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Ikegbunam M, Maurer M, Abone H, Ezeagwuna D, Sandri TL, Esimone C, Ojurongbe O, Woldearegai TG, Kreidenweiss A, Held J, Fendel R. Evaluating Malaria Rapid Diagnostic Tests and Microscopy for Detecting Plasmodium Infection and Status of Plasmodium falciparum Histidine-Rich Protein 2/3 Gene Deletions in Southeastern Nigeria. Am J Trop Med Hyg 2024; 110:902-909. [PMID: 38531105 PMCID: PMC11066366 DOI: 10.4269/ajtmh.23-0690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/12/2023] [Indexed: 03/28/2024] Open
Abstract
Delays in malaria diagnosis increase treatment failures and deaths. In endemic regions, standard diagnostic methods are microscopy and malaria rapid diagnostic tests (mRDTs) detecting Plasmodium falciparum histidine-rich protein 2/3 (PFHRP2/PFHRP3), but gene deletions can allow certain parasites to remain undetected. We enlisted a cohort comprising 207 symptomatic individuals, encompassing both children and adults, at a hospital in Nnewi, Nigeria. The prevalence of parasites was determined using a highly sensitive, species-specific quantitative polymerase chain reaction (SS-qPCR). Within a subset of 132 participants, we assessed the sensitivity and specificity of microscopy and HRP2-mRDTs in comparison to SS-qPCR for the detection of P. falciparum. We also investigated the prevalence of pfhrp2/pfhrp3 gene deletions. Greater sensitivity was achieved with mRDTs (95%) compared with microscopy (77%). Also, mRDTs exhibited greater specificity (68%) than microscopy (44%). The positive predictive value of mRDTs (89%) surpassed that of microscopy (80%), suggesting a greater probability of accurately indicating the presence of infection. The negative predictive value of mRDTs (82%) was far greater than microscopy (39%). Of the 165 P. falciparum-positive samples screened for pfhrp2/pfhrp3 gene deletions, one gene deletion was detected in one sample. Regarding infection prevalence, 84% were positive for Plasmodium spp. (by reverse transcription [RT]-qPCR), with P. falciparum responsible for the majority (97%) of positive cases. Thus, exclusive reliance on microscopy in endemic areas may impede control efforts resulting from false negatives, underscoring the necessity for enhanced training and advocating for high-throughput molecular testing such as RT-qPCR or qPCR at referral centers to address limitations.
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Affiliation(s)
- Moses Ikegbunam
- Department of Pharmaceutical Microbiology and Biotechnology, Nnamdi Azikiwe University, Awka, Nigeria
- Molecular Research Foundation for Students and Scientist, Nnamdi Azikiwe University, Awka, Nigeria
| | - Maike Maurer
- Institute of Tropical Medicine, University of Tübingen, Germany
| | - Harrison Abone
- Department of Pharmaceutical Microbiology and Biotechnology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Dorothy Ezeagwuna
- Departement of Parasitology and Entomology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Thaisa Lucas Sandri
- Institute of Tropical Medicine, University of Tübingen, Germany
- Synovo GmbH, Tübingen, Germany
| | - Charles Esimone
- Department of Pharmaceutical Microbiology and Biotechnology, Nnamdi Azikiwe University, Awka, Nigeria
- Molecular Research Foundation for Students and Scientist, Nnamdi Azikiwe University, Awka, Nigeria
| | - Olusola Ojurongbe
- Department of Medical Microbiology & Parasitology, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
| | - Tamirat Gebru Woldearegai
- Institute of Tropical Medicine, University of Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
- Center de Recherches Médicales de Lambaréné (CERMEL), Gabon
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
- Center de Recherches Médicales de Lambaréné (CERMEL), Gabon
| | - Rolf Fendel
- Institute of Tropical Medicine, University of Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
- Center de Recherches Médicales de Lambaréné (CERMEL), Gabon
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Schäfer TM, Pessanha de Carvalho L, Inoue J, Kreidenweiss A, Held J. The problem of antimalarial resistance and its implications for drug discovery. Expert Opin Drug Discov 2024; 19:209-224. [PMID: 38108082 DOI: 10.1080/17460441.2023.2284820] [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: 07/28/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Malaria remains a devastating infectious disease with hundreds of thousands of casualties each year. Antimalarial drug resistance has been a threat to malaria control and elimination for many decades and is still of concern today. Despite the continued effectiveness of current first-line treatments, namely artemisinin-based combination therapies, the emergence of drug-resistant parasites in Southeast Asia and even more alarmingly the occurrence of resistance mutations in Africa is of great concern and requires immediate attention. AREAS COVERED A comprehensive overview of the mechanisms underlying the acquisition of drug resistance in Plasmodium falciparum is given. Understanding these processes provides valuable insights that can be harnessed for the development and selection of novel antimalarials with reduced resistance potential. Additionally, strategies to mitigate resistance to antimalarial compounds on the short term by using approved drugs are discussed. EXPERT OPINION While employing strategies that utilize already approved drugs may offer a prompt and cost-effective approach to counter antimalarial drug resistance, it is crucial to recognize that only continuous efforts into the development of novel antimalarial drugs can ensure the successful treatment of malaria in the future. Incorporating resistance propensity assessment during this developmental process will increase the likelihood of effective and enduring malaria treatments.
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Affiliation(s)
| | | | - Juliana Inoue
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research (DZIF), Tübingen, Germany
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Mouzinga FH, Heinzel C, Lissom A, Kreidenweiss A, Batchi‐Bouyou AL, Mbama Ntabi JD, Djontu JC, Ngumbi E, Kremsner PG, Fendel R, Ntoumi F. Mucosal response of inactivated and recombinant COVID-19 vaccines in Congolese individuals. Immun Inflamm Dis 2023; 11:e1116. [PMID: 38156395 PMCID: PMC10751728 DOI: 10.1002/iid3.1116] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/07/2023] [Accepted: 12/09/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND The efficacy of immunization against an airborne pathogen depends in part on its ability to induce antibodies at the major entry site of the virus, the mucosa. Recent studies have revealed that mucosal immunity is poorly activated after vaccination with messenger RNA vaccines, thus failing in blocking virus acquisition upon its site of initial exposure. Little information is available about the induction of mucosal immunity by inactivated and recombinant coronavirus disease 2019 (COVID-19) vaccines. This study aims to investigate this topic. METHODS Saliva and plasma samples from 440 healthy Congolese were collected including (1) fully vaccinated 2 month postvaccination with either an inactivated or a recombinant COVID-19 vaccine and (2) nonvaccinated control group. Total anti-severe acute respiratory syndrome coronavirus 2 receptor-binding domain IgG and IgA antibodies were assessed using in-house enzyme-linked immunosorbent assays for both specimens. FINDINGS Altogether, the positivity of IgG was significantly higher in plasma than in saliva samples both in vaccinated and nonvaccinated control groups. Inversely, IgA positivity was slightly higher in saliva than in plasma of vaccinated group. The overall IgG and IgA levels were respectively over 103 and 14 times lower in saliva than in plasma samples. We found a strong positive correlation between IgG in saliva and plasma also between IgA in both specimens (r = .70 for IgG and r = .52 for IgA). Interestingly, contrary to IgG, the level of salivary IgA was not different between seropositive control group and seropositive vaccinated group. No significant difference was observed between recombinant and inactivated COVID-19 vaccines in total IgG and IgA antibody concentration release 2 months postvaccination both in plasma and saliva. CONCLUSION Inactivated and recombinant COVID-19 vaccines in use in the Republic of Congo poorly activated mucosal IgA-mediated antibody response 2 months postvaccination.
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Affiliation(s)
- Freisnel H. Mouzinga
- Fondation Congolaise pour la Recherche MédicaleBrazzavilleRepublic of Congo
- Faculté des Sciences et TechniquesUniversité Marien NgouabiBrazzavilleRepublic of Congo
| | | | - Abel Lissom
- Fondation Congolaise pour la Recherche MédicaleBrazzavilleRepublic of Congo
- Department of Zoology, Faculty of ScienceUniversity of BamendaBamendaCameroon
| | - Andrea Kreidenweiss
- Institute of Tropical MedicineUniversity of TübingenTübingenGermany
- Centre de Recherches Médicales de Lambaréné (CERMEL)LambareneGabon
- German Center for Infectious Diseases (DZIF)Partner Site TübingenTübingenGermany
| | - Armel L. Batchi‐Bouyou
- Fondation Congolaise pour la Recherche MédicaleBrazzavilleRepublic of Congo
- Faculté des Sciences et TechniquesUniversité Marien NgouabiBrazzavilleRepublic of Congo
- Global Clinical Scholars Research Training ProgramHarvard Medical SchoolBostonMassachusettsUSA
| | - Jacques D. Mbama Ntabi
- Fondation Congolaise pour la Recherche MédicaleBrazzavilleRepublic of Congo
- Faculté des Sciences et TechniquesUniversité Marien NgouabiBrazzavilleRepublic of Congo
| | - Jean C. Djontu
- Fondation Congolaise pour la Recherche MédicaleBrazzavilleRepublic of Congo
| | - Etienne Ngumbi
- Faculté des Sciences et TechniquesUniversité Marien NgouabiBrazzavilleRepublic of Congo
| | - Peter G. Kremsner
- Institute of Tropical MedicineUniversity of TübingenTübingenGermany
- Centre de Recherches Médicales de Lambaréné (CERMEL)LambareneGabon
- German Center for Infectious Diseases (DZIF)Partner Site TübingenTübingenGermany
| | - Rolf Fendel
- Institute of Tropical MedicineUniversity of TübingenTübingenGermany
- Centre de Recherches Médicales de Lambaréné (CERMEL)LambareneGabon
- German Center for Infectious Diseases (DZIF)Partner Site TübingenTübingenGermany
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche MédicaleBrazzavilleRepublic of Congo
- Institute of Tropical MedicineUniversity of TübingenTübingenGermany
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de Carvalho LP, Niepoth E, Mavraj-Husejni A, Kreidenweiss A, Herrmann J, Müller R, Knaab T, Burckhardt BB, Kurz T, Held J. Quantification of Plasmodium falciparum HRP-2 as an alternative method to [ 3H]hypoxanthine incorporation to measure the parasite reduction ratio in vitro. Int J Antimicrob Agents 2023; 62:106894. [PMID: 37348620 DOI: 10.1016/j.ijantimicag.2023.106894] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023]
Abstract
In the absence of a highly efficacious vaccine, chemotherapy remains the cornerstone to control malaria morbidity and mortality. The threat of the emergence of parasites resistant to artemisinin-based combination therapies highlights the need for new antimalarial drugs ideally with superior properties. The killing rate reflects the speed of action of antimalarial drugs, which can be measured in vitro through the parasite reduction ratio (PRR) assay to shortlist interesting candidates. As a standard, the in vitro PRR assay is performed by measuring [3H]hypoxanthine incorporation of Plasmodium falciparum. This methodology is restricted to specialised laboratories owing to the handling of radioactive material. In this work, we describe a sandwich enzyme-linked immunosorbent assay to detect P. falciparum histidine-rich protein 2 (HRP-2) as an alternative methodology to assess the PRR. We first validated the methodology with established antimalarial drugs (artesunate, chloroquine, pyrimethamine and atovaquone) by comparing our results with previous results of the [3H]hypoxanthine incorporation readout provided by an expert laboratory, and subsequently assessed the speed of action of four new antimalarial candidates (compound 22, chlorotonil A, boromycin and ivermectin). The HRP-2 PRR assay achieved comparable results to the [3H]hypoxanthine incorporation readout in terms of parasite growth rate over time, lag phase and parasite clearance time. In addition, parasite growth following drug exposure was quantified after 7, 14, 21 and 28 days of recovery time. In conclusion, the PRR assay based on HRP-2 is similar to [3H]hypoxanthine in determining a drug's parasite killing rate and can be widely used in all research laboratories.
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Affiliation(s)
| | - Elena Niepoth
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | | | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Jennifer Herrmann
- German Center for Infection Research (DZIF), Braunschweig, Germany; Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrücken, Germany
| | - Rolf Müller
- German Center for Infection Research (DZIF), Braunschweig, Germany; Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrücken, Germany
| | - Tanja Knaab
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bjoern B Burckhardt
- Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Münster, Germany
| | - Thomas Kurz
- Institute of Pharmaceutical and Medicinal Chemistry, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; German Center for Infection Research (DZIF), Braunschweig, Germany.
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Wiethoff JP, Sandmann S, Theiler T, Nze Nkogue C, Akomo-Okoue EF, Varghese J, Kreidenweiss A, Mellmann A, Lell B, Adegnika AA, Held J, Schaumburg F. Pharyngeal Communities and Antimicrobial Resistance in Pangolins in Gabon. Microbiol Spectr 2023; 11:e0066423. [PMID: 37338382 PMCID: PMC10434165 DOI: 10.1128/spectrum.00664-23] [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: 02/13/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
Wildlife can be a reservoir and source of zoonotic pathogens for humans. For instance, pangolins were considered one of the potential animal reservoirs of SARS-CoV-2. The aim of this study was to assess the prevalence of antimicrobial-resistant species (e.g., extended-spectrum β-lactamase [ESBL]-producing Enterobacterales) and Staphylococcus aureus-related complex and to describe the bacterial community in wild Gabonese pangolins. The pharyngeal colonization of pangolins sold in Gabon (n = 89, 2021 to 2022) was analyzed using culture media selective for ESBL-producing Enterobacterales, S. aureus-related complex, Gram-positive bacteria and nonfermenters. Phylogenetic analyses of ESBL-producing Enterobacterales was done using core-genome multilocus sequence typing (cgMLST) and compared with publicly available genomes. Patterns of cooccurring species were detected by network analysis. Of the 439 bacterial isolates, the majority of species belonged to the genus Pseudomonas (n = 170), followed by Stenotrophomonas (n = 113) and Achromobacter (n = 37). Three Klebsiella pneumoniae isolates and one Escherichia coli isolate were ESBL-producers, which clustered with human isolates from Nigeria (MLST sequence type 1788 [ST1788]) and Gabon (ST38), respectively. Network analysis revealed a frequent cooccurrence of Stenotrophomonas maltophilia with Pseudomonas putida and Pseudomonas aeruginosa. In conclusion, pangolins can be colonized with human-related ESBL-producing K. pneumoniae and E. coli. Unlike in other African wildlife, S. aureus-related complex was not detected in pangolins. IMPORTANCE There is an ongoing debate if pangolins are a relevant reservoir for viruses such as SARS-CoV-2. Here, we wanted to know if African pangolins are colonized with bacteria that are relevant for human health. A wildlife reservoir of antimicrobial resistance would be of medical relevance in regions were consumption of so-called bushmeat is common. In 89 pangolins, we found three ESBL-producing Klebsiella pneumoniae strains and one ESBL-producing Escherichia coli strains, which were closely related to isolates from humans in Africa. This points toward either a transmission between pangolins and humans or a common source from which both humans and pangolins became colonized.
