1
|
Arrivillaga MR, Gold M, Rivera EP, Juárez JG. Incorporating an intersectional gender approach to improve access to maternal and child health screening services. Int J Equity Health 2024; 23:32. [PMID: 38378594 PMCID: PMC10880357 DOI: 10.1186/s12939-024-02109-3] [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: 08/04/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND In the Americas, the Pan American Health Organization (PAHO) has promoted initiatives that aim at the elimination of mother-to-child transmitted diseases for over two decades. Although Guatemala has assumed the commitment to improve access and coverage of reproductive and perinatal services, the goals have not yet been reached. Often, the implementation of these efforts is hampered by complexities rooted in social, cultural, and environmental intersections. The objective of this work is to share our experience applying gender intersectionality as a methodological and analytical tool in a participatory research project that aims to improve access to maternal and child health screening services. The study shows the novel strategy that incorporates intersectionality contributing to evidence on how it can be applied to strengthen public health efforts around the implementation of the EMTCT Plus (Elimination of mother-to-child transmission of HIV, Syphilis, Hepatitis B, and Chagas disease) framework, in the mostly rural municipality of Comapa, in Guatemala. METHODS We applied a participatory methodology, integrating theoretical and methodological frameworks to have an intersectional understanding of health services delivered by both, midwives, and the public health institution, for the prevention, diagnosis, treatment, and follow-up of HIV, Syphilis, Hepatitis B, and Chagas. The data was collected by conducting interviews, focus groups, workshops, and reviewing laboratory databases, guided by five strategies from a cultural appropriateness framework. RESULTS The intersectional analysis shed light on the synergies and gaps of the current efforts and protocols implemented by both the midwives and the Ministry of Health. The services offered for the four diseases were often delivered independently from each other, and a comprehensive educational and communication material strategy was absent. However, our findings will be used to inform consistent, locally relevant, and culturally appropriate educational content for the local population, also following the national policy guidelines. CONCLUSIONS Using intersectionality as a method and as an analytical tool allowed us to understand the (1) interrelation of diverse social, cultural, and environmental determinants which influence the delivery of health services, as well as (2) the dynamics between the traditional and institutional health systems. (3) Community engagement and the participation of different stakeholders in a consultative process have been fundamental for the conceptual and methodological tenets of this research. (4) Finally, giving a more prominent role to midwives can strengthen sustainability and cultural appropriateness, which is complementary to the delivery of institutional health services.
Collapse
Affiliation(s)
- Margarita Rivera Arrivillaga
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95 Zona 15 VH III, Guatemala City, Guatemala.
| | - Marina Gold
- Fundación Mundo Sano, Recaredo, 3. Puerta Garaje, 28002, Madrid, Spain.
| | - Elizabeth Pellecer Rivera
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95 Zona 15 VH III, Guatemala City, Guatemala
- Environmental Sciences, University of Maine, Orono, ME, 04469-5755, USA
| | - Jose Guillermo Juárez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95 Zona 15 VH III, Guatemala City, Guatemala
| |
Collapse
|
2
|
Rivera EP, Arrivillaga MR, Juárez JG, De Urioste-Stone SM, Berganza E, Pennington PM. Adoption of community-based strategies for sustainable vector control and prevention. BMC Public Health 2023; 23:1834. [PMID: 37730592 PMCID: PMC10512496 DOI: 10.1186/s12889-023-16516-8] [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: 12/03/2022] [Accepted: 08/11/2023] [Indexed: 09/22/2023] Open
Abstract
Community engagement strategies provide tools for sustainable vector-borne disease control. A previous cluster randomized control trial engaged nine intervention communities in seven participatory activities to promote management of the domestic and peri-domestic environment to reduce risk factors for vector-borne Chagas disease. This study aims to assess the adoption of this innovative community-based strategy, which included chickens' management, indoor cleaning practices, and domestic rodent infestation control, using concepts from the Diffusion of Innovations Theory. We used questionnaires and semi-structured interviews to understand perceptions of knowledge gained, intervention adoption level, innovation attributes, and limiting or facilitating factors for adoption. The analysis process focused on five innovation attributes proposed by the Diffusion of Innovations Theory: relative advantage, compatibility, complexity, trialability, and observability. Rodent management was highly adopted by participants, as it had a relative advantage regarding the use of poison and was compatible with local practices. The higher complexity was reduced by offering several types of trapping systems and having practical workshops allowed trialability. Observability was limited because the traps were indoors, but information and traps were shared with neighbors. Chicken management was not as widely adopted due to the higher complexity of the method, and lower compatibility with local practices. Using the concepts proposed by the Diffusion of Innovations Theory helped us to identify the enablers and constraints in the implementation of the Chagas vector control strategy. Based on this experience, community engagement and intersectoral collaboration improve the acceptance and adoption of novel and integrated strategies to improve the prevention and control of neglected diseases.
