out, focusing on the following four main topics: a) short-term efficacy in the treatment of the disease, b) long-term efficacy in the treatment of patients with post-acute symptoms of COVID-19, c) efficacy in the prophylaxis of the disease, and c) safety of ivermectin. RESULTS The reviewed literature suggests that there seems to be sufficient evidence about the safety of oral ivermectin, as well as the efficacy of the drug in the early-treatment and the prophylaxis of COVID-19. CONCLUSIONS In the view of the available evidence, the Frontline COVID-19 Critical Care Alliance (FLCCC) recommends the use of oral ivermectin for both prophylaxis and early-treatment of COVID-19. Further well-designed studies should be conducted in order to explore the efficacy and safety of invermectin at low and high doses, following different dosing schedules, in both, the short and long-term treatment.
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Affiliation(s)
- R Cobos-Campos
- Bioaraba Health Research Institute, Epidemiology and Public Health Research Group, Vitoria-Gasteiz, Spain.
| | - A Apiñaniz
- Bioaraba Health Research Institute, Epidemiology and Public Health Research Group, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Aranbizkarra I Health Centre, Vitoria-Gasteiz, Spain; Department of Preventive Medicine and Public Health, EHU/UPV, Vitoria-Gasteiz, Spain.
| | - N Parraza
- Bioaraba Health Research Institute, Epidemiology and Public Health Research Group, Vitoria-Gasteiz, Spain.
| | - J Cordero
- Bioaraba Health Research Institute, Epidemiology and Public Health Research Group, Vitoria-Gasteiz, Spain.
| | - S García
- Bioaraba Health Research Institute, Epidemiology and Public Health Research Group, Vitoria-Gasteiz, Spain.
| | - E Orruño
- Bioaraba Health Research Institute, Epidemiology and Public Health Research Group, Vitoria-Gasteiz, Spain.
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4
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Broekhuizen H, Fehr A, Nieto-Sanchez C, Muela J, Peeters-Grietens K, Smekens T, Kalleh M, Rijndertse E, Achan J, D'Alessandro U. Costs and barriers faced by households seeking malaria treatment in the Upper River Region, The Gambia. Malar J 2021; 20:368. [PMID: 34530823 PMCID: PMC8447575 DOI: 10.1186/s12936-021-03898-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 08/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria transmission in The Gambia decreased substantially over the last 20 years thanks to the scale-up of control interventions. However, malaria prevalence is still relatively high in eastern Gambia and represents both a health and a financial burden for households. This study aims to quantify the out-of-pocket costs and productivity losses of seeking malaria treatment at household level. METHODS A household survey was carried out through in-person interviews. Respondents were asked about malaria prevention methods, their treatment-seeking behaviour, and any costs incurred for transport, services, food, and/or overnight stays. A bottom-up costing approach was used to calculate the unit cost of treatment and a tobit regression approach to investigate cost drivers. RESULTS The survey included 864 respondents, mainly subsistence farmers. Most respondents (87%) considered malaria to be a problem affecting their ability to perform their regular duties. Respondents preferred going to a health facility for treatment. The primary reason for not going was related to costs; 70% of respondents incurred costs for seeking health care, with a median of £3.62 (IQR: £1.73 to £6.10). The primary driver of cost was living in one of the villages that are off the main road and/or far from health facilities. 66% reported productivity loss of 5 working days on average during a malaria episode of them or their child. CONCLUSIONS Although malaria prevalence is decreasing and treatment is provided free of charge, households seeking treatment are confronted with out-of-pocket expenditures and lost working days; particularly in remote villages.