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Affiliation(s)
- Johanna P. Wiethoff
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Sarah Sandmann
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Tom Theiler
- Institute of Medical Microbiology, University of Münster, Münster, Germany
| | | | | | - Julian Varghese
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
| | | | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Ayôla A. Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Frieder Schaumburg
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Medical Microbiology, University of Münster, Münster, Germany
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Heinzel C, Pinilla YT, Binder A, Kremsner PG, Held J, Fendel R, Kreidenweiss A. Saliva and Plasma Antibody Levels in Children and Adolescents After Primary Infection With Omicron Variants of SARS-CoV-2 Infection in Germany. JAMA Pediatr 2023:2804012. [PMID: 37067824 PMCID: PMC10111229 DOI: 10.1001/jamapediatrics.2023.0631] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
This cross-sectional study evaluates IgG antibody levels in children and adolescents in Germany following SARS-CoV-2 infection.
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Affiliation(s)
- Constanze Heinzel
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Yudi T Pinilla
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Ayla Binder
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Peter G Kremsner
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- German Center for Infection Research, Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- German Center for Infection Research, Tübingen, Germany
| | - Rolf Fendel
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- German Center for Infection Research, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- German Center for Infection Research, Tübingen, Germany
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Rodi M, Gross C, Sandri TL, Berner L, Marcet-Houben M, Kocak E, Pogoda M, Casadei N, Köhler C, Kreidenweiss A, Agnandji ST, Gabaldón T, Ossowski S, Held J. Whole genome analysis of two sympatric human Mansonella: Mansonella perstans and Mansonella sp "DEUX". Front Cell Infect Microbiol 2023; 13:1159814. [PMID: 37124042 PMCID: PMC10145164 DOI: 10.3389/fcimb.2023.1159814] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/15/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Mansonella species are filarial parasites that infect humans worldwide. Although these infections are common, knowledge of the pathology and diversity of the causative species is limited. Furthermore, the lack of sequencing data for Mansonella species, shows that their research is neglected. Apart from Mansonella perstans, a potential new species called Mansonella sp "DEUX" has been identified in Gabon, which is prevalent at high frequencies. We aimed to further determine if Mansonella sp "DEUX" is a genotype of M. perstans, or if these are two sympatric species. Methods We screened individuals in the area of Fougamou, Gabon for Mansonella mono-infections and generated de novo assemblies from the respective samples. For evolutionary analysis, a phylogenetic tree was reconstructed, and the differences and divergence times are presented. In addition, mitogenomes were generated and phylogenies based on 12S rDNA and cox1 were created. Results We successfully generated whole genomes for M. perstans and Mansonella sp "DEUX". Phylogenetic analysis based on annotated protein sequences, support the hypothesis of two distinct species. The inferred evolutionary analysis suggested, that M. perstans and Mansonella sp "DEUX" separated around 778,000 years ago. Analysis based on mitochondrial marker genes support our hypothesis of two sympatric human Mansonella species. Discussion The results presented indicate that Mansonella sp "DEUX" is a new Mansonella species. These findings reflect the neglect of this research topic. And the availability of whole genome data will allow further investigations of these species.
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Affiliation(s)
- Miriam Rodi
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Caspar Gross
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Thaisa Lucas Sandri
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Laboratory of Molecular Immunopathology, Department of Clinical Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Lilith Berner
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Marina Marcet-Houben
- Life Science Department, Barcelona Supercomputing Centre (BSC-CNS), Barcelona, Spain
- Mechanisms and Defense, Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Ersoy Kocak
- NGS Competence Center Tübingen (NCCT), Tübingen, Germany
| | - Michaela Pogoda
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- NGS Competence Center Tübingen (NCCT), Tübingen, Germany
| | - Nicolas Casadei
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- NGS Competence Center Tübingen (NCCT), Tübingen, Germany
| | - Carsten Köhler
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | - Selidji Todagbe Agnandji
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | - Toni Gabaldón
- Life Science Department, Barcelona Supercomputing Centre (BSC-CNS), Barcelona, Spain
- Mechanisms and Defense, Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Stephan Ossowski
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- *Correspondence: Jana Held,
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Richie TL, Church LWP, Murshedkar T, Billingsley PF, James ER, Chen MC, Abebe Y, KC N, Chakravarty S, Dolberg D, Healy SA, Diawara H, Sissoko MS, Sagara I, Cook DM, Epstein JE, Mordmüller B, Kapulu M, Kreidenweiss A, Franke-Fayard B, Agnandji ST, López Mikue MSA, McCall MBB, Steinhardt L, Oneko M, Olotu A, Vaughan AM, Kublin JG, Murphy SC, Jongo S, Tanner M, Sirima SB, Laurens MB, Daubenberger C, Silva JC, Lyke KE, Janse CJ, Roestenberg M, Sauerwein RW, Abdulla S, Dicko A, Kappe SHI, Lee Sim BK, Duffy PE, Kremsner PG, Hoffman SL. Sporozoite immunization: innovative translational science to support the fight against malaria. Expert Rev Vaccines 2023; 22:964-1007. [PMID: 37571809 PMCID: PMC10949369 DOI: 10.1080/14760584.2023.2245890] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/31/2022] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION Malaria, a devastating febrile illness caused by protozoan parasites, sickened 247,000,000 people in 2021 and killed 619,000, mostly children and pregnant women in sub-Saharan Africa. A highly effective vaccine is urgently needed, especially for Plasmodium falciparum (Pf), the deadliest human malaria parasite. AREAS COVERED Sporozoites (SPZ), the parasite stage transmitted by Anopheles mosquitoes to humans, are the only vaccine immunogen achieving >90% efficacy against Pf infection. This review describes >30 clinical trials of PfSPZ vaccines in the U.S.A., Europe, Africa, and Asia, based on first-hand knowledge of the trials and PubMed searches of 'sporozoites,' 'malaria,' and 'vaccines.' EXPERT OPINION First generation (radiation-attenuated) PfSPZ vaccines are safe, well tolerated, 80-100% efficacious against homologous controlled human malaria infection (CHMI) and provide 18-19 months protection without boosting in Africa. Second generation chemo-attenuated PfSPZ are more potent, 100% efficacious against stringent heterologous (variant strain) CHMI, but require a co-administered drug, raising safety concerns. Third generation, late liver stage-arresting, replication competent (LARC), genetically-attenuated PfSPZ are expected to be both safe and highly efficacious. Overall, PfSPZ vaccines meet safety, tolerability, and efficacy requirements for protecting pregnant women and travelers exposed to Pf in Africa, with licensure for these populations possible within 5 years. Protecting children and mass vaccination programs to block transmission and eliminate malaria are long-term objectives.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sara A. Healy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Halimatou Diawara
- Malaria Research and Training Center, Mali-NIAID ICER, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mahamadou S. Sissoko
- Malaria Research and Training Center, Mali-NIAID ICER, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Issaka Sagara
- Malaria Research and Training Center, Mali-NIAID ICER, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - David M. Cook
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Judith E. Epstein
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Benjamin Mordmüller
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Melissa Kapulu
- Biosciences Department, Kenya Medical Research Institute KEMRI-Wellcome Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Andrea Kreidenweiss
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | | | - Selidji T. Agnandji
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | - Matthew B. B. McCall
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Laura Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Martina Oneko
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Ally Olotu
- Bagamoyo Research and Training Center, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Ashley M. Vaughan
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - James G. Kublin
- Department of Global Health, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sean C. Murphy
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
- Center for Emerging and Re-emerging Infectious Diseases and Department of Microbiology, University of Washington, Seattle, WA, USA
| | - Said Jongo
- Bagamoyo Research and Training Center, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Marcel Tanner
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Matthew B. Laurens
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Claudia Daubenberger
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Joana C. Silva
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kirsten E. Lyke
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chris J. Janse
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Meta Roestenberg
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert W. Sauerwein
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Salim Abdulla
- Bagamoyo Research and Training Center, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Alassane Dicko
- Malaria Research and Training Center, Mali-NIAID ICER, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Stefan H. I. Kappe
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | | | - Patrick E. Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Peter G. Kremsner
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
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Koehne E, Kreidenweiss A, Adegbite BR, Manego RZ, McCall MB, Mombo-Ngoma G, Adegnika AA, Agnandji ST, Mordmüller B, Held J. Erratum to ‘In vitro activity of eravacycline, a novel synthetic halogenated tetracycline, against the malaria parasite Plasmodium falciparum’ [Journal of Global Antimicrobial Resistance 24 (2021) 93-97]. J Glob Antimicrob Resist 2022; 31:395. [DOI: 10.1016/j.jgar.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Siekman SL, Pongracz T, Wang W, Nouta J, Kremsner PG, da Silva-Neto PV, Esen M, Kreidenweiss A, Held J, Trapé ÁA, Fendel R, de Miranda Santos IKF, Wuhrer M. The IgG glycome of SARS-CoV-2 infected individuals reflects disease course and severity. Front Immunol 2022; 13:993354. [PMID: 36389824 PMCID: PMC9641981 DOI: 10.3389/fimmu.2022.993354] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/27/2022] [Indexed: 09/05/2023] Open
Abstract
Immunoglobulin G (IgG) antibodies play an important role in the immune response against viruses such as SARS-CoV-2. As the effector functions of IgG are modulated by N-glycosylation of the Fc region, the structure and possible function of the IgG N-glycome has been under investigation in relation to divergent COVID-19 disease courses. Through LC-MS analysis we studied both total IgG1 and spike protein-specific IgG1 Fc glycosylation of 129 German and 163 Brazilian COVID-19 patients representing diverse patient populations. We found that hospitalized COVID-19 patients displayed decreased levels of total IgG1 bisection and galactosylation and lowered anti-S IgG1 fucosylation and bisection as compared to mild outpatients. Anti-S IgG1 glycosylation was dynamic over the disease course and both anti-S and total IgG1 glycosylation were correlated to inflammatory markers. Further research is needed to dissect the possible role of altered IgG glycosylation profiles in (dys)regulating the immune response in COVID-19.
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Affiliation(s)
- Sterre L. Siekman
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Tamas Pongracz
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Wenjun Wang
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Jan Nouta
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Peter G. Kremsner
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Medicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, Deutschen Zentrum für Infektionsforschung (DZIF), Partner Site Tübingen, Tübingen, Germany
| | | | - Meral Esen
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Medicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, Deutschen Zentrum für Infektionsforschung (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Medicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, Deutschen Zentrum für Infektionsforschung (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Medicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, Deutschen Zentrum für Infektionsforschung (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Átila Alexandre Trapé
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rolf Fendel
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Medicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, Deutschen Zentrum für Infektionsforschung (DZIF), Partner Site Tübingen, Tübingen, Germany
| | | | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
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Junker D, Becker M, Wagner TR, Kaiser PD, Maier S, Grimm TM, Griesbaum J, Marsall P, Gruber J, Traenkle B, Heinzel C, Pinilla YT, Held J, Fendel R, Kreidenweiss A, Nelde A, Maringer Y, Schroeder S, Walz JS, Althaus K, Uzun G, Mikus M, Bakchoul T, Schenke-Layland K, Bunk S, Haeberle H, Göpel S, Bitzer M, Renk H, Remppis J, Engel C, Franz AR, Harries M, Kessel B, Lange B, Strengert M, Krause G, Zeck A, Rothbauer U, Dulovic A, Schneiderhan-Marra N. Antibody Binding and Angiotensin-Converting Enzyme 2 Binding Inhibition Is Significantly Reduced for Both the BA.1 and BA.2 Omicron Variants. Clin Infect Dis 2022; 76:e240-e249. [PMID: 35717657 PMCID: PMC9384292 DOI: 10.1093/cid/ciac498] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/11/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The rapid emergence of the Omicron variant and its large number of mutations led to its classification as a variant of concern (VOC) by the World Health Organization. Subsequently, Omicron evolved into distinct sublineages (eg, BA.1 and BA.2), which currently represent the majority of global infections. Initial studies of the neutralizing response toward BA.1 in convalescent and vaccinated individuals showed a substantial reduction. METHODS We assessed antibody (immunoglobulin G [IgG]) binding, ACE2 (angiotensin-converting enzyme 2) binding inhibition, and IgG binding dynamics for the Omicron BA.1 and BA.2 variants compared to a panel of VOCs/variants of interest, in a large cohort (N = 352) of convalescent, vaccinated, and infected and subsequently vaccinated individuals. RESULTS While Omicron was capable of efficiently binding to ACE2, antibodies elicited by infection or immunization showed reduced binding capacities and ACE2 binding inhibition compared to wild type. Whereas BA.1 exhibited less IgG binding compared to BA.2, BA.2 showed reduced inhibition of ACE2 binding. Among vaccinated samples, antibody binding to Omicron only improved after administration of a third dose. CONCLUSIONS Omicron BA.1 and BA.2 can still efficiently bind to ACE2, while vaccine/infection-derived antibodies can bind to Omicron. The extent of the mutations within both variants prevents a strong inhibitory binding response. As a result, both Omicron variants are able to evade control by preexisting antibodies.