Collapse
Affiliation(s)
- Elizabeth Pellecer Rivera
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95 Zona 15 VH III, Guatemala City, Guatemala.
- Ecology and Environmental Sciences, University of Maine, Orono, ME, USA.
| | - Margarita Rivera Arrivillaga
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95 Zona 15 VH III, Guatemala City, Guatemala.
| | - José G Juárez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95 Zona 15 VH III, Guatemala City, Guatemala
| | - Sandra M De Urioste-Stone
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95 Zona 15 VH III, Guatemala City, Guatemala
- Present Address: School of Forest Resources, University of Maine, Orono, ME, USA
| | - Elsa Berganza
- Área de Salud de Jutiapa, Ministerio de Salud Pública y Asistencia Social, Jutiapa, Guatemala
| | - Pamela Marie Pennington
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95 Zona 15 VH III, Guatemala City, Guatemala
| |
Collapse
|
3
|
TORCH Congenital Syndrome Infections in Central America's Northern Triangle. Microorganisms 2023; 11:microorganisms11020257. [PMID: 36838223 PMCID: PMC9964893 DOI: 10.3390/microorganisms11020257] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
TORCH pathogens are a group of globally prevalent infectious agents that may cross the placental barrier, causing severe negative sequalae in neonates, including fetal death and lifelong morbidity. TORCH infections are classically defined by Toxoplasma gondii, other infectious causes of concern (e.g., syphilis, Zika virus, malaria, human immunodeficiency virus), rubella virus, cytomegalovirus, and herpes simplex viruses. Neonatal disorders and congenital birth defects are the leading causes of neonatal mortality in Central America's Northern Triangle, yet little is known about TORCH congenital syndrome in this region. This review synthesizes the little that is known regarding the most salient TORCH infections among pregnant women and neonates in Central America's Northern Triangle and highlights gaps in the literature that warrant further research. Due to the limited publicly available information, this review includes both peer-reviewed published literature and university professional degree theses. Further large-scale studies should be conducted to clarify the public health impact these infections in this world region.
Collapse
|
4
|
Ince I, Prins K, Willmann S, Sutter G, Hanze E, Sadre-Marandi F, Stass H, Garmann D. Population Pharmacokinetics of Nifurtimox in Adult and Pediatric Patients with Chagas' Disease. J Clin Pharmacol 2022; 62:1273-1284. [PMID: 35460577 DOI: 10.1002/jcph.2064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/17/2022] [Indexed: 11/11/2022]
Abstract
Nifurtimox (LAMPIT®) has been used for decades for the treatment of Chagas' Disease, a chronic and potentially life-threatening disease caused by the parasite Trypanonosma Cruzi. The pharmacokinetics (PK) information on nifurtimox in humans derived from controlled clinical studies is very limited. The objective was to investigate and compare the Population PK (PopPK) of nifurtimox in adult and pediatric patients with Chagas' disease to confirm the clinical dosing regimen in children, which was based on allometric approaches using the concept that a dose equivalent exposure would reach equivalent antiparasitic efficacy as in adults. The resulting adult model adequately described the PK in adults. Significant predictors of the availability in PK were food intake, tablet formulation (fast vs. slow dissolution tablet), study, and body weight (WT). As the resulting adult model could not adequately predict the sparse sampled pediatric patient data, these data were analyzed separately to derive exposure estimates for comparison with adult exposure. In the PopPK model for pediatric patients, significant covariates were WT and age. As compared to adults, children older than 2 years were estimated to have 50.6 % higher apparent clearance (CL/F). No hints of dose-nonlinearity were observed in a dose range of 30 to 240 mg single dose in adults and 15 to 300 mg 3 times daily (8 to 20 mg/kg) in children. Altogether, this study retroactively showed that the current mg/kg dosing regimen in children reached similar exposure as in adults receiving an 8 mg/kg total daily dose. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Ibrahim Ince
