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Hanscheid T, Del Portal Luyten CR, Hermans SM, Grobusch MP. Repurposing of anti-malarial drugs for the treatment of tuberculosis: realistic strategy or fanciful dead end? Malar J 2024; 23:132. [PMID: 38702649 DOI: 10.1186/s12936-024-04967-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Drug repurposing offers a strategic alternative to the development of novel compounds, leveraging the known safety and pharmacokinetic profiles of medications, such as linezolid and levofloxacin for tuberculosis (TB). Anti-malarial drugs, including quinolones and artemisinins, are already applied to other diseases and infections and could be promising for TB treatment. METHODS This review included studies on the activity of anti-malarial drugs, specifically quinolones and artemisinins, against Mycobacterium tuberculosis complex (MTC), summarizing results from in vitro, in vivo (animal models) studies, and clinical trials. Studies on drugs not primarily developed for TB (doxycycline, sulfonamides) and any novel developed compounds were excluded. Analysis focused on in vitro activity (minimal inhibitory concentrations), synergistic effects, pre-clinical activity, and clinical trials. RESULTS Nineteen studies, including one ongoing Phase 1 clinical trial, were analysed: primarily investigating quinolones like mefloquine and chloroquine, and, to a lesser extent, artemisinins. In vitro findings revealed high MIC values for anti-malarials versus standard TB drugs, suggesting a limited activity. Synergistic effects with anti-TB drugs were modest, with some synergy observed in combinations with isoniazid or pyrazinamide. In vivo animal studies showed limited activity of anti-malarials against MTC, except for one study of the combination of chloroquine with isoniazid. CONCLUSIONS The repurposing of anti-malarials for TB treatment is limited by high MIC values, poor synergy, and minimal in vivo effects. Concerns about potential toxicity at effective dosages and the risk of antimicrobial resistance, especially where TB and malaria overlap, further question their repurposing. These findings suggest that focusing on novel compounds might be both more beneficial and rewarding.
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Affiliation(s)
- Thomas Hanscheid
- Instituto de Microbiologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Claire Ruiz Del Portal Luyten
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Infection and Immunity, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Sabine M Hermans
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Infection and Immunity, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Infection and Immunity, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
- Institute of Tropical Medicine, German Centre for Infection Research (DZIF), University of Tübingen, Tübingen, Germany.
- Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon.
- Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone.
- Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.
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Odera PA, Otieno G, Onyango JO, Owuor JJ, Oloo FA, Ongas M, Gathirwa J, Ogutu B. NANOPARTICLE-BASED formulation of dihydroartemisinin-lumefantrine duo-drugs: Preclinical Evaluation and enhanced antimalarial efficacy in a mouse model. Heliyon 2024; 10:e26868. [PMID: 38501019 PMCID: PMC10945123 DOI: 10.1016/j.heliyon.2024.e26868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Artemisinin-based combinations (ACTs) are World Health Organization-recommended treatment for malaria. Artemether (A) and lumefantrine (LUM) were the first co-formulated ACT and first-line treatment for malaria globally, artemether is dihydroartemisinin's (DHA's) prodrug. Artemisinins and LUM face low aqueous solubility while artemisinin has low bioavailability and short half-life thus requiring continuous dosage to maintain adequate therapeutic drug-plasma concentration. This study aimed at improving ACTs limitations by nano-formulating DHA-LUM using solid lipid nanoparticles (SLNs) as nanocarrier. SLNs were prepared by modified solvent extraction method based on water-in-oil-in-water double emulsion. Mean particle size, polydispersity index and zeta potential were 308.4 nm, 0.29 and -16.0 mV respectively. Nanoencapsulation efficiencies and drug loading of DHA and LUM were 93.9%, 33.7%, 11.9%, and 24.10% respectively. Nanoparticles were spherically shaped and drugs followed Kors-Peppas release model, steadily released for over 72 h. DHA-LUM-SLNs were 31% more efficacious than conventional oral doses in clearing Plasmodium berghei from infected Swiss albino mice.
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Affiliation(s)
- Pesila Akeyo Odera
- School of Chemistry and Material Science, Technical University of Kenya, Nairobi Kenya
| | - Geoffrey Otieno
- School of Chemistry and Material Science, Technical University of Kenya, Nairobi Kenya
| | - Joab Otieno Onyango
- School of Chemistry and Material Science, Technical University of Kenya, Nairobi Kenya
| | - James Jorum Owuor
- School of Chemistry and Material Science, Technical University of Kenya, Nairobi Kenya
| | - Florence Anyango Oloo
- School of Chemistry and Material Science, Technical University of Kenya, Nairobi Kenya
- Centre for Research in Therapeutic Sciences, Strathmore University Medical Centre, Nairobi, Kenya
| | - Martin Ongas
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Research in Therapeutic Sciences, Strathmore University Medical Centre, Nairobi, Kenya
| | - Jeremiah Gathirwa
- Centre of Traditional Medicine and Drug Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Bernhards Ogutu
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Research in Therapeutic Sciences, Strathmore University Medical Centre, Nairobi, Kenya
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Viana Dos Santos MB, Braga de Oliveira A, Veras Mourão RH. Brazilian plants with antimalarial activity: A review of the period from 2011 to 2022. J Ethnopharmacol 2024; 322:117595. [PMID: 38122914 DOI: 10.1016/j.jep.2023.117595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/16/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Malaria continues to be a serious global public health problem in subtropical and tropical countries of the world. The main drugs used in the treatment of human malaria, quinine and artemisinin, are isolates of medicinal plants, making the use of plants a widespread practice in countries where malaria is endemic. Over the years, due to the increased resistance of the parasite to chloroquine and artemisinin in certain regions, new strategies for combating malaria have been employed, including research with medicinal plants. AIM This review focuses on the scientific production regarding medicinal plants from Brazil whose antimalarial activity was evaluated during the period from 2011 to 2022. 2. METHODOLOGY For this review, four electronic databases were selected for research: Pubmed, ScienceDirect, Scielo and Periódicos CAPES. Searches were made for full texts published in the form of scientific articles written in Portuguese or English and in a digital format. In addition, prospects for new treatments as well as future research that encourages the search for natural products and antimalarial derivatives are also presented. RESULTS A total of 61 publications were encountered, which cited 36 botanical families and 92 species using different Plasmodium strains in in vitro and in vivo assays. The botanical families with the most expressive number of species found were Rubiaceae, Apocynaceae, Fabaceae and Asteraceae (14, 14, 9 and 6 species, respectively), and the most frequently cited species were of the genera Psychotria L. (8) and Aspidosperma Mart. (12), which belong to the families Rubiaceae and Apocynaceae. Altogether, 75 compounds were identified or isolated from 28 different species, 31 of which are alkaloids. In addition, the extracts of the analyzed species, including the isolated compounds, showed a significant reduction of parasitemia in P. falciparum and P. berghei, especially in the clones W2 CQ-R (in vitro) and ANKA (in vivo), respectively. The Brazilian regions with the highest number of species analyzed were those of the north, especially the states of Pará and Amazonas, and the southeast, especially the state of Minas Gerais. CONCLUSION Although many plant species with antimalarial potential have been identified in Brazil, studies of new antimalarial molecules are slow and have not evolved to the production of a phytotherapeutic medicine. Given this, investigations of plants of traditional use and biotechnological approaches are necessary for the discovery of natural antimalarial products that contribute to the treatment of the disease in the country and in other endemic regions.
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Affiliation(s)
- Maria Beatriz Viana Dos Santos
- Laboratório de Bioprospecção e Biologia Experimental - LabBBEx, Universidade Federal do Oeste do Pará, Rua Vera Paz, s/n, Salé, 68035-110, Santarém, PA, Brazil; Programa de Pós-Graduação Doutorado em Rede de Biodiversidade e Biotecnologia - BIONORTE/Polo Pará. Universidade Federal do Pará, Rua Augusto Corrêa, 01, Guamá, 66075-110, Belém, PA, Brazil.
| | - Alaíde Braga de Oliveira
- Laboratório de Bioprospecção e Biologia Experimental - LabBBEx, Universidade Federal do Oeste do Pará, Rua Vera Paz, s/n, Salé, 68035-110, Santarém, PA, Brazil; Programa de Pós-Graduação Doutorado em Rede de Biodiversidade e Biotecnologia - BIONORTE/Polo Pará. Universidade Federal do Pará, Rua Augusto Corrêa, 01, Guamá, 66075-110, Belém, PA, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas - PPGCF, Faculdade de Farmácia, Departamento de Produtos Farmacêuticos, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, MG, Brazil.
| | - Rosa Helena Veras Mourão
- Laboratório de Bioprospecção e Biologia Experimental - LabBBEx, Universidade Federal do Oeste do Pará, Rua Vera Paz, s/n, Salé, 68035-110, Santarém, PA, Brazil; Programa de Pós-Graduação Doutorado em Rede de Biodiversidade e Biotecnologia - BIONORTE/Polo Pará. Universidade Federal do Pará, Rua Augusto Corrêa, 01, Guamá, 66075-110, Belém, PA, Brazil
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Uddin A, Gupta S, Shoaib R, Aneja B, Irfan I, Gupta K, Rawat N, Combrinck J, Kumar B, Aleem M, Hasan P, Joshi MC, Chhonker YS, Zahid M, Hussain A, Pandey K, Alajmi MF, Murry DJ, Egan TJ, Singh S, Abid M. Blood-stage antimalarial activity, favourable metabolic stability and in vivo toxicity of novel piperazine linked 7-chloroquinoline-triazole conjugates. Eur J Med Chem 2024; 264:115969. [PMID: 38039787 DOI: 10.1016/j.ejmech.2023.115969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
The persistence of drug resistance poses a significant obstacle to the advancement of efficacious malaria treatments. The remarkable efficacy displayed by 1,2,3-triazole-based compounds against Plasmodium falciparum highlights the potential of triazole conjugates, with diverse pharmacologically active structures, as potential antimalarial agents. We aimed to synthesize 7-dichloroquinoline-triazole conjugates and their structure-activity relationship (SAR) derivatives to investigate their anti-plasmodial activity. Among them, QP11, featuring a m-NO2 substitution, demonstrated efficacy against both chloroquine-sensitive and -resistant parasite strains. QP11 selectively inhibited FP2, a cysteine protease involved in hemoglobin degradation, and showed synergistic effects when combined with chloroquine. Additionally, QP11 hindered hemoglobin degradation and hemozoin formation within the parasite. Metabolic stability studies indicated high stability of QP11, making it a promising antimalarial candidate. In vivo evaluation using a murine malaria model demonstrated QP11's efficacy in eradicating parasite growth without neurotoxicity, presenting it as a promising compound for novel antimalarial development.
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Affiliation(s)
- Amad Uddin
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi, 110025, India; Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Sonal Gupta
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Rumaisha Shoaib
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi, 110025, India; Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Babita Aneja
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi, 110025, India
| | - Iram Irfan
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi, 110025, India
| | - Kanika Gupta
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Neha Rawat
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Jill Combrinck
- Department of Chemistry, University of Cape Town, Private Bag, Rondebosch, Cape Town, 7701, South Africa
| | - Bhumika Kumar
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi, 110025, India; National Institute of Malaria Research, New Delhi, 110077, India
| | - Mohd Aleem
- Division of Behavioral Neuroscience, Institute of Nuclear Medicine and Allied Sciences, Delhi, 110054, India
| | - Phool Hasan
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi, 110025, India
| | - Mukesh C Joshi
- Department of Chemistry, Kirori Mal College, University of Delhi, Delhi, 110007, India
| | - Yashpal S Chhonker
- Department of Pharmacy Practice and Science College of Pharmacy, University of Nebraska Medical Center, 986145, Nebraska Medical Center, Omaha, NE, 68198-6145, USA
| | - Muhammad Zahid
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, 986145, Nebraska Medical Center, Omaha, NE, 68198-6145, USA
| | - Afzal Hussain
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Kailash Pandey
- National Institute of Malaria Research, New Delhi, 110077, India
| | - Mohamed F Alajmi
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Daryl J Murry
- Department of Pharmacy Practice and Science College of Pharmacy, University of Nebraska Medical Center, 986145, Nebraska Medical Center, Omaha, NE, 68198-6145, USA
| | - Timothy J Egan
- Department of Chemistry, University of Cape Town, Private Bag, Rondebosch, Cape Town, 7701, South Africa
| | - Shailja Singh
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India.
| | - Mohammad Abid
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi, 110025, India.
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Akafity G, Kumi N, Ashong J. Diagnosis and management of malaria in the intensive care unit. J Intensive Med 2024; 4:3-15. [PMID: 38263976 PMCID: PMC10800773 DOI: 10.1016/j.jointm.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/17/2023] [Accepted: 09/02/2023] [Indexed: 01/25/2024]
Abstract
Malaria is responsible for approximately three-quarters of a million deaths in humans globally each year. Most of the morbidity and mortality reported are from Sub-Saharan Africa and Asia, where the disease is endemic. In non-endemic areas, malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination programs. Severe malaria often requires intensive care unit admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. Intensive care management includes prompt diagnosis and early initiation of effective antimalarial therapy, recognition of complications, and appropriate supportive care. However, the lack of diagnostic capacities due to limited advances in equipment, personnel, and infrastructure presents a challenge to the effective diagnosis and management of malaria. This article reviews the clinical classification, diagnosis, and management of malaria as relevant to critical care clinicians, highlighting the role of diagnostic capacity, treatment options, and supportive care.
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Affiliation(s)
- George Akafity
- Department of Research, Monitoring, and Evaluation, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Nicholas Kumi
- Intensive Care Unit, Department of Critical Care and Anesthesia, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joyce Ashong
- Department of Paediatrics and Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana
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Ravipati A, Randolph M, Al-Salhi W, Tosti A. Use of Hydroxychloroquine in Hair Disorders. Skin Appendage Disord 2023; 9:416-422. [PMID: 38058539 PMCID: PMC10697765 DOI: 10.1159/000533583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/10/2023] [Indexed: 12/08/2023] Open
Abstract
Hydroxychloroquine (HCQ) is an antimalarial that is utilized to treat a range of dermatologic and autoimmune disorders. With its ability to alter immunologic mechanisms, it has been used to slow or halt the progression of hair loss in conditions secondary to autoimmune dysfunction. Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and alopecia areata (AA) are hair disorders with underlying autoimmune components and no standardized treatment guidelines. We summarized the available literature on the use of HCQ to treat LPP, FFA, and AA. For all three conditions, HCQ showed variable efficacy from halted hair loss to no improvement. While patients did show success with HCQ treatment, there were no clear treatment patterns. Regimens ranged from HCQ monotherapy to combination treatments with other agents like steroids. Overall, HCQ should certainly be considered by clinicians as a treatment option for patient suffering from these hair disorders. While there is no standardized treatment, incorporation of HCQ should take into consideration individual patient characteristics, clinical judgment, and risks of side effects.