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Affiliation(s)
- Henk Broekhuizen
- Dept. Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands. .,Dept. Health and Society, Wageningen University and Research, Wageningen, The Netherlands.
| | - Alexandra Fehr
- Department of Sociology and Anthropology, Faculty of Social and Behavioural Science, University of Amsterdam, Amsterdam, The Netherlands.,Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Claudia Nieto-Sanchez
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Koen Peeters-Grietens
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Tom Smekens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Esmé Rijndertse
- Dept. Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jane Achan
- MRC The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.,Malaria Research Consortium, London, UK
| | - Umberto D'Alessandro
- MRC The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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5
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Nicolas P, Kiuru C, Wagah MG, Muturi M, Duthaler U, Hammann F, Maia M, Chaccour C. Potential metabolic resistance mechanisms to ivermectin in Anopheles gambiae: a synergist bioassay study. Parasit Vectors 2021; 14:172. [PMID: 33743783 PMCID: PMC7981804 DOI: 10.1186/s13071-021-04675-9] [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: 12/01/2020] [Accepted: 03/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Despite remarkable success obtained with current malaria vector control strategies in the last 15 years, additional innovative measures will be needed to achieve the ambitious goals for malaria control set for 2030 by the World Health Organization (WHO). New tools will need to address insecticide resistance and residual transmission as key challenges. Endectocides such as ivermectin are drugs that kill mosquitoes which feed on treated subjects. Mass administration of ivermectin can effectively target outdoor and early biting vectors, complementing the still effective conventional tools. Although this approach has garnered attention, development of ivermectin resistance is a potential pitfall. Herein, we evaluate the potential role of xenobiotic pumps and cytochrome P450 enzymes in protecting mosquitoes against ivermectin by active efflux and metabolic detoxification, respectively. Methods We determined the lethal concentration 50 for ivermectin in colonized Anopheles gambiae; then we used chemical inhibitors and inducers of xenobiotic pumps and cytochrome P450 enzymes in combination with ivermectin to probe the mechanism of ivermectin detoxification. Results Dual inhibition of xenobiotic pumps and cytochromes was found to have a synergistic effect with ivermectin, greatly increasing mosquito mortality. Inhibition of xenobiotic pumps alone had no effect on ivermectin-induced mortality. Induction of xenobiotic pumps and cytochromes may confer partial protection from ivermectin. Conclusion There is a clear pathway for development of ivermectin resistance in malaria vectors. Detoxification mechanisms mediated by cytochrome P450 enzymes are more important than xenobiotic pumps in protecting mosquitoes against ivermectin.![]()
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Affiliation(s)
- Patricia Nicolas
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Rosello 132, 5ª 2ª, 08036, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, 1929, Maputo, Mozambique
| | - Caroline Kiuru
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Rosello 132, 5ª 2ª, 08036, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, 1929, Maputo, Mozambique
| | - Martin G Wagah
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 91SA, UK.,Department of Biosciences, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Martha Muturi
- Department of Biosciences, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Urs Duthaler
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University and University Hospital Basel, 4056, Basel, Switzerland.,Division of Clinical Pharmacology and Toxicology, Department of Pharmaceutical Sciences, University of Basel, 4056, Basel, Switzerland
| | - Felix Hammann
- Division of Clinical Pharmacology and Toxicology, Department of Internal Medicine, University Hospital Bern, 3010, Bern, Switzerland
| | - Marta Maia
- Department of Biosciences, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Carlos Chaccour
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Rosello 132, 5ª 2ª, 08036, Barcelona, Spain. .,Ifakara Health Institute, Ifakara, 67501, United Republic of Tanzania. .,Facultad de Medicina, Universidad de Navarra, 31008, Pamplona, Spain.
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Madrid RR, Mathews PD, Patta AC, Gonzales-Flores AP, Ramirez CA, Rigoni VL, Tavares-Dias M, Mertins O. Safety of oral administration of high doses of ivermectin by means of biocompatible polyelectrolytes formulation. Heliyon 2020; 7:e05820. [PMID: 33426351 PMCID: PMC7775035 DOI: 10.1016/j.heliyon.2020.e05820] [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: 09/13/2020] [Revised: 11/02/2020] [Accepted: 12/18/2020] [Indexed: 12/23/2022] Open
Abstract
The FDA-approved drug ivermectin is applied for treatments of onchocerciasis and lymphatic filariasis. The anti-cancer and anti-viral activities have been demonstrated stressing possibilities for the drug repurposing and therefore new information on high dosage safety is on demand. We analyzed in vivo tissue responses for high doses of ivermectin using Corydoras fish as animal model. We made intestinal histology and hematologic assays after oral administration of ivermectin transported with polyelectrolytes formulation. Histology showed any apparent damage of intestinal tissues at 0.22–170 mg of ivermectin/kg body weight. Immunofluorescence evidenced delocalization of Myosin-Vb at enterocytes only for the higher dose. Hematology parameters showed random variations after 7 days from administration, but a later apparent recover after 14 and 21 days. The study evaluated the potential of high doses of oral administration of ivermectin formulation, which could be an alternative with benefits in high compliance therapies.