- Clinical Pharmacometrics, Research & Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| | | | - Stefan Willmann
- Clinical Pharmacometrics, Research & Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| | - Gabriele Sutter
- Clinical Pharmacometrics, Research & Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| | - Eva Hanze
- qPharmetra, LLC, Nijmegen, The Netherlands
| | | | - Heino Stass
- Clinical Pharmacology, Bayer AG, Wuppertal, Germany
| | - Dirk Garmann
- Clinical Pharmacometrics, Research & Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| |
Collapse
|
5
|
Gaspe MS, Cardinal MV, Fernández MDP, Vassena CV, Santo-Orihuela PL, Enriquez GF, Alvedro A, Laiño MA, Nattero J, Alvarado-Otegui JA, Macchiaverna NP, Cecere MC, Freilij H, Gürtler RE. Improved vector control of Triatoma infestans limited by emerging pyrethroid resistance across an urban-to-rural gradient in the Argentine Chaco. Parasit Vectors 2021; 14:437. [PMID: 34454569 PMCID: PMC8401064 DOI: 10.1186/s13071-021-04942-9] [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: 02/17/2021] [Accepted: 08/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background The sustainable elimination of Triatoma infestans in the Gran Chaco region represents an enduring challenge. Following the limited effects of a routine pyrethroid insecticide spraying campaign conducted over 2011–2013 (first period) in Avia Terai, an endemic municipality with approximately 2300 houses, we implemented a rapid-impact intervention package to suppress house infestation across the urban-to-rural gradient over 2015–2019 (second period). Here, we assess their impacts and whether persisting infestations were associated with pyrethroid resistance. Methods The 2011–2013 campaign achieved a limited detection and spray coverage across settings (< 68%), more so during the surveillance phase. Following community mobilization and school-based interventions, the 2015–2019 program assessed baseline house infestation using a stratified sampling strategy; sprayed all rural houses with suspension concentrate beta-cypermethrin, and selectively sprayed infested and adjacent houses in urban and peri-urban settings; and monitored house infestation and performed selective treatments over the follow-up. Results Over the first period, house infestation returned to pre-intervention levels within 3–4 years. The adjusted relative odds of house infestation between 2011–2013 and 2015–2016 differed very little (adj. OR: 1.17, 95% CI 0.91–1.51). Over the second period, infestation decreased significantly between 0 and 1 year post-spraying (YPS) (adj. OR: 0.36, 95% CI 0.28–0.46), with heterogeneous effects across the gradient. Mean bug abundance also dropped between 0 and 1 YPS and thereafter remained stable in rural and peri-urban areas. Using multiple regression models, house infestation and bug abundance at 1 YPS were 3–4 times higher if the house had been infested before treatment, or was scored as high-risk or non-participating. No low-risk house was ever infested. Persistent foci over two successive surveys increased from 30.0 to 59.3% across the gradient. Infestation was more concentrated in peridomestic rather than domestic habitats. Discriminating-dose bioassays showed incipient or moderate pyrethroid resistance in 7% of 28 triatomine populations collected over 2015–2016 and in 83% of 52 post-spraying populations. Conclusions The intervention package was substantially more effective than the routine insecticide spraying campaign, though the effects were lower than predicted due to unexpected incipient or moderate pyrethroid resistance. Increased awareness and diagnosis of vector control failures in the Gran Chaco, including appropriate remedial actions, are greatly needed. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-04942-9.
