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Tesfaye M, Assefa A, Hailgiorgis H, Gidey B, Mohammed H, Tollera G, Tasew G, Assefa G, Bekele W, Mamo H. Therapeutic efficacy and safety of artemether-lumefantrine for uncomplicated Plasmodium falciparum malaria treatment in Metehara, Central-east Ethiopia. Malar J 2024; 23:184. [PMID: 38867217 PMCID: PMC11170838 DOI: 10.1186/s12936-024-04991-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/20/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Malaria remains a major global health problem although there was a remarkable achievement between 2000 and 2015. Malaria drug resistance, along with several other factors, presents a significant challenge to malaria control and elimination efforts. Numerous countries in sub-Saharan Africa have documented the presence of confirmed or potential markers of partial resistance against artemisinin, the drug of choice for the treatment of uncomplicated Plasmodium falciparum malaria. The World Health Organization (WHO) recommends regular surveillance of artemisinin therapeutic efficacy to inform policy decisions. METHODS This study aimed to evaluate the therapeutic efficacy of artemether-lumefantrine (AL), which is the first-line treatment for uncomplicated P. falciparum malaria in Ethiopia since 2004. Using a single-arm prospective evaluation design, the study assessed the clinical and parasitological responses of patients with uncomplicated P. falciparum malaria in Metehara Health Centre, central-east Ethiopia. Out of 2332 malaria suspects (1187 males, 1145 females) screened, 80 (50 males, 30 females) were enrolled, followed up for 28 days, and 73 (44 males, 29 females) completed the follow up. The study was conducted and data was analysed by employing the per-protocol and Kaplan-Meier analyses following the WHO Malaria Therapeutic Efficacy Evaluation Guidelines 2009. RESULTS The results indicated rapid parasite clearance and resolution of clinical symptoms, with all patients achieving complete recovery from asexual parasitaemia and fever by day (D) 3. The prevalence of gametocytes decreased from 6.3% on D0 to 2.5% on D2, D3, D7, and ultimately achieving complete clearance afterward. CONCLUSION The overall cure rate for AL treatment was 100%, demonstrating its high efficacy in effectively eliminating malaria parasites in patients. No serious adverse events related to AL treatment were reported during the study, suggesting its safety and tolerability among the participants. These findings confirm that AL remains a highly efficacious treatment for uncomplicated P. falciparum malaria in the study site after 20 years of its introduction in Ethiopia.
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Affiliation(s)
- Mahelet Tesfaye
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Institute of Infectious Disease and Global Health, University of North Carolina, Chapel Hill, USA
| | | | | | | | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Worku Bekele
- World Health Organization, Addis Ababa, Ethiopia
| | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Wilairatana P, Chanmol W, Rattaprasert P, Masangkay FR, Milanez GDJ, Kotepui KU, Kotepui M. Prevalence and characteristics of malaria co-infection among individuals with visceral leishmaniasis in Africa and Asia: a systematic review and meta-analysis. Parasit Vectors 2021; 14:545. [PMID: 34688312 PMCID: PMC8542298 DOI: 10.1186/s13071-021-05045-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Malaria and visceral leishmaniasis (VL) co-infection can occur due to the overlapping geographical distributions of these diseases; however, only limited data of this co-infection have been reported and reviewed. This study aimed to explore the pooled prevalence and characteristics of this co-infection using a systematic review approach. Methods The PubMed, Web of Science and Scopus databases were searched for relevant studies. The quality of these studies was assessed in accordance with strengthening the reporting of observational studies in epidemiology (STROBE) guidelines. The numbers of individuals co-infected with Plasmodium and VL and the total numbers of individuals with VL were used to estimate the pooled prevalence using random-effects models. Differences in age, sex and the presence of anemia and malnutrition on admission were compared between co-infected individuals and individuals with VL using a random-effects model; the results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity among the included studies was assessed and quantified using Cochrane Q and I2 statistics. Results Of the 3075 studies identified, 12 met the eligibility criteria and were included in this systematic review. The pooled prevalence of Plasmodium infection among the 6453 individuals with VL was 13%, with substantial heterogeneity of the data (95% CI 7–18%, I2 97.9%). Subgroup analysis demonstrated that the highest prevalence of co-infection occurred in African countries, whereas the lowest prevalence occurred in Asian countries. Patients aged < 5 years had higher odds of having co-infection than having VL (co-infection, n = 202; VL, n = 410) (OR 1.66, 95% CI 1.37–2.01, I2 0%; P < 0.0001), whereas patients aged 20–29 years had lower odds of having co-infection than having VL (co-infection, n = 170; VL, n = 699) (OR 0.75, 95% CI 0.60–0.93, I2 18%; P = 0.01). Male patients had equivalent odds of having co-infection and having VL (co-infection, n = 525; VL, n = 2232) (OR 0.92, 95% CI 0.078–1.08, I2 0%; P = 0.29). Patients with co-infection had lower odds of having anemia at admission than those with VL (co-infection, n = 902; VL, n = 2939) (OR 0.64, 95% CI 0.44–0.93, I2 0%; P = 0.02). No difference in malnutrition at admission was found in the meta-analysis. Conclusions The prevalence of malaria co-infection among individuals with VL was heterogeneous and ranged from 7 to 18%, depending on geographical area. Age and anemia at admission were associated with co-infection status. Further longitudinal studies are needed to determine if co-infection with malaria has an impact on the severity of VL. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-05045-1.