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Affiliation(s)
- Rafael R.M. Madrid
- Laboratory of Nano Bio Materials (LNBM), Department of Biophysics, Paulista Medical School, Federal University of Sao Paulo (UNIFESP), 04023-062 Sao Paulo, SP, Brazil
| | - Patrick D. Mathews
- Laboratory of Nano Bio Materials (LNBM), Department of Biophysics, Paulista Medical School, Federal University of Sao Paulo (UNIFESP), 04023-062 Sao Paulo, SP, Brazil
- Corresponding author.
| | - Ana C.M.F. Patta
- Laboratory of Nano Bio Materials (LNBM), Department of Biophysics, Paulista Medical School, Federal University of Sao Paulo (UNIFESP), 04023-062 Sao Paulo, SP, Brazil
| | - Anai P. Gonzales-Flores
- Post-Graduate Program in Tropical Biodiversity, Federal University of Amapá, 68903-419 Macapá, AP, Brazil
- Institute of Research of the Peruvian Amazon (IIAP, AQUAREC), 17000 Puerto Maldonado, Peru
| | - Carlos A.B. Ramirez
- Laboratory of Nano Bio Materials (LNBM), Department of Biophysics, Paulista Medical School, Federal University of Sao Paulo (UNIFESP), 04023-062 Sao Paulo, SP, Brazil
| | - Vera L.S. Rigoni
- Laboratory of Nano Bio Materials (LNBM), Department of Biophysics, Paulista Medical School, Federal University of Sao Paulo (UNIFESP), 04023-062 Sao Paulo, SP, Brazil
| | | | - Omar Mertins
- Laboratory of Nano Bio Materials (LNBM), Department of Biophysics, Paulista Medical School, Federal University of Sao Paulo (UNIFESP), 04023-062 Sao Paulo, SP, Brazil
- Corresponding author.
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Chaccour C. Veterinary endectocides for malaria control and elimination: prospects and challenges. Philos Trans R Soc Lond B Biol Sci 2020; 376:20190810. [PMID: 33357062 DOI: 10.1098/rstb.2019.0810] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Residual transmission is the persistence of malaria transmission after scale-up of appropriate vector control tools and is one of the key challenges for malaria elimination today. Although long associated with outdoor biting, other mosquito behaviours such as partly feeding upon animals contribute greatly to sustaining transmission. Peri-domestic livestock can be used as decoy to protect humans from blood-seeking vectors but this approach often leads to an increased malaria risk in a phenomenon known as zoopotentiation. Treating the said livestock with drugs capable of killing intestinal parasites as well as mosquitoes that feed upon them has the potential to tackle malaria through a previously unexplored mechanism. The advantages and challenges associated with this approach are briefly discussed here. Numerous references are purposely provided. This article is part of the theme issue 'Novel control strategies for mosquito-borne diseases'.
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Affiliation(s)
- Carlos Chaccour
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Rosello 132, 5ª 2ª, 08036 Barcelona, Spain.,Ifakara Health Institute, Off Mlabani Passage, PO Box 53, Ifakara, United Republic of Tanzania.,Faculty of Medicine, Universidad de Navarra, Calle de Irunlarrea 1, 31008 Pamplona, Spain
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Cortez-Maya S, Moreno-Herrera A, Palos I, Rivera G. Old Antiprotozoal Drugs: Are They Still Viable Options for Parasitic Infections or New Options for Other Diseases? Curr Med Chem 2020; 27:5403-5428. [DOI: 10.2174/0929867326666190628163633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/31/2019] [Accepted: 06/10/2019] [Indexed: 01/16/2023]
Abstract
Parasitic diseases, caused by helminths (ascariasis, hookworm, trichinosis, and schistosomiasis)
and protozoa (chagas, leishmaniasis, and amebiasis), are considered a serious public
health problem in developing countries. Additionally, there is a limited arsenal of anti-parasitic
drugs in the current pipeline and growing drug resistance. Therefore, there is a clear need for the
discovery and development of new compounds that can compete and replace these drugs that have
been controlling parasitic infections over the last decades. However, this approach is highly resource-
intensive, expensive and time-consuming. Accordingly, a drug repositioning strategy of the
existing drugs or drug-like molecules with known pharmacokinetics and safety profiles is alternatively
being used as a fast approach towards the identification of new treatments. The artemisinins,
mefloquine, tribendimidine, oxantel pamoate and doxycycline for the treatment of helminths, and
posaconazole and hydroxymethylnitrofurazone for the treatment of protozoa are promising candidates.