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Affiliation(s)
- Advaitaa Ravipati
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Michael Randolph
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Waleed Al-Salhi
- Department of Dermatology, Majmaah University College of Medicine, Al-Majmaah, Saudi Arabia
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA
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Rao IR, Kolakemar A, Shenoy SV, Prabhu RA, Nagaraju SP, Rangaswamy D, Bhojaraja MV. Hydroxychloroquine in nephrology: current status and future directions. J Nephrol 2023; 36:2191-2208. [PMID: 37530940 PMCID: PMC10638202 DOI: 10.1007/s40620-023-01733-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
Hydroxychloroquine is one of the oldest disease-modifying anti-rheumatic drugs in clinical use. The drug interferes with lysosomal activity and antigen presentation, inhibits autophagy, and decreases transcription of pro-inflammatory cytokines. Owing to its immunomodulatory, anti-inflammatory, anti-thrombotic effect, hydroxychloroquine has been an integral part of therapy for systemic lupus erythematosus and lupus nephritis for several decades. The therapeutic versatility of hydroxychloroquine has led to repurposing it for other clinical conditions, with recent studies showing reduction in proteinuria in IgA nephropathy. Research is also underway to investigate the efficacy of hydroxychloroquine in primary membranous nephropathy, Alport's syndrome, systemic vasculitis, anti-GBM disease, acute kidney injury and for cardiovascular risk reduction in chronic kidney disease. Hydroxychloroquine is well-tolerated, inexpensive, and widely available and therefore, should its indications expand in the future, it would certainly be welcomed. However, clinicians should be aware of the risk of irreversible and progressive retinal toxicity and rarely, cardiomyopathy. Monitoring hydroxychloroquine levels in blood appears to be a promising tool to evaluate compliance, individualize the dose and reduce the risk of retinal toxicity, although this is not yet standard clinical practice. In this review, we discuss the existing knowledge regarding the mechanism of action of hydroxychloroquine, its utility in lupus nephritis and other kidney diseases, the main adverse effects and the evidence gaps that need to be addressed in future research. Created with Biorender.com. HCQ, hydroxychloroquine; GBM, glomerular basement membrane; mDC, myeloid dendritic cell; MHC, major histocompatibility complex; TLR, toll-like receptor.
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Affiliation(s)
- Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104.
| | - Ashwija Kolakemar
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| | - Srinivas Vinayak Shenoy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| | - Ravindra Attur Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| | - Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| | - Dharshan Rangaswamy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
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Mbassi DE, Pfaffendorf C, Mombo-Ngoma G, Kreuels B, Ramharter M. Real-life effectiveness of anti-malarial treatment regimens: what are we aiming for? Malar J 2023; 22:189. [PMID: 37340324 DOI: 10.1186/s12936-023-04606-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/25/2023] [Indexed: 06/22/2023] Open
Abstract
Three-day artemisinin-based combination therapy (ACT) is the current standard of care for the treatment of malaria. However, specific drug resistance associated with reduced efficacy of ACT has been observed, therefore necessitating the clinical development of new anti-malarial drugs and drug combinations. Previously, Single Encounter Radical Cure and Prophylaxis (SERCAP) has been proposed as ideal target-product-profile for any new anti-malarial drug regimen as this would improve treatment adherence besides ensuring complete cure and prevention of early reinfection. Arguably, this concept may not be ideal as it (1) necessitates administration of an excessively high dose of drug to achieve plasmodicidal plasma levels for a sufficient time span, (2) increases the risk for drug related adverse drug reactions, and (3) leaves the patient with a one-time opportunity to achieve-or not-cure by a single drug intake. Over the past years, SERCAP has led to the halt of promising drug development programmes, leading to potentially unnecessary attrition in the anti-malarial development pipeline. One proposition could be the concept of single-day multi-dose regimens as a potentially better alternative, as this allows to (1) administer a lower dose of the drug at each time-point leading to better tolerability and safety, (2) increase treatment adherence based on the intake of the anti-malarial drug within 24 h when malaria-related symptoms are still present, and (3) have more than one opportunity for adequate intake of the drug in case of early vomiting or other factors causing reduced bioavailability. In line with a recently published critical viewpoint on the concept of SERCAP, an alternative proposition is-in contrast to the current World Health Organization (WHO) treatment guidelines-to aim for less than three days, but still multiple-dose anti-malarial treatment regimens. This may help to strike the optimal balance between improving treatment adherence, maximizing treatment effectiveness, while keeping attrition of new drugs and drug regimens as low as possible.
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Affiliation(s)
- Dorothea Ekoka Mbassi
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Christoph Pfaffendorf
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, 20146, Hamburg, Germany
| | - Ghyslain Mombo-Ngoma
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Benno Kreuels
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Hamburg, Germany.
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.
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Madhav H, Patel TS, Rizvi Z, Reddy GS, Rahman A, Rahman MA, Ahmedi S, Fatima S, Saxena K, Manzoor N, Bhattacharjee S, Dixit BC, Sijwali PS, Hoda N. Development of diphenylmethylpiperazine hybrids of chloroquinoline and triazolopyrimidine using Petasis reaction as new cysteine proteases inhibitors for malaria therapeutics. Eur J Med Chem 2023; 258:115564. [PMID: 37321109 DOI: 10.1016/j.ejmech.2023.115564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/17/2023]
Abstract
Malaria is a widespread infectious disease, causing nearly 247 million cases in 2021. The absence of a broadly effective vaccine and rapidly decreasing effectiveness of most of the currently used antimalarials are the major challenges to malaria eradication efforts. To design and develop novel antimalarials, we synthesized a series of 4,7-dichloroquinoline and methyltriazolopyrimidine analogues using a multi-component Petasis reaction. The synthesized molecules (11-31) were screened for in-vitro antimalarial activity against drug-sensitive and drug-resistant strains of Plasmodium falciparum with an IC50 value of 0.53 μM. The selected compounds were screened to evaluate in-vitro and in-silico enzyme inhibition efficacy against two cysteine proteases, PfFP2 and PfFP3. The compounds 15 and 17 inhibited PfFP2 with an IC50 = 3.5 and 4.8 μM, respectively and PfFP3 with an IC50 = 4.9 and 4.7 μM, respectively. Compounds 15 and 17 were found equipotent against the Pf3D7 strain with an IC50 value of 0.74 μM, whereas both were displayed IC50 values of 1.05 μM and 1.24 μM for the PfW2 strain, respectively. Investigation of effect of compounds on parasite development demonstrated that compounds were able to arrest the growth of the parasites at trophozoite stage. The selected compounds were screened for in-vitro cytotoxicity against mammalian lines and human red-blood-cell (RBC), which demonstrated no significant cytotoxicity associated with the molecules. In addition, in silico ADME prediction and physiochemical properties supported the drug-likeness of the synthesized molecules. Thus, the results highlighted the diphenylmethylpiperazine group cast on 4,7-dichloroquinoline and methyltriazolopyrimidine using Petasis reaction may serve as models for the development of new antimalarial agents.
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Affiliation(s)
- Hari Madhav
- Drug Design and Synthesis Laboratory, Department of Chemistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Tarosh S Patel
- Chemistry Department, V. P. & R. P. T. P Science College, Affiliated to Sardar Patel University, Vallabh Vidyanagar, 388 120, Gujarat, India
| | - Zeba Rizvi
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, 500007, TS, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, UP, India
| | - G Srinivas Reddy
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, 500007, TS, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, UP, India
| | - Abdur Rahman
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Md Ataur Rahman
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, 02138, USA
| | - Saiema Ahmedi
- Medical Mycology Lab, Department of Biosciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Sadaf Fatima
- Drug Design and Synthesis Laboratory, Department of Chemistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Kanika Saxena
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, 500007, TS, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, UP, India
| | - Nikhat Manzoor
- Medical Mycology Lab, Department of Biosciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Souvik Bhattacharjee
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Bharat C Dixit
- Chemistry Department, V. P. & R. P. T. P Science College, Affiliated to Sardar Patel University, Vallabh Vidyanagar, 388 120, Gujarat, India
| | - Puran Singh Sijwali
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, 500007, TS, India.
| | - Nasimul Hoda
- Drug Design and Synthesis Laboratory, Department of Chemistry, Jamia Millia Islamia, New Delhi, 110025, India.
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10
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Katarzyna PB, Wiktor S, Ewa D, Piotr L. Current treatment of systemic lupus erythematosus: a clinician's perspective. Rheumatol Int 2023:10.1007/s00296-023-05306-5. [PMID: 37171669 DOI: 10.1007/s00296-023-05306-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/04/2023] [Indexed: 05/13/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Its variable course makes it difficult to standardize patient treatment. This article aims at a literature review on available drugs for treating SLE and on drugs that have shown therapeutic effects in this disease. The PubMed/MEDLINE electronic search engine was used to identify relevant studies. This review presents the current therapeutic options, new biological therapies, and combination therapies of biologics with standard immunosuppressive and immunomodulating drugs. We have also underlined the importance to implement the treat-to-target strategy aimed at reducing or discontinuing therapy with glucocorticosteroids (GCs). The awareness of the benefits and risks of using GCs helps in refining their dosage and thereby obtaining a better safety profile. The advent of biological targeted therapies, and more recently, low-molecular-weight compounds such as kinase inhibitors, initiated numerous clinical trials in SLE patients and led to the approval of two biological drugs, belimumab, and anifrolumab, for SLE treatment. Progress in the treatment of SLE was reflected in the 2019 and 2021 recommendations of the European Alliance of Associations for Rheumatology (EULAR). However, a mass of recent clinical research data requires continuous consolidation to optimize patient outcomes.
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Affiliation(s)
- Pawlak-Buś Katarzyna
- Department of Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland.
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Struś Municipal Hospital, Poznań, Poland.
| | - Schmidt Wiktor
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Struś Municipal Hospital, Poznań, Poland
- Doctoral School, Poznań University of Medical Sciences, Poznań, Poland
| | - Dudziec Ewa
- Department of Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland
| | - Leszczyński Piotr
- Department of Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Struś Municipal Hospital, Poznań, Poland
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11
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Azeem K, Irfan I, Rashid Q, Singh S, Patel R, Abid M. Recent Updates on Interaction Studies and Drug Delivery of Antimalarials with Serum Albumin proteins. Curr Med Chem 2023; 30:CMC-EPUB-131646. [PMID: 37218197 DOI: 10.2174/0929867330666230509121931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 05/24/2023]
Abstract
This review focuses on recent trends in the binding study of various antimalarial agents with serum albumins in detail. Serum albumin has a significant role in the transport of drugs and endogenous ligands. The nature and magnitude of serum albumin and drug interactions have a tremendous impact on the pharmacological behavior and toxicity of that drug. Binding of drug to serum albumin not only controls its free and active concentration, but also provides a reservoir for a long duration of action. This ultimately affects drug absorption, distribution, metabolism, and excretion. Such interaction determines the actual drug efficacy as the drug action can be correlated with the amount of unbound drug. With the advancement in spectroscopic techniques and simulation studies, binding studies play an increasingly important role in biophysical and biomedical science, especially in the field of drug delivery and development. This review assesses the insight we have gained so far to improve drug delivery and discovery of antimalarials on the basis of a plethora of drug-serum protein interaction studies done so far.
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Affiliation(s)
- Kashish Azeem
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
- Biophysical Chemistry Laboratory, Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Iram Irfan
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Qudsia Rashid
- Department of Clinical Biochemistry, Government Degree College, Pulwama, Jammu and Kashmir 192301, India
| | - Shailja Singh
- Host-Parasite Interaction Biology, Laboratory Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, India
| | - Rajan Patel
- Biophysical Chemistry Laboratory, Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Mohammad Abid
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
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12
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Costa Souza RM, Montenegro Pimentel LML, Ferreira LKM, Pereira VRA, Santos ACDS, Dantas WM, Silva CJO, De Medeiros Brito RM, Andrade JL, De Andrade-Neto VF, Fujiwara RT, Bueno LL, Silva Junior VA, Pena L, Camara CA, Rathi B, De Oliveira RN. Biological activity of 1,2,3-triazole-2-amino-1,4-naphthoquinone derivatives and their evaluation as therapeutic strategy for malaria control. Eur J Med Chem 2023; 255:115400. [PMID: 37130472 DOI: 10.1016/j.ejmech.2023.115400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
Malaria can be caused by several Plasmodium species and the development of an effective vaccine is challenging. Currently, the most effective tool to control the disease is the administration of specific chemotherapy; however, resistance to the frontline antimalarials is one of the major problems in malaria control and thus the development of new drugs becomes urgent. The study presented here sought to evaluate the antimalarial activities of compounds derived from 2-amino-1,4-naphthoquinones containing 1,2,3-triazole using in vivo and in vitro models. 1H-1,2,3-Triazole 2-amino-1,4-naphthoquinone derivatives were synthesized and evaluated for antimalarial activity in vitro, using P. falciparum W2 chloroquine (CQ) resistant strain and in vivo using the murine-P. berghei ANKA strain. Acute toxicity was determined as established by the OECD (2001). Cytotoxicity was evaluated against HepG2 and Vero mammalian cell lines. Transmission electron microscopy of the Plasmodium falciparum trophozoite (early and late stages) was used to evaluate the action of compounds derived at ultra-structural level. The compounds displayed low cytotoxicity CC50 > 100 μM, neither did they cause hemolysis at the tested doses and nor the signs of toxicity in the in vivo acute toxicity test. Among the five compounds tested, one showed IC50 values in submicromolar range of 0.8 μM. Compounds 7, 8 and 11 showed IC50 values < 5 μM, and selectivity index (SI) ranging from 6.8 to 343 for HepG2, and from 13.7 to 494.8 for Vero cells. Compounds 8 and 11 were partially active against P. berghei induced parasitemia in vivo. Analysis of the ultrastructural changes associated with the treatment of these two compounds, showed trophozoites with completely degraded cytoplasm, loss of membrane integrity, organelles in the decomposition stage and possible food vacuole deterioration. Our results indicated that compounds 8 and 11 may be considered hit molecules for antimalarial drug discovery platform and deserve further optimization studies.