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Affiliation(s)
- Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Wetpisit Chanmol
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, 80160, Thailand
| | - Pongruj Rattaprasert
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Frederick Ramirez Masangkay
- Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University-Manila, 10100, Manila, Philippines
| | - Giovanni De Jesus Milanez
- Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, 10100, Manila, Philippines
| | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, 80160, Thailand
| | - Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, 80160, Thailand.
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Alteration of Blood Lactate Levels in Severe Falciparum Malaria: A Systematic Review and Meta-Analysis. BIOLOGY 2021; 10:biology10111085. [PMID: 34827078 PMCID: PMC8614809 DOI: 10.3390/biology10111085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022]
Abstract
Simple Summary Alteration of blood lactate levels in patients with severe falciparum malaria is well recognized. However, data on blood lactate in literatures were based on a limited number of participants. The present systematic review aimed to collate the blood lactate levels recorded in the literature and used a metaanalysis approach to pool the evidence in a larger sample size than that used in the individual studies to determine the trend. Results from this study will provide the pooled evidence of blood lactate levels in patients with severe malaria for further studies that identifying patients with a high risk of developing severe malaria or death. Abstract Metabolic acidosis in severe malaria usually occurs in the form of lactic acidosis. The present study aimed to collate articles from the literature that have reported blood lactate levels in patients with severe malaria and tested the hypothesis that blood lactate levels are elevated in patients with malaria compared to those with uncomplicated malaria. Moreover, the difference in lactate levels between patients who died and those who survived was estimated using a meta-analytic approach. Potentially relevant studies were searched for in PubMed, Web of Science, and Scopus. The quality of the included studies was assessed using the Jadad scale and strengthening the reporting of observational studies in epidemiology (STROBE). The pooled mean blood lactate in patients with severe malaria, the pooled weighted mean difference (WMD) of blood lactate between patients with severe malaria and those with uncomplicated malaria, and the pooled WMD and 95% CI of blood lactate between patients who died from and those who survived severe malaria were estimated using the random-effects model. Heterogeneity among the outcomes of the included studies was assessed using Cochran’s Q and I2 statistics. A meta-regression analysis was performed to identify the source(s) of heterogeneity of outcomes among the included studies. A subgroup analysis was further performed to separately analyze the outcomes stratified by the probable source(s) of heterogeneity. Publication bias was assessed by the visual inspection of the funnel plot asymmetry. Of 793 studies retrieved from the searches, 30 studies were included in qualitative and quantitative syntheses. The pooled mean lactate in patients with severe malaria was 5.04 mM (95% CI: 4.44–5.64; I2: 99.9%; n = 30,202 cases from 30 studies). The mean lactate in patients with severe malaria (1568 cases) was higher than in those with uncomplicated malaria (1693 cases) (p = 0.003; MD: 2.46; 95% CI: 0.85–4.07; I2: 100%; nine studies). The mean lactate in patients with severe malaria who died (272 cases) was higher than in those with severe malaria who survived (1370 cases) (p < 0.001; MD: 2.74; 95% CI: 1.74–3.75; I2: 95.8%; six studies). In conclusion, the present study showed a high mean difference in blood lactate level between patients with severe malaria and patients with uncomplicated malaria. In addition, there was a high mean difference in blood lactate level between patients with severe malaria who died compared to those with severe malaria who survived. Further studies are needed to investigate the prognostic value of blood lactate levels to identify patients who are at high risk of developing severe malaria or dying.