Therefore, traditional antiprotozoal drugs, which were developed in some cases decades ago,
are a valid solution. Herein, we review the current status of traditional anti-helminthic and antiprotozoal
drugs in terms of drug targets, mode of action, doses, adverse effects, and parasite resistance
to define their suitability for repurposing strategies. Current antiparasitic drugs are not only
still viable for the treatment of helminth and protozoan infections but are also important candidates
for new pharmacological treatments.
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Affiliation(s)
- Sandra Cortez-Maya
- Instituto de Quimica, Universidad Nacional Autonoma de Mexico, Cd. Universitaria, Circuito Exterior, Coyoacan, 04510 Ciudad de Mexico, Mexico
| | - Antonio Moreno-Herrera
- Laboratorio de Biotecnologia Farmaceutica, Centro de Biotecnologia Genomica, Instituto Politecnico Nacional, 88710 Reynosa, Mexico
| | - Isidro Palos
- Unidad AcadEmica Multidisciplinaria Reynosa-Rodhe, Universidad AutOnoma de Tamaulipas, 88710 Reynosa, Mexico
| | - Gildardo Rivera
- Laboratorio de Biotecnologia Farmaceutica, Centro de Biotecnologia Genomica, Instituto Politecnico Nacional, 88710 Reynosa, Mexico
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Safety of oral ivermectin during pregnancy: a systematic review and meta-analysis. LANCET GLOBAL HEALTH 2020; 8:e92-e100. [PMID: 31839144 PMCID: PMC7613514 DOI: 10.1016/s2214-109x(19)30453-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/23/2019] [Accepted: 10/11/2019] [Indexed: 12/11/2022]
Abstract
Background About 3·7 billion doses of ivermectin have been distributed in mass drug administration (MDA) campaigns globally over the past 30 years. At 10−100 times higher than current human doses, ivermectin is a known teratogen in mammals. During these campaigns with recommended doses, pregnant women might be inadvertently exposed. We therefore aimed to evaluate the existing evidence for serious and non-serious adverse events after ivermectin exposure in pregnant women. Methods For this systematic review and meta-analysis, we searched relevant databases and trial registry platforms on July 15, 2018, for randomised controlled trials (RCTs) and observational studies that reported adverse events in pregnant women. We did not use language or date restrictions. Outcomes of interest were spontaneous abortions, stillbirths, congenital anomalies, and neonatal death (serious adverse events), as well as maternal morbidity, preterm births, and low birthweight (adverse events). The risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias Tool for RCTs. We did the meta-analysis of observational studies and RCTs separately. The quality of evidence was assessed using the GRADE approach. The study protocol is registered with PROSPERO, protocol CRD42016046914. Findings We identified 147 records, of which only five observational studies and one RCT were included for quantitative analysis; these studies were published between 1990 and 2008, and were done in six African countries. 893 women with 899 pregancy outcomes were included, of whom 496 pregnant women (500 pregnancy outcomes) received ivermectin inadvertently during MDA campaigns in the observational studies and 397 pregnant women (399 pregnancy outcomes) purposely received ivermectin as part of the open-label RCT. No study reported neonatal deaths, maternal morbidity, preterm births, or low birthweight. It is unclear whether exposure to ivermectin during pregnancy increases the risk of spontaneous abortions and stillbirths (odds ratio [OR] 1·15 [95% CI 0·75−1·78] with very low certainty of evidence for the four observational studies and 0·62 [0·18−2·14] with very low certainty of evidence for the RCT) or congenital anomalies (OR 1·69 [95% CI 0·83−3·41] with very low certainty of evidence for the five observational studies and 1·10 [0·07−17·65] with very low certainty of evidence for the RCT). Interpretation There is insufficient evidence to conclude on the safety profile of ivermectin during pregnancy. Treatment campaigns should focus additional efforts on preventing inadvertent treatment of pregnant women. Funding Unitaid.