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Affiliation(s)
| | | | | | - Philipp D Kaiser
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - Sandra Maier
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - Tanja M Grimm
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - Johanna Griesbaum
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - Patrick Marsall
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - Jens Gruber
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - Bjoern Traenkle
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - Constanze Heinzel
- Institute of Tropical Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Yudi T Pinilla
- Institute of Tropical Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Rolf Fendel
- Institute of Tropical Medicine, University Hospital Tuebingen, Tuebingen, Germany,German Center for Infection Research, partner site Tuebingen, Tuebingen, Germany,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University Hospital Tuebingen, Tuebingen, Germany,German Center for Infection Research, partner site Tuebingen, Tuebingen, Germany,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Annika Nelde
- Department of Peptide-Based Immunotherapy, University of Tuebingen and University Hospital Tuebingen, Tuebingen, Germany,Department of Internal Medicine, Clinical Collaboration Unit Translational Immunology, German Cancer Consortium, University Hospital Tuebingen, Tuebingen, Germany,Department of Immunology, Institute for Cell Biology, University of Tuebingen, Tuebingen, Germany,Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies,” University of Tuebingen, Tuebingen, Germany
| | - Yacine Maringer
- Department of Peptide-Based Immunotherapy, University of Tuebingen and University Hospital Tuebingen, Tuebingen, Germany,Department of Internal Medicine, Clinical Collaboration Unit Translational Immunology, German Cancer Consortium, University Hospital Tuebingen, Tuebingen, Germany,Department of Immunology, Institute for Cell Biology, University of Tuebingen, Tuebingen, Germany,Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies,” University of Tuebingen, Tuebingen, Germany
| | - Sarah Schroeder
- Department of Peptide-Based Immunotherapy, University of Tuebingen and University Hospital Tuebingen, Tuebingen, Germany,Department of Immunology, Institute for Cell Biology, University of Tuebingen, Tuebingen, Germany,Department of Otorhinolaryngology, Head and Neck Surgery, University of Tuebingen, Tuebingen, Germany
| | - Juliane S Walz
- Department of Peptide-Based Immunotherapy, University of Tuebingen and University Hospital Tuebingen, Tuebingen, Germany,Department of Internal Medicine, Clinical Collaboration Unit Translational Immunology, German Cancer Consortium, University Hospital Tuebingen, Tuebingen, Germany,Department of Immunology, Institute for Cell Biology, University of Tuebingen, Tuebingen, Germany,Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies,” University of Tuebingen, Tuebingen, Germany
| | - Karina Althaus
- Center for Clinical Transfusion Medicine, Tuebingen, Germany,Institute of Clinical and Experimental Transfusion Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Gunalp Uzun
- Center for Clinical Transfusion Medicine, Tuebingen, Germany
| | - Marco Mikus
- Center for Clinical Transfusion Medicine, Tuebingen, Germany
| | - Tamam Bakchoul
- Center for Clinical Transfusion Medicine, Tuebingen, Germany,Institute of Clinical and Experimental Transfusion Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Katja Schenke-Layland
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany,Department of Immunology, Institute for Cell Biology, University of Tuebingen, Tuebingen, Germany,Department for Medical Technologies and Regenerative Medicine, Institute of Biomedical Engineering, University of Tuebingen, Tuebingen, Germany,Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Stefanie Bunk
- Infectious Diseases, Department of Internal Medicine I, University Hospital Tuebingen, Tuebingen, Germany
| | - Helene Haeberle
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Siri Göpel
- German Center for Infection Research, partner site Tuebingen, Tuebingen, Germany,Infectious Diseases, Department of Internal Medicine I, University Hospital Tuebingen, Tuebingen, Germany
| | - Michael Bitzer
- Infectious Diseases, Department of Internal Medicine I, University Hospital Tuebingen, Tuebingen, Germany,Center for Personalized Medicine, University of Tuebingen, Tuebingen, Germany
| | - Hanna Renk
- University Children’s Hospital, Tuebingen, Germany
| | | | - Corinna Engel
- University Children’s Hospital, Tuebingen, Germany,Center for Pediatric Clinical Studies, University Hospital Tuebingen, Tuebingen, Germany
| | - Axel R Franz
- University Children’s Hospital, Tuebingen, Germany,Center for Pediatric Clinical Studies, University Hospital Tuebingen, Tuebingen, Germany
| | - Manuela Harries
- Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Barbora Kessel
- Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Berit Lange
- Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Monika Strengert
- Helmholtz Centre for Infection Research, Braunschweig, Germany,TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture of Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Gerard Krause
- Helmholtz Centre for Infection Research, Braunschweig, Germany,TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture of Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Anne Zeck
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - Ulrich Rothbauer
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany,Pharmaceutical Biotechnology, University of Tuebingen, Tuebingen, Germany
| | - Alex Dulovic
- Correspondence: A. Dulovic, Natural and Medical Sciences Institute at the University of Tuebingen, Markwiesenstrasse 55, Reutlingen, 72770 Germany ()
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Koehne E, Zander N, Rodi M, Held J, Hoffmann W, Zoleko-Manego R, Ramharter M, Mombo-Ngoma G, Kremsner PG, Kreidenweiss A. Correction: Evidence for in vitro and in vivo activity of the antimalarial pyronaridine against Schistosoma. PLoS Negl Trop Dis 2022; 16:e0010512. [PMID: 35653329 PMCID: PMC9162304 DOI: 10.1371/journal.pntd.0010512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kremsner PG, Ahuad Guerrero RA, Arana-Arri E, Aroca Martinez GJ, Bonten M, Chandler R, Corral G, De Block EJL, Ecker L, Gabor JJ, Garcia Lopez CA, Gonzales L, Granados González MA, Gorini N, Grobusch MP, Hrabar AD, Junker H, Kimura A, Lanata CF, Lehmann C, Leroux-Roels I, Mann P, Martinez-Reséndez MF, Ochoa TJ, Poy CA, Reyes Fentanes MJ, Rivera Mejia LM, Ruiz Herrera VV, Sáez-Llorens X, Schönborn-Kellenberger O, Schunk M, Sierra Garcia A, Vergara I, Verstraeten T, Vico M, Oostvogels L, Lovesio L, Diez F, Grazziani F, Ganaha MC, Zalatnik VJ, Dittrich RJ, Espínola L, Lambert S, Longhi A, Vecchio C, Mastruzzo M, Fernandez A, Borchowiek S, Potito R, Ahuad Guerrero RA, Guardiani FM, Castella S, Foccoli M, Pedernera A, Braida A, Durigan V, Martella C, Bobat A, Boggia BE, Nemi SA, Tartaglione JG, Piedimonte FC, De Bie J, Reynales Londoño H, Rodríguez Ordoñez PA, García Cruz JM, Bautista Toloza L, Ladino González MC, Zambrano Ochoa AP, Prieto Pradera I, Torres Hernandez D, Mazo Elorza DP, Collazos Lennis MF, Vanegas Dominguez B, Solano Mosquera LM, Fendel R, Fleischmann WA, Koehne E, Kreidenweiss A, Köhler C, Esen M, Horn C, Eberts S, Kroidl A, Huber K, Thiel V, Mazara Rosario S, Reyes G, Rivera L, Donastorg Y, Lantigua F, Torres Almanzar D, Candelario R, Peña Mendez L, Rosario Gomez N, Portolés-Pérez A, Ascaso del Río A, Laredo Velasco L, Bustinduy Odriozola MJ, Larrea Arranz I, Martínez Alcorta LI, Durán Laviña MI, Imaz-Ayo N, Meijide S, García-de-Vicuña A, Santorcuato A, Gallego M, Aguirre-García GM, Olmos Vega J, González Limón P, Vázquez Villar A, Chávez Barón J, Arredondo Saldaña F, Luján Palacios JDD, Camacho Choza LJ, Vázquez Saldaña EG, Ortega Dominguez SJ, Vega Orozco KS, Torres Quiroz IA, Martinez Avendaño A, Herrera Sanchez J, Guzman E, Castro Castrezana L, Ruiz Palacios y Santos GM, de Winter RFJ, de Jonge HK, Schnyder JL, Boersma W, Hessels L, Djamin R, van der Sar S, DeAntonio R, Peña M, Rebollon G, Rojas M, Escobar J, Hammerschlag Icaza B, Wong T DY, Barrera Perigault P, Ruiz S, Chan M, Arias Hoo DJ, Gil AI, Celis CR, Balmaceda MP, Flores O, Ochoa M, Peña B, de la Flor C, Webb CM, Cornejo E, Sanes F, Mayorga V, Valdiviezo G, Ramírez Lamas SP, Grandez Castillo GA, Lama JR, Matta Aguirre ME, Arancibia Luna LA, Carbajal Paulet Ó, Zambrano Ortiz J, Camara A, Guzman Quintanilla F, Diaz-Parra C, Morales-Oliva J, Cornejo RE, Ricalde SA, Vidal J, Rios Nogales L, Cheatham-Seitz D, Gregoraci G, Brecx A, Walz L, Vahrenhorst D, Seibel T, Quintini G. Efficacy and safety of the CVnCoV SARS-CoV-2 mRNA vaccine candidate in ten countries in Europe and Latin America (HERALD): a randomised, observer-blinded, placebo-controlled, phase 2b/3 trial. Lancet Infect Dis 2022; 22:329-340. [PMID: 34826381 PMCID: PMC8610426 DOI: 10.1016/s1473-3099(21)00677-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Additional safe and efficacious vaccines are needed to control the COVID-19 pandemic. We aimed to analyse the efficacy and safety of the CVnCoV SARS-CoV-2 mRNA vaccine candidate. METHODS HERALD is a randomised, observer-blinded, placebo-controlled, phase 2b/3 clinical trial conducted in 47 centres in ten countries in Europe and Latin America. By use of an interactive web response system and stratification by country and age group (18-60 years and ≥61 years), adults with no history of virologically confirmed COVID-19 were randomly assigned (1:1) to receive intramuscularly either two 0·6 mL doses of CVnCoV containing 12 μg of mRNA or two 0·6 mL doses of 0·9% NaCl (placebo) on days 1 and 29. The primary efficacy endpoint was the occurrence of a first episode of virologically confirmed symptomatic COVID-19 of any severity and caused by any strain from 15 days after the second dose. For the primary endpoint, the trial was considered successful if the lower limit of the CI was greater than 30%. Key secondary endpoints were the occurrence of a first episode of virologically confirmed moderate-to-severe COVID-19, severe COVID-19, and COVID-19 of any severity by age group. Primary safety outcomes were solicited local and systemic adverse events within 7 days after each dose and unsolicited adverse events within 28 days after each dose in phase 2b participants, and serious adverse events and adverse events of special interest up to 1 year after the second dose in phase 2b and phase 3 participants. Here, we report data up to June 18, 2021. The study is registered at ClinicalTrials.gov, NCT04652102, and EudraCT, 2020-003998-22, and is ongoing. FINDINGS Between Dec 11, 2020, and April 12, 2021, 39 680 participants were enrolled and randomly assigned to receive either CVnCoV (n=19 846) or placebo (n=19 834), of whom 19 783 received at least one dose of CVnCoV and 19 746 received at least one dose of placebo. After a mean observation period of 48·2 days (SE 0·2), 83 cases of COVID-19 occurred in the CVnCoV group (n=12 851) in 1735·29 person-years and 145 cases occurred in the placebo group (n=12 211) in 1569·87 person-years, resulting in an overall vaccine efficacy against symptomatic COVID-19 of 48·2% (95·826% CI 31·0-61·4; p=0·016). Vaccine efficacy against moderate-to-severe COVID-19 was 70·7% (95% CI 42·5-86·1; CVnCoV 12 cases in 1735·29 person-years, placebo 37 cases in 1569·87 person-years). In participants aged 18-60 years, vaccine efficacy against symptomatic disease was 52·5% (95% CI 36·2-64·8; CVnCoV 71 cases in 1591·47 person-years, placebo, 136 cases in 1449·23 person-years). Too few cases occurred in participants aged 61 years or older (CVnCoV 12, placebo nine) to allow meaningful assessment of vaccine efficacy. Solicited adverse events, which were mostly systemic, were more common in CVnCoV recipients (1933 [96·5%] of 2003) than in placebo recipients (1344 [67·9%] of 1978), with 542 (27·1%) CVnCoV recipients and 61 (3·1%) placebo recipients reporting grade 3 solicited adverse events. The most frequently reported local reaction after any dose in the CVnCoV group was injection-site pain (1678 [83·6%] of 2007), with 22 grade 3 reactions, and the most frequently reported systematic reactions were fatigue (1603 [80·0%] of 2003) and headache (1541 [76·9%] of 2003). 82 (0·4%) of 19 783 CVnCoV recipients reported 100 serious adverse events and 66 (0·3%) of 19 746 placebo recipients reported 76 serious adverse events. Eight serious adverse events in five CVnCoV recipients and two serious adverse events in two placebo recipients were considered vaccination-related. None of the fatal serious adverse events reported (eight in the CVnCoV group and six in the placebo group) were considered to be related to study vaccination. Adverse events of special interest were reported for 38 (0·2%) participants in the CVnCoV group and 31 (0·2%) participants in the placebo group. These events were considered to be related to the trial vaccine for 14 (<0·1%) participants in the CVnCoV group and for five (<0·1%) participants in the placebo group. INTERPRETATION CVnCoV was efficacious in the prevention of COVID-19 of any severity and had an acceptable safety profile. Taking into account the changing environment, including the emergence of SARS-CoV-2 variants, and timelines for further development, the decision has been made to cease activities on the CVnCoV candidate and to focus efforts on the development of next-generation vaccine candidates. FUNDING German Federal Ministry of Education and Research and CureVac.
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14
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Sandri TL, Kreidenweiss A, Cavallo S, Weber D, Juhas S, Rodi M, Woldearegai TG, Gmeiner M, Veletzky L, Ramharter M, Tazemda-Kuitsouc GB, Matsiegui PB, Mordmüller B, Held J. Corrigendum to: Molecular Epidemiology of Mansonella Species in Gabon. J Infect Dis 2022; 225:929. [PMID: 35106595 DOI: 10.1093/infdis/jiab439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thaisa Lucas Sandri
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Laboratory of Molecular Immunopathology, Department of Clinical Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Simon Cavallo
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - David Weber
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Sascha Juhas
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Miriam Rodi
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Tamirat Gebru Woldearegai
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Markus Gmeiner
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Luzia Veletzky
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Benjamin Mordmüller
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
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15
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de Carvalho LP, Groeger-Otero S, Kreidenweiss A, Kremsner PG, Mordmüller B, Held J. Boromycin has Rapid-Onset Antibiotic Activity Against Asexual and Sexual Blood Stages of Plasmodium falciparum. Front Cell Infect Microbiol 2022; 11:802294. [PMID: 35096650 PMCID: PMC8795978 DOI: 10.3389/fcimb.2021.802294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Boromycin is a boron-containing macrolide antibiotic produced by Streptomyces antibioticus with potent activity against certain viruses, Gram-positive bacteria and protozoan parasites. Most antimalarial antibiotics affect plasmodial organelles of prokaryotic origin and have a relatively slow onset of action. They are used for malaria prophylaxis and for the treatment of malaria when combined to a fast-acting drug. Despite the success of artemisinin combination therapies, the current gold standard treatment, new alternatives are constantly needed due to the ability of malaria parasites to become resistant to almost all drugs that are in heavy clinical use. In vitro antiplasmodial activity screens of tetracyclines (omadacycline, sarecycline, methacycline, demeclocycline, lymecycline, meclocycline), macrolides (oleandomycin, boromycin, josamycin, troleandomycin), and control drugs (chloroquine, clindamycin, doxycycline, minocycline, eravacycline) revealed boromycin as highly potent against Plasmodium falciparum and the zoonotic Plasmodium knowlesi. In contrast to tetracyclines, boromycin rapidly killed asexual stages of both Plasmodium species already at low concentrations (~ 1 nM) including multidrug resistant P. falciparum strains (Dd2, K1, 7G8). In addition, boromycin was active against P. falciparum stage V gametocytes at a low nanomolar range (IC50: 8.5 ± 3.6 nM). Assessment of the mode of action excluded the apicoplast as the main target. Although there was an ionophoric activity on potassium channels, the effect was too low to explain the drug´s antiplasmodial activity. Boromycin is a promising antimalarial candidate with activity against multiple life cycle stages of the parasite.