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Heidari A, Keshavarz H. The Drug Resistance of Plasmodium falciparum and P. vivax in Iran: A Review Article. IRANIAN JOURNAL OF PARASITOLOGY 2021; 16:173-185. [PMID: 34557232 PMCID: PMC8418652 DOI: 10.18502/ijpa.v16i2.6265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
Background One of the main obstacles to malaria control in the world has been the emergence of resistance in Plasmodium falciparum to chloroquine and other anti-malarial drugs. This study aimed to review studies in Iran on resistance in P. falciparum and P. vivax to drugs, and to reveal the mechanisms and molecular markers of resistance of these two species. Methods The databases of PubMed, Scopus, Google Scholar, Magiran, and reputable Iranian journals were searched to find published studies on the resistance in P. falciparum and P. vivax to antimalarial drugs in Iran. Results There is a significant relationship between resistance to chloroquine in P. falciparum and the emergence of K76T mutation in the P. falciparum chloroquine-resistance transporter gene in Iran. Resistance to sulfadoxine-pyrimethamine (SP) in P. falciparum is also significantly associated with the development of mutations in the dihydrofolate reductase and dihydropteroate synthase genes. Resistance to chloroquine in P. vivax has not been reported in Iran and it is used as a first-line treatment for P. vivax malaria. Conclusion P. falciparum has become resistant to chloroquine in different regions of Iran and is not currently used to treat malaria. Besides, cases have emerged of P. falciparum resistance to SP in different parts of southern Iran, and SP is not administered alone for treating P. falciparum.
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Affiliation(s)
- Aliehsan Heidari
- Department of Medical Parasitology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Hossein Keshavarz
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Endemic Parasites of Iran, Tehran University of Medical Sciences, Tehran, Iran
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Maiga FO, Wele M, Toure SM, Keita M, Tangara CO, Refeld RR, Thiero O, Kayentao K, Diakite M, Dara A, Li J, Toure M, Sagara I, Djimdé A, Mather FJ, Doumbia SO, Shaffer JG. Artemisinin-based combination therapy for uncomplicated Plasmodium falciparum malaria in Mali: a systematic review and meta-analysis. Malar J 2021; 20:356. [PMID: 34461901 PMCID: PMC8404312 DOI: 10.1186/s12936-021-03890-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Artemisinin-based combination therapy (ACT) was deployed in 2005 as an alternative to chloroquine and is considered the most efficacious treatment currently available for uncomplicated falciparum malaria. While widespread artemisinin resistance has not been reported to date in Africa, recent studies have reported partial resistance in Rwanda. The purpose of this study is to provide a current systematic review and meta-analysis on ACT at Mali study sites, where falciparum malaria is highly endemic. METHODS A systematic review of the literature maintained in the bibliographic databases accessible through the PubMed, ScienceDirect and Web of Science search engines was performed to identify research studies on ACT occurring at Mali study sites. Selected studies included trials occurring at Mali study sites with reported polymerase chain reaction (PCR)-corrected adequate clinical and parasite response rates (ACPRcs) at 28 days. Data were stratified by treatment arm (artemether-lumefantrine (AL), the first-line treatment for falciparum malaria in Mali and non-AL arms) and analysed using random-effects, meta-analysis approaches. RESULTS A total of 11 studies met the inclusion criteria, and a risk of bias assessment carried out by two independent reviewers determined low risk of bias among all assessed criteria. The ACPRc for the first-line AL at Mali sites was 99.0% (95% CI (98.3%, 99.8%)), while the ACPRc among non-AL treatment arms was 98.9% (95% CI (98.3%, 99.5%)). The difference in ACPRcs between non-AL treatment arms and AL treatment arms was not statistically significant (p = .752), suggesting that there are potential treatment alternatives beyond the first-line of AL in Mali. CONCLUSIONS ACT remains highly efficacious in treating uncomplicated falciparum malaria in Mali. Country-specific meta-analyses on ACT are needed on an ongoing basis for monitoring and evaluating drug efficacy patterns to guide local malaria treatment policies, particularly in the wake of observed artemisinin resistance in Southeast Asia and partial resistance in Rwanda.