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Navarro M, Camprubí D, Requena-Méndez A, Buonfrate D, Giorli G, Kamgno J, Gardon J, Boussinesq M, Muñoz J, Krolewiecki A. Safety of high-dose ivermectin: a systematic review and meta-analysis. J Antimicrob Chemother 2020; 75:827-834. [PMID: 31960060 DOI: 10.1093/jac/dkz524] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/17/2019] [Accepted: 11/26/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ivermectin is a key anthelmintic for the control of neglected tropical diseases. The main indications for population-level control with ivermectin through mass drug administration are onchocerciasis and lymphatic filariasis; however, there is interest in using higher, fixed-dose regimens for the control of scabies, soil-transmitted helminths and malaria. Safety data for these higher-dose regimens are needed. METHODS A systematic literature review and meta-analysis on the safety and doses of ivermectin was conducted. Eligible studies reported patient-level data and, for the meta-analysis, clinical trials reporting data on doses ≥200 and ≥400 μg/kg were included. Incidence ratios were used to compare adverse events by severity and organ system affected. RESULTS The systematic search identified six studies for inclusion, revealing no differences in the number of individuals experiencing adverse events. A descriptive analysis of these clinical trials for a variety of indications showed no difference in the severity of the adverse events between standard (up to 400 μg/kg) and higher doses of ivermectin. Organ system involvement only showed an increase in ocular events in the higher-dose group in one trial for the treatment of onchocerciasis, all of them transient and mild to moderate in intensity. CONCLUSIONS Although within this review the safety of high-dose ivermectin appears to be comparable to standard doses, there are not enough data to support a recommendation for its use in higher-than-approved doses. Ocular adverse events, despite being transient, are of concern in onchocerciasis patients. These data can inform programme managers and guide operational research activities as new approaches for the use of ivermectin are evaluated.
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Affiliation(s)
- Miriam Navarro
- Department of Public Health, Science History and Gynecology, Universidad Miguel Hernández de Elche, Alicante, Spain
| | - Daniel Camprubí
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Dora Buonfrate
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Giovanni Giorli
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Joseph Kamgno
- Centre de Recherche sur les Filarioses et autres Maladies tropicales, Yaounde, Cameroon
| | - Jacques Gardon
- Institut de Recherche pour le Développement, Montpellier, France
| | | | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alejandro Krolewiecki
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Instituto de Investigaciones de Enfermedades Tropicales Universidad Nacional de Salta/CONICET, Orán, Argentina
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11
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Billingsley P, Binka F, Chaccour C, Foy B, Gold S, Gonzalez-Silva M, Jacobson J, Jagoe G, Jones C, Kachur P, Kobylinski K, Last A, Lavery JV, Mabey D, Mboera D, Mbogo C, Mendez-Lopez A, Rabinovich NR, Rees S, Richards F, Rist C, Rockwood J, Ruiz-Castillo P, Sattabongkot J, Saute F, Slater H, Steer A, Xia K, Zullinger R. A Roadmap for the Development of Ivermectin as a Complementary Malaria Vector Control Tool. Am J Trop Med Hyg 2020; 102:3-24. [PMID: 31971144 PMCID: PMC7008306 DOI: 10.4269/ajtmh.19-0620] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022] Open
Abstract
In the context of stalling progress against malaria, resistance of mosquitoes to insecticides, and residual transmission, mass drug administration (MDA) of ivermectin, an endectocide used for neglected tropical diseases (NTDs), has emerged as a promising complementary vector control method. Ivermectin reduces the life span of Anopheles mosquitoes that feed on treated humans and/or livestock, potentially decreasing malaria parasite transmission when administered at the community level. Following the publication by WHO of the preferred product characteristics for endectocides as vector control tools, this roadmap provides a comprehensive view of processes needed to make ivermectin available as a vector control tool by 2024 with a completely novel mechanism of action. The roadmap covers various aspects, which include 1) the definition of optimal dosage/regimens for ivermectin MDA in both humans and livestock, 2) the risk of resistance to the drug and environmental impact, 3) ethical issues, 4) political and community engagement, 5) translation of evidence into policy, and 6) operational aspects of large-scale deployment of the drug, all in the context of a drug given as a prevention tool acting at the community level. The roadmap reflects the insights of a multidisciplinary group of global health experts who worked together to elucidate the path to inclusion of ivermectin in the toolbox against malaria, to address residual transmission, counteract insecticide resistance, and contribute to the end of this deadly disease.