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Affiliation(s)
| | - Sara Groeger-Otero
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Peter G. Kremsner
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Benjamin Mordmüller
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
- *Correspondence: Jana Held, ;
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16
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Pinilla YT, Heinzel C, Caminada LF, Consolaro D, Esen M, Kremsner PG, Held J, Kreidenweiss A, Fendel R. SARS-CoV-2 Antibodies Are Persisting in Saliva for More Than 15 Months After Infection and Become Strongly Boosted After Vaccination. Front Immunol 2021; 12:798859. [PMID: 34956236 PMCID: PMC8695841 DOI: 10.3389/fimmu.2021.798859] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/15/2021] [Indexed: 01/15/2023] Open
Abstract
SARS-CoV-2 antibodies in saliva serve as first line of defense against the virus. They are present in the mucosa, more precisely in saliva, after a recovered infection and also following vaccination. We report here the antibody persistence in plasma and in saliva up to 15 months after mild COVID-19. The IgG antibody response was measured every two months in 72 participants using an established and validated in-house ELISA assay. In addition, the virus inhibitory activity of plasma antibodies was assessed in a surrogate virus neutralization test before and after vaccination. SARS-CoV-2-specific antibody concentrations remained stable in plasma and saliva and the response was strongly boosted after one dose COVID-19 vaccination.
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Affiliation(s)
- Yudi T Pinilla
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Constanze Heinzel
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | | | - Douglas Consolaro
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Meral Esen
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Cluster of Excellence: Exzellenzcluster (EXC) 2124: Controlling Microbes to Fight Infection, Tübingen, Germany
| | - Peter G Kremsner
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Jana Held
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Rolf Fendel
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
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17
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Fusco D, Rakotozandrindrainy R, Rakotoarivelo RA, Andrianarivelo MR, Rakotozandrindrainy N, Rasamoelina T, Puradiredja DI, Klein P, Stahlberg K, Dechenaud M, Lorenz E, Jaeger A, Kreidenweiss A, Hoekstra PT, Adegnika AA, Sicuri E, Corstjens PLAM, van Dam GJ, May J, Schwarz NG. A cluster randomized controlled trial for assessing POC-CCA test based praziquantel treatment for schistosomiasis control in pregnant women and their young children: study protocol of the freeBILy clinical trial in Madagascar. Trials 2021; 22:822. [PMID: 34801082 PMCID: PMC8605548 DOI: 10.1186/s13063-021-05769-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/08/2021] [Accepted: 10/27/2021] [Indexed: 01/16/2023] Open
Abstract
Background Mass drug administration (MDA) of praziquantel is one of the main control measures against human schistosomiasis. Although there are claims for including pregnant women, infants and children under the age of 5 years in high-endemic regions in MDA campaigns, they are usually not treated without a diagnosis. Diagnostic tools identifying infections at the primary health care centre (PHCC) level could therefore help to integrate these vulnerable groups into control programmes. freeBILy (fast and reliable easy-to-use-diagnostics for eliminating bilharzia in young children and mothers) is an international consortium focused on implementing and evaluating new schistosomiasis diagnostic strategies. In Madagascar, the study aims to determine the effectiveness of a test-based schistosomiasis treatment (TBST) strategy for pregnant women and their infants and children up until the age of 2 years. Methods A two-armed, cluster-randomized, controlled phase III trial including 5200 women and their offspring assesses the impact of TBST on child growth and maternal haemoglobin in areas of medium to high endemicity of Schistosoma mansoni. The participants are being tested with the point of care-circulating cathodic antigen (POC-CCA) test, a commercially available urine-based non-invasive rapid diagnostic test for schistosomiasis. In the intervention arm, a POC-CCA-TBST strategy is offered to women during pregnancy and 9 months after delivery, for their infants at 9 months of age. In the control arm, study visit procedures are the same, but without the POC-CCA-TBST procedure. All participants are being offered the POC-CCA-TBST 24 months after delivery. This trial is being integrated into the routine maternal and child primary health care programmes at 40 different PHCC in Madagascar’s highlands. The purpose of the trial is to assess the effectiveness of the POC-CCA-TBST for controlling schistosomiasis in young children and mothers. Discussion This trial assesses a strategy to integrate pregnant women and their children under the age of 2 years into schistosomiasis control programmes using rapid diagnostic tests. It includes local capacity building for clinical trials and large-scale intervention research. Trial registration Pan-African Clinical Trial Register PACTR201905784271304. Retrospectively registered on 15 May 2019
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Affiliation(s)
- Daniela Fusco
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Strasse 74, D-20359, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Borstel-, Lübeck, Riems, Germany
| | | | - Rivo Andry Rakotoarivelo
- Department of Infectious Diseases, University of Fianarantsoa Andrainjato, 301, Fianarantsoa, Madagascar
| | - Mala Rakoto Andrianarivelo
- Centre d'Infectiologie Charles Mérieux (CICM), University of Antananarivo, PO Box 4299, 101, Antananarivo, Madagascar
| | - Njary Rakotozandrindrainy
- Department of Microbiology and Parasitology, University of Antananarivo, 101, Antananarivo, Madagascar.,UPFR in Parasitology-Mycology of University Hospital Joseph Ravoahangy Andrianavalona Ampefiloha, 101, Antananarivo, Madagascar
| | - Tahinamandranto Rasamoelina
- Centre d'Infectiologie Charles Mérieux (CICM), University of Antananarivo, PO Box 4299, 101, Antananarivo, Madagascar
| | - Dewi Ismajani Puradiredja
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Strasse 74, D-20359, Hamburg, Germany
| | - Philipp Klein
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Strasse 74, D-20359, Hamburg, Germany
| | - Karl Stahlberg
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Strasse 74, D-20359, Hamburg, Germany
| | - Marie Dechenaud
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Strasse 74, D-20359, Hamburg, Germany
| | - Eva Lorenz
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Strasse 74, D-20359, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Borstel-, Lübeck, Riems, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anna Jaeger
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Strasse 74, D-20359, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Borstel-, Lübeck, Riems, Germany
| | - Andrea Kreidenweiss
- Institut für Tropenmedizin, Universität Tübingen, Wilhelmstrasse 27, D-72074, Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Wilhelmstrasse 27, D-72074, Tübingen, Germany
| | - Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Akim Ayola Adegnika
- Institut für Tropenmedizin, Universität Tübingen, Wilhelmstrasse 27, D-72074, Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Wilhelmstrasse 27, D-72074, Tübingen, Germany.,Department of Parasitology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.,Centre de Recherches Médicales de Lambaréné, 242, Lambarene, BP, Gabon
| | - Elisa Sicuri
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Spain C/ Rosselló, 132, 5th 2nd, 08036, Barcelona, Spain
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Jürgen May
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Strasse 74, D-20359, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Borstel-, Lübeck, Riems, Germany
| | - Norbert Georg Schwarz
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Strasse 74, D-20359, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Borstel-, Lübeck, Riems, Germany
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18
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Heinzel C, Pinilla YT, Elsner K, Friessinger E, Mordmüller B, Kremsner PG, Held J, Fendel R, Kreidenweiss A. Non-Invasive Antibody Assessment in Saliva to Determine SARS-CoV-2 Exposure in Young Children. Front Immunol 2021; 12:753435. [PMID: 34691072 PMCID: PMC8531807 DOI: 10.3389/fimmu.2021.753435] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Saliva is a body fluid with hitherto unused potential for the assessment of SARS-CoV-2 antibodies. Specific antibodies can indicate a past SARS-CoV-2 infection and allow to estimate the proportion of individuals with a potential protective immunity. First, we carefully characterized plasma samples obtained from adult control groups with and without prior SARS-CoV-2 infection using certified reference ELISAs. Simultaneously collected saliva samples of confirmed convalescent and negative individuals where then used to validate the herein newly developed ELISA for the detection of SARS-CoV-2 IgG antibodies in saliva. The saliva ELISA was applied to assess SARS-CoV-2 exposure in young children (N = 837) in the age between 1 and 10 years in Tübingen, Germany, towards the end of the first pandemic year 2020. Sensitivity and specificity of the new saliva ELISA was 87% and 100%, respectively. With 12% of all Tübingen children sampled via their respective educational institutions, estimates of SARS-CoV-2 antibody prevalence was 1.6%. Interestingly, only 0.4% preschool kids were positive compared to 3.0% of primary school children. Less than 20% of positive children self-reported symptoms within two months prior to saliva sampling that could be associated - but not exclusively - with a SARS-CoV-2 infection. The saliva ELISA is a valid and suitable protocol to enable population-based surveys for SARS-CoV-2 antibodies. Using non-invasive sampling and saliva ELISA testing, we found that prevalence of SARS-CoV-2 antibodies was significantly lower in young children than in primary school children.
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Affiliation(s)
- Constanze Heinzel
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Yudi T Pinilla
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Käthe Elsner
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Evelyn Friessinger
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Benjamin Mordmüller
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter G Kremsner
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Jana Held
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Rolf Fendel
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
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19
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Pinilla YT, Friessinger E, Griesbaum JM, Berner L, Heinzel C, Elsner K, Fendel R, Held J, Kreidenweiss A. Prevalence of SARS-CoV-2 Infection in Children by Antibody Detection in Saliva: Protocol for a Prospective Longitudinal Study (Coro-Buddy). JMIR Res Protoc 2021; 10:e27739. [PMID: 34533472 PMCID: PMC8510152 DOI: 10.2196/27739] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/22/2021] [Accepted: 08/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The world has been confronted with the COVID-19 pandemic for more than one year. Severe disease is more often found among elderly people, whereas most young children and adolescents show mild symptoms or even remain asymptomatic, so that infection might be undiagnosed. Therefore, only limited epidemiological data on SARS-CoV-2 infection in children and young adults are available. OBJECTIVE This study aims to determine the prevalence of SARS-CoV-2 antibodies in children from the city of Tübingen, Germany, and to measure the incidence of new cases over 12 months. METHODS SARS-CoV-2 antibodies will be measured in saliva as a surrogate for a previous SARS-CoV-2 infection. Children will be sampled at their preschools, primary schools, and secondary schools at three time points: July 2020, October to December 2020, and April to July 2021. An adult cohort will be sampled at the same time points (ie, adult comparator group). The saliva-based SARS-CoV-2-antibody enzyme-linked immunosorbent assay will be validated using blood and saliva samples from adults with confirmed previous SARS-CoV-2 infections (ie, adult validation group). RESULTS The first study participant was enrolled in July 2020, and recruitment and enrollment continued until July 2021. We have recruited and enrolled 1850 children, 560 adults for the comparator group, and 83 adults for the validation group. We have collected samples from the children and the adults for the comparator group at the three time points. We followed up with participants in the adult validation group every 2 months and, as of the writing of this paper, we were at time point 7. We will conduct data analysis after the data collection period. CONCLUSIONS Infection rates in children are commonly underreported due to a lack of polymerase chain reaction testing. This study will report on the prevalence of SARS-CoV-2 infections in infants, school children, and adolescents as well as the incidence change over 12 months in the city of Tübingen, Germany. The saliva sampling approach for SARS-CoV-2-antibody measurement allows for a unique, representative, population-based sample collection process. TRIAL REGISTRATION ClinicalTrials.gov NCT04581889; https://clinicaltrials.gov/ct2/show/NCT04581889. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27739.
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Affiliation(s)
- Yudi T Pinilla
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Evelyn Friessinger
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Lilith Berner
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Constanze Heinzel
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Käthe Elsner
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Rolf Fendel
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Jana Held
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, partner site Tübingen, Tübingen, Germany
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20
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Sandri TL, Kreidenweiss A, Cavallo S, Weber D, Juhas S, Rodi M, Woldearegai TG, Gmeiner M, Veletzky L, Ramharter M, Tazemda-Kuitsouc GB, Matsiegui PB, Mordmüller B, Held J. Molecular Epidemiology of Mansonella Species in Gabon. J Infect Dis 2021; 223:287-296. [PMID: 33099649 DOI: 10.1093/infdis/jiaa670] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/03/2020] [Accepted: 10/20/2020] [Indexed: 01/04/2023] Open
Abstract
Mansonella perstans, a filarial nematode, infects large populations in Africa and Latin America. Recently, a potential new species, Mansonella sp "DEUX," was reported. Carriage of endosymbiotic Wolbachia opens treatment options for Mansonella infections. Within a cross-sectional study, we assessed the prevalence of filarial infections in 834 Gabonese individuals and the presence of the endosymbiont Wolbachia. Almost half of the participants (400/834 [48%]) were infected with filarial nematodes, with Mansonella sp "DEUX" being the most frequent (295/400 [74%]), followed by Loa loa (273/400 [68%]) and Mansonella perstans (82/400 [21%]). Being adult/elderly, male, and living in rural areas was associated with a higher risk of infection. Wolbachia carriage was confirmed in M. perstans and Mansonella sp "DEUX." In silico analysis revealed that Mansonella sp "DEUX" is not detected with currently published M. perstans-specific assays. Mansonella infections are highly prevalent in Gabon and might have been underreported, likely also beyond Gabon.
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Affiliation(s)
- Thaisa Lucas Sandri
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Laboratory of Molecular Immunopathology, Department of Clinical Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Simon Cavallo
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - David Weber
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Sascha Juhas
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Miriam Rodi
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Tamirat Gebru Woldearegai
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Markus Gmeiner
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Luzia Veletzky
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Benjamin Mordmüller
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
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21
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Kremsner PG, Mann P, Kroidl A, Leroux-Roels I, Schindler C, Gabor JJ, Schunk M, Leroux-Roels G, Bosch JJ, Fendel R, Kreidenweiss A, Velavan TP, Fotin-Mleczek M, Mueller SO, Quintini G, Schönborn-Kellenberger O, Vahrenhorst D, Verstraeten T, Alves de Mesquita M, Walz L, Wolz OO, Oostvogels L. Safety and immunogenicity of an mRNA-lipid nanoparticle vaccine candidate against SARS-CoV-2 : A phase 1 randomized clinical trial. Wien Klin Wochenschr 2021; 133:931-941. [PMID: 34378087 PMCID: PMC8354521 DOI: 10.1007/s00508-021-01922-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND We used the RNActive® technology platform (CureVac N.V., Tübingen, Germany) to prepare CVnCoV, a COVID-19 vaccine containing sequence-optimized mRNA coding for a stabilized form of SARS-CoV‑2 spike (S) protein encapsulated in lipid nanoparticles (LNP). METHODS This is an interim analysis of a dosage escalation phase 1 study in healthy 18-60-year-old volunteers in Hannover, Munich and Tübingen, Germany, and Ghent, Belgium. After giving 2 intramuscular doses of CVnCoV or placebo 28 days apart we assessed solicited local and systemic adverse events (AE) for 7 days and unsolicited AEs for 28 days after each vaccination. Immunogenicity was measured as enzyme-linked immunosorbent assay (ELISA) IgG antibodies to SARS-CoV‑2 S‑protein and receptor binding domain (RBD), and SARS-CoV‑2 neutralizing titers (MN50). RESULTS In 245 volunteers who received 2 CVnCoV vaccinations (2 μg, n = 47, 4 μg, n = 48, 6 μg, n = 46, 8 μg, n = 44, 12 μg, n = 28) or placebo (n = 32) there were no vaccine-related serious AEs. Dosage-dependent increases in frequency and severity of solicited systemic AEs, and to a lesser extent local AEs, were mainly mild or moderate and transient in duration. Dosage-dependent increases in IgG antibodies to S‑protein and RBD and MN50 were evident in all groups 2 weeks after the second dose when 100% (23/23) seroconverted to S‑protein or RBD, and 83% (19/23) seroconverted for MN50 in the 12 μg group. Responses to 12 μg were comparable to those observed in convalescent sera from known COVID-19 patients. CONCLUSION In this study 2 CVnCoV doses were safe, with acceptable reactogenicity and 12 μg dosages elicited levels of immune responses that overlapped those observed in convalescent sera.