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Affiliation(s)
- Renata Maria Costa Souza
- Department of Immunology, Laboratory of Immunoepidemiology of Aggeu Magalhães Institute, Fiocruz-PE, Recife, Pernambuco, Brazil; Department of Chemistry, Laboratory of Synthesis of Bioactive Compounds, Federal Rural University of Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Valéria Rêgo Alves Pereira
- Department of Immunology, Laboratory of Immunoparasitology, Aggeu Magalhães Institute, Fiocruz-PE, Recife, Pernambuco, Brazil
| | - Aline Caroline Da Silva Santos
- Department of Immunology, Laboratory of Immunoparasitology, Aggeu Magalhães Institute, Fiocruz-PE, Recife, Pernambuco, Brazil
| | - Willyenne Marília Dantas
- Department of Virology and Experimental Therapy Aggeu Magalhães Institute - Fiocruz-PE, Recife, Pernambuco, Brazil; Department of Chemistry, Laboratory of Synthesis of Bioactive Compounds, Federal Rural University of Pernambuco, Recife, Pernambuco, Brazil
| | - Carla Jasmine Oliveira Silva
- Department of Chemistry, Laboratory of Synthesis of Bioactive Compounds, Federal Rural University of Pernambuco, Recife, Pernambuco, Brazil
| | - Ramayana Morais De Medeiros Brito
- Department of Microbiology and Parasitology, Laboratory of Malaria and Toxoplasmosis Biology, LaBMAT/DMP/CB, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; Department of Parasitology, Laboratory of Immunobiology and Parasites Control, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Lucas Andrade
- Department of Microbiology and Parasitology, Laboratory of Malaria and Toxoplasmosis Biology, LaBMAT/DMP/CB, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Valter Ferreira De Andrade-Neto
- Department of Microbiology and Parasitology, Laboratory of Malaria and Toxoplasmosis Biology, LaBMAT/DMP/CB, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ricardo Toshio Fujiwara
- Department of Parasitology, Laboratory of Immunobiology and Parasites Control, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lilian Lacerda Bueno
- Department of Parasitology, Laboratory of Immunobiology and Parasites Control, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Lindomar Pena
- Department of Virology and Experimental Therapy Aggeu Magalhães Institute - Fiocruz-PE, Recife, Pernambuco, Brazil
| | - Celso Amorim Camara
- Department of Chemistry, Laboratory of Synthesis of Bioactive Compounds, Federal Rural University of Pernambuco, Recife, Pernambuco, Brazil
| | - Brijesh Rathi
- Laboratory for Translational Chemistry and Drug Discovery, Department of Chemistry, Hansraj College, University of Delhi, Delhi, 110007, India
| | - Ronaldo Nascimento De Oliveira
- Department of Chemistry, Laboratory of Synthesis of Bioactive Compounds, Federal Rural University of Pernambuco, Recife, Pernambuco, Brazil.
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13
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Tiwari R, Checkley L, Ferdig MT, Vennerstrom JL, Miller MJ. Synthesis and antimalarial activity of amide and ester conjugates of siderophores and ozonides. Biometals 2023; 36:315-320. [PMID: 35229216 PMCID: PMC9433463 DOI: 10.1007/s10534-022-00375-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/14/2022] [Indexed: 11/25/2022]
Abstract
Despite advances in chemotherapeutic interventions for the treatment of malaria, there is a continuing need for the development of new antimalarial agents. Previous studies indicated that co-administration of chloroquine with antioxidants such as the iron chelator deferoxamine (DFO) prevented the development of persistent cognitive damage in surrogate models of cerebral malaria. The work described herein reports the syntheses and antimalarial activities of covalent conjugates of both natural (siderophores) and artificial iron chelators, namely DFO, ferricrocin and ICL-670, with antimalarial 1,2,4-trioxolanes (ozonides). All of the synthesized conjugates had potent antimalarial activities against the in vitro cultures of drug resistant and drug sensitive strains of Plasmodium falciparum. The work described herein provides the basis for future development of covalent combination of iron chelators and antimalarial chemotherapeutic agents for the treatment of cerebral malaria.
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Affiliation(s)
- Rohit Tiwari
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Lisa Checkley
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Michael T Ferdig
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Jonathan L Vennerstrom
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Marvin J Miller
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, 46556, USA.
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14
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Hetzel MW, Okitawutshu J, Tshefu A, Omoluabi E, Awor P, Signorell A, Kwiatkowski M, Lambiris MJ, Visser T, Cohen JM, Buj V, Burri C, Lengeler C. Pre-referral rectal artesunate is no "magic bullet" in weak health systems. BMC Med 2023; 21:119. [PMID: 36991404 PMCID: PMC10060914 DOI: 10.1186/s12916-023-02777-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/09/2023] [Indexed: 03/31/2023] Open
Abstract
Severe malaria is a potentially fatal condition that requires urgent treatment. In a clinical trial, a sub-group of children treated with rectal artesunate (RAS) before being referred to a health facility had an increased chance of survival. We recently published in BMC Medicine results of the CARAMAL Project that did not find the same protective effect of pre-referral RAS implemented at scale under real-world conditions in three African countries. Instead, CARAMAL identified serious health system shortfalls that impacted the entire continuum of care, constraining the effectiveness of RAS. Correspondence to the article criticized the observational study design and the alleged interpretation and consequences of our findings.Here, we clarify that we do not dispute the life-saving potential of RAS, and discuss the methodological criticism. We acknowledge the potential for confounding in observational studies. Nevertheless, the totality of CARAMAL evidence is in full support of our conclusion that the conditions under which RAS can be beneficial were not met in our settings, as children often failed to complete referral and post-referral treatment was inadequate.The criticism did not appear to acknowledge the realities of highly malarious settings documented in detail in the CARAMAL project. Suggesting that trial-demonstrated efficacy is sufficient to warrant large-scale deployment of pre-referral RAS ignores the paramount importance of functioning health systems for its delivery, for completing post-referral treatment, and for achieving complete cure. Presenting RAS as a "magic bullet" distracts from the most urgent priority: fixing health systems so they can provide a functioning continuum of care and save the lives of sick children.The data underlying our publication is freely accessible on Zenodo.
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Affiliation(s)
- Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Jean Okitawutshu
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Phyllis Awor
- Makerere University School of Public Health, Kampala, Uganda
| | - Aita Signorell
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Marek Kwiatkowski
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Mark J Lambiris
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Valentina Buj
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- UNICEF, New York, NY, USA
| | - Christian Burri
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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15
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Grebenyuk V, Stejskal F, Nohýnková E, Zicklerová I, Richterová L, Roháčová H, Rozsypal H, Trojánek M. Artemether-lumefantrine, mefloquine and atovaquone-proguanil in the treatment of uncomplicated Plasmodium falciparum malaria in travellers: A retrospective comparative study of efficacy and treatment failures. Travel Med Infect Dis 2023; 52:102549. [PMID: 36792022 DOI: 10.1016/j.tmaid.2023.102549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/12/2023] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the rates of parasitaemia clearance and the prevalence of treatment failure in patients with uncomplicated Plasmodium falciparum malaria treated with artemether-lumefantrine (AL), mefloquine (MQ), and atovaquone-proguanil (AP). METHOD The retrospective descriptive study included adult patients with uncomplicated P. falciparum malaria treated at the University Hospital Bulovka in Prague from 2006 to 2019. Parasitaemia clearance was estimated using a linear regression model. RESULTS The study included 72 patients with a median age of 33 years (IQR 27-45) and a male to female ratio of 3.2:1. Thirty-six patients (50.0%) were treated with AL, 27 (37.5%) with MQ and 9 (12.5%) with AP. The proportion of VFR and migrants was 22.2% with no significant differences among the three groups. The median time to the parasitaemia clearance was two days (IQR 2-3) in patients treated with AL versus four days in the MQ (IQR 3-4) and AP (IQR 3-4) groups, p < 0.001. The clearance rate constant was 3.3/hour (IQR 2.5-4.0) for AL, 1.6/hour (IQR 1.3-1.9) for MQ, and 1.9/hour (IQR 1.3-2.4) for AP, p < 0.001. Malaria recrudescence occurred in 5/36 (13.9%) patients treated with AL and in no patients treated with MQ or AP. CONCLUSIONS The findings demonstrate the superior efficacy of AL compared to other oral antimalarials in early malaria treatment. However, we observed a higher rate of late treatment failure in patients treated with AL than previously reported. This issue warrants further investigation of possible dose adjustments, extended regimens, or alternative artemisinin-based combinations.
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Affiliation(s)
- Vyacheslav Grebenyuk
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic; Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic; Department of Infectious Diseases and Travel Medicine, University Hospital Motol, V Úvalu 84, 150 06, Prague, Czech Republic.
| | - František Stejskal
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic; Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic; Department of Infectious Diseases, Regional Hospital Liberec, Husova 10, 460 63, Liberec, Czech Republic; Institute of Immunology and Microbiology, 1st Faculty of Medicine, Charles University, Studničkova 7, 128 00, Prague, Czech Republic
| | - Eva Nohýnková
- Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic; Institute of Immunology and Microbiology, 1st Faculty of Medicine, Charles University, Studničkova 7, 128 00, Prague, Czech Republic; National Reference Laboratory for the Diagnosis of Tropical Parasitic Infections, Budínova 2, 180 81, Prague, Czech Republic; Department of Infectious and Tropical Diseases, 1st Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic
| | - Ivana Zicklerová
- National Reference Laboratory for the Diagnosis of Tropical Parasitic Infections, Budínova 2, 180 81, Prague, Czech Republic; Department of Clinical Microbiology, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic
| | - Lenka Richterová
- National Reference Laboratory for the Diagnosis of Tropical Parasitic Infections, Budínova 2, 180 81, Prague, Czech Republic; Department of Infectious and Tropical Diseases, 1st Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic; Department of Clinical Microbiology, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic; Department of Microbiology of the 3rd Faculty of Medicine, Charles University, University Hospital Královské Vinohrady and the National Institute of Public Health, Šrobárova 50, 100 34, Prague, Czech Republic
| | - Hana Roháčová
- Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic
| | - Hanuš Rozsypal
- Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic; Department of Infectious and Tropical Diseases, 1st Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic
| | - Milan Trojánek
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic; Department of Infectious Diseases and Travel Medicine, University Hospital Motol, V Úvalu 84, 150 06, Prague, Czech Republic
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16
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Arena L, Zanamwe M, Halleux CM, Carrara V, Angus BJ, Ariana P, Humphreys GS, Richmond C, Stepniewska K, Guérin PJ, Olliaro PL. Malaria patient spectrum representation in therapeutic clinical trials of uncomplicated malaria: a scoping review of the literature. Malar J 2023; 22:50. [PMID: 36765317 PMCID: PMC9913008 DOI: 10.1186/s12936-023-04441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/03/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND For the results of clinical trials to have external validity, the patients included in the study must be representative of the population presenting in the general clinical settings. A scoping literature review was performed to evaluate how the eligibility criteria used in anti-malarial efficacy and safety trials translate into patient selection. METHODS A search of the WorldWide Antimalarial Resistance Network (WWARN) Clinical Trials Publication Library, MEDLINE, The Cochrane Library, and clinicaltrials.gov was conducted to identify trials investigating anti-malarial efficacy and safety, published between 14th April 2001 and 31st December 2017. An updated search using the WWARN Clinical Trial Publication Library was undertaken to identify eligible publications from 1st January 2018 to 31st July 2021. The review included studies in patients of any age with uncomplicated malaria and any pharmaceutical therapeutic intervention administered. The proportion of trials with malaria-positive patients excluded was calculated and linked to the reported reason for exclusion. A subgroup analysis on eligibility criteria and trial baseline demographics was conducted to assess whether criteria are complied with when recruiting patients. RESULTS Out of 847 studies, 176 (21%) trials were included in the final synthesis, screening a total of 157,516 malaria-positive patients, of whom 56,293 (36%) were enrolled and treated. Across the 176 studies included, 84 different inclusion and exclusion criteria were identified. The reason for exclusion of patients who tested positive for malaria was reported in 144 (82%) studies. Three criteria account for about 70% of malaria-positive patients excluded: mixed-species malaria infections or other specific Plasmodium species, parasite counts outside the set study ranges, and refusal of consent. CONCLUSIONS Nearly two-thirds of the malaria-positive subjects who present to health facilities are systematically excluded from anti-malarial treatment trials. Reasons for exclusions are largely under-reported. Anti-malarial treatment in the general population is informed by studies on a narrow selection of patients who do not fully represent the totality of those seeking antimalarial treatment in routine practice. While entry criteria ensure consistency across trials, pragmatic trials are also necessary to supplement the information currently available and improve the external validity of the findings of malaria clinical trials.
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Affiliation(s)
- Lorenzo Arena
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Mazvita Zanamwe
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christine M. Halleux
- grid.3575.40000000121633745Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization (WHO), Geneva, Switzerland
| | - Verena Carrara
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK ,grid.8591.50000 0001 2322 4988Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Brian J. Angus
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Proochista Ariana
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Georgina S. Humphreys
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Caitlin Richmond
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Kasia Stepniewska
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Philippe J. Guérin
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Piero L. Olliaro
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948ISARIC Global Support Centre, International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
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17
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Ounjaijean S, Somsak V. Synergistic antimalarial treatment of Plasmodium berghei infection in mice with dihydroartemisinin and Gymnema inodorum leaf extract. BMC Complement Med Ther 2023; 23:20. [PMID: 36690988 PMCID: PMC9869572 DOI: 10.1186/s12906-023-03850-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Chemotherapy is crucial in the fight against malaria. The rise of resistance to most antimalarial medicines has been a serious hurdle to effective treatment. Artemisinin-based combination therapies (ACTs) are currently the most effective antimalarial medication. Malaria parasites are growing more resistant to ACTs, particularly in Southeast Asia. As a result, effective alternative antimalarials are in high demand. The leaf extract of Gymnema inodorum (GIE) has previously shown promise as an effective antimalarial. Therefore, this study evaluated the antimalarial potential of combination dihydroartemisinin (DHA) and GIE therapy against Plasmodium berghei in a mouse model. METHODS The medications were evaluated using the standard 4-day test for determining the 50% effective dosage (ED50) of DHA and GIE on P. berghei ANKA (PbANKA). DHA and GIE were combined using a fixed-ratio approach, with DHA/GIE ED50s of 100/0, 80/20, 60/40, 40/60, 20/80, and 0/100, respectively. RESULTS The ED50 against PbANKA was determined to be 2 mg/kg of DHA and 100 mg/kg of GIE. The 60/40 (DHA/GIE) ratio demonstrated significantly higher antimalarial activity than the other ratios (p < 0.001) against PbANKA, with 88.95% inhibition, suggesting synergistic efficacy (combination index (CI) = 0.68695). Furthermore, this ratio protected PbANKA-infected mice against loss of body weight and packed cell volume decline, leading to a longer survival time over 30 days. CONCLUSION Our results suggest that GIE could be an effective adjuvant to DHA that can enhance the antimalarial effects in the treatment of PbANKA-infected mice.