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Affiliation(s)
| | - Fred Binka
- University of Health and Allied Sciences
| | | | | | | | | | | | | | | | | | | | - Anna Last
- London School of Hygiene and Tropical Medicine
| | | | - David Mabey
- London School of Hygiene and Tropical Medicine
| | | | | | | | | | | | | | - Cassidy Rist
- Virginia-Maryland College of Veterinary Medicine at Virginia Tech
| | | | | | | | | | | | | | - Kang Xia
- School of Plant and Environmental Sciences, Virginia Tech
| | - Rose Zullinger
- US President’s Malaria Initiative/US Centers for Disease Control and Prevention
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12
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Foy BD, Rao S, Parikh S, Slater HC, Dabiré RK. Analysis of the RIMDAMAL trial - Authors' reply. Lancet 2019; 394:1006-1007. [PMID: 31544742 DOI: 10.1016/s0140-6736(19)32139-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Brian D Foy
- Arthropod-borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523-1692, USA.
| | - Sangeeta Rao
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sunil Parikh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | - Roch K Dabiré
- Institute of Research in Health Sciences, Western Regional Direction, National Center for Scientific and Technological Research, Bobo-Dioulasso, Burkina Faso
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13
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Ivermectin Impairs the Development of Sexual and Asexual Stages of Plasmodium falciparum In Vitro. Antimicrob Agents Chemother 2019; 63:AAC.00085-19. [PMID: 31109978 DOI: 10.1128/aac.00085-19] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022] Open
Abstract
Ivermectin is the drug of choice for many parasitic infections, with more than one billion doses being distributed in onchocerciasis programs. The drug has been put into focus recently by the malaria community because of its potential to kill blood-sucking mosquitoes, thereby reducing malaria transmission. However, the activity of ivermectin against the malaria parasite itself has been only partly investigated. This study aimed to investigate the in vitro activity of ivermectin against asexual and sexual stages of Plasmodium falciparum Both asexual and late-stage gametocytes were incubated with ivermectin and control drugs in vitro The growth-inhibiting effects were assessed for asexual stages of different Plasmodium falciparum laboratory strains and culture-adapted clinical isolates using the histidine-rich protein 2 enzyme-linked immunosorbent assay technique. The effect against stage IV/V gametocytes was evaluated based on ATP quantification. Ivermectin showed activities at nanomolar concentrations against asexual stages (50% inhibitory concentration of ∼100 nM) and stage IV/V gametocytes (500 nM) of P. falciparum Stage-specific assays suggested that ivermectin arrests the parasite cycle at the trophozoite stage. Ivermectin might add a feature to its "wonder drug" properties with activity against asexual stages of the malaria parasite Plasmodium falciparum The observed activities might be difficult to reach with current regimens but will be more relevant with future high-dose regimens under investigation. Further studies should be performed to confirm these results in vitro and in vivo.