Collapse
Affiliation(s)
- María Sol Gaspe
- Laboratorio de Eco-Epidemiología, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina. .,Instituto de Ecología, Genética y Evolución de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina.
| | - Marta Victoria Cardinal
- Laboratorio de Eco-Epidemiología, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina.,Instituto de Ecología, Genética y Evolución de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina
| | - María Del Pilar Fernández
- Laboratorio de Eco-Epidemiología, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina.,Washington State University, Paul G. Allen School for Global Animal Health, Allen Center, 1155 College Ave., Pullman, WA, 99164, USA
| | - Claudia Viviana Vassena
- Centro de Investigaciones de Plagas e Insecticidas (CIPEIN, CONICET/UNIDEF/CITEDEF), Juan Bautista La Salle 4397, Villa Martelli, CP 1603, Buenos Aires, Argentina.,Universidad Nacional de San Martín, Buenos Aires, Argentina
| | - Pablo Luis Santo-Orihuela
- Centro de Investigaciones de Plagas e Insecticidas (CIPEIN, CONICET/UNIDEF/CITEDEF), Juan Bautista La Salle 4397, Villa Martelli, CP 1603, Buenos Aires, Argentina.,Cátedra de Química Analítica Instrumental, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo Fabián Enriquez
- Laboratorio de Eco-Epidemiología, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina.,Instituto de Ecología, Genética y Evolución de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina
| | - Alejandra Alvedro
- Laboratorio de Eco-Epidemiología, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina.,Instituto de Ecología, Genética y Evolución de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina
| | - Mariano Alberto Laiño
- Laboratorio de Eco-Epidemiología, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina.,Instituto de Ecología, Genética y Evolución de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina
| | - Julieta Nattero
- Laboratorio de Eco-Epidemiología, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina.,Instituto de Ecología, Genética y Evolución de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina
| | - Julián Antonio Alvarado-Otegui
- Laboratorio de Eco-Epidemiología, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina
| | - Natalia Paula Macchiaverna
- Laboratorio de Eco-Epidemiología, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina.,Instituto de Ecología, Genética y Evolución de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina
| | - María Carla Cecere
- Laboratorio de Eco-Epidemiología, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina.,Instituto de Ecología, Genética y Evolución de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina
| | - Héctor Freilij
- Servicio de Parasitología, Hospital de Niños Ricardo Gutiérrez, Instituto Multidisciplinario de Investigación en Patologías Pediátricas, CONICET-GCBA, Buenos Aires, Argentina
| | - Ricardo Esteban Gürtler
- Laboratorio de Eco-Epidemiología, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina. .,Instituto de Ecología, Genética y Evolución de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Universitaria, C1428EHA, Buenos Aires, Argentina.
| |
Collapse
|
6
|
Stass H, Just S, Weimann B, Ince I, Willmann S, Feleder E, Freitas C, Yerino G, Münster U. Clinical investigation of the biopharmaceutical characteristics of nifurtimox tablets - Implications for quality control and application. Eur J Pharm Sci 2021; 166:105940. [PMID: 34265407 DOI: 10.1016/j.ejps.2021.105940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 10/20/2022]
Abstract
Nifurtimox is approved in Chagas disease and has been used in endemic countries since the 1960s. Nifurtimox, available as a 120 mg tablet, is administered with food typically three times daily, and dose is adjusted for age and bodyweight. Accurately or reproducibly fragmenting the 120 mg tablet for dose adjustment in young children and those with low bodyweight is problematic. Based on the existing tablet formulation, new nifurtimox 30 mg and 120 mg tablets have been developed in a format that can be divided accurately into 15 mg and 60 mg fragments. In adults with chronic Chagas disease, we investigated whether nifurtimox bioavailability is affected by tablet dissolution rate, and whether different diets affect nifurtimox bioavailability. In an open-label, three-period cross-over study (n=36; ClinicalTrials.gov, NCT03350295), patients randomly received three 30 mg tablet formulations (slow, medium, or fast dissolution; a 4 × 30 mg dose of one formulation per period). In an open-label, four-period cross-over study (n=24; ClinicalTrials.gov, NCT03334838) patients randomly fasted or received one of three meal types (high-fat/high-calorie, low-fat, dairy-based) before ingesting nifurtimox (a 4 × 30 mg dose per period). Acceptance criteria for no difference between groups were 90% confidence intervals (CIs) of exposure ratios in the range 0.8-1.25. Nifurtimox bioavailability was unaffected by tablet dissolution kinetics. Ratios of area under the curve at final assessment (AUC(0-tlast) [90% CI]) were: fast/medium dissolution, 1.061 (0.990-1.137); slow/medium dissolution, 0.964 (0.900-1.033); fast/slow dissolution, 1.100 (1.027-1.179). Compared with a fasting state, nifurtimox bioavailability increased by 73% after a high-fat/high-calorie meal (AUC(0-tlast) ratio [90% CI], 1.732 [1.581-1.898]); smaller increases were seen with the other meal types (low-fat: 1.602 [1.462-1.755]; dairy-based: 1.340 [1.222-1.468]). Although type of diet can affect bioavailability, taking nifurtimox with food is most important.