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Affiliation(s)
- Sakaewan Ounjaijean
- grid.7132.70000 0000 9039 7662Research Institute for Health Sciences, Chiang Mai University, 50200 Chiang Mai, Thailand ,grid.7132.70000 0000 9039 7662Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Group (EOHS and NCD Research Group), Research Institute for Health Sciences, Chiang Mai University, 50200 Chiang Mai, Thailand
| | - Voravuth Somsak
- grid.412867.e0000 0001 0043 6347School of Allied Health Sciences, Walailak University, 80160 Nakhon Si Thammarat, Thailand ,grid.412867.e0000 0001 0043 6347Research Excellence Center for Innovation and Health Products, Walailak University, 80160 Nakhon Si Thammarat, Thailand
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18
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Schnyder JL, de Jong HK, Bache EB, van Hest RM, Schlagenhauf P, Borrmann S, Hanscheid T, Grobusch MP. On the potential for discontinuing atovaquone-proguanil (AP) ad-hoc post-exposure and other abbreviated AP-regimens: Pharmacology, pharmacokinetics and perspectives. Travel Med Infect Dis 2022; 52:102520. [PMID: 36526126 DOI: 10.1016/j.tmaid.2022.102520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/30/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
According to current guidelines, atovaquone-proguanil (AP) malaria chemoprophylaxis should be taken once daily starting one day before travel and continued for seven days post-exposure. However, drug-sparing regimens, including discontinuing AP after leaving malaria-endemic areas are cost-saving and probably more attractive to travelers, and may thus enhance adherence. AP has causal prophylactic effects, killing malaria parasites during the hepatic stage. If early hepatic stages were already targeted by AP, AP could possibly be discontinued upon return. Pharmacokinetic data and studies on drug-sparing AP regimens suggest this to be the case. Nevertheless, the evidence is weak and considered insufficient to modify current recommendations. Field trials require large numbers of travelers and inherently suffer from the lack of a control group. Safely-designed controlled human malaria infection trials could significantly reduce study participant numbers and safely establish an effective AP abbreviated regimen which we propose as the optimal trial design to test this concept.
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Affiliation(s)
- Jenny L Schnyder
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Hanna K de Jong
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Emmanuel B Bache
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Reinier M van Hest
- Department of Hospital Pharmacy & Clinical Pharmacology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Patricia Schlagenhauf
- University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travelers' Health, Department of Public and Global Health, Military Medicine Biology Competence Centre, Institute for Epidemiology, Biostatistics and Prevention, Zurich, Switzerland
| | - Steffen Borrmann
- Institute of Tropical Medicine, German Centre for Infection Research (DZIF), University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon
| | - Thomas Hanscheid
- Instituto de Microbiologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands; Institute of Tropical Medicine, German Centre for Infection Research (DZIF), University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon; Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone; Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.
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19
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Bassanini I, Parapini S, Basilico N, Taramelli D, Romeo S. From DC18 to MR07: A Metabolically Stable 4,4'-Oxybisbenzoyl Amide as a Low-Nanomolar Growth Inhibitor of P. falciparum. ChemMedChem 2022; 17:e202200355. [PMID: 36089546 PMCID: PMC9827966 DOI: 10.1002/cmdc.202200355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/02/2022] [Indexed: 01/12/2023]
Abstract
To improve the metabolic stability of a 4,4'-oxybisbenzoyl-based novel and potent (nanomolar-range IC50 ) antiplasmodial agent previously described by us, in silico-guided structure-activity relationship (SAR) campaigns have been conducted to substitute its peptide decorations with more metabolically stable residues. The effects of the various structural modifications were then correlated with the antiplasmodial activity in vitro in phenotypic assays. Among the several derivatives synthetized and compared with the 3D-pharmacophoric map of the original lead, a novel compound, characterized by a western tert-butyl glycine residue and an eastern 1S,2S-aminoacyclohexanol, showed low-nanomolar-range antiplasmodial activity, no signs of cross-resistance and, most importantly, 47-fold improved Phase I metabolic stability when incubated with human liver microsomes. These results highlight the efficacy of in silico-guided SAR campaigns which will allow us to further optimize the structure of the new lead aiming at testing its efficacy in vivo using different routes of administration.
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Affiliation(s)
- Ivan Bassanini
- Istituto di Scienze e Tecnologie Chimiche “Giulio Natta”Consiglio Nazionale delle RicercheVia Mario Bianco 920131MilanoItaly,Centro Interuniversitario di Ricerca sulla Malaria-Italian Malaria NetworkVia Festa del Perdono 720122MilanoItaly
| | - Silvia Parapini
- Dipartimento di Scienze Biomediche per la SaluteUniversità degli Studi di MilanoVia Pascal 3620133MilanoItaly,Centro Interuniversitario di Ricerca sulla Malaria-Italian Malaria NetworkVia Festa del Perdono 720122MilanoItaly
| | - Nicoletta Basilico
- Dipartimento di Scienze Biomediche, Chirurgiche e OdontoiatricheUniversità degli Studi di MilanoVia Pascal 3620133MilanoItaly,Centro Interuniversitario di Ricerca sulla Malaria-Italian Malaria NetworkVia Festa del Perdono 720122MilanoItaly
| | - Donatella Taramelli
- Dipartimento di Scienze Farmacologiche e BiomolecolariUniversità degli Studi di MilanoVia Pascal 3620133MilanoItaly,Centro Interuniversitario di Ricerca sulla Malaria-Italian Malaria NetworkVia Festa del Perdono 720122MilanoItaly
| | - Sergio Romeo
- Dipartimento di Scienze FarmaceuticheUniversità degli Studi di MilanoVia Mangiagalli 2520133MilanoItaly,Centro Interuniversitario di Ricerca sulla Malaria-Italian Malaria NetworkVia Festa del Perdono 720122MilanoItaly
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20
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Akilimali A, Bisimwa C, Aborode AT, Biamba C, Sironge L, Balume A, Sayadi R, Ajibade SB, Akintayo AA, Oluwadairo TO, Fajemisin EA. Self-medication and Anti-malarial Drug Resistance in the Democratic Republic of the Congo (DRC): A silent threat. Trop Med Health 2022; 50:73. [PMID: 36195896 PMCID: PMC9533625 DOI: 10.1186/s41182-022-00466-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Malaria is a global infectious (vector-borne: Anopheles mosquitoes) disease which is a leading cause of morbidity and mortality in Sub-Saharan Africa (SSA). Among all its parasitic (protozoan: Plasmodium sp.) variants, Plasmodium falciparum (PF) is the most virulent and responsible for above 90% of global malaria deaths hence making it a global public health threat. Main context Despite current front-line antimalarial treatments options especially allopathic medications and malaria prevention (and control) strategies especially governmental policies and community malaria intervention programs in SSA, PF infections remains prevalent due to increased antimicrobial/antimalarial drug resistance caused by several factors especially genetic mutations and auto(self)-medication practices in SSA. In this article, we focused on the Democratic Republic of Congo (DRC) as the largest SSA country by bringing perspective into the impact of self-medication and antimalarial drug resistance, and provided recommendation for long-term improvement and future analysis in malaria prevention and control in SSA. Conclusions Self-medication and anti-malarial drug resistance is a major challenge to malaria control in DRC and sub-Saharan Africa, and to achieve sustainable control, individual, community and governmental efforts must be aligned to stop self-medication, and strengthen the health systems against malaria.
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Affiliation(s)
- Aymar Akilimali
- Faculty of Medicine, Official University of Bukavu, Bukavu, DR, Congo.
| | - Charles Bisimwa
- Faculty of Pharmacy and Public Health, Official University of Bukavu, Bukavu, DR, Congo
| | | | | | - Leonard Sironge
- Faculty of Pharmacy and Public Health, Official University of Bukavu, Bukavu, DR, Congo
| | - Alain Balume
- Faculty of Medicine, Official University of Bukavu, Bukavu, DR, Congo
| | - Rahma Sayadi
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | | | - Akintola Ashraf Akintayo
- Department of Biomedical Convergence Science and Technology, Kyungpook National University, Daegu, 41566, South Korea
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21
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Trojánek M, Grebenyuk V, Richterová L, Zicklerová I, Nohýnková E, Manďáková Z, Kantor J, Roháčová H, Stejskal F. Epidemiology and clinical features of imported malaria: a 14-year retrospective single-centre descriptive study in Prague, Czech Republic. Malar J 2022; 21:257. [PMID: 36068598 PMCID: PMC9447980 DOI: 10.1186/s12936-022-04282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Malaria represents one of the most important imported tropical infectious diseases in European travellers. The objective of the study was to identify changes in the epidemiological features of imported malaria and to analyse the clinical findings and outcomes of imported malaria. Methods This single-centre descriptive study retrospectively analysed the medical records of all imported malaria cases in travellers treated at the Department of Infectious Diseases of University Hospital Bulovka in Prague from 2006 to 2019. Results The study included 203 patients with a median age of 37 years (IQR 30–48) and a male to female ratio of 3.72:1. Plasmodium falciparum was the predominant species (149/203), and its proportion significantly increased from 35/60 cases (58.3%) in 2006–2011 to 69/80 (86.3%) in 2016–2019 (p < 0.001). In contrast, the incidence of Plasmodium vivax malaria decreased from 19/60 cases (31.7%) in 2006–2011 to 5/80 (6.3%) in 2016–2019 (p < 0.001). Malaria was imported from sub-Saharan Africa in 161/203 cases (79.3%). The proportion of travellers from Southeast and South Asia decreased from 16/60 (26.7%) and 6/60 (10.0%) in 2006–2011 to 2/80 (2.5%) and no cases (0.0%) in 2016–2019, respectively (p < 0.001 and p = 0.006). Tourism was the most common reason for travel (82/203), however, the proportion of non-tourists significantly increased over time from 29/60 (48.3%) in 2006–2011 to 55/80 (68.8%) in 2016–2019, p = 0.015. Severe malaria developed in 32/203 (15.8%) patients who were significantly older (p = 0.013) and whose treatment was delayed (p < 0.001). Two lethal outcomes were observed during the study period. Conclusions This study demonstrated a significant increase in P. falciparum malaria, which frequently resulted in severe disease, especially in older patients and those with delayed treatment initiation. The rising proportion of imported malaria in non-tourists, including business travellers and those visiting friends and relatives, is another characteristic finding analogous to the trends observed in Western European and North American centres. The described changes in the aetiology and epidemiology of imported malaria may serve to optimize pre-travel consultation practices and improve post-travel diagnostics and medical care. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04282-8.
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Affiliation(s)
- Milan Trojánek
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic.,Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic.,Department of Infectious Diseases, Institute for Postgraduate Medical Education, Prague, Czech Republic
| | - Vyacheslav Grebenyuk
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic. .,Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic.
| | - Lenka Richterová
- Department of Clinical Microbiology, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic.,National Reference Laboratory for the Diagnosis of Tropical Parasitic Infections, Budínova 2, 180 81, Prague, Czech Republic.,Department of Infectious and Tropical Diseases, 1st Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic.,Department of Microbiology of the 3rd Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, National Institute of Public Health, Šrobárova 50, 100 34, Prague, Czech Republic
| | - Ivana Zicklerová
- Department of Clinical Microbiology, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic.,National Reference Laboratory for the Diagnosis of Tropical Parasitic Infections, Budínova 2, 180 81, Prague, Czech Republic
| | - Eva Nohýnková
- National Reference Laboratory for the Diagnosis of Tropical Parasitic Infections, Budínova 2, 180 81, Prague, Czech Republic.,Institute of Immunology and Microbiology, 1st Faculty of Medicine, Charles University, Studničkova 7, 128 00, Prague, Czech Republic
| | - Zdenka Manďáková
- Department of Epidemiology of Infectious Diseases, National Institute of Public Health, Šrobárova, Prague, Czech Republic
| | - Jakub Kantor
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic
| | - Hana Roháčová
- Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic
| | - František Stejskal
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic.,Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic.,Department of Infectious Diseases, Regional Hospital Liberec, Husova 10, 460 63, Liberec, Czech Republic
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22
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Mansoor R, Commons RJ, Douglas NM, Abuaku B, Achan J, Adam I, Adjei GO, Adjuik M, Alemayehu BH, Allan R, Allen EN, Anvikar AR, Arinaitwe E, Ashley EA, Ashurst H, Asih PBS, Bakyaita N, Barennes H, Barnes KI, Basco L, Bassat Q, Baudin E, Bell DJ, Bethell D, Bjorkman A, Boulton C, Bousema T, Brasseur P, Bukirwa H, Burrow R, Carrara VI, Cot M, D’Alessandro U, Das D, Das S, Davis TME, Desai M, Djimde AA, Dondorp AM, Dorsey G, Drakeley CJ, Duparc S, Espié E, Etard JF, Falade C, Faucher JF, Filler S, Fogg C, Fukuda M, Gaye O, Genton B, Ghulam Rahim A, Gilayeneh J, Gonzalez R, Grais RF, Grandesso F, Greenwood B, Grivoyannis A, Hatz C, Hodel EM, Humphreys GS, Hwang J, Ishengoma D, Juma E, Kachur SP, Kager PA, Kamugisha E, Kamya MR, Karema C, Kayentao K, Kazienga A, Kiechel JR, Kofoed PE, Koram K, Kremsner PG, Lalloo DG, Laman M, Lee SJ, Lell B, Maiga AW, Mårtensson A, Mayxay M, Mbacham W, McGready R, Menan H, Ménard D, Mockenhaupt F, Moore BR, Müller O, Nahum A, Ndiaye JL, Newton PN, Ngasala BE, Nikiema F, Nji AM, Noedl H, Nosten F, Ogutu BR, Ojurongbe O, Osorio L, Ouédraogo JB, Owusu-Agyei S, Pareek A, Penali LK, Piola P, Plucinski M, Premji Z, Ramharter M, Richmond CL, Rombo L, Roper C, Rosenthal PJ, Salman S, Same-Ekobo A, Sibley C, Sirima SB, Smithuis FM, Somé FA, Staedke SG, Starzengruber P, Strub-Wourgaft N, Sutanto I, Swarthout TD, Syafruddin D, Talisuna AO, Taylor WR, Temu EA, Thwing JI, Tinto H, Tjitra E, Touré OA, Tran TH, Ursing J, Valea I, Valentini G, van Vugt M, von Seidlein L, Ward SA, Were V, White NJ, Woodrow CJ, Yavo W, Yeka A, Zongo I, Simpson JA, Guerin PJ, Stepniewska K, Price RN. Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data. BMC Med 2022; 20:85. [PMID: 35249546 PMCID: PMC8900374 DOI: 10.1186/s12916-022-02265-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/18/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. METHODS Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. RESULTS A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0-19.7 g/dL) in Africa, 11.6 g/dL (range 5.0-20.0 g/dL) in Asia and 12.3 g/dL (range 6.9-17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39-3.05], p < 0.001). CONCLUSIONS In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery.