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14
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Badhan R, Zakaria Z, Olafuyi O. The Repurposing of Ivermectin for Malaria: A Prospective Pharmacokinetics-Based Virtual Clinical Trials Assessment of Dosing Regimen Options. J Pharm Sci 2018; 107:2236-2250. [DOI: 10.1016/j.xphs.2018.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/09/2018] [Accepted: 03/30/2018] [Indexed: 12/30/2022]
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15
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Targeting cattle for malaria elimination: marked reduction of Anopheles arabiensis survival for over six months using a slow-release ivermectin implant formulation. Parasit Vectors 2018; 11:287. [PMID: 29728135 PMCID: PMC5935946 DOI: 10.1186/s13071-018-2872-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/24/2018] [Indexed: 12/12/2022] Open
Abstract
Background Mosquitoes that feed on animals can survive and mediate residual transmission of malaria even after most humans have been protected with insecticidal bednets or indoor residual sprays. Ivermectin is a widely-used drug for treating parasites of humans and animals that is also insecticidal, killing mosquitoes that feed on treated subjects. Mass administration of ivermectin to livestock could be particularly useful for tackling residual malaria transmission by zoophagic vectors that evade human-centred approaches. Ivermectin comes from a different chemical class to active ingredients currently used to treat bednets or spray houses, so it also has potential for mitigating against emergence of insecticide resistance. However, the duration of insecticidal activity obtained with ivermectin is critical to its effectiveness and affordability. Results A slow-release formulation for ivermectin was implanted into cattle, causing 40 weeks of increased mortality among Anopheles arabiensis that fed on them. For this zoophagic vector of residual malaria transmission across much of Africa, the proportion surviving three days after feeding (typical mean duration of a gonotrophic cycle in field populations) was approximately halved for 25 weeks. Conclusions This implantable ivermectin formulation delivers stable and sustained insecticidal activity for approximately 6 months. Residual malaria transmission by zoophagic vectors could be suppressed by targeting livestock with this long-lasting formulation, which would be impractical or unacceptable for mass treatment of human populations. Electronic supplementary material The online version of this article (10.1186/s13071-018-2872-y) contains supplementary material, which is available to authorized users.
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16
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Maroccia Z, Loizzo S, Travaglione S, Frank C, Fabbri A, Fiorentini C. New therapeutics from Nature: The odd case of the bacterial cytotoxic necrotizing factor 1. Biomed Pharmacother 2018; 101:929-937. [PMID: 29635902 DOI: 10.1016/j.biopha.2018.02.140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 12/13/2022] Open
Abstract
Natural products may represent a rich source of new drugs. The enthusiasm toward this topic has recently been fueled by the 2015 Nobel Prize in Physiology or Medicine, awarded for the discovery of avermectin and artemisinin, natural products from Bacteria and Plantae, respectively, which have targeted one of the major global health issues, the parasitic diseases. Specifically, bacteria either living in the environment or colonizing our body may produce compounds of unexpected biomedical value with the potentiality to be employed as therapeutic drugs. In this review, the fascinating history of CNF1, a protein toxin produced by pathogenic strains of Escherichia coli, is divulged. Even if produced by bacteria responsible for a variety of diseases, CNF1 can behave as a promising benefactor to mankind. By modulating the Rho GTPases, this bacterial product plays a key role in organizing the actin cytoskeleton, enhancing synaptic plasticity and brain energy level, rescuing cognitive deficits, reducing glioma growth in experimental animals. These abilities strongly suggest the need to proceed with the studies on this odd drug in order to pave the way toward clinical trials.
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Affiliation(s)
- Zaira Maroccia
- Italian Centre for Global Health, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - Stefano Loizzo
- Italian Centre for Global Health, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - Sara Travaglione
- Italian Centre for Global Health, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - Claudio Frank
- Italian Centre for Rare Diseases, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - Alessia Fabbri
- Italian Centre for Global Health, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - Carla Fiorentini
- Italian Centre for Global Health, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy.