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Affiliation(s)
- Peter G Kremsner
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- German Centre for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
- Centre de Recherches Medicales de Lambarene, Lambarene, Gabon
| | - Philipp Mann
- CureVac AG, Schumannstraße 27, 60325, Frankfurt, Germany.
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | | | | | - Julian J Gabor
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | | | | | - Rolf Fendel
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- German Centre for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- German Centre for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Thirumalaisamy P Velavan
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Viet Nam
| | | | | | | | | | | | | | | | - Lisa Walz
- CureVac AG, Schumannstraße 27, 60325, Frankfurt, Germany
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Abstract
INTRODUCTION Malaria, the most devastating parasitic disease, is currently treated with artemisinin-based combination therapies (ACTs). Unfortunately, some ACTs are unable to rapidly clear Plasmodium falciparum parasites from the blood stream and are failing to cure malaria patients; a problem, so far, largely confined to Southeast Asia. There is a fear of resistant Plasmodium falciparum emerging in other parts of the world including Sub-Saharan Africa. Strategies for alternative treatments, ideally non-artemisinin based, are needed. AREAS COVERED This narrative review gives an overview of approved antimalarials and of some compounds in advanced drug development that could be used when an ACT is failing. The selection was based on a literature search in PubMed and WHO notes for malaria treatment. EXPERT OPINION The ACT drug class can still cure malaria in malaria endemic regions. However, the appropriate ACT drug should be chosen considering the background resistance of the partner drug of the local parasite population. Artesunate-pyronaridine, the 'newest' recommended ACT, and atovaquone-proguanil are, so far, effective, and safe treatments for uncomplicated falciparum malaria. Therefore, all available ACTs should be safeguarded from parasite resistance and the development of new antimalarial drug classes needs to be accelerated.
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Affiliation(s)
- Erik Koehne
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Ayola Akim Adegnika
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Jana Held
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
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23
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Nouatin O, Mengue JB, Dejon-Agobé JC, Fendel R, Ibáñez J, Ngoa UA, Edoa JR, Adégbité BR, Honkpéhédji YJ, Zinsou JF, Hounkpatin AB, Moutairou K, Homoet A, Esen M, Kreidenweiss A, Hoffman SL, Theisen M, Luty AJF, Lell B, Agnandji ST, Mombo-Ngoma G, Ramharter M, Kremsner P, Mordmüller B, Adegnika AA. Exploratory analysis of the effect of helminth infection on the immunogenicity and efficacy of the asexual blood-stage malaria vaccine candidate GMZ2. PLoS Negl Trop Dis 2021; 15:e0009361. [PMID: 34061838 PMCID: PMC8195366 DOI: 10.1371/journal.pntd.0009361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/11/2021] [Accepted: 04/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Helminths can modulate the host immune response to Plasmodium falciparum and can therefore affect the risk of clinical malaria. We assessed here the effect of helminth infections on both the immunogenicity and efficacy of the GMZ2 malaria vaccine candidate, a recombinant protein consisting of conserved domains of GLURP and MSP3, two asexual blood-stage antigens of P. falciparum. Controlled human malaria infection (CHMI) was used to assess the efficacy of the vaccine. Methodology In a randomized, double-blind Phase I clinical trial, fifty, healthy, lifelong malaria-exposed adult volunteers received three doses of GMZ2 adjuvanted with either Cationic Adjuvant Formulation (CAF) 01 or Alhydrogel, or a control vaccine (Rabies) on days (D) 0, D28 and D56, followed by direct venous inoculation (DVI) of 3,200 P. falciparum sporozoites (PfSPZ Challenge) approximately 13 weeks after last vaccination to assess vaccine efficacy. Participants were followed-up on a daily basis with clinical examinations and thick blood smears to monitor P. falciparum parasitemia for 35 days. Malaria was defined as the presence of P. falciparum parasites in the blood associated with at least one symptom that can be associated to malaria over 35 days following DVI of PfSPZ Challenge. Soil-transmitted helminth (STH) infection was assessed by microscopy and by polymerase chain reaction (PCR) on stool, and Schistosoma infection was assessed by microscopy on urine. Participants were considered as infected if positive for any helminth either by PCR and/or microscopy at D0 and/or at D84 (Helm+) and were classified as mono-infection or co-infection. Total vaccine-specific IgG concentrations assessed on D84 were analysed as immunogenicity outcome. Main findings The helminth in mono-infection, particularly Schistosoma haematobium and STH were significantly associated with earlier malaria episodes following CHMI, while no association was found in case of coinfection. In further analyses, the anti-GMZ2 IgG concentration on D84 was significantly higher in the S. haematobium-infected and significantly lower in the Strongyloides stercoralis-infected groups, compared to helminth-negative volunteers. Interesting, in the absence of helminth infection, a high anti-GMZ2 IgG concentration on D84 was significantly associated with protection against malaria. Conclusions Our results suggest that helminth infection may reduce naturally acquired and vaccine-induced protection against malaria. Vaccine-specific antibody concentrations on D84 may be associated with protection in participants with no helminth infection. These results suggest that helminth infection affect malaria vaccine immunogenicity and efficacy in helminth endemic countries. Helminths, mainly because of their immune regulatory effects, are able to impact the response induced by vaccines. In the context of clinical trial designs that measure accrual of natural infections during follow up or outcome of controlled human malaria infection (CHMI), their effect on vaccine efficacy can be measured. Indeed, most of such clinical trials on malaria vaccine candidates conducted in Africa, especially where the prevalence of helminths is high, have shown a certain limit in their efficacy and immunogenicity, as compared to results observed in European and U.S volunteers. The present analysis assessed the effect of helminths on GMZ2, a malaria vaccine candidate. We found a high level of anti-GMZ2 antibodies among volunteers not infected with helminths and protected against CHMI, indicating efficacy of the candidate vaccine in this population. We found a species-dependent effect of helminths on the level of post-immunization GMZ2-specific IgG concentration, and an association of helminths with an early onset of malaria in CHMI. Our findings reveal that helminths are associated with immunogenicity and may decrease the protective effect of antibodies induced by vaccination. Helminth infection status shall be determined when measuring the immunogenicity and efficacy of malaria vaccine candidates in helminth endemic countries.
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Affiliation(s)
- Odilon Nouatin
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Cotonou, Bénin
| | | | - Jean Claude Dejon-Agobé
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Rolf Fendel
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Javier Ibáñez
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | | | | | - Bayodé Roméo Adégbité
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.,Fondation pour la Recherche Scientifique, Cotonou, Bénin
| | - Yabo Josiane Honkpéhédji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Fondation pour la Recherche Scientifique, Cotonou, Bénin.,Department of Parasitology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Jeannot Fréjus Zinsou
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Fondation pour la Recherche Scientifique, Cotonou, Bénin.,Department of Parasitology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Aurore Bouyoukou Hounkpatin
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Kabirou Moutairou
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Andreas Homoet
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Meral Esen
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | | | - Michael Theisen
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark.,Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Adrian J F Luty
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Calavi, Bénin.,Université de Paris, MERIT, IRD, Paris, France
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I, Department of Medicine, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I, Department of Medicine, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Benjamin Mordmüller
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ayôla Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany.,Fondation pour la Recherche Scientifique, Cotonou, Bénin.,Department of Parasitology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
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24
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Becker M, Dulovic A, Junker D, Ruetalo N, Kaiser PD, Pinilla YT, Heinzel C, Haering J, Traenkle B, Wagner TR, Layer M, Mehrlaender M, Mirakaj V, Held J, Planatscher H, Schenke-Layland K, Krause G, Strengert M, Bakchoul T, Althaus K, Fendel R, Kreidenweiss A, Koeppen M, Rothbauer U, Schindler M, Schneiderhan-Marra N. Immune response to SARS-CoV-2 variants of concern in vaccinated individuals. Nat Commun 2021; 12:3109. [PMID: 34035301 PMCID: PMC8149389 DOI: 10.1038/s41467-021-23473-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [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: 03/08/2021] [Accepted: 04/28/2021] [Indexed: 12/20/2022] Open
Abstract
SARS-CoV-2 is evolving with mutations in the receptor binding domain (RBD) being of particular concern. It is important to know how much cross-protection is offered between strains following vaccination or infection. Here, we obtain serum and saliva samples from groups of vaccinated (Pfizer BNT-162b2), infected and uninfected individuals and characterize the antibody response to RBD mutant strains. Vaccinated individuals have a robust humoral response after the second dose and have high IgG antibody titers in the saliva. Antibody responses however show considerable differences in binding to RBD mutants of emerging variants of concern and substantial reduction in RBD binding and neutralization is observed against a patient-isolated South African variant. Taken together our data reinforce the importance of the second dose of Pfizer BNT-162b2 to acquire high levels of neutralizing antibodies and high antibody titers in saliva suggest that vaccinated individuals may have reduced transmission potential. Substantially reduced neutralization for the South African variant further highlights the importance of surveillance strategies to detect new variants and targeting these in future vaccines.
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Affiliation(s)
- Matthias Becker
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Alex Dulovic
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Daniel Junker
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Natalia Ruetalo
- Institute for Medical Virology and Epidemiology, University Hospital Tübingen, Tübingen, Germany
| | - Philipp D Kaiser
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Yudi T Pinilla
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Constanze Heinzel
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Julia Haering
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Bjoern Traenkle
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Teresa R Wagner
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
- Pharmaceutical Biotechnology, University of Tübingen, Tübingen, Germany
| | - Mirjam Layer
- Institute for Medical Virology and Epidemiology, University Hospital Tübingen, Tübingen, Germany
| | - Martin Mehrlaender
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Valbona Mirakaj
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | | | - Katja Schenke-Layland
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Women's Health, Research Institute for Women's Health, University of Tübingen, Tübingen, Germany
- Department of Medicine/Cardiology, Cardiovascular Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Gérard Krause
- Helmholtz Centre for Infection Research, Braunschweig, Germany
- TWINCORE GmbH, Centre for Experimental and Clinical Infection Research, a joint venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Monika Strengert
- Helmholtz Centre for Infection Research, Braunschweig, Germany
- TWINCORE GmbH, Centre for Experimental and Clinical Infection Research, a joint venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Tamam Bakchoul
- Institute for Clinical and Experimental Transfusion Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Karina Althaus
- Institute for Clinical and Experimental Transfusion Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Rolf Fendel
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Michael Koeppen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Ulrich Rothbauer
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany.
- Pharmaceutical Biotechnology, University of Tübingen, Tübingen, Germany.
| | - Michael Schindler
- Institute for Medical Virology and Epidemiology, University Hospital Tübingen, Tübingen, Germany.
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Pessanha de Carvalho L, Kreidenweiss A, Held J. Drug Repurposing: A Review of Old and New Antibiotics for the Treatment of Malaria: Identifying Antibiotics with a Fast Onset of Antiplasmodial Action. Molecules 2021; 26:2304. [PMID: 33921170 PMCID: PMC8071546 DOI: 10.3390/molecules26082304] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/17/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
Malaria is one of the most life-threatening infectious diseases and constitutes a major health problem, especially in Africa. Although artemisinin combination therapies remain efficacious to treat malaria, the emergence of resistant parasites emphasizes the urgent need of new alternative chemotherapies. One strategy is the repurposing of existing drugs. Herein, we reviewed the antimalarial effects of marketed antibiotics, and described in detail the fast-acting antibiotics that showed activity in nanomolar concentrations. Antibiotics have been used for prophylaxis and treatment of malaria for many years and are of particular interest because they might exert a different mode of action than current antimalarials, and can be used simultaneously to treat concomitant bacterial infections.
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Affiliation(s)
- Lais Pessanha de Carvalho
- Institute of Tropical Medicine, University of Tuebingen, 72074 Tuebingen, Germany; (L.P.d.C.); (A.K.)
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tuebingen, 72074 Tuebingen, Germany; (L.P.d.C.); (A.K.)
- Centre de Recherches Medicales de Lambaréné (CERMEL), Lambaréné BP 242, Gabon
| | - Jana Held
- Institute of Tropical Medicine, University of Tuebingen, 72074 Tuebingen, Germany; (L.P.d.C.); (A.K.)
- Centre de Recherches Medicales de Lambaréné (CERMEL), Lambaréné BP 242, Gabon
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26
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Gabor JJ, Kreidenweiss A, Weber S, Salama M, Sulyok M, Sulyok Z, Koehne E, Esen M, Kreuels B, Shamsrizi P, Biecker E, Mordmüller B, Berg CP, Fusco S, Köhler C, Kubicka S, Leitlein J, Addo M, Ramharter M, Schwab M, Bissinger AL, Velavan TP, Krishna S, Kremsner PG. A call to caution when hydroxychloroquine is given to elderly patients with COVID-19. Int J Infect Dis 2021; 106:265-268. [PMID: 33848675 PMCID: PMC8035801 DOI: 10.1016/j.ijid.2021.04.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Use of hydroxychloroquine in patients with coronavirus disease 2019 (COVID-19) was widespread and uncontrolled until recently. Patients vulnerable to severe COVID-19 are at risk of hydroxychloroquine interactions with co-morbidities and co-medications contributing to detrimental, including fatal, adverse treatment effects. Methods A retrospective survey was undertaken of health conditions and co-medications of patients with COVID-19 who were pre-screened for enrolment in a randomized, double-blind, placebo-controlled hydroxychloroquine multi-centre trial. Results The survey involved 305 patients [median age 71 (interquartile range 59–81) years]. The majority of patients (n = 279, 92%) considered for inclusion in the clinical trial were not eligible, mainly due to safety concerns caused by health conditions or co-medications. The most common were QT-prolonging drugs (n = 188, 62%) and haematologic/haemato-oncologic diseases (n = 39, 13%) which prohibited the administration of hydroxychloroquine. In addition, 165 (54%) patients had health conditions and 167 (55%) patients were on co-medications that did not prohibit the use of hydroxychloroquine but had a risk of adverse interactions with hydroxychloroquine. The most common were diabetes (n = 86, 28%), renal insufficiency (n = 69, 23%) and heart failure (n = 58, 19%). Conclusion The majority of hospitalized patients with COVID-19 had health conditions or took co-medications precluding safe treatment with hydroxychloroquine. Therefore, hydroxychloroquine should be administered with extreme caution in elderly patients with COVID-19, and only in clinical trials.