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23
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Rúa-Figueroa I, Rúa-Figueroa D, Pérez-Veiga N, Anzola AM, Galindo-Izquierdo M, Calvo-Alén J, Fernández-Nebro A, Sangüesa C, Menor-Almagro R, Tomero E, Del Val N, Uriarte-Isazelaya E, Blanco R, Andreu JL, Boteanu A, Narváez J, Cobo T, Bohórquez C, Montilla C, Salas E, Toyos FJ, Bernal JA, Salgado E, Freire M, Mas AJ, Expósito L, Hernández-Beriain JA, Ibarguengoitia O, Velloso-Feijoo ML, Lozano-Rivas N, Bonilla G, Moreno M, Jiménez I, Quevedo-Vila V, Pecondón A, Aurrecoechea E, Valls E, Mouriño C, Vázquez-Rodríguez T, Pego-Reigosa JM. Antimalarials exert a cardioprotective effect in lupus patients: Insights from the Spanish Society of Rheumatology Lupus Register (RELESSER) analysis of factors associated with heart failure. Semin Arthritis Rheum 2022; 52:151946. [PMID: 35033377 PMCID: PMC8720299 DOI: 10.1016/j.semarthrit.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVES Factors associated with chronic heart failure (CHF) in patients with systemic lupus erythematosus (SLE) have received little attention. Recent data on the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection have cast doubt on its cardiac safety. The factors associated with CHF, including therapy with antimalarials, were analyzed in a large multicenter SLE cohort. METHODS Cross-sectional study including all patients with SLE (ACR-1997 criteria) included in the Spanish Society of Rheumatology Lupus Register (RELESSER), based on historically gathered data. Patients with CHF prior to diagnosis of SLE were excluded. A multivariable analysis exploring factors associated with CHF was conducted. RESULTS The study population comprised 117 patients with SLE (ACR-97 criteria) and CHF and 3,506 SLE controls. Ninety percent were women. Patients with CHF were older and presented greater SLE severity, organ damage, and mortality than those without CHF. The multivariable model revealed the factors associated with CHF to be ischemic heart disease (7.96 [4.01-15.48], p < 0.0001), cardiac arrhythmia (7.38 [4.00-13.42], p < 0.0001), pulmonary hypertension (3.71 [1.84-7.25], p < 0.0002), valvulopathy (6.33 [3.41-11.62], p < 0.0001), non-cardiovascular damage (1.29 [1.16-1.44], p < 0.000) and calcium/vitamin D treatment (5.29 [2.07-16.86], p = 0.0015). Female sex (0.46 [0.25-0.88], p = 0.0147) and antimalarials (0.28 [0.17-0.45], p < 0.000) proved to be protective factors. CONCLUSIONS Patients with SLE and CHF experience more severe SLE. Treatment with antimalarials appears to confer a cardioprotective effect.
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Affiliation(s)
| | - David Rúa-Figueroa
- Hospital Universitario de Gran Canaria Doctor Negrin, Las Palmas GC, Spain.
| | | | - Ana M Anzola
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Ricardo Blanco
- Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - José L Andreu
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | | | | | - Cristina Bohórquez
- Hospital Universitario Príncipe de Asturias (Alcalá de Henares), Madrid, Spain.
| | | | - Esteban Salas
- Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
| | | | - José A Bernal
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Eva Salgado
- Complejo Hospitalario De Orense, Orense, Spain.
| | | | | | - Lorena Expósito
- Hospital Universitario de Canarias, La Laguna (Tenerife), Spain
| | | | | | | | | | | | | | | | | | | | | | - Elia Valls
- Hospital Universitario Doctor Peset, Valencia, Spain
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Conceição C, Medeiros M, Pereira N, Gonçalves L, Antunes A, Blondé E, Teodósio R, Araújo C, Pereira F. Health Problems During and After Travel: A Prospective Observational Study in a Travel Clinic in Portugal. ACTA MEDICA PORT 2021; 34:842-850. [PMID: 33661729 DOI: 10.20344/amp.14098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/03/2020] [Accepted: 09/17/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In order to improve the health of travellers during travel it is important to better understand the health problems faced by travellers in different destinations. The main objective of this study was to characterise the perceived health problems of travellers during and up to six months after travel on a pre-travel clinic in Lisbon, Portugal. MATERIAL AND METHODS This is a prospective observational study. Participants were recruited among those travellers attending a pretravel clinic between May 2016 and April 2017, meeting the inclusion criteria (age over 18 years old and predicted time of stay from five to 90 days). Structured questionnaires were applied by telephone interviews, three and six months after arrival. Associations and their magnitude were sought between travel and traveller's characteristics with total and specific health problems, using multiple logistic regression models. RESULTS Out of 364 participants who completed the study, 60% were under 37 years of age, and 87.9% presented a higher educationaldegree. Africa and Asia were travel destinations for 89.1% of travellers. Three months after travel, 39.3% confirmed some travel-acquired health problem, namely diarrhoea (26.6%) and unmeasured fever (12.4%). A malaria case was diagnosed, occurring 3.5 months after return. From a total of 189 travellers to countries with high risk of malaria and chemoprophylaxis recommendation, 65.6% adhered completely and 6.9% of those presenting fever during travel sought healthcare. DISCUSSION The proportion of travellers that became ill was lower compared to other published studies. Failure to follow a randomsampling method and the characteristics of the travel consultation with a particular profile of travellers in terms of level of education and ability to pay, challenges the external validity of the study. CONCLUSION Health problems during or after travel occurred in 39.3% of travellers with diarrhoeal disease being the most common (26.6%). From our findings, the need for taking chemoprophylaxis for malaria or seeking health care in the presence of fever is not translated into appropriate action. The reasons are unclear and should be the subject of further research. Furthermore, research is needed with inclusion of other centres practicing travel medicine in Portugal, both in the pre-travel setting and others, in order to better understand the health risks associated with Portuguese traveller's characteristics and destinations.
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Affiliation(s)
- Cláudia Conceição
- Global Health and Tropical Medicine. Instituto de Higiene e Medicina Tropical. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Márcia Medeiros
- Global Health and Tropical Medicine. Instituto de Higiene e Medicina Tropical. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Nélia Pereira
- Associação para o Desenvolvimento da Medicina Tropical. Instituto de Higiene e Medicina Tropical. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Luzia Gonçalves
- Global Health and Tropical Medicine. Instituto de Higiene e Medicina Tropical. Universidade NOVA de Lisboa. Lisboa. Centro de Estatística e Aplicações da Universidade de Lisboa. Lisboa. Portugal
| | - Abilio Antunes
- Associação para o Desenvolvimento da Medicina Tropical. Instituto de Higiene e Medicina Tropical. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Ellen Blondé
- Associação para o Desenvolvimento da Medicina Tropical. Instituto de Higiene e Medicina Tropical. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Rosa Teodósio
- Global Health and Tropical Medicine. Instituto de Higiene e Medicina Tropical. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Carlos Araújo
- Associação para o Desenvolvimento da Medicina Tropical. Instituto de Higiene e Medicina Tropical. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Filomena Pereira
- Global Health and Tropical Medicine. Instituto de Higiene e Medicina Tropical. Universidade NOVA de Lisboa. Lisboa. Portugal
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Prata AR, Luís M, Assunção H, da Silva JAP, Inês LS. Antimalarial treatment and minimizing prednisolone are associated with lower risk of infection in SLE: a 24-month prospective cohort study. Clin Rheumatol 2021. [PMID: 34782940 DOI: 10.1007/s10067-021-05988-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION/OBJECTIVES Infections are a major cause of morbidity and death in systemic lupus erythematosus (SLE). Perfecting the understanding of contributors to infection burden in SLE is pivotal to improve management and outcomes. This study aims to identify clinical predictors of infection in SLE. METHOD We conducted a prospective cohort study at a referral SLE clinic. Infections were identified at each visit and categorized as (a) any type, (b) serious, (c) non-serious, and (d) bacterial. Survival analysis followed by multivariate Cox regression with an estimation of hazard ratios (HR) with 95% confidence intervals (95%CI) was performed. RESULTS We included 259 patients during a mean follow-up of 23.3 ± 5.7 months. The incidence rate of infection of any type was 59.3 cases per 100 patient-years. Multivariate Cox models showed that (a) prednisolone ≥ 7.5 mg/day (HR = 1.95, 95%CI 1.26-3.03) and female gender (HR = 2.08, 95%CI 1.12-3.86) were associated with higher risk of infection of any type; (b) prednisolone ≥ 10 mg/day was associated with higher (HR = 4.32, 95%CI 1.39-13.40), and antimalarials with lower risk (HR = 0.18, 95%CI 0.06-0.51) of serious infection; (c) female gender (HR = 1.92, 95%CI 1.04-3.57) and prednisolone ≥ 7.5 mg/day (HR = 1.89, 95%CI 1.21-2.96) were associated with higher risk of non-serious infection; (d) antimalarials were associated with lower (HR = 0.49, 95%CI 0.26-0.93) and female gender (HR = 5.12; 95%CI 1.62-16.18) with higher risk of bacterial infection. CONCLUSIONS The risk of infection was higher in females in this young, well-controlled, low-comorbidity SLE cohort. Antimalarials were associated with lower and prednisolone ≥ 7.5 mg with higher risk of infection. Key Points • Lupus patients treated with prednisolone ≥ 7.5 mg/day were 89% more likely to present infections. • Lupus patients receiving prednisolone ≥ 10 mg/day were four times more likely to present serious infections. • Lupus patients receiving antimalarials were 82% less likely to present serious infections.
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Munguía-Realpozo P, Mendoza-Pinto C, García-Carrasco M, Berra-Romani R, Sierra-Benito C, Méndez-Martínez S, Cervera R. The impact of antimalarial agents on traditional and non-traditional subclinical atherosclerosis biomarkers in systemic lupus erythematosus: A systematic review and meta-analysis. Autoimmun Rev 2021; 20:102887. [PMID: 34237422 DOI: 10.1016/j.autrev.2021.102887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Cardiovascular (CV) morbidity is a well-established problem in systemic lupus erythematosus (SLE). Antimalarial (AM) therapy has been seen as a potential atheroprotective agent. The aim was to assess the impact of AM therapy on traditional and novel atherosclerosis (AT) biomarkers in patients with SLE. METHODS A search of MEDLINE, EMbase, and Cochrane library for studies evaluating the impact of AM on AT biomarkers in SLE was conducted. Data extraction included serum, functional and structural traditional and novel biomarkers. A narrative synthesis of the findings and a meta-analysis with random effects was conducted estimating mean differences (MD), OR, HR and 95% CIs. RESULTS The search strategy produced 148 articles, of which 64 were extracted for analysis. The MD in VLDL-cholesterol (-10.29, 95% CI -15.35, 5.24), triglycerides (-15.68, 95% CI -27.51, -3.86), and diastolic BP (-3.42, 95% CI -5.62, -1.23) differed significantly in patients on AM therapy compared with those without AM therapy. Patients on AM had a lower prevalence and incidence of diabetes mellitus than patients not on AM (HR: 0.39, 95% CI 0.17, 0.88). HCQ use was associated with lower blood pressure (BP) variability. Structural markers like carotid intima-media thickness (IMT), carotid plaque (CP) and coronary artery calcification (CAC) were not influenced by AM. For functional markers like endothelial and arterial stiffness the benefit was unclear. The GRADE approach showed a very low-to-low quality of evidence (QoE) per outcome. CONCLUSIONS There is some evidence on the associations between AM therapy and some AT markers. However, the data on which this conclusion was based was of low to very low evidence.
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Egwu CO, Tsamesidis I, Pério P, Augereau JM, Benoit-Vical F, Reybier K. Superoxide: A major role in the mechanism of action of essential antimalarial drugs. Free Radic Biol Med 2021; 167:271-275. [PMID: 33722628 DOI: 10.1016/j.freeradbiomed.2021.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Abstract
Understanding the mode of action of antimalarials is central to optimizing their use and the discovery of new therapeutics. Currently used antimalarials belong to a limited series of chemical structures and their mechanisms of action are coutinuously debated. Whereas the involvement of reactive species that in turn kill the parasites sensitive to oxidative stress, is accepted for artemisinins, little is known about the generation of such species in the case of quinolines or hydroxynaphtoquinone. Moreover, the nature of the reactive species involved has never been characterized in Plasmodium-infected erythrocytes. The aim of this work was to determine and elucidate the production of the primary radical, superoxide in Plasmodium-infected erythrocytes treated with artemisinin, dihydroartemisinin, chloroquine and atovaquone, as representatives of three major classes of antimalarials. The intracellular generation of superoxide was quantified by liquid chromatography coupled to mass spectrometry (LC-MS). We demonstrated that artemisinins, atovaquone and to a lesser extent chloroquine, generate significant levels of superoxide radicals in Plasmodium falciparum sensitive strains. More so, the production of superoxide was lowered in chloroquine-resistant strain of Plasmodium treated with chloroquine. These results consolidate the knowledge about the mechanism of action of these different antimalarials and should be taken into consideration in the design of future drugs to fight drug-resistant parasites.
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Affiliation(s)
- Chinedu O Egwu
- PharmaDev, UMR 152, Université de Toulouse, IRD, UPS, Toulouse, France; Medical Biochemistry, College of Medicine, Alex-Ekwueme Federal University, Ndufu-Alike Ikwo, P.M.B. 1010, Abakaliki, Ebonyi State, Nigeria; CNRS, LCC, Laboratoire de Chimie de Coordination, Université de Toulouse, Toulouse, France; Institut de Pharmacologie et de Biologie Structurale, IPBS, Université de Toulouse, CNRS, UPS, France; New Antimalarial Molecules and Pharmacological Approaches, Inserm ERL 1289, Toulouse, France
| | | | - Pierre Pério
- PharmaDev, UMR 152, Université de Toulouse, IRD, UPS, Toulouse, France
| | - Jean-Michel Augereau
- CNRS, LCC, Laboratoire de Chimie de Coordination, Université de Toulouse, Toulouse, France; Institut de Pharmacologie et de Biologie Structurale, IPBS, Université de Toulouse, CNRS, UPS, France; New Antimalarial Molecules and Pharmacological Approaches, Inserm ERL 1289, Toulouse, France
| | - Françoise Benoit-Vical
- CNRS, LCC, Laboratoire de Chimie de Coordination, Université de Toulouse, Toulouse, France; Institut de Pharmacologie et de Biologie Structurale, IPBS, Université de Toulouse, CNRS, UPS, France; New Antimalarial Molecules and Pharmacological Approaches, Inserm ERL 1289, Toulouse, France.
| | - Karine Reybier
- PharmaDev, UMR 152, Université de Toulouse, IRD, UPS, Toulouse, France.