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Affiliation(s)
- Fatoumata O Maiga
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
| | - Mamadou Wele
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sounkou M Toure
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Makan Keita
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Randi R Refeld
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street #8310, Suite 1610, New Orleans, LA, 70112-2703, USA
| | - Oumar Thiero
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Kassoum Kayentao
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mahamadou Diakite
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Antoine Dara
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Jian Li
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street #8310, Suite 1610, New Orleans, LA, 70112-2703, USA
| | - Mahamoudou Toure
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Issaka Sagara
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Abdoulaye Djimdé
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Frances J Mather
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street #8310, Suite 1610, New Orleans, LA, 70112-2703, USA
| | - Seydou O Doumbia
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
| | - Jeffrey G Shaffer
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street #8310, Suite 1610, New Orleans, LA, 70112-2703, USA.
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Abamecha A, Yilma D, Adissu W, Yewhalaw D, Abdissa A. Efficacy and safety of artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Ethiopia: a systematic review and meta-analysis. Malar J 2021; 20:213. [PMID: 33957925 PMCID: PMC8101141 DOI: 10.1186/s12936-021-03745-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Regular monitoring of anti-malarial drug efficacy is vital for establishing rational malaria treatment guidelines and ensuring adequate treatment outcomes. This study aimed to synthesize the available evidence on the efficacy of artemether–lumefantrine for the management of uncomplicated falciparum malaria in Ethiopia. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant published studies were searched from the databases (PubMed, Google Scholar and Clinical trial registry) on published artemether–lumefantrine therapeutic efficacy studies conducted in Ethiopia from 2004 to 2020. The retrieved studies were assessed for quality using the modified Newcastle Ottawa Scale for observational studies and modified Jadad scale for interventional studies. Risk of bias was also assessed by using ROBINS-I tool. OpenMeta-Analyst software was used for the statistical analysis. The review protocol is registered in PROSPERO, number CRD42020201859. Results Fifteen studies (1523 participants) were included in the final analysis. The overall PCR-uncorrected pooled proportion of treatment success of artemether–lumefantrine therapy for uncomplicated falciparum malaria was 98.4% (95%CI 97.6–99.1). A random-effects model was used because of considerable heterogeneity [χ2 = 20.48, df (14), P = 0.011 and I2 = 31.65]. PCR-corrected pooled proportion of treatment success of artemether–lumefantrine therapy was 98.7% (95% CI 97.7–99.6). A random-effects model was used [χ2 = 7.37, df(6), P = 0.287 and I2 = 18.69]. Most studies included in the present review achieved a rapid reduction of fevers and parasitaemia between D0 and D3 of assessment. Adverse events were mostly mild and only two cases were reported as serious, but were not directly attributed to the drug. Conclusion The present meta-analysis suggests that artemether–lumefantrine therapy is efficacious and safe in treating uncomplicated falciparum malaria in Ethiopia. However, owing to the high risk of bias in the included studies, strong conclusions cannot be drawn. Further high-quality RCTs assessing anti-malarial efficacy and safety should be performed to demonstrates strong evidence of changes in parasite sensitivity to artemether–lumefantrine in Ethiopia. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03745-8.
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Affiliation(s)
- Abdulhakim Abamecha
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia. .,Clinical Trial Unit, Jimma University, Jimma, Ethiopia. .,Tropical and Infectious Diseases Research Center (TIDRC), Jimma University, Jimma, Ethiopia. .,Department of Biomedical, College of Public Health and Medical Science, Mettu University, Mettu, Ethiopia.