Collapse
Affiliation(s)
- Heino Stass
- Bayer AG, Research & Development - Pharmaceuticals, Clinical PK CV, Building 0431 - 403, 42096 Wuppertal, Germany.
| | - Sarah Just
- Bayer AG, Research & Development - Pharmaceuticals, Clinical PK CV, Building 0431 - 403, 42096 Wuppertal, Germany
| | - Boris Weimann
- Chrestos Concept GmbH & Co. KG, 45131 Essen, Germany
| | | | - Stefan Willmann
- Bayer AG, Research & Development - Pharmaceuticals, Clinical PK CV, Building 0431 - 403, 42096 Wuppertal, Germany
| | | | - Cecilia Freitas
- Bayer AG, Research & Development - Pharmaceuticals, Clinical PK CV, Building 0431 - 403, 42096 Wuppertal, Germany
| | | | - Uwe Münster
- Bayer AG, Research & Development - Pharmaceuticals, Clinical PK CV, Building 0431 - 403, 42096 Wuppertal, Germany
| |
Collapse
|
7
|
Cerny N, Bivona AE, Sanchez Alberti A, Trinitario SN, Morales C, Cardoso Landaburu A, Cazorla SI, Malchiodi EL. Cruzipain and Its Physiological Inhibitor, Chagasin, as a DNA-Based Therapeutic Vaccine Against Trypanosoma cruzi. Front Immunol 2020; 11:565142. [PMID: 33162979 PMCID: PMC7583359 DOI: 10.3389/fimmu.2020.565142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022] Open
Abstract
Chagas disease caused by the protozoan parasite Trypanosoma cruzi is endemic in 21 Latin American countries and the southern United States and now is spreading into several other countries due to migration. Despite the efforts to control the vector throughout the Americas, currently, there are almost seven million infected people worldwide, causing ~10,000 deaths per year, and 70 million people at risk to acquire the infection. Chagas disease treatment is restricted only to two parasiticidal drugs, benznidazole and nifurtimox, which are effective during the acute and early infections but have not been found to be as effective in chronic infection. No prophylactic or therapeutic vaccine for human use has been communicated at this moment. Here, we evaluate in a mouse model a therapeutic DNA vaccine combining Cruzipain (Cz), a T. cruzi cysteine protease that proved to be protective in several settings, and Chagasin (Chg), which is the natural Cz inhibitor. The DNAs of both antigens, as well as a plasmid encoding GM-CSF as adjuvant, were orally administrated and delivered by an attenuated Salmonella strain to treat mice during the acute phase of T. cruzi infection. The bicomponent vaccine based on Salmonella carrying Cz and Chg (SChg+SCz) was able to improve the protection obtained by each antigen as monocomponent therapeutic vaccine and significantly increased the titers of antigen- and parasite-specific antibodies. More importantly, the bicomponent vaccine triggered a robust cellular response with interferon gamma (IFN-γ) secretion that rapidly reduced the parasitemia during the acute phase and decreased the tissue damage in the chronic stage of the infection, suggesting it could be an effective tool to ameliorate the pathology associated to Chagas disease.