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Sharma B, Singh P, Singh AK, Awasthi SK. Advancement of chimeric hybrid drugs to cure malaria infection: An overview with special emphasis on endoperoxide pharmacophores. Eur J Med Chem 2021; 219:113408. [PMID: 33989911 DOI: 10.1016/j.ejmech.2021.113408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 12/27/2022]
Abstract
Emergence and spread of Plasmodium falciparum resistant to artemisinin-based combination therapy has led to a situation of haste in the scientific and pharmaceutical communities. Sincere efforts are redirected towards finding alternative chemotherapeutic agents that are capable of combating multidrug-resistant parasite strains. Extensive research yielded the concept of "Chimeric Bitherapy (CB)" which involves the linking of two molecules with individual pharmacological activity and exhibit dual mode of action into a single hybrid molecule. Current research in this field seems to endorse hybrid molecules as the next-generation antimalarial drugs and are more effective compared to the multi-component drugs because of the lower occurrence of drug-drug adverse effects. This review is an attempt to congregate complete survey on endoperoxide based hybrid antiplasmodial molecules that will give glimpse on the future directions for successful development and discovery of useful antimalarial hybrid drugs.
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Affiliation(s)
- Bhawana Sharma
- Chemical Biology Laboratory, Department of Chemistry, University of Delhi, Delhi 110007, India
| | - Preeti Singh
- Chemical Biology Laboratory, Department of Chemistry, University of Delhi, Delhi 110007, India
| | - Ashawani Kumar Singh
- Chemical Biology Laboratory, Department of Chemistry, University of Delhi, Delhi 110007, India
| | - Satish K Awasthi
- Chemical Biology Laboratory, Department of Chemistry, University of Delhi, Delhi 110007, India.
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Dima A, Jurcut C, Arnaud L. Hydroxychloroquine in systemic and autoimmune diseases: Where are we now? Joint Bone Spine 2021; 88:105143. [PMID: 33515791 DOI: 10.1016/j.jbspin.2021.105143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022]
Abstract
Hydroxychloroquine (HCQ), one of the oldest drugs used in rheumatology, came recently into attention as one of the potential therapies tested for the severe acute respiratory syndrome coronavirus-2 disease treatment. Used initially as an antimalarial, then translated to rheumatic diseases, HCQ has been used in a wide range of pathologies, including infectious diseases, immune disorders, diabetes, dyslipidemia, or neoplasia. Regarding systemic diseases, HCQ is the mainstay treatment for systemic lupus erythematosus (SLE), where, according to last European guidelines, it is proposed to all SLE patients unless contraindicated or with side effects. HCQ proved positive impact in SLE on robust outcomes, such as accrual damage, disease activity and survival, but also pleiomorphic effects, including decrease in the need for glucocorticoids, reduction in the risk of neonatal lupus, lower fasting glucose and protection against diabetes, thrombotic risk, dyslipidemia, infections, etc. Moreover, HCQ can be used during pregnancy and breast-feeding. Besides SLE, the role for HCQ in the anti-phospholipid syndrome and Sjögren's disease is still under debate. On the contrary, recent advances showed only limited interest for rheumatoid arthritis, especially due the lack of structural damage prevention. There are still no strong data to sustain the HCQ use in other systemic diseases. In this review, we summarised the utility and efficacy of HCQ in different clinical conditions relevant for rheumatology practice.
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Affiliation(s)
- Alina Dima
- Department of rheumatology, Colentina clinical hospital, 020125 Bucharest, Romania
| | - Ciprian Jurcut
- Department of internal medicine, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Laurent Arnaud
- National reference centre for rare auto-immune and systemic diseases Est Sud-Est (RESO), 67000 Strasbourg, France; Department of rheumatology, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France; Université de Strasbourg, Inserm UMR-S 1109, 67000 Strasbourg, France.
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Lenormand C, Lipsker D. Lupus erythematosus: Significance of dermatologic findings. Ann Dermatol Venereol 2021; 148:6-15. [PMID: 33483145 DOI: 10.1016/j.annder.2020.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/07/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
Herein, the different skin manifestations in patients with lupus erythematosus are reviewed, and their diagnostic, pathogenic and prognostic relevance are discussed, as well as their impact on therapeutic choices. The so-called specific lesions of LE result from an autoimmune pathomechanism and they allow diagnosis of LE by simple clinicopathological correlation since the findings are characteristic. They include the classic acute, subacute and chronic variants, characterised microscopically by interface dermatitis; the dermal variants of lupus, such as tumid lupus, displaying dermal perivascular lymphocytic infiltrate with mucin deposition under the microscope, and lupus profundus, in which lymphocytic lobular panniculitis progressing to hyaline fibrosis is found. Antimalarials are the treatment of choice for patients with specific LE lesions. The presence of some dermatological signs is the result of thrombotic vasculopathy. Their recognition allows the identification of lupus patients at increased cardiovascular risk and with a worse overall prognosis. Those signs include reticulated erythema on the tip of the toes, splinter hemorrhages, atrophie blanche, pseudo-Degos lesions, racemosa-type livedo, anetoderma, ulceration and necrosis. Those clinical manifestations, often subtle, must be recognised, and if present, patients should be treated with antiplatelet drugs. Finally, neutrophilic cutaneous lupus erythematosus includes a few entities that suggest that autoinflammatory mechanisms might play a key role in certain lupus manifestations. Among those entities, it is very important to diagnose neutrophilic urticarial dermatosis, which can mimic a classic lupus flare, because it is characterised by rash with joint pain, but immunosuppressants are not helpful. Dapsone is the treatment of choice.
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Affiliation(s)
- C Lenormand
- Faculty of medicine, University of Strasbourg, and Dermatology clinic, Strasbourg university hospital, Strasbourg, France
| | - D Lipsker
- Faculty of medicine, University of Strasbourg, and Dermatology clinic, Strasbourg university hospital, Strasbourg, France.
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Grebenyuk V, Lhoťan J, Rudová T, Richterová L, Roháčová H, Stejskal F, Trojánek M. Preventive measures, risk behaviour and the most common health problems in Czech travellers: a prospective questionnaire study in post-travel clinic outpatients. Epidemiol Mikrobiol Imunol 2021; 70:32-41. [PMID: 33853336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate attitudes towards the available preventive measures, risk behaviour and health problems in Czech travellers to tropical and subtropical regions. MATERIALS AND METHODS The prospective study included patients of all ages with a history of recent travel to risky countries who presented to the post-travel clinic of the Hospital Na Bulovce in Prague within two months after return, from February 2009 to June 2018. The data were collec-ted through a questionnaire survey and from electronic medical records. RESULTS Nine hundred and thirty-four patients (473 M and 461 F, age median of 32 years, IQR 27-39) participated in the study. The most frequent destinations were South-East Asia (332; 35.5%), South Asia (176, 18.8%), and Sub-Saharan Africa (172; 18.4%). The most common reasons for tra-vel were tourism (772; 82.7%) and business (111; 11.9%). An underlying chronic disease was reported by 317 patients (33.9%). Pre-travel health consultation was sought by 415 travellers (44.4%); however, only 312 (33.4%) of the respondents were properly vaccinated. Preventive malaria chemoprophylaxis was indicated in a total of 151 travellers (16.2%) but was only received by 44/151 patients (29.1%). Risky eating or drinking behaviour was admitted by 832 (89.1%) respondents and low standard accommodation by 525 (56.2 %) travellers. The most commonly reported clinical syndromes were acute and chronic diarrhoea (266; 28.5%), febrile illness (240; 25.7%) and skin lesions (166; 17.8%). A total of 199 patients presented with tropical infection (21.3%) and 63 with a vaccine-preventable infection or malaria (6.7%). Conclusions: The study shows that the adherence of Czech travellers to preventive measures is relatively low, and along with risky behaviours, has a significant impact on travel-related morbidity. However, vaccine-preventable infections only accounted for a small fraction of travel-related illness, which is in accordance with other epidemiological studies and points out the need for a more comprehensive interdisciplinary approach to pre-travel health consultations.
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Raza HA, Tariq J, Agarwal V, Gupta L. COVID-19, hydroxychloroquine and sudden cardiac death: implications for clinical practice in patients with rheumatic diseases. Rheumatol Int 2021; 41:257-73. [PMID: 33386447 DOI: 10.1007/s00296-020-04759-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/21/2020] [Indexed: 12/15/2022]
Abstract
Sudden cardiac death is commonly seen due to arrhythmias, which is a common cardiac manifestation seen in COVID-19 patients, especially those with underlying cardiovascular disease (CVD). Administration of hydroxychloroquine (HCQ) as a potential treatment option during SARS-CoV-2, initially gained popularity, but later, its safe usage became questionable due to its cardiovascular safety, largely stemming from instances of cardiac arrhythmias in COVID-19. Moreover, in the setting of rheumatic diseases, in which patients are usually on HCQ for their primary disease, there is a need to scale the merits and demerits of HCQ usage for the treatment of COVID-19. In this narrative review, we aim to address the association between usage of HCQ and sudden cardiac death in COVID-19 patients. MEDLINE, EMBASE, ClinicalTrials.gov and SCOPUS databases were used to review articles in English ranging from case reports, case series, letter to editors, systematic reviews, narrative reviews, observational studies and randomized control trials. HCQ is a potential cause of sudden cardiac death in COVID-19 patients. As opposed to the reduction in CVD with HCQ in treatment of systemic lupus erythematous, rheumatoid arthritis, and other rheumatic diseases, safe usage of HCQ in COVID-19 patients is unclear; whereby, it is observed to result in QTc prolongation and Torsades de pointes even in patients with no underlying cardiovascular comorbidity. This is occasionally associated with sudden cardiac death or cardiac arrest; hence, its clinical efficacy needs further investigation by large-scale clinical trials.
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Egeli BH, Sparks JA, Kim AHJ, Liew JW. Hydroxychloroquine for the treatment of COVID-19 and its potential cardiovascular toxicity: Hero or villain? Best Pract Res Clin Rheumatol 2021; 35:101658. [PMID: 33483287 DOI: 10.1016/j.berh.2020.101658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A variety of treatment modalities have been investigated since the beginning of the Coronavirus Disease-19 (COVID-19) pandemic. The use of antimalarials (hydroxychloroquine and chloroquine) for COVID-19 treatment and prevention has proven to be a cautionary tale for widespread, off-label use of a medication during a crisis. The investigation of antimalarials for COVID-19 has also been a driver for a deluge of scientific output in a short amount of time. In this narrative review, we detail the evidence for and against antimalarial use in COVID-19, starting with the early small observational studies that influenced strategies worldwide. We then contrast these findings to later published larger observational studies and randomized controlled trials. We detail the emerging possible cardiovascular risks associated with antimalarial use in COVID-19 and whether COVID-19-related outcomes and cardiovascular risks may differ for antimalarials used in rheumatic diseases.
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Balmant BD, Torrinhas RS, Rocha IM, Fonseca DC, Formiga FFC, Bonfá ESDO, Borba EF, Waitzberg DL. SARS-CoV-2 infection, gut dysbiosis, and heterogeneous clinical results of hydroxychloroquine on COVID-19 therapy-Is there a link? Nutrition 2020; 85:111115. [PMID: 33545540 PMCID: PMC7832980 DOI: 10.1016/j.nut.2020.111115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022]
Abstract
Clinical manifestations of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can include gastrointestinal signals and symptoms. Individuals with previous clinical conditions that usually enroll gut dysbiosis have been identified as being at high risk to develop more severe infectious phenotypes. Actually, intestinal dysbiosis has been observed in infected patients and potentially linked to systemic hyperinflammation. These observations suggest that a previous gut dysbiosis may be aggravated by SARS-CoV-2 infection and related to progression of the coronavirus disease 2019 (COVID-19) into more severe stages. While COVID-19’s pathophysiology is not fully understood, it seems relevant to consider the interactions of candidate therapeutic drugs with the host, gut microbiota, and SARS-CoV-2. Here we summarize scientific evidence supporting the potential relevance of these interactions and suggest that unfavorable clinical data on hydroxychloroquine administration in COVID-19 may have been influenced by the dose provided and its impact on gut dysbiosis. The proposition is based on preliminary data on gut microbiota composition from individuals with inactive systemic lupus erythematosus under exclusive continuous hydroxychloroquine treatment, displaying a direct correlation between drug doses and markers typically associated with gut dysbiosis.
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Affiliation(s)
- Bianca D Balmant
- Laboratory of Nutrition and Metabolic Surgery (LIM-35), Department of Gastroenterology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
| | - Raquel S Torrinhas
- Laboratory of Nutrition and Metabolic Surgery (LIM-35), Department of Gastroenterology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Ilanna M Rocha
- Laboratory of Nutrition and Metabolic Surgery (LIM-35), Department of Gastroenterology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Danielle C Fonseca
- Laboratory of Nutrition and Metabolic Surgery (LIM-35), Department of Gastroenterology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco F C Formiga
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Eloisa S D O Bonfá
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Dan L Waitzberg
- Laboratory of Nutrition and Metabolic Surgery (LIM-35), Department of Gastroenterology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
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Pontes KAO, Silva LS, Santos EC, Pinheiro AS, Teixeira DE, Peruchetti DB, Silva-Aguiar RP, Wendt CHC, Miranda KR, Coelho-de-Souza AN, Leal-Cardoso JH, Caruso-Neves C, Pinheiro AAS. Eugenol disrupts Plasmodium falciparum intracellular development during the erythrocytic cycle and protects against cerebral malaria. Biochim Biophys Acta Gen Subj 2020; 1865:129813. [PMID: 33321150 DOI: 10.1016/j.bbagen.2020.129813] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Malaria is a parasitic disease that compromises the human host. Currently, control of the Plasmodium falciparum burden is centered on artemisinin-based combination therapies. However, decreased sensitivity to artemisinin and derivatives has been reported, therefore it is important to identify new therapeutic strategies. METHOD We used human erythrocytes infected with P. falciparum and experimental cerebral malaria (ECM) animal model to assess the potential antimalarial effect of eugenol, a component of clove bud essential oil. RESULTS Plasmodium falciparum cultures treated with increasing concentrations of eugenol reduced parasitemia in a dose-dependent manner, with IC50 of 532.42 ± 29.55 μM. This effect seems to be irreversible and maintained even in the presence of high parasitemia. The prominent effect of eugenol was detected in the evolution from schizont to ring forms, inducing important morphological changes, indicating a disruption in the development of the erythrocytic cycle. Aberrant structural modification was observed by electron microscopy, showing the separation of the two nuclear membrane leaflets as well as other subcellular membranes, such as from the digestive vacuole. Importantly, in vivo studies using ECM revealed a reduction in blood parasitemia and cerebral edema when mice were treated for 6 consecutive days upon infection. CONCLUSIONS These data suggest a potential effect of eugenol against Plasmodium sp. with an impact on cerebral malaria. GENERAL SIGNIFICANCE Our results provide a rational basis for the use of eugenol in therapeutic strategies to the treatment of malaria.