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Affiliation(s)
- Julian J Gabor
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Zollernalb Hospital Balingen, Balingen, Germany.
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; German Centre for Infection Research, Tübingen / Hamburg, Germany
| | - Stefan Weber
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany
| | | | - Mihaly Sulyok
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Zollernalb Hospital Balingen, Balingen, Germany; Department of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Zita Sulyok
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Neonatology, University Hospital Tübingen, Tübingen, Germany
| | - Erik Koehne
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Zollernalb Hospital Balingen, Balingen, Germany
| | - Meral Esen
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; German Centre for Infection Research, Tübingen / Hamburg, Germany
| | - Benno Kreuels
- Department of Tropical Medicine Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Parichehr Shamsrizi
- Department of Tropical Medicine Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Benjamin Mordmüller
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Christoph P Berg
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Stefano Fusco
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Carsten Köhler
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; German Centre for Infection Research, Tübingen / Hamburg, Germany
| | | | | | - Marylyn Addo
- Department of Tropical Medicine Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Infection Research, Tübingen / Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicale de Lambaréné, Lambaréné, Gabon; Department of Tropical Medicine Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Infection Research, Tübingen / Hamburg, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany; Departments of Clinical Pharmacology, and Pharmacy and Biochemistry, University Tübingen, Tübingen, Germany
| | - Alfred Lennart Bissinger
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany
| | - Thirumalaisamy P Velavan
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Vietnamese-German Centre for Medical Research, Hanoi, Viet Nam
| | | | - Peter G Kremsner
- Institute of Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital Tübingen, Tübingen, Germany; Centre de Recherches Médicale de Lambaréné, Lambaréné, Gabon; German Centre for Infection Research, Tübingen / Hamburg, Germany
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27
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Velavan TP, Kieu Linh LT, Kreidenweiss A, Gabor J, Krishna S, Kremsner PG. Longitudinal Monitoring of Lactate in Hospitalized and Ambulatory COVID-19 Patients. Am J Trop Med Hyg 2021; 104:1041-1044. [PMID: 33432902 PMCID: PMC7941812 DOI: 10.4269/ajtmh.20-1282] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
Hypoxemia is readily detectable by assessing SpO2 levels, and these are important in optimizing COVID-19 patient management. Hyperlactatemia is a marker of tissue hypoxia, particularly in patients with increased oxygen requirement and microvascular obstruction. We monitored peripheral venous lactate concentrations in hospitalized patients with moderate to severe COVID-19 (n = 18) and in mild ambulatory COVID-19 patients in home quarantine (n = 16). Whole blood lactate decreased significantly during the clinical course and recovery in hospitalized patients (P = 0.008). The blood lactate levels were significantly higher in hospitalized patients than ambulatory patients (day 1: hospitalized versus ambulatory patients P = 0.002; day 28: hospitalized versus ambulatory patients P = < 0.0001). Elevated lactate levels may be helpful in risk stratification, and serial monitoring of lactate may prove useful in the care of hospitalized COVID-19 patients.
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Affiliation(s)
- Thirumalaisamy P Velavan
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Vietnamese-German Center for Medical Research, Hanoi, Vietnam
| | - Le Thi Kieu Linh
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | | | - Julian Gabor
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Sanjeev Krishna
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institute for Infection Immunity, St George's University of London, London, United Kingdom.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
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28
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Koehne E, Kreidenweiss A, Adegbite BR, Manego RZ, McCall MBB, Mombo-Ngoma G, Adegnika AA, Agnandji ST, Mordmüller B, Held J. In vitro activity of eravacycline, a novel synthetic halogenated tetracycline, against the malaria parasite Plasmodium falciparum. J Glob Antimicrob Resist 2020; 24:93-97. [PMID: 33301999 DOI: 10.1016/j.jgar.2020.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/31/2020] [Revised: 10/26/2020] [Accepted: 11/22/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Eravacycline is a novel synthetic halogenated tetracycline derivative with a broad antibacterial spectrum. Antibiotics, including tetracyclines, have been used for prophylaxis and, more rarely, for the treatment of malaria for several decades. The rise in drug-resistant malaria parasites renders the search for new treatment candidates urgent. We determined the in vitro potency of eravacycline against Plasmodium falciparum and investigated the apicoplast as a potential drug target. METHODS Four tetracyclines, including eravacycline, tetracycline, tigecycline, and doxycycline, and the lincosamide clindamycin, were tested in 3-day and 6-day in vitro susceptibility assays of P. falciparum laboratory strain 3D7 and/or of clinical isolates obtained from 33 P. falciparum infected individuals from Gabon in 2018. Assays with isopentenyl pyrophosphate substitution were performed to investigate whether apicoplast-encoded isoprenoid biosynthesis is inhibited by these antibiotics. RESULTS Eravacycline showed the highest activity of all tetracyclines tested in clinical isolates in the 3-day and 6-day assays. Substitution of isopentenyl pyrophosphate in vitro using the laboratory strain 3D7 reversed the activity of eravacycline and comparator antibiotics, indicating the apicoplast to be the main target organelle. CONCLUSIONS These results demonstrate the potential of novel antibiotics, and eravacycline, as candidate antimalarial therapies.
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Affiliation(s)
- Erik Koehne
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon; German Center for Infection Research, partner site Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon; German Center for Infection Research, partner site Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany
| | | | - Rella Zoleko Manego
- Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Dep of Medicine, University Medical Center Hamburg-Eppendorf, Bernhard-Nocht-Straße 74, D-20359 Hamburg, Germany
| | - Matthew B B McCall
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon; German Center for Infection Research, partner site Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany
| | - Ghyslain Mombo-Ngoma
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Dep of Medicine, University Medical Center Hamburg-Eppendorf, Bernhard-Nocht-Straße 74, D-20359 Hamburg, Germany
| | - Ayola Akim Adegnika
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon; German Center for Infection Research, partner site Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany
| | - Sélidji Todagbé Agnandji
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon; German Center for Infection Research, partner site Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany
| | - Benjamin Mordmüller
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon; German Center for Infection Research, partner site Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon; German Center for Infection Research, partner site Tübingen, Wilhelmstraße 27, D-72074 Tübingen, Germany.
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29
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Hoekstra PT, Schwarz NG, Adegnika AA, Andrianarivelo MR, Corstjens PLAM, Rakotoarivelo RA, Rakotozandrindrainy R, Sicuri E, Kreidenweiss A, van Dam GJ. Fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers: An introduction to the freeBILy project. Acta Trop 2020; 211:105631. [PMID: 32679109 DOI: 10.1016/j.actatropica.2020.105631] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
Schistosoma antigen detection tests have a large potential for schistosomiasis control programs due to their ability to detect active and ongoing Schistosoma infections, their much higher sensitivity compared to microscopical methods, and the possibility to use non-invasive urine samples. Pregnant women and young children could especially benefit from affordable and easy-to-use antigen tests as inclusion of these vulnerable groups in mass drug administration campaigns will always require higher justification hurdles, especially in low to middle endemic regions with a higher proportion of individuals who are not infected and thus unnecessarily exposed to praziquantel. The overall objective of the 'fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers' (freeBILy, www.freeBILy.eu) project is to thoroughly evaluate the point-of-care circulating cathodic antigen (POC-CCA) and the up-converting phosphor reporter particle, lateral flow circulating anodic antigen (UCP-LF CAA) urine strip tests to diagnose Schistosoma infections in pregnant women and young children and to assess their potential as a schistosomiasis control tool in test-and-treat strategies. The freeBILy project will generate valuable, evidence-based findings on improved tools and test-and-treat strategies to reduce the burden of schistosomiasis in pregnant women and young children.
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Affiliation(s)
- Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Norbert G Schwarz
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Germany; German Center for Infection Research, Germany
| | - Ayola A Adegnika
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands; German Center for Infection Research, Germany; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Elisa Sicuri
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Andrea Kreidenweiss
- German Center for Infection Research, Germany; Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
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30
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Honkpehedji YJ, Adegnika AA, Dejon-Agobe JC, Zinsou JF, Mba RB, Gerstenberg J, Rakotozandrindrainy R, Rakotoarivelo RA, Rasamoelina T, Sicuri E, Schwarz NG, Corstjens PLAM, Hoekstra PT, van Dam GJ, Kreidenweiss A. Prospective, observational study to assess the performance of CAA measurement as a diagnostic tool for the detection of Schistosoma haematobium infections in pregnant women and their child in Lambaréné, Gabon: study protocol of the freeBILy clinical trial in Gabon. BMC Infect Dis 2020; 20:718. [PMID: 32993559 PMCID: PMC7523491 DOI: 10.1186/s12879-020-05445-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schistosoma antigen detection in urine is a valuable diagnostic approach for schistosomiasis control programmes because of the higher sensitivity compared to parasitological methods and preferred sampling of urine over stool. Highly accurate diagnostics are important in low Schistosoma transmission areas. Pregnant women and young children could particularly benefit from antigen testing as praziquantel (PZQ) can be given to only confirmed Schistosoma cases. This prevents the unborn baby from unnecessary exposure to PZQ. We present here the protocol of a diagnostic study that forms part of the freeBILy project. The aim is to evaluate the accuracy of circulating anodic antigen (CAA) detection for diagnosis of Schistosoma haematobium infections in pregnant women and to validate CAA as an endpoint measure for anti-Schistosoma drug efficacy. The study will also investigate Schistosoma infections in infants. METHODS A set of three interlinked prospective, observational studies is conducted in Gabon. The upconverting phosphor lateral flow (UCP-LF) CAA test is the index diagnostic test that will be evaluated. The core trial, sub-study A, comprehensively evaluates the accuracy of the UCP-LF CAA urine test against a set of other Schistosoma diagnostics in a cross-sectional trial design. Women positive for S. haematobium will proceed with sub-study B and will be randomised to receive PZQ treatment immediately or after delivery followed by weekly sample collection. This approach includes comparative monitoring of CAA levels following PZQ intake and will also contribute further data for safety of PZQ administration during pregnancy. Sub-study C is a longitudinal study to determine the incidence of S. haematobium infection as well as the age for first infection in life-time. DISCUSSION The freeBILy trial in Gabon will generate a comprehensive set of data on the accuracy of the UCP-LF CAA test for the detection of S. haematobium infection in pregnant women and newborn babies and for the use of CAA as a marker to determine PZQ efficacy. Furthermore, incidence of Schistosoma infection in infants will be reported. Using the ultrasensitive diagnostics, this information will be highly relevant for Schistosoma prevalence monitoring by national control programs as well as for the development of medicaments and vaccines. TRIAL REGISTRATION The registration number of this study is NCT03779347 ( clinicaltrials.gov , date of registration: 19 December 2018).
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Affiliation(s)
- Yabo Josiane Honkpehedji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ayôla Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Jean Claude Dejon-Agobe
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeannot Fréjus Zinsou
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Romuald Beh Mba
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Jacob Gerstenberg
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | | | | | | | - Elisa Sicuri
- Fundación Privada Instituto de Salud Global Barcelona, Barcelona, Spain
| | | | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Andrea Kreidenweiss
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.
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31
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de Carvalho LP, Kreidenweiss A, Held J. The preclinical discovery and development of rectal artesunate for the treatment of malaria in young children: a review of the evidence. Expert Opin Drug Discov 2020; 16:13-22. [PMID: 32921162 DOI: 10.1080/17460441.2020.1804357] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Plasmodium falciparum, the deadliest malaria parasite, kills hundreds of thousands of people per year, mainly young children in Sub-Saharan Africa. Artesunate suppositories are recommended as pre-referral malaria treatment in remote endemic areas for severely ill children to prevent progression of the disease and to provide extra time for patients until the definitive severe malaria treatment can be administered. AREAS COVERED The authors provide an overview of the discovery of artesunate and its different formulations focusing on rectal administration, summarizing key studies concerning the pharmacokinetic, pharmacodynamic, safety, tolerability and efficacy of rectal artesunate leading to WHO recommendation and market authorization in Africa. In addition, studies on acceptance and adherence to rectal artesunate administration and the post-launch status are also covered. EXPERT OPINION Efforts by ministries of health in malaria endemic countries together with international health organizations should establish and enforce guidelines to ensure the correct use of artesunate suppositories only as pre-referral medication in presumed severe malaria cases to minimize the risk of abuse as a monotherapy for treatment of uncomplicated malaria. The priority is to not jeopardize the efficacy of artesunate and to prevent resistance development against this valuable drug class in Africa.