| | - Daniel Yilma
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia.,Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Wondimagegn Adissu
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.,Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Delenasaw Yewhalaw
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.,Tropical and Infectious Diseases Research Center (TIDRC), Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.,Clinical Trial Unit, Jimma University, Jimma, Ethiopia.,Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Huang HW, Bow YD, Wang CY, Chen YC, Fu PR, Chang KF, Wang TW, Tseng CH, Chen YL, Chiu CC. DFIQ, a Novel Quinoline Derivative, Shows Anticancer Potential by Inducing Apoptosis and Autophagy in NSCLC Cell and In Vivo Zebrafish Xenograft Models. Cancers (Basel) 2020; 12:cancers12051348. [PMID: 32466291 PMCID: PMC7281296 DOI: 10.3390/cancers12051348] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 12/12/2022] Open
Abstract
Lung cancer is one of the deadliest cancers worldwide due to chemoresistance in patients with late-stage disease. Quinoline derivatives show biological activity against HIV, malaria, bacteriuria, and cancer. DFIQ is a novel synthetic quinoline derivative that induces cell death in both in vitro and in vivo zebrafish xenograft models. DFIQ induced cell death, including apoptosis, and the IC50 values were 4.16 and 2.31 μM at 24 and 48 h, respectively. DFIQ was also found to induce apoptotic protein cleavage and DNA damage, reduce cell cycle-associated protein expression, and disrupt reactive oxygen species (ROS) reduction, thus resulting in the accumulation of superoxide radicals. Autophagy is also a necessary process associated with chemotherapy-induced cell death. Lysosome accumulation and lysosome-associated membrane protein-2 (LAMP2) depletion were observed after DFIQ treatment, and cell death induction was restored upon treatment with the autophagy inhibitor 3-methyladenine (3-MA). Nevertheless, ROS production was found to be involved in DFIQ-induced autophagy activation and LAMP2 depletion. Our data provide the first evidence for developing DFIQ for clinical usage and show the regulatory mechanism by which DFIQ affects ROS, autophagy, and apoptosis.
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Affiliation(s)
- Hurng-Wern Huang
- Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung 804, Taiwan;
| | - Yung-Ding Bow
- Ph.D Program in Life Sciences, Kaohsiung Medical University; Kaohsiung 807, Taiwan;
| | - Chia-Yih Wang
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
| | - Yen-Chun Chen
- Department of Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-C.C.); (P.-R.F.); (K.-F.C.); (T.-W.W.)
| | - Pei-Rong Fu
- Department of Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-C.C.); (P.-R.F.); (K.-F.C.); (T.-W.W.)
| | - Kuo-Feng Chang
- Department of Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-C.C.); (P.-R.F.); (K.-F.C.); (T.-W.W.)
| | - Tso-Wen Wang
- Department of Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-C.C.); (P.-R.F.); (K.-F.C.); (T.-W.W.)
| | - Chih-Hua Tseng
- School of Pharmacy, College of Pharmacy, Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Yeh-Long Chen
- Department of Medicinal and Applied Chemistry, Drug Development and Value Creation Research Center, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (Y.-L.C.); (C.-C.C.); Tel.: +886-7-312-1101 (ext. 2684) (Y.-L.C.); +886-7-312-1101 (ext. 2368) (C.-C.C.); Fax: +886-7-312-5339 (Y.-L.C. & C.-C.C.)
| | - Chien-Chih Chiu
- Department of Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-C.C.); (P.-R.F.); (K.-F.C.); (T.-W.W.)
- Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- The Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Correspondence: (Y.-L.C.); (C.-C.C.); Tel.: +886-7-312-1101 (ext. 2684) (Y.-L.C.); +886-7-312-1101 (ext. 2368) (C.-C.C.); Fax: +886-7-312-5339 (Y.-L.C. & C.-C.C.)
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Rangel G, Teerawattanapong N, Chamnanchanunt S, Umemura T, Pinyachat A, Wanram S. Candidate microRNAs as Biomarkers in Malaria Infection: A Systematic Review. Curr Mol Med 2019; 20:36-43. [PMID: 31429687 DOI: 10.2174/1566524019666190820124827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/15/2019] [Accepted: 07/30/2019] [Indexed: 01/15/2023]
Abstract
Malaria disease is a public health problem especially in tropical countries, 445.000 of malaria-related deaths have been reported in 2017. MicroRNAs (miRNAs) are small non-coding RNAs with 18-24 nucleotides in length, which have been demonstrated to regulate gene expression of several biological processes. The dysregulation of host immune-related gene expressions during the transcriptional process by microRNA has been extensively reported in malaria parasite invasion of erythrocytes infection. The candidate's miRNAs would be used as potential biomarkers in the future and perspective. A systematic review on miRNAs as candidate clinical biomarkers in malaria infection has been established in this study. Electronic databases (Medline, EMBASE, CINAHL and Cochrane data bases) were screened and articles were included as per established selection criteria. We comprehensively searched to identify publications related to malaria and miRNA. PRISMA guidelines were followed, 262 articles were searched, duplicates and unconnected papers were excluded. Nineteen articles were included in the study. It was found that malaria parasite infected liver or tissue produce tissue-specific miRNAs and release to the blood stream. The association of miRNAs including miR-16, miR-155, miR-150, miR-451 and miR-223 with the dysregulations of immune-related genes expression such as PfEMP-1, IFN-γ, AGO- 1 AGO-2; IL4, CD80, CD86, CD36, ANG-1 and ANG-2 during early, severe and/or cerebral malaria infections indicate the potential use of those miRNAs as biomarkers for malaria infection.