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Affiliation(s)
- Kesley A O Pontes
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Estadual do Ceará, Fortaleza, Brazil
| | - Leandro S Silva
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edgleyson C Santos
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alessandro S Pinheiro
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Douglas E Teixeira
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diogo B Peruchetti
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo P Silva-Aguiar
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila H C Wendt
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kildare R Miranda
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Centro Nacional de Biologia Estrutural e Bioimagem /CENABIO, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagem, INBEB, Conselho Nacional de Desenvolvimento Científico e Tecnológico/MCTIC, Rio de Janeiro, Brazil
| | | | | | - Celso Caruso-Neves
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Instituto Nacional de Ciência e Tecnologia em Medicina Regenerativa, INCT-Regenera, Conselho Nacional de Desenvolvimento Científico e Tecnológico/MCTIC, Rio de Janeiro, Brazil; Rio de Janeiro Innovation Network in Nanosystems for Health - NanoSAUDE/FAPERJ, Rio de Janeiro, Brazil
| | - Ana Acacia S Pinheiro
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Rio de Janeiro Innovation Network in Nanosystems for Health - NanoSAUDE/FAPERJ, Rio de Janeiro, Brazil.
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Cismaru CA, Cismaru GL, Seyed Nabavi F, Seyed Nabavi M, Berindan-Neagoe I. COVID-19 and antimalarials. Have we been doing it wrong all along? Eur J Pharmacol 2021; 891:173694. [PMID: 33130275 DOI: 10.1016/j.ejphar.2020.173694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/21/2020] [Accepted: 10/26/2020] [Indexed: 12/03/2022]
Abstract
In the context of the current SARS-CoV-2 pandemic, associations of drugs which interfere with specific steps of the viral infectious cycle are currently being exploited as therapeutic strategies since a specific treatment by vaccination is still unavailable. A widespread association of repurposed agents is the combination of the antimalarial drug Hydroxychloroquine and the macrolide antibiotic Azithromycin in the setting of clinical trials. But a closer analysis of their mechanism of action suggests that their concomitant administration may be impractical, and this is supported by experimental data with other agents of the same classes. However a sequential administration of the lysosomotropic antimalarial with the addition of the macrolide proton pump inhibitor after the first has reached a certain threshold could better exploit their antiviral potential.
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Madhav H, Hoda N. An insight into the recent development of the clinical candidates for the treatment of malaria and their target proteins. Eur J Med Chem 2020; 210:112955. [PMID: 33131885 DOI: 10.1016/j.ejmech.2020.112955] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/18/2023]
Abstract
Malaria is an endemic disease, prevalent in tropical and subtropical regions which cost half of million deaths annually. The eradication of malaria is one of the global health priority nevertheless, current therapeutic efforts seem to be insufficient due to the emergence of drug resistance towards most of the available drugs, even first-line treatment ACT, unavailability of the vaccine, and lack of drugs with a new mechanism of action. Intensification of antimalarial research in recent years has resulted into the development of single dose multistage therapeutic agents which has advantage of overcoming the antimalarial drug resistance. The present review explored the current progress in the development of new promising antimalarials against prominent target proteins that have the potential to be a clinical candidate. Here, we also reviewed different aspects of drug resistance and highlighted new drug candidates that are currently in a clinical trial or clinical development, along with a few other molecules with excellent antimalarial activity overs ACTs. The summarized scientific value of previous approaches and structural features of antimalarials related to the activity are highlighted that will be helpful for the development of next-generation antimalarials.
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Affiliation(s)
- Hari Madhav
- Drug Design and Synthesis Laboratory, Department of Chemistry, Jamia Millia Islamia (A Central University), New Delhi, 110025, India.
| | - Nasimul Hoda
- Drug Design and Synthesis Laboratory, Department of Chemistry, Jamia Millia Islamia (A Central University), New Delhi, 110025, India.
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Ortega-Peña M, González-Cuevas R. Familiar Dermatologic Drugs as Therapies for COVID-19. Actas Dermosifiliogr (Engl Ed) 2020; 112:118-126. [PMID: 33045209 PMCID: PMC7546972 DOI: 10.1016/j.ad.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/22/2020] [Accepted: 09/26/2020] [Indexed: 12/16/2022] Open
Abstract
Frente a la necesidad de encontrar una alternativa terapéutica que logre disminuir el impacto negativo de la COVID-19 y mejore el pronóstico actual de los pacientes, investigadores de todo el mundo se esfuerzan por aportar información que nos acerque a esta meta. Dentro de los potenciales fármacos, existen algunos de uso frecuente en dermatología: los antipalúdicos (cloroquina e hidroxicloroquina), la ivermectina, los antiandrógenos y la melatonina. Tanto estos como otros tratamientos se encuentran en la mira de la comunidad científica, siendo algunos foco de polémica y controversia. En el presente trabajo realizamos una revisión breve de los fármacos previamente mencionados, presentando los más recientes hallazgos con relación a su uso en la COVID-19.
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Affiliation(s)
- M Ortega-Peña
- Escuela de Medicina, Universidad Mayor, Santiago, Chile
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Afra TP, Nampoothiri RV, Razmi T M, Hafi NAB. Linking hydroxychloroquine to hemolysis in a 'suspected' glucose-6-phosphate dehydrogenase deficient patient with COVID-19 infection - a critical appraisal. Eur J Intern Med 2020; 80:101-102. [PMID: 32651040 PMCID: PMC7340024 DOI: 10.1016/j.ejim.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/06/2020] [Indexed: 01/01/2023]
Affiliation(s)
- T P Afra
- Department of Dermatology, IQRAA Aesthetics, IQRAA International Hospital, and Research Centre, Calicut, Kerala, INDIA
| | - Ram Vasudevan Nampoothiri
- Department of Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, CANADA
| | - Muhammed Razmi T
- Department of Dermatology, IQRAA Aesthetics, IQRAA International Hospital, and Research Centre, Calicut, Kerala, INDIA.
| | - N A Bishurul Hafi
- Department of Dermatology, IQRAA Aesthetics, IQRAA International Hospital, and Research Centre, Calicut, Kerala, INDIA
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Arsuaga M, de Miguel R, Trigo E, Barreiro P, de la Calle F, Tarin EJ, Loli-Ausejo D, Diaz M. A case of acute generalized exanthematous pustulosis caused by exposure to Atovaquone/proguanil. J Travel Med 2020; 27:5803292. [PMID: 32163144 DOI: 10.1093/jtm/taaa034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
Abstract
We present a returning traveler with acute generalized exanthematous pustulosis after atovaquone/proguanil prophylaxis. Diagnosis was confirmed with biopsy and allergy testing, symptoms resolved after steroid treatment. Atovaquone/proguanil prophylaxis is generally well tolerated, however, some patients may present severe adverse events that require prompt medical evaluation and treatment.
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Affiliation(s)
- Marta Arsuaga
- National Referral Unit for Tropical and Travel Medicine, University Hospital La Paz - Carlos III, Paseo de la Castellana 261, Madrid. CP 28046, Madrid, Spain
| | - Rosa de Miguel
- National Referral Unit for Tropical and Travel Medicine, University Hospital La Paz - Carlos III, Paseo de la Castellana 261, Madrid. CP 28046, Madrid, Spain
| | - Elena Trigo
- National Referral Unit for Tropical and Travel Medicine, University Hospital La Paz - Carlos III, Paseo de la Castellana 261, Madrid. CP 28046, Madrid, Spain
| | - Pablo Barreiro
- National Referral Unit for Tropical and Travel Medicine, University Hospital La Paz - Carlos III, Paseo de la Castellana 261, Madrid. CP 28046, Madrid, Spain
| | - Fernando de la Calle
- National Referral Unit for Tropical and Travel Medicine, University Hospital La Paz - Carlos III, Paseo de la Castellana 261, Madrid. CP 28046, Madrid, Spain
| | - Eloy José Tarin
- Department of Dermatology, University Hospital La Paz- Carlos III, Paseo de la Castellana 261, Madrid. CP 28046, Madrid, Spain
| | - D Loli-Ausejo
- Department of Allergology, University Hospital La Paz - Carlos III, Paseo de la Castellana 261, Madrid. CP 28046, Madrid, Spain
| | - Marta Diaz
- National Referral Unit for Tropical and Travel Medicine, University Hospital La Paz - Carlos III, Paseo de la Castellana 261, Madrid. CP 28046, Madrid, Spain
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Ong WY, Go ML, Wang DY, Cheah IKM, Halliwell B. Effects of Antimalarial Drugs on Neuroinflammation-Potential Use for Treatment of COVID-19-Related Neurologic Complications. Mol Neurobiol 2020; 58:106-117. [PMID: 32897518 PMCID: PMC7477069 DOI: 10.1007/s12035-020-02093-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
The SARS-CoV-2 virus that is the cause of coronavirus disease 2019 (COVID-19) affects not only peripheral organs such as the lungs and blood vessels, but also the central nervous system (CNS)—as seen by effects on smell, taste, seizures, stroke, neuropathological findings and possibly, loss of control of respiration resulting in silent hypoxemia. COVID-19 induces an inflammatory response and, in severe cases, a cytokine storm that can damage the CNS. Antimalarials have unique properties that distinguish them from other anti-inflammatory drugs. (A) They are very lipophilic, which enhances their ability to cross the blood-brain barrier (BBB). Hence, they have the potential to act not only in the periphery but also in the CNS, and could be a useful addition to our limited armamentarium against the SARS-CoV-2 virus. (B) They are non-selective inhibitors of phospholipase A2 isoforms, including cytosolic phospholipase A2 (cPLA2). The latter is not only activated by cytokines but itself generates arachidonic acid, which is metabolized by cyclooxygenase (COX) to pro-inflammatory eicosanoids. Free radicals are produced in this process, which can lead to oxidative damage to the CNS. There are at least 4 ways that antimalarials could be useful in combating COVID-19. (1) They inhibit PLA2. (2) They are basic molecules capable of affecting the pH of lysosomes and inhibiting the activity of lysosomal enzymes. (3) They may affect the expression and Fe2+/H+ symporter activity of iron transporters such as divalent metal transporter 1 (DMT1), hence reducing iron accumulation in tissues and iron-catalysed free radical formation. (4) They could affect viral replication. The latter may be related to their effect on inhibition of PLA2 isoforms. Inhibition of cPLA2 impairs an early step of coronavirus replication in cell culture. In addition, a secretory PLA2 (sPLA2) isoform, PLA2G2D, has been shown to be essential for the lethality of SARS-CoV in mice. It is important to take note of what ongoing clinical trials on chloroquine and hydroxychloroquine can eventually tell us about the use of antimalarials and other anti-inflammatory agents, not only for the treatment of COVID-19, but also for neurovascular disorders such as stroke and vascular dementia.
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Affiliation(s)
- Wei-Yi Ong
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore.
- Neurobiology Programme, Life Sciences Institute, National University of Singapore, Singapore, 119260, Singapore.
| | - Mei-Lin Go
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, 119260, Singapore
| | - De-Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore
| | - Irwin Kee-Mun Cheah
- Neurobiology Programme, Life Sciences Institute, National University of Singapore, Singapore, 119260, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore
| | - Barry Halliwell
- Neurobiology Programme, Life Sciences Institute, National University of Singapore, Singapore, 119260, Singapore.
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore.
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Jackson KD, Higgins CR, Laing SK, Mwila C, Kobayashi T, Ippolito MM, Sylvia S, Ozawa S. Impact of substandard and falsified antimalarials in Zambia: application of the SAFARI model. BMC Public Health 2020; 20:1083. [PMID: 32646393 PMCID: PMC7350731 DOI: 10.1186/s12889-020-08852-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries are striving to become malaria-free, but global reduction in case estimates has stagnated in recent years. Substandard and falsified medicines may contribute to this lack of progress. Zambia aims to eliminate their annual burden of 1.2 million pediatric malaria cases and 2500 child deaths due to malaria. We examined the health and economic impact of poor-quality antimalarials in Zambia. METHODS An agent-based model, Substandard and Falsified Antimalarial Research Impact (SAFARI), was modified and applied to Zambia. The model was developed to simulate population characteristics, malaria incidence, patient care-seeking, disease progression, treatment outcomes, and associated costs of malaria for children under age five. Zambia-specific demographic, epidemiological, and cost inputs were extracted from the literature. Simulations were run to estimate the health and economic impact of poor-quality antimalarials, the effect of potential artemisinin resistance, and six additional malaria focused policy interventions. RESULTS We simulated annual malaria cases among Zambian children under five. At baseline, we found 2610 deaths resulting in $141.5 million in annual economic burden of malaria. We estimated that elimination of substandard and falsified antimalarials would result in an 8.1% (n = 213) reduction in under-five deaths, prevent 937 hospitalizations, and realize $8.5 million in economic savings, annually. Potential artemisinin resistance could further increase deaths by 6.3% (n = 166) and cost an additional $9.7 million every year. CONCLUSIONS Eliminating substandard and falsified antimalarials is an important step towards a malaria-free Zambia. Beyond the dissemination of insecticide-treated bed nets, indoor residual spraying, and other malaria control measures, attention must also be paid to assure the quality of antimalarial treatments.
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Affiliation(s)
- Kathryn D Jackson
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Colleen R Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, CB#7574, Beard Hall, 115H, Chapel Hill, NC, 27599, USA
| | - Sarah K Laing
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Chiluba Mwila
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew M Ippolito
- Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Clinical Pharmacology and Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sean Sylvia
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, CB#7574, Beard Hall, 115H, Chapel Hill, NC, 27599, USA. .,Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
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Pornputtapong N, Suriyapakorn B, Satayamapakorn A, Larpadisorn K, Janviriyakul P, Khemawoot P. In silico analysis for factors affecting anti-malarial penetration into red blood cells. Malar J 2020; 19:215. [PMID: 32576193 PMCID: PMC7310442 DOI: 10.1186/s12936-020-03280-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 05/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Malaria is a parasitic disease that produces significant infection in red blood cells. The objective of this study is to investigate the relationships between factors affecting the penetration of currently available anti-malarials into red blood cells. Methods Fifteen anti-malarial drugs listed in the third edition of the World Health Organization malaria treatment guidelines were enrolled in the study. Relationship analysis began with the prioritization of the physicochemical properties of the anti-malarials to create a multivariate linear regression model that correlates the red blood cell penetration. Results It was found that protein binding was significantly correlated with red blood cell penetration, with a negative coefficient. The next step was repeated analysis to find molecular descriptors that influence protein binding. The coefficients of the number of rotating bonds and the number of aliphatic hydrocarbons are negative, as opposed to the positive coefficients of the number of hydrogen bonds and the number of aromatic hydrocarbons. The p-value was less than 0.05. Conclusions Anti-malarials with a small number of hydrogen bonds and aromatic hydrocarbons, together with a high number of rotatable bonds and aliphatic hydrocarbons, may have a higher tendency to penetrate the red blood cells.