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Affiliation(s)
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen , Tübingen, Germany.,Centre De Recherches Médicales De Lambaréné , Lambaréné, Gabon
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen , Tübingen, Germany.,Centre De Recherches Médicales De Lambaréné , Lambaréné, Gabon
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Adegbite BR, Edoa JR, Honkpehedji YJ, Zinsou FJ, Dejon-Agobe JC, Mbong-Ngwese M, Lotola-Mougueni F, Koehne E, Lalremruata A, Kreidenweiss A, Nguyen TT, Kun J, Agnandji ST, Lell B, Safiou AR, Obone Atome FA, Mombo-Ngoma G, Ramharter M, Velavan TP, Mordmüller B, Kremsner PG, Adegnika AA. Monitoring of efficacy, tolerability and safety of artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Lambaréné, Gabon: an open-label clinical trial. Malar J 2019; 18:424. [PMID: 31842893 PMCID: PMC6916217 DOI: 10.1186/s12936-019-3015-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/14/2019] [Accepted: 11/20/2019] [Indexed: 02/01/2023] Open
Abstract
Background Malaria remains a major public health problem, affecting mainly low-and middle-income countries. The management of this parasitic disease is challenged by ever increasing drug resistance. This study, investigated the therapeutic efficacy, tolerability and safety of artemether–lumefantrine (AL) and artesunate–amodiaquine (AS–AQ), used as first-line drugs to treat uncomplicated malaria in Lambaréné, Gabon. Methods A non-randomized clinical trial was conducted between October 2017 and March 2018 to assess safety, clinical and parasitological efficacy of fixed-doses of AL and AS–AQ administered to treat uncomplicated Plasmodium falciparum malaria in children aged from 6 months to 12 years. After 50 children were treated with AL, another 50 children received ASAQ. The 2009 World Health Organization protocol for monitoring of the efficacy of anti‑malarial drugs was followed. Molecular markers msp1 and msp2 were used to differentiate recrudescence and reinfection. For the investigation of artemisinin resistant markers, gene mutations in Pfk13 were screened. Results Per-protocol analysis on day 28 showed a PCR corrected cure rate of 97% (95% CI 86–100) and 95% (95% CI 84–99) for AL and AS–AQ, respectively. The most frequent adverse event in both groups was asthenia. No mutations in the kelch-13 gene associated with artemisinin resistance were identified. All participants had completed microscopic parasite clearance by day 3 post-treatment. Conclusion This study showed that AL and AS–AQ remain efficacious, well-tolerated, and are safe to treat uncomplicated malaria in children from Lambaréné. However, a regular monitoring of efficacy and a study of molecular markers of drug resistance to artemisinin in field isolates is essential. Trial registration ANZCTR, ACTRN12616001600437. Registered 18 November, http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12616001600437p&isBasic=True
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Affiliation(s)
- Bayode R Adegbite
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon
| | - Jean R Edoa
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon
| | - Yabo J Honkpehedji
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frejus J Zinsou
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean C Dejon-Agobe
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Erik Koehne
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Albert Lalremruata
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - The T Nguyen
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Vietnamese-German Center for Medical Research, Hanoi, Vietnam
| | - Jutta Kun
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Selidji T Agnandji
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Abdou R Safiou
- Programme National de Lutte contre le paludisme, Libreville, Gabon
| | | | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thirumalaisamy P Velavan
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Vietnamese-German Center for Medical Research, Hanoi, Vietnam
| | - Benjamin Mordmüller
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research, Tübingen, Germany
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research, Tübingen, Germany
| | - Ayola A Adegnika
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon. .,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany. .,Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands. .,German Center for Infection Research, Tübingen, Germany.
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33
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Zoleko Manego R, Koehne E, Kreidenweiss A, Nzigou Mombo B, Adegbite BR, Dimessa Mbadinga LB, Akinosho M, Matthewman J, Adegnika AA, Ramharter M, Mombo-Ngoma G. Description of Plasmodium falciparum infections in central Gabon demonstrating high parasite densities among symptomatic adolescents and adults. Malar J 2019; 18:371. [PMID: 31752891 PMCID: PMC6873720 DOI: 10.1186/s12936-019-3002-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/10/2019] [Accepted: 11/11/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Malaria remains a public health issue, particularly in sub-Saharan Africa with special features of seriousness in young children and pregnant women. Adolescents and adults are reported to have acquired a semi-immune status and, therefore, present with low parasitaemia. Children are understood to present with a much higher parasitaemia and severe malaria. It is a concern that effective malaria control programmes targeting young children may lead to a delay in the acquisition of acquired immunity and, therefore, causing a shift in the epidemiology of malaria. Prevalence and parasitaemia were explored in adolescents and adults with Plasmodium falciparum infections compared to young children in the area of Lambaréné, Gabon as an indicator for semi-immunity. METHODS A cross-sectional study was conducted at the Centre de Recherches Médicales de Lambaréné (CERMEL) during a 6-month period in 2018. Symptomatic patients, of all ages were screened for malaria at health facilities in Lambaréné and Fougamou and their respective surrounding villages in the central region of Gabon. Plasmodium falciparum infections were determined either by rapid diagnostic test (RDT) or by microscopy. Descriptive analysis of data on parasite densities, anaemia, and fever are presented. RESULTS 1589 individuals screened were included in this analysis, including 731 (46%) adolescents and adults. Out of 1377 assessed, the proportion of P. falciparum positive RDTs was high among adolescents (68%) and adults (44%), compared to young children (55%) and school children (72%). Out of 274 participants assessed for malaria by microscopy, 45 (16%) had a parasite count above 10,000/µl of which 9 (20%) were adults. CONCLUSION This study shows a high rate of P. falciparum infections in adolescents and adults associated with high-level parasitaemia similar to that of young children. Adolescents and adults seem to be an at-risk population, suggesting that malaria programmes should consider adolescents and adults during the implementation of malaria prevention and case management programmes with continuous care, since they also act as reservoirs for P. falciparum.
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Affiliation(s)
- Rella Zoleko Manego
- Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, und Deutsches Zentrum für Infektionsforschung, Wilhelmstrasse 27, 72074, Tübingen, Germany.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Dep. of Medicine, University Medical Center Hamburg-Eppendorf, Bernhard-Nocht-Straße 74, 20359, Hamburg, Germany
| | - Erik Koehne
- Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, und Deutsches Zentrum für Infektionsforschung, Wilhelmstrasse 27, 72074, Tübingen, Germany
| | - Andrea Kreidenweiss
- Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, und Deutsches Zentrum für Infektionsforschung, Wilhelmstrasse 27, 72074, Tübingen, Germany
| | | | | | | | - Malik Akinosho
- Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon
| | - Julian Matthewman
- Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, und Deutsches Zentrum für Infektionsforschung, Wilhelmstrasse 27, 72074, Tübingen, Germany
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Dep. of Medicine, University Medical Center Hamburg-Eppendorf, Bernhard-Nocht-Straße 74, 20359, Hamburg, Germany
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon. .,Institut für Tropenmedizin, Universität Tübingen, und Deutsches Zentrum für Infektionsforschung, Wilhelmstrasse 27, 72074, Tübingen, Germany. .,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Dep. of Medicine, University Medical Center Hamburg-Eppendorf, Bernhard-Nocht-Straße 74, 20359, Hamburg, Germany.
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Kreidenweiss A, Trauner F, Rodi M, Koehne E, Held J, Wyndorps L, Manouana GP, McCall M, Adegnika AA, Lalremruata A, Kremsner PG, Fendel R, Sandri TL. Monitoring the threatened utility of malaria rapid diagnostic tests by novel high-throughput detection of Plasmodium falciparum hrp2 and hrp3 deletions: A cross-sectional, diagnostic accuracy study. EBioMedicine 2019; 50:14-22. [PMID: 31761619 PMCID: PMC6921222 DOI: 10.1016/j.ebiom.2019.10.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 10/25/2019] [Accepted: 10/26/2019] [Indexed: 11/03/2022] Open
Abstract
Background Plasmodium falciparum deficient for hrp2 and hrp3 genes are a threat to malaria management and elimination, since they escape widely used HRP2-based rapid diagnostic tests and treatment. Hrp2/hrp3 deletions are increasingly reported from all malaria endemic regions but are currently only identified by laborious methodologies. Methods We developed a novel hydrolysis probe-based, quantitative, real-time PCR (4plex qPCR) for detection and discrimination of P. falciparum infection (cytb) and hrp2 and hrp3 gene status, and to control assay validity (btub). A cross-sectional, diagnostic accuracy study was performed in Gabon for assay validation and deletion screening. Findings In parallel to identification of P. falciparum infection in samples down to 0.05 parasites/µl, the 4plex qPCR enabled specific and valid interrogation of the parasites´s hrp2 and hrp3 genes in one go - even in low parasitemic samples. The assay was precise and robust also when performed in a routine healthcare setting in Gabon. The risk of falsely identifying hrp2 or hrp3 deletion was reduced by 100-fold compared to conventional PCR. Evaluation against microscopy was performed on 200 blood samples collected in Gabon: sensitivity and specificity of 4plex qPCR (cytb) were 100% and 80%, respectively. Stringent testing revealed hrp2 deletion in 2 of 95 P. falciparum positive and validated samples. Interpretation The novel 4plex qPCR is sensitive, accurate and allows resource-efficient rapid screening. Monitoring and mapping of hrp2/hrp3 deletions is required to identify areas where control strategies may need to be adapted to ensure appropriate patient care and ultimately achieve malaria elimination. Funding BMBF (03VP00402).
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Affiliation(s)
- Andrea Kreidenweiss
- Institute of Tropical Medicine, University Hospital Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon.
| | - Franziska Trauner
- Institute of Tropical Medicine, University Hospital Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany
| | - Miriam Rodi
- Institute of Tropical Medicine, University Hospital Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany
| | - Erik Koehne
- Institute of Tropical Medicine, University Hospital Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University Hospital Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon
| | - Lea Wyndorps
- Institute of Tropical Medicine, University Hospital Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany
| | | | - Matthew McCall
- Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon
| | - Ayola Akim Adegnika
- Institute of Tropical Medicine, University Hospital Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon; German Center for Infection Research (DZIF), Tübingen, Germany
| | - Albert Lalremruata
- Institute of Tropical Medicine, University Hospital Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany
| | - Peter G Kremsner
- Institute of Tropical Medicine, University Hospital Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany; Centre de Recherches Médicales de Lambaréné, B.P. 242, Lambaréné, Gabon; German Center for Infection Research (DZIF), Tübingen, Germany
| | - Rolf Fendel
- Institute of Tropical Medicine, University Hospital Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany
| | - Thaisa Lucas Sandri
- Institute of Tropical Medicine, University Hospital Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany.
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35
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Ward DJ, Van de Langemheen H, Koehne E, Kreidenweiss A, Liskamp RMJ. Highly tunable thiosulfonates as a novel class of cysteine protease inhibitors with anti-parasitic activity against Schistosoma mansoni. Bioorg Med Chem 2019; 27:2857-2870. [PMID: 31126821 DOI: 10.1016/j.bmc.2019.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/12/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 11/18/2022]
Abstract
The development of a new class of cysteine protease inhibitors utilising the thiosulfonate moiety as an SH specific electrophile is described. This moiety has been introduced into suitable amino acid derived building blocks, which were incorporated into peptidic sequences leading to very potent i.e. sub micromolar inhibitors of the cysteine protease papain in the same range as the vinyl sulfone based inhibitor K11777. Therefore, their inhibitory effect on Schistosoma mansoni, a human blood parasite, that expresses several cysteine proteases, was evaluated. The homophenylalanine side chain containing compounds 27-30 and especially 36 showed promising activities compared with K11777 and warrant further investigations of these peptidic thiosulfonate inhibitors as new potential anti-parasitic compounds.
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Affiliation(s)
- D J Ward
- School of Chemistry, Joseph Black Building, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - H Van de Langemheen
- School of Chemistry, Joseph Black Building, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - E Koehne
- Institute of Tropical Medicine, University of Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany
| | - A Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Wilhelmstrasse 27, D-72074 Tübingen, Germany.
| | - R M J Liskamp
- School of Chemistry, Joseph Black Building, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK.
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36
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Hounkpatin AB, Kreidenweiss A, Held J. Clinical utility of tafenoquine in the prevention of relapse of Plasmodium vivax malaria: a review on the mode of action and emerging trial data. Infect Drug Resist 2019; 12:553-570. [PMID: 30881061 PMCID: PMC6411314 DOI: 10.2147/idr.s151031] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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] [Indexed: 01/03/2023] Open
Abstract
Tafenoquine is an 8-aminoquinoline with activity against all human life cycle stages of Plasmodium vivax, including dormant liver stages – so called hypnozoites. Its long half-life of ~15 days is allowing for a single exposure regimen. It has been under development since 1980 and received approval by the US Food and Drug Administration in summer 2018 as an anti-relapse drug for P. vivax malaria in patients aged 16 years and older and for prophylaxis of malaria caused by any Plasmodium species in adults. Prior to tafenoquine administration, glucose-6-phosphate dehydrogenase (G6PD) deficiency needs to be excluded by testing. Individuals with a deficient G6PD activity are at risk of tafenoquine-induced hemolysis – as is the case for primaquine, the mainstay drug for P. vivax radical cure. A wealth of clinical studies have been conducted and are still ongoing to assess the safety, tolerability, and efficacy of tafenoquine. This review focuses on data emerging from the latest clinical trials on P. vivax radical cure with tafenoquine, the key studies for regulatory approval of tafenoquine, and elucidates the latest hypothesis on the mode of action.
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Affiliation(s)
- Aurore B Hounkpatin
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany, .,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon,
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany,
| | - Jana Held
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany, .,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon,
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37
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Affiliation(s)
- Juliana Boex Mengue
- Institute of Tropical Medicine, University Hospital Tuebingen, Tuebingen,
Germany
| | - Jana Held
- Institute of Tropical Medicine, University Hospital Tuebingen, Tuebingen,
Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University Hospital Tuebingen, Tuebingen,
Germany
- Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital,
Lambaréné, Gabon
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38
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Held J, Supan C, Salazar CLO, Tinto H, Bonkian LN, Nahum A, Sié A, Abdulla S, Cantalloube C, Djeriou E, Bouyou-Akotet M, Ogutu B, Mordmüller B, Kreidenweiss A, Siribie M, Sirima SB, Kremsner PG. Safety and efficacy of the choline analogue SAR97276 for malaria treatment: results of two phase 2, open-label, multicenter trials in African patients. Malar J 2017; 16:188. [PMID: 28472957 PMCID: PMC5418711 DOI: 10.1186/s12936-017-1832-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 01/30/2017] [Accepted: 04/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria remains one of the most important infectious diseases. Treatment options for severe malaria are limited and the choline analogue SAR97276A is a novel chemical entity that was developed primarily as treatment for severe malaria. Before starting clinical investigations in severely ill malaria patients, safety and efficacy of SAR97276A was studied in patients with uncomplicated malaria. Here, we summarize two open-label, multi-center phase 2 trials assessing safety and efficacy of parenterally administered SAR97276A in African adults and children with falciparum malaria. RESULTS Study 1 was conducted in Burkina Faso, Gabon, Benin and Tanzania between August 2008 and July 2009 in malaria patients in an age de-escalating design (adults, children). A total of 113 malaria patients received SAR97276A. Adults were randomized to receive a single dose SAR97296A given either intramuscularly (IM) (0.18 mg/kg) or intravenously (IV) (0.14 mg/kg). If a single dose was not efficacious a second adult group was planned to test a three dose regimen administered IM once daily for 3 days. Single dose SAR97276A showed insufficient efficacy in adults (IM: 20 of 34 cured, 59%; and IV: 23/30 cured, 77%). The 3-day IM regimen showed acceptable efficacy in adults (27/30, 90%) but not in children (13/19, 68%). SAR97276A was well tolerated but no further groups were recruited due lack of efficacy. Study 2 was conducted between October 2011 and January 2012 in Burkina Faso, Gabon and Kenya. SAR97276A administered at a higher dose given IM was compared to artemether-lumefantrine. The study population was restricted to underage malaria patients to be subsequently enrolled in two age cohorts (teenagers, children). Rescue therapy was required in all teenaged malaria patients (8/8) receiving SAR97276A once daily (0.5 mg/kg) for 3 days and in 5 out of 8 teenaged patients treated twice daily (0.25 mg/kg) for 3 days. All patients (4/4) in the control group were cured. The study was stopped, before enrollment of children, due to lack of efficacy but the overall safety profile was good. CONCLUSIONS Monotherapy with SAR97276A up to twice daily for 3 days is not an efficacious treatment for falciparum malaria. SAR97276A will not be further developed for the treatment of malaria. Trial registration at clinicaltrials.gov: NCT00739206, retrospectively registered August 20, 2008 for Study 1 and NCT01445938 registered September 26, 2011 for Study 2.