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Affiliation(s)
- Gregorio Rangel
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
- Centre for Excellence in Biomedical Science and Engineering, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
| | - Nattawat Teerawattanapong
- Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
| | - Supat Chamnanchanunt
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tsukuru Umemura
- Departments of Medical Technology and Sciences, International University of Health and Welfare, Ohkawa, Fukuoka 831-8501, Japan
| | - Anuwat Pinyachat
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
- Centre for Excellence in Biomedical Science and Engineering, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
| | - Surasak Wanram
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
- Centre for Excellence in Biomedical Science and Engineering, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
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Gurmu AE, Kisi T, Shibru H, Graz B, Willcox M. Treatments used for malaria in young Ethiopian children: a retrospective study. Malar J 2018; 17:451. [PMID: 30518377 PMCID: PMC6280453 DOI: 10.1186/s12936-018-2605-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background In Ethiopia, medicinal plants have been used to treat different diseases, including malaria, for many centuries. People living in rural areas are especially noted for their use of medicinal plants as a major component of their health care. This study aimed to study treatment-seeking and prioritize plants/plant recipes as anti-malarials, in Dembia district, one of the malarious districts in Northwest Ethiopia. Methods Parents of children aged under 5 years who had had a recent episode of fever were interviewed retrospectively about their child’s treatment and self-reported outcome. Treatments and subsequent clinical outcomes were analysed using Fisher’s exact test to elicit whether there were statistically significant correlations between them. Results and discussion Of 447 children with malaria-like symptoms, only 30% took the recommended first-line treatment (ACT) (all of whom were cured), and 47% took chloroquine (85% cured). Ninety-nine (22.2%) had used medicinal plants as their first-choice treatment. Allium sativum (Liliaceae), Justicia schimperiana (Acanthaceae), Buddleja polystachya (Scrophulariaceae) and Phytolacca dodecandra (Phytolaccaceae) were the most frequently used. Justicia schimperiana was the one associated with the best clinical outcomes (69% self-reported cure rate). However, the difference in clinical outcomes between the plants was not statistically significant. Conclusion In this study, only 30% of children took the recommended first-line treatment. 22% of children with presumed malaria were first treated with herbal medicines. The most commonly used herbal medicine was garlic, but J. schimperiana was associated with the highest reported cure rate of the plants. Further research is warranted to investigate its anti-malarial properties.
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Affiliation(s)
- Abyot Endale Gurmu
- Department of Pharmacognosy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Teresa Kisi
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Habteweld Shibru
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Merlin Willcox
- Department of Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
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Recht J, Ashley EA, White NJ. Use of primaquine and glucose-6-phosphate dehydrogenase deficiency testing: Divergent policies and practices in malaria endemic countries. PLoS Negl Trop Dis 2018; 12:e0006230. [PMID: 29672516 PMCID: PMC5908060 DOI: 10.1371/journal.pntd.0006230] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Primaquine is the only available antimalarial drug that kills dormant liver stages of Plasmodium vivax and Plasmodium ovale malarias and therefore prevents their relapse (‘radical cure’). It is also the only generally available antimalarial that rapidly sterilises mature P. falciparum gametocytes. Radical cure requires extended courses of primaquine (usually 14 days; total dose 3.5–7 mg/kg), whereas transmissibility reduction in falciparum malaria requires a single dose (formerly 0.75 mg/kg, now a single low dose [SLD] of 0.25 mg/kg is recommended). The main adverse effect of primaquine is dose-dependent haemolysis in glucose 6-phosphate dehydrogenase (G6PD) deficiency, the most common human enzymopathy. X-linked mutations conferring varying degrees of G6PD deficiency are prevalent throughout malaria-endemic regions. Phenotypic screening tests usually detect <30% of normal G6PD activity, identifying nearly all male hemizygotes and female homozygotes and some