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Benelli G, Beier JC. Current vector control challenges in the fight against malaria. Acta Trop 2017; 174:91-96. [PMID: 28684267 DOI: 10.1016/j.actatropica.2017.06.028] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/30/2017] [Indexed: 01/18/2023]
Abstract
The effective and eco-friendly control of Anopheles vectors plays a key role in any malaria management program. Integrated Vector Management (IVM) suggests making use of the full range of vector control tools available. The strategies for IVM require novel technologies to control outdoor transmission of malaria. Despite the wide number of promising control tools tested against mosquitoes, current strategies for malaria vector control used in most African countries are not sufficient to achieve successful malaria control. The majority of National Malaria Control Programs in Africa still rely on indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs). These methods reduce malaria incidence but generally have little impact on malaria prevalence. In addition to outdoor transmission, growing levels of insecticide resistance in targeted vectors threaten the efficacy of LLINs and IRS. Larvicidal treatments can be useful, but are not recommended for rural areas. The research needed to improve the quality and delivery of mosquito vector control should focus on (i) optimization of processes and methods for vector control delivery; (ii) monitoring of vector populations and biting activity with reliable techniques; (iii) the development of effective and eco-friendly tools to reduce the burden or locally eliminate malaria and other mosquito-borne diseases; (iv) the careful evaluation of field suitability and efficacy of new mosquito control tools to prove their epidemiological impact; (v) the continuous monitoring of environmental changes which potentially affect malaria vector populations; (vi) the cooperation among different disciplines, with main emphasis on parasitology, tropical medicine, ecology, entomology, and ecotoxicology. A better understanding of behavioral ecology of malaria vectors is required. Key ecological obstacles that limit the effectiveness of vector control include the variation in mosquito behavior, development of insecticide resistance, presence of behavioral avoidance, high vector biodiversity, competitive and food web interactions, lack of insights on mosquito dispersal and mating behavior, and the impact of environmental changes on mosquito ecological traits. Overall, the trans-disciplinary cooperation among parasitologists and entomologists is crucial to ensure proper evaluation of the epidemiological impact triggered by novel mosquito vector control strategies.
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Abstract
As the world begins to realize the very real prospect of eliminating malaria as a public health problem globally, the scientific community is acutely aware that novel and innovative new tools will be required if that lofty goal is to be accomplished. Moreover, the need for comprehensive, integrated products and interventions is being recognized in order for the critical 'final steps' toward elimination to be taken successfully. Failure to take these crucial last steps have dogged all past global disease elimination programmes, except for smallpox. The success of ivermectin in driving two of the most devastating and disfiguring neglected tropical diseases (NTD) to the brink of elimination has been well documented. The drug also bestows immeasurable non-target benefits, increasing the health and socioeconomic prospects of all communities where mass drug administration (MDA) has been carried out. Ivermectin kills a variety of parasites and insects, including the Anopheline vectors of malaria parasites. In view of long-standing MDA programmes, increasing attention is now being paid to the potential offered by re-formulating and re-purposing ivermectin to function as a feed-though mosquitocidal tool. This will provide a comprehensively beneficial weapon, for the anti-malarial armamentarium, as well as for probably improving the impact on existing target diseases. Prospects currently look highly promising, especially as the drug is already proven to be extremely safe for human use. However, for maximum impact, detailed analysis of various analogues of the unique ivermectin, as well as the parent avermectin compounds, will need to be undertaken. 'Ivermectin' comprises an imprecise mix of two compounds, both of which are potent anthelmintics. Yet recently, it has been confirmed that only the minor of the two component compounds is molluscicidal. Further structure activity relationship studies may well identify the analogue, analogues or combination thereof best suited for use in a concerted initiative to simultaneously tackle malaria and other NTD in poly-parasitized communities.
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Affiliation(s)
- Satoshi Ōmura
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan
| | - Andy Crump
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan.
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19
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Chaccour C, Rabinovich NR. Ivermectin to reduce malaria transmission II. Considerations regarding clinical development pathway. Malar J 2017; 16:166. [PMID: 28434405 DOI: 10.1186/s12936-017-1802-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/06/2017] [Indexed: 12/31/2022] Open
Abstract
The development of ivermectin as a complementary vector control tool will require good quality evidence. This paper reviews the different eco-epidemiological contexts in which mass drug administration with ivermectin could be useful. Potential scenarios and pharmacological strategies are compared in order to help guide trial design. The rationale for a particular timing of an ivermectin-based tool and some potentially useful outcome measures are suggested.
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Affiliation(s)
- Carlos Chaccour
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. .,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique. .,Instituto de Salud Tropical Universidad de Navarra, Pamplona, Spain.
| | - N Regina Rabinovich
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
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