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Affiliation(s)
- Natapol Pornputtapong
- Department of Biochemistry and Microbiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.,Vaccine and Therapeutic Protein, The Special Task Force for Activating Research, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Systems Biology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Bovornpat Suriyapakorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Anchisa Satayamapakorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Kanidsorn Larpadisorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Pariyachut Janviriyakul
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Phisit Khemawoot
- Preclinical Pharmacokinetics and Interspecies Scaling for Drug Development Research Unit, Chulalongkorn University, Bangkok, Thailand. .,Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodhi Hospital, Mahidol University, Bang Phli, Samut Prakarn, 10540, Thailand.
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Kim AHJ, Sparks JA, Liew JW, Putman MS, Berenbaum F, Duarte-García A, Graef ER, Korsten P, Sattui SE, Sirotich E, Ugarte-Gil MF, Webb K, Grainger R. A Rush to Judgment? Rapid Reporting and Dissemination of Results and Its Consequences Regarding the Use of Hydroxychloroquine for COVID-19. Ann Intern Med 2020; 172:819-821. [PMID: 32227189 PMCID: PMC7138335 DOI: 10.7326/m20-1223] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Hydroxychloroquine, an essential treatment for many patients with rheumatologic conditions, has recently garnered widespread attention as a potential treatment for COVID-19 infection. The authors appraise the study generating this interest and highlight the potential consequences of rapid dissemination of overinterpreted data, particularly for people with conditions for which hydroxychloroquine has demonstrated benefits in preventing organ damage and life-threatening disease flares.
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Affiliation(s)
- Alfred H J Kim
- Washington University School of Medicine, St. Louis, Missouri (A.H.K.)
| | - Jeffrey A Sparks
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (J.A.S.)
| | - Jean W Liew
- University of Washington, Seattle, Washington (J.W.L.)
| | | | - Francis Berenbaum
- Sorbonne University, Inserm CRSA, AP-HP Saint-Antoine Hospital, Paris, France (F.B.)
| | | | - Elizabeth R Graef
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (E.R.G.)
| | - Peter Korsten
- University Medical Center Göttingen, Göttingen, Germany (P.K.)
| | | | - Emily Sirotich
- McMaster University, Hamilton, and Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada (E.S.)
| | - Manuel F Ugarte-Gil
- School of Medicine, Universidad Científica del Sur and Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru (M.F.U.)
| | - Kate Webb
- University of Cape Town, Cape Town, South Africa, and the Francis Crick Institute, London, United Kingdom (K.W.)
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Dos Reis Neto ET, Kakehasi AM, de Medeiros Pinheiro M, Ferreira GA, Marques CDL, da Mota LMH, Dos Santos Paiva E, Pileggi GCS, Sato EI, Reis APMG, Xavier RM, Provenza JR. Revisiting hydroxychloroquine and chloroquine for patients with chronic immunity-mediated inflammatory rheumatic diseases. Adv Rheumatol 2020; 60:32. [PMID: 32517786 PMCID: PMC7282202 DOI: 10.1186/s42358-020-00134-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/27/2020] [Indexed: 12/31/2022] Open
Abstract
Hydroxychloroquine and chloroquine, also known as antimalarial drugs, are widely used in the treatment of rheumatic diseases and have recently become the focus of attention because of the ongoing COVID-19 pandemic. Rheumatologists have been using antimalarials to manage patients with chronic immune-mediated inflammatory rheumatic diseases for decades. It is an appropriate time to review their immunomodulatory and anti-inflammatory mechanisms impact on disease activity and survival of systemic lupus erythematosus patient, including antiplatelet effect, metabolic and lipid benefits. We also discuss possible adverse effects, adding a practical and comprehensive approach to monitoring rheumatic patients during treatment with these drugs.
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Affiliation(s)
- Edgard Torres Dos Reis Neto
- Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Adriana Maria Kakehasi
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | | | - Gilda Aparecida Ferreira
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Eduardo Dos Santos Paiva
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | | | - Emília Inoue Sato
- Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Ricardo Machado Xavier
- Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Abstract
Two medications often used for treatment of immune-mediated conditions, hydroxychloroquine and chloroquine, have recently attracted widespread interest as potential therapies for coronavirus disease 2019. The authors of this commentary provide guidance for clinical decision making for patients with coronavirus disease 2019 as well as for patients with rheumatologic conditions, such as systemic lupus erythematosus and rheumatoid arthritis
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Affiliation(s)
- Jinoos Yazdany
- Zuckerberg San Francisco General Hospital, University of California, San Francisco, California (J.Y.)
| | - Alfred H J Kim
- Washington University School of Medicine, St. Louis, Missouri (A.H.K.)
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Kalange M, Nansunga M, Kasozi KI, Kasolo J, Namulema J, Atusiimirwe JK, Ayikobua ET, Ssempijja F, Munanura EI, Matama K, Semuyaba I, Zirintunda G, Okpanachi AO. Antimalarial combination therapies increase gastric ulcers through an imbalance of basic antioxidative-oxidative enzymes in male Wistar rats. BMC Res Notes 2020; 13:230. [PMID: 32326975 PMCID: PMC7178572 DOI: 10.1186/s13104-020-05073-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/16/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Antimalarials are globally used against plasmodium infections, however, information on the safety of new antimalarial combination therapies on the gastric mucosa is scarce. The aim of this study was to investigate the effects of Artesunate-Amodiaquine and Artemether-Lumefantrine on ulcer induction. Malondialdehyde (MDA), reduced glutathione (GSH) and major histological changes in male Wistar rats following ulcer induction using Indomethacin were investigated. Gastric ulcers were in four groups; Group I was administered Artesunate, group II received Artesunate-Amodiaquine, group III received Artemether-Lumefantrine, and group IV was a positive control (normal saline). Group V was the negative control consisting of healthy rats. RESULTS Antimalarial combination therapies were associated with a high gastric ulcer index than a single antimalarial agent, Artesunate. In addition, levels of MDA were significantly higher in the combination of therapies while levels of GSH were lower in comparison to Artesunate and the negative control. Microscopically, antimalarial combination therapies were associated with severe inflammation and tissue damage than Artesunate in the gastric mucosa showing that antimalarial combination therapies exert their toxic effects through oxidative stress mechanisms, and this leads to cellular damage. Findings in this study demonstrate a need to revisit information on the pharmacodynamics of major circulating antimalarial agents in developing countries.
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Affiliation(s)
- Muhamudu Kalange
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Box 71, Bushenyi, Uganda.
| | - Miriam Nansunga
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Box 71, Bushenyi, Uganda
| | - Keneth Iceland Kasozi
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Box 71, Bushenyi, Uganda.
| | - Josephine Kasolo
- Department of Physiology, College of Health Sciences, Makerere University, Box 7062, Kampala, Uganda
| | - Jackline Namulema
- Department of Physiology, Faculty of Medicine, Uzima University College CUEA, Box 2502, Kisumu, Kenya
| | - Jovile Kasande Atusiimirwe
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Box 71, Bushenyi, Uganda
| | - Emmanuel Tiyo Ayikobua
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Box 71, Bushenyi, Uganda.,Department of Physiology, Faculty of Biomedical Sciences, School of Medicine, Soroti University, Soroti, Uganda.,Department of Physiology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Fred Ssempijja
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Box 71, Bushenyi, Uganda
| | - Edson Ireeta Munanura
- Department of Pharmacy, College of Health Sciences, Makerere University, Box 7062, Kampala, Uganda.,Department of Therapeutics and Toxicology, School of Pharmacy, Kampala International University Western Campus, Box 71, Bushenyi, Uganda
| | - Kevin Matama
- Department of Therapeutics and Toxicology, School of Pharmacy, Kampala International University Western Campus, Box 71, Bushenyi, Uganda
| | - Ibrahim Semuyaba
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Box 71, Bushenyi, Uganda
| | - Gerald Zirintunda
- Department of Animal Production, Faculty of Agriculture and Animal Sciences, Busitema University Arapai Campus, Box 203, Soroti, Uganda
| | - Alfred Omachonu Okpanachi
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Box 71, Bushenyi, Uganda
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Ceribelli A, Motta F, De Santis M, Ansari AA, Ridgway WM, Gershwin ME, Selmi C. Recommendations for coronavirus infection in rheumatic diseases treated with biologic therapy. J Autoimmun 2020; 109:102442. [PMID: 32253068 PMCID: PMC7127009 DOI: 10.1016/j.jaut.2020.102442] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 12/20/2022]
Abstract
The Coronavirus-associated disease, that was first identified in 2019 in China (CoViD-19), is a pandemic caused by a bat-derived beta-coronavirus, named SARS-CoV2. It shares homology with SARS and MERS-CoV, responsible for past outbreaks in China and in Middle East. SARS-CoV2 spread from China where the first infections were described in December 2019 and is responsible for the respiratory symptoms that can lead to acute respiratory distress syndrome. A cytokine storm has been shown in patients who develop fatal complications, as observed in past coronavirus infections. The management includes ventilatory support and broad-spectrum antiviral drugs, empirically utilized, as a targeted therapy and vaccines have not been developed. Based upon our limited knowledge on the pathogenesis of CoViD-19, a potential role of some anti-rheumatic drugs may be hypothesized, acting as direct antivirals or targeting host immune response. Antimalarial drugs, commonly used in rheumatology, may alter the lysosomal proteases that mediates the viral entry into the cell and have demonstrated efficacy in improving the infection. Anti-IL-1 and anti-IL-6 may interfere with the cytokine storm in severe cases and use of tocilizumab has shown good outcomes in a small cohort. Baricitinib has both antiviral and anti-inflammatory properties. Checkpoints inhibitors such as anti-CD200 and anti-PD1 could have a role in the treatment of CoViD-19. Rheumatic disease patients taking immunosuppressive drugs should be recommended to maintain the chronic therapy, prevent infection by avoiding social contacts and pausing immunosuppressants in case of infection. National and international registries are being created to collect data on rheumatic patients with CoViD-19. CoViD-19 is a pandemic caused by SARS-CoV2, that can lead to acute respiratory distress syndrome. Antimalarial drugs, anti-IL-1 and anti-IL-6 may be used in severe cases targeting the cytokine storm induced by CoViD-19. Recommendations for rheumatic disease patients include the prevention of infection by avoiding social contacts. Patients should also continue their ongoing therapy except in the case of overt infection.
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Affiliation(s)
- Angela Ceribelli
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano (Mi) , Italy
| | - Francesca Motta
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele Milan, Italy
| | - Maria De Santis
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano (Mi) , Italy
| | - Aftab A Ansari
- Rheumatology, Allergy, and Clinical Immunology, University of California Davis, Davis, CA, USA
| | - William M Ridgway
- Rheumatology, Allergy, and Clinical Immunology, University of California Davis, Davis, CA, USA
| | - M Eric Gershwin
- Rheumatology, Allergy, and Clinical Immunology, University of California Davis, Davis, CA, USA.
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano (Mi) , Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele Milan, Italy.
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Abstract
INTRODUCTION The unique physicochemical properties and chemical diversity of organofluorine compounds have remarkably contributed for their wide utility in the area of pharmaceuticals, materials and agrochemicals. The noteworthy characteristics of fluorine include high electron affinity, lipophilicity and bioavailability, extending the half-life of the drugs. The incorporation of fluorine substituents, particularly trifluoromethyl groups, into organic molecules has led to their high potency against various diseases, including malaria. Hence, organofluorinated molecules offer valuable avenues for the design of new drug candidates against malaria. AREAS COVERED In this review, the authors discuss the importance of fluorine substituents present in the chemical compounds, and their potential applications for antimalarial drug discovery. EXPERT OPINION Fluorinated molecules represent a reliable strategy to develop new antimalarial drugs. Fluorine or fluorinated groups have been identified as a promising precursor, and their presence in approximately twenty-five percent of approved drugs is notable. Selective fluorination of chemical entities has the potential to be applied not only to improve the activity profile against the malaria parasite, but could be extrapolated for favorable pharmacological applications. Hazardous reagents such as HF, F2 and SF4 used for fluorination, are not considered as safe, and therefore, this process remains challenging, particularly for the pharmaceutical industry.
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Affiliation(s)
- Charu Upadhyay
- Department of Chemistry, Miranda House, University of Delhi , Delhi, India
| | - Monika Chaudhary
- Laboratory for Translational Chemistry and Drug Discovery, Department of Chemistry, Hansraj College University Enclave, University of Delhi , Delhi, India
| | - Ronaldo N De Oliveira
- Laboratory of Synthesis of Bioactive Compounds, Department of Chemistry, Federal Rural University of Pernambuco , Recife, Brazil
| | - Aniko Borbas
- Department of Pharmaceutical Chemistry, University of Debrecen , Debrecen, Hungary
| | - Prakasha Kempaiah
- Department of Medicine, Loyola University Stritch School of Medicine , Chicago, USA
| | - Poonam Singh
- Department of Chemistry, Miranda House, University of Delhi , Delhi, India
| | - Brijesh Rathi
- Laboratory for Translational Chemistry and Drug Discovery, Department of Chemistry, Hansraj College University Enclave, University of Delhi , Delhi, India
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Lowe RA, Taylor D, Chibale K, Nelson A, Marsden SP. Synthesis and evaluation of the performance of a small molecule library based on diverse tropane-related scaffolds. Bioorg Med Chem 2020; 28:115442. [PMID: 32209295 DOI: 10.1016/j.bmc.2020.115442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 12/20/2022]
Abstract
A unified synthetic approach was developed that enabled the synthesis of diverse tropane-related scaffolds. The key intermediates that were exploited were cycloadducts formed by reaction between 3-hydroxy-pyridinium salts and vinyl sulfones or sulfonamides. The diverse tropane-related scaffolds were formed by addition of substituents to, cyclisation reactions of, and fusion of additional ring(s) to the key bicyclic intermediates. A set of 53 screening compounds was designed, synthesised and evaluated in order to determine the biological relevance of the scaffolds accessible using the synthetic approach. Two inhibitors of Hedgehog signalling, and four compounds with weak activity against the parasite P. falciparum, were discovered. Three of the active compounds may be considered to be indotropane or pyrrotropane pseudo natural products in which a tropane is fused with a fragment from another natural product class. It was concluded that the unified synthetic approach had yielded diverse scaffolds suitable for the design of performance-diverse screening libraries.
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Affiliation(s)
- Robert A Lowe
- Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds LS2 9JT, UK; School of Chemistry, University of Leeds, Leeds LS2 9JT, UK
| | - Dale Taylor
- H3D Drug Discovery and Development Center, University of Cape Town, Private Bag, Rondebosch 7700, South Africa
| | - Kelly Chibale
- Department of Chemistry, University of Cape Town, Rondebosch 7701, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa; South African Medical Research Council, Drug Discovery and Development Research Unit, University of Cape Town, Rondebosch 7701, South Africa
| | - Adam Nelson
- Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds LS2 9JT, UK; School of Chemistry, University of Leeds, Leeds LS2 9JT, UK.
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