Collapse
Affiliation(s)
- Natacha Cerny
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Augusto Ernesto Bivona
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Andrés Sanchez Alberti
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Sebastián Nicolás Trinitario
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Celina Morales
- Instituto de Fisiopatología Cardiovascular, Departamento de Patología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Cardoso Landaburu
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Silvia Inés Cazorla
- Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.,Laboratorio de Inmunología, Centro de Referencia Para Lactobacilos (CERELA-CONICET), Tucumán, Argentina
| | - Emilio Luis Malchiodi
- Cátedra de Inmunología and Instituto de Estudios de la Inmunidad Humoral Prof. Ricardo A. Margni (IDEHU, UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Microbiología y Parasitología Médica (IMPaM, UBA-CONICET), Departamento de Microbiología Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
8
|
Stass H, Feleder E, Garcia-Bournissen F, Nagelschmitz J, Weimann B, Yerino G, Altcheh J. Biopharmaceutical Characteristics of Nifurtimox Tablets for Age- and Body Weight-Adjusted Dosing in Patients With Chagas Disease. Clin Pharmacol Drug Dev 2020; 10:542-555. [PMID: 33029953 PMCID: PMC8246722 DOI: 10.1002/cpdd.871] [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: 06/25/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022]
Abstract
Treatment of Chagas disease with nifurtimox requires age‐ and body weight‐adjusted dosing, resulting in complex dosing instructions. Appropriate formulations are needed for precise and compliant dosing, especially in pediatric patients. We characterized the biopharmaceutical features of a standard nifurtimox 120‐mg tablet and a 30‐mg tablet developed to improve dose accuracy. Two open‐label, randomized crossover studies were conducted in adult outpatients with Chagas disease. One study investigated whether 4 × 30‐mg tablets and 1 × 120‐mg tablet were bioequivalent and whether tablets can be administered as an aqueous slurry without affecting bioavailability. The second study investigated the effect of a high‐calorie/high‐fat diet versus fasting on the absorption of nifurtimox after a single 4 × 30‐mg dose. Interventions were equivalent if the 90% confidence interval (CI) of their least‐squares (LS) mean ratios for both AUC0‐tlast and Cmax were in the range of 80%‐125%. The 4 × 30‐mg and 1 × 120‐mg tablet doses were bioequivalent (AUC0‐tlast: LS mean ratio, 104.7%; 90%CI, 99.1%‐110.7%; Cmax: LS mean ratio, 101.7%; 90%CI, 89.4%‐115.6%; n = 24). Exposure when giving the 4 × 30‐mg dose as a slurry or as tablets was comparable, with an AUC0‐tlast ratio of 93.2% (84.2%‐103.1%; n = 12) and a slightly decreased Cmax ratio for the slurry of 76.5% (68.8%‐85.1%). Food improved the bioavailability of nifurtimox substantially (AUC0‐tlast ratiofed/fasted, 172%; 90%CI, 154%‐192%; Cmax ratiofed/fasted, 168%; 90%CI, 150%‐187%). The data indicate that the 30‐ and 120‐mg tablets are suitable for dosing adult and pediatric patients accurately; nifurtimox should be administered under fed conditions.
Collapse
Affiliation(s)
| | | | - Facundo Garcia-Bournissen
- Division of Pediatric Clinical Pharmacology, Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,CONICET-GCBA, Hospital de Niños Ricardo Gutiérrez and Instituto Multidisciplinario de Investigación en Patologías Pediátricas, Buenos Aires, Argentina
| | | | | | | | - Jaime Altcheh
- CONICET-GCBA, Hospital de Niños Ricardo Gutiérrez and Instituto Multidisciplinario de Investigación en Patologías Pediátricas, Buenos Aires, Argentina
| |
Collapse
|
9
|
Peterson JK, Yoshioka K, Hashimoto K, Caranci A, Gottdenker N, Monroy C, Saldaña A, Rodriguez S, Dorn P, Zúniga C. Chagas Disease Epidemiology in Central America: an Update. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00176-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
10
|
Chagas Disease in Central America: Recent Findings and Current Challenges in Vector Ecology and Control. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00175-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|