heterozygotes. Unfortunately, G6PD deficiency screening is usually unavailable at point of care, and, as a consequence, radical cure is greatly underused. Both haemolytic risk (determined by the prevalence and severity of G6PD deficiency polymorphisms) and relapse rates vary, so there has been considerable uncertainty in both policies and practices related to G6PD deficiency testing and use of primaquine for radical cure. Review of available information on the prevalence and severity of G6PD variants together with countries’ policies for the use of primaquine and G6PD deficiency testing confirms a wide range of practices. There remains lack of consensus on the requirement for G6PD deficiency testing before prescribing primaquine radical cure regimens. Despite substantially lower haemolytic risks, implementation of SLD primaquine as a P. falciparum gametocytocide also varies. In Africa, a few countries have recently adopted SLD primaquine, yet many with areas of low seasonal transmission do not use primaquine as an antimalarial at all. Most countries that recommended the higher 0.75 mg/kg single primaquine dose for falciparum malaria (e.g., most countries in the Americas) have not changed their recommendation. Some vivax malaria–endemic countries where G6PD deficiency testing is generally unavailable have adopted the once-weekly radical cure regimen (0.75 mg/kg/week for 8 weeks), known to be safer in less severe G6PD deficiency variants. There is substantial room for improvement in radical cure policies and practices.
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Affiliation(s)
- Judith Recht
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Elizabeth A. Ashley
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas J. White
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Adam I, Ibrahim Y, Gasim GI. Efficacy and safety of artemisinin-based combination therapy for uncomplicated Plasmodium falciparum malaria in Sudan: a systematic review and meta-analysis. Malar J 2018. [PMID: 29534720 PMCID: PMC5850971 DOI: 10.1186/s12936-018-2265-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Malaria is a major public health problem in endemic countries including Sudan, where about 75% of populations are at risk. Due to widespread of chloroquine-resistant strains of Plasmodium falciparum, artemisinin-based combination therapy (ACT) is currently treatment of choice for malaria in the vast majority of malaria-endemic countries. This systematic review and meta-analysis is performed to obtain an overall stronger evidence of the outcomes of ACT in the treatment of uncomplicated falciparum malaria from the existing literature in Sudan. Methods The preferred reporting items for systematic review and meta-analysis statement were used to select studies to be included in this review. A computerized systematic strategy was adopted to search articles from PubMed, Google Scholar and Science Direct databases. Unpublished materials were also included. Open Meta-Analyst software was used to perform the meta-analysis. Random effects model was used to combine the included studies and the heterogeneity of studies was assessed using Cochrane Q and I2 (χ2 = 73.05, df (19), P < 0.001 and I2 = 73.99). Results Twenty studies fulfilled the inclusion criteria (ACT in the treatment of uncomplicated falciparum malaria) and were included in the final analysis with a total number of 4070 participants. Malaria treatment outcome was assessed using World Health Organization guidelines. Adequate clinical and parasitological response was used to assess treatment success at the 28th day. Treatment success of all combined studies was 98% [(95% CI 97.2–98.8%), P < 0.001]. Treatment success was higher in malaria patients treated with artemether + lumefantrine (AL) than patients treated with artesunate + sulfadoxine–pyrimethamine (AS + SP) (98.9% (95% CI 98.4–99.4%) vs 97.1% (95% CI 95.5–98.6%), P < 0.001). Eleven studies reported adverse drug reactions (ADRs) to ACT (184 participants out of 3957 (4.65%). The ADRs were mild and resolved spontaneously. There was no severe ADRs or deaths. Conclusion Based on this review, the overall malaria treatment success was high (98%). AL regimen showed higher efficacy compared to AS + SP. The overall regimens were associated with mild low rates ADRs. Electronic supplementary material The online version of this article (10.1186/s12936-018-2265-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ishag Adam
- Faculty of Medicine, University of Khartoum, P.O. Box 102, Khartoum, Sudan.
| | - Yassin Ibrahim
- Faculty of Medicine, University of Tabuk, P.O. Box 741, Tabuk, Kingdom of Saudi Arabia
| | - Gasim I Gasim
- Faculty of Medicine, Alneelain University, Khartoum, Sudan
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