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Affiliation(s)
- Jana Held
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany. .,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon. .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany.
| | - Christian Supan
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Carmen L Ospina Salazar
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | | | - Alain Nahum
- Centre de Recherche Entomologique de Cotonou, Cotonou, Benin
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Salim Abdulla
- Ifakara Health Research Center, Bagamoyo, United Republic of Tanzania
| | | | | | - Marielle Bouyou-Akotet
- Département de Parasitologie, Mycologie, Médecine Tropicale, Université des Sciences de la Santé, Libreville, Gabon
| | | | - Benjamin Mordmüller
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany
| | | | - Sodiomon B Sirima
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Peter G Kremsner
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany. .,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon. .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany.
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Abstract
INTRODUCTION Malaria is a major health problem in endemic countries and chemotherapy remains the most important tool in combating it. Treatment options are limited and essentially rely on a single drug class - the artemisinins. Efforts are ongoing to restrict the evolving threat of artemisinin resistance but declining sensitivity has been reported. Fueled by the ambitious aim of malaria eradication, novel antimalarial compounds, with improved properties, are now in the progressive phase of drug development. AREAS COVERED Herein, the authors describe antimalarial compounds currently in Phase II clinical development and present the results of these investigations. EXPERT OPINION Thanks to recent efforts, a number of promising antimalarial compounds are now in the pipeline. First safety data have been generated for all of these candidates, although their efficacy as antimalarials is still unclear for most of them. Of particular note are KAE609, KAF156 and DSM265, which are of chemical scaffolds new to malaria chemotherapy and would truly diversify antimalarial options. Apart from SAR97276, which also has a novel chemical scaffold that has had its development stopped, all other compounds in the pipeline belong to already known substance classes, which have been chemically modified. At this moment in time, there is not one standout compound that will revolutionize malaria treatment but several compounds that will add to its control in the future.
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Affiliation(s)
- Jana Held
- Institut für Tropenmedizin, Eberhard Karls Universität , Wilhelmstraße 27, D-72074 Tübingen , Germany +49 7071 29 85569 ; +49 7071 295189 ;
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Gehringer C, Kreidenweiss A, Flamen A, Antony JS, Grobusch MP, Bélard S. Molecular Evidence ofWolbachiaEndosymbiosis inMansonella perstansin Gabon, Central Africa. J Infect Dis 2014; 210:1633-8. [DOI: 10.1093/infdis/jiu320] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kreidenweiss A, Hopkins AV, Mordmüller B. 2A and the auxin-based degron system facilitate control of protein levels in Plasmodium falciparum. PLoS One 2013; 8:e78661. [PMID: 24236031 PMCID: PMC3827281 DOI: 10.1371/journal.pone.0078661] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/23/2013] [Indexed: 11/19/2022] Open
Abstract
Analysis of gene function in Plasmodium falciparum, the most important human malaria parasite, is restricted by the lack of robust and simple reverse genetic tools. Approaches to manipulate protein levels post-translationally are powerful tools to study protein-off effects especially in the haploid malaria parasite where genetic knockouts of essential genes are lethal. We investigated if the auxin-inducible degron system is functional in P. falciparum and found that degron-tagged yellow fluorescent protein levels were efficiently reduced upon addition of auxin which otherwise had no effect on parasite viability. The genetic components required in this conditional approach were co-expressed in P. falciparum by applying the small peptide 2A. 2A is a self-processing peptide from Foot-And-Mouth Disease virus that allows the whole conditional system to be accommodated on a single plasmid vector and ensures stoichiometric expression levels.
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Affiliation(s)
- Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- * E-mail:
| | - Annika V. Hopkins
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
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Abstract
INTRODUCTION The development of new antimalarial drugs remains of the utmost importance, since Plasmodium falciparum has developed resistance against nearly all chemotherapeutics in clinical use. In an effort to contain the resistance of P. falciparum against artemisinins and to further eradication efforts, studies are ongoing to identify novel and more efficacious approaches to develop antimalarials. AREAS COVERED The authors review the classical and new approaches to antimalarial drug discovery, with a special emphasis on the various stages of the parasite's life cycle and the different Plasmodium species. The authors discuss the methodologies and strategies for early efficacy testing that aim to narrow down the portfolio of promising compounds. EXPERT OPINION The increased efforts in the discovery and development of new antimalarial compounds have led to the recognition of new promising hits. However, there is still major roadblock of selecting the most promising compounds and then further testing them in early clinical trials, especially in the current restricted economy. Controlled human malaria infection has much potential for speeding-up the early development process of many drug candidates including those which target the pre-erythrocytic stages.
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Affiliation(s)
- Jana Held
- University of Tübingen, Institute of Tropical Medicine , Wilhelmstraße 27, D-72074 Tübingen , Germany +49 7071 29 82364 ; +49 7071 295189 ;
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Fendel R, Brandts C, Rudat A, Kreidenweiss A, Steur C, Appelmann I, Ruehe B, Schröder P, Berdel WE, Kremsner PG, Mordmüller B. Hemolysis is associated with low reticulocyte production index and predicts blood transfusion in severe malarial anemia. PLoS One 2010; 5:e10038. [PMID: 20386613 PMCID: PMC2850371 DOI: 10.1371/journal.pone.0010038] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 02/25/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Falciparum Malaria, an infectious disease caused by the apicomplexan parasite Plasmodium falciparum, is among the leading causes of death and morbidity attributable to infectious diseases worldwide. In Gabon, Central Africa, one out of four inpatients have severe malarial anemia (SMA), a life-threatening complication if left untreated. Emerging drug resistant parasites might aggravate the situation. This case control study investigates biomarkers of enhanced hemolysis in hospitalized children with either SMA or mild malaria (MM). METHODS AND FINDINGS Ninety-one children were included, thereof 39 SMA patients. Strict inclusion criteria were chosen to exclude other causes of anemia. At diagnosis, erythrophagocytosis (a direct marker for extravascular hemolysis, EVH) was enhanced in SMA compared to MM patients (5.0 arbitrary units (AU) (interquartile range (IR): 2.2-9.6) vs. 2.1 AU (IR: 1.3-3.9), p<0.01). Furthermore, indirect markers for EVH, (i.e. serum neopterin levels, spleen size enlargement and monocyte pigment) were significantly increased in SMA patients. Markers for erythrocyte ageing, such as CD35 (complement receptor 1), CD55 (decay acceleration factor) and phosphatidylserine exposure (annexin-V-binding) were investigated by flow cytometry. In SMA patients, levels of CD35 and CD55 on the red blood cell surface were decreased and erythrocyte removal markers were increased when compared to MM or reconvalescent patients. Additionally, intravascular hemolysis (IVH) was quantified using several indirect markers (LDH, alpha-HBDH, haptoglobin and hemopexin), which all showed elevated IVH in SMA. The presence of both IVH and EVH predicted the need for blood transfusion during antimalarial treatment (odds ratio 61.5, 95% confidence interval (CI): 8.9-427). Interestingly, this subpopulation is characterized by a significantly lowered reticulocyte production index (RPI, p<0.05). CONCLUSIONS Our results show the multifactorial pathophysiology of SMA, whereby EVH and IVH play a particularly important role. We propose a model where removal of infected and non-infected erythrocytes of all ages (including reticulocytes) by EVH and IVH is a main mechanism of SMA. Further studies are underway to investigate the mechanism and extent of reticulocyte removal to identify possible interventions to reduce the risk of SMA development.
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Affiliation(s)
- Rolf Fendel
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Department of Pharmacology, University of Illinois College of Medicine, Chicago, Illinois, United States of America
| | - Christian Brandts
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Department of Medicine, Hematology/Oncology, University of Münster, Münster, Germany
- Department of Medicine, Hematology/Oncology, Goethe-University, Frankfurt, Germany
| | - Annika Rudat
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Department of Medicine, Hematology/Oncology, University of Münster, Münster, Germany
| | - Andrea Kreidenweiss
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Claudia Steur
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
| | - Iris Appelmann
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Department of Medicine, Hematology/Oncology, University of Münster, Münster, Germany
| | - Bettina Ruehe
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
| | - Paul Schröder
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
| | - Wolfgang E. Berdel
- Department of Medicine, Hematology/Oncology, University of Münster, Münster, Germany
| | - Peter G. Kremsner
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Benjamin Mordmüller
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- * E-mail:
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Kreidenweiss A, Kremsner PG, Mordmüller B. Comprehensive study of proteasome inhibitors against Plasmodium falciparum laboratory strains and field isolates from Gabon. Malar J 2008; 7:187. [PMID: 18816382 PMCID: PMC2569964 DOI: 10.1186/1475-2875-7-187] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 09/24/2008] [Indexed: 11/15/2022] Open
Abstract
Background The emergence and spread of Plasmodium falciparum resistance to almost all available antimalarial drugs necessitates the search for new chemotherapeutic compounds. The ubiquitin/proteasome system plays a major role in overall protein turnover, especially in fast dividing eukaryotic cells including plasmodia. Previous studies show that the 20S proteasome is expressed and catalytically active in plasmodia and treatment with proteasome inhibitors arrests parasite growth. This is the first comprehensive screening of proteasome inhibitors with different chemical modes of action against laboratory strains of P. falciparum. Subsequently, a selection of inhibitors was tested in field isolates from Lambaréné, Gabon. Methods Epoxomicin, YU101, YU102, MG132, MG115, Z-L3-VS, Ada-Ahx3-L3-VS, lactacystin, bortezomib (Velcade®), gliotoxin, PR11 and PR39 were tested and compared to chloroquine- and artesunate-activities in a standardized in vitro drug susceptibility assay against P. falciparum laboratory strains 3D7, D10 and Dd2. Freshly obtained field isolates from Lambaréné, Gabon, were used to measure the activity of chloroquine, artesunate, epoxomicin, MG132, lactacystin and bortezomib. Parasite growth was detected through histidine-rich protein 2 (HRP2) production. Raw data were fitted by a four-parameter logistic model and individual inhibitory concentrations (50%, 90%, and 99%) were calculated. Results Amongst all proteasome inhibitors tested, epoxomicin showed the highest activity in chloroquine-susceptible (IC50: 6.8 nM [3D7], 1.7 nM [D10]) and in chloroquine-resistant laboratory strains (IC50: 10.4 nM [Dd2]) as well as in field isolates (IC50: 8.5 nM). The comparator drug artesunate was even more active (IC50: 1.0 nM), whereas all strains were chloroquine-resistant (IC50: 113 nM). Conclusion The peptide α',β'-epoxyketone epoxomicin is highly active against P. falciparum regardless the grade of the parasite's chloroquine susceptibility. Therefore, inhibition of the proteasome is a highly promising strategy to develop new antimalarials. Epoxomicin can serve as a standard to compare new inhibitors with species-specific activity.
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Fendel R, Mordmüller B, Kreidenweiss A, Rudat A, Steur C, Ambrosch C, Kirstein M, Berdel WE, Kremsner PG, Brandts C. New method to quantify erythrophagocytosis by autologous monocytes. Cytometry A 2007; 71:258-64. [PMID: 17342773 DOI: 10.1002/cyto.a.20360] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anemia is the net result of decreased red blood cell (RBC) production and increased removal of RBCs. Replication and maturation of erythroid precursors and RBC lysis can be measured by standardized in vitro methods and surrogate markers, respectively. In contrast, erythrophagocytosis by autologous phagocytes is more difficult to quantify. METHODS We developed a method to assess erythrophagocytosis by autologous monocytes from 5 ml of whole blood. RBCs were labeled with carboxyfluorescein-diacetate-succinimidyl ester (CFDA-SE) and subsequently coincubated with autologous CD14(+) monocytes. Phagocytosis was quantified using flow cytometry. After standardization, the assay was validated in patients with severe malarial anemia (SMA), a condition that is associated with increased erythrophagocytosis. RESULTS After labeling, CFDA-SE was stably incorporated into RBCs and no significant leakage leading to contamination of nonlabeled cells was observed. Monocytes ingested opsonized, labeled RBCs seven times more than nonopsonized controls. Erythrophagocytosis was significantly higher in SMA than in healthy controls. CONCLUSIONS The established assay showed enhanced autoerythrophagocytosis associated with SMA and hence was able to detect clinically relevant erythrophagocytosis. This novel assay is well suited for rapid quantification of in vitro erythrophagocytosis by autologous monocytes.
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Affiliation(s)
- Rolf Fendel
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
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Kreidenweiss A, Kremsner PG, Dietz K, Mordmüller B. In vitro activity of ferroquine (SAR97193) is independent of chloroquine resistance in Plasmodium falciparum. Am J Trop Med Hyg 2006; 75:1178-81. [PMID: 17172389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Nowadays, chloroquine-resistant malaria appears in almost all endemic regions. Ferroquine is a derivative of chloroquine and shows good activity in vitro and in animal models, but the development of cross-resistance is of concern. We tested in vitro susceptibilities of Plasmodium falciparum field isolates from Gabon to ferroquine, chloroquine, and artesunate. As expected, chloroquine resistance was present in all parasite isolates (median 50% inhibitory concentration = 113 nmol/L). Ferroquine (1.94 nmol/L) and artesunate (0.96 nmol/L) were highly active, and no significant correlation between any of the three drugs was observed. In contrast to our findings, previous studies showed an association between chloroquine and ferroquine activities. We could reproduce this association by using different initial parasitemias, but analysis of covariance revealed that initial parasitemia and not parasite strain was the critical determinant for the correlation between chloroquine and ferroquine activities. We conclude that ferroquine is highly active in chloroquine-resistant parasites, and we anticipate no enhanced selection for resistance against ferroquine in chloroquine-resistant parasites.
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Mordmüller B, Fendel R, Kreidenweiss A, Gille C, Hurwitz R, Metzger WG, Kun JFJ, Lamkemeyer T, Nordheim A, Kremsner PG. Plasmodia express two threonine-peptidase complexes during asexual development. Mol Biochem Parasitol 2006; 148:79-85. [PMID: 16616382 DOI: 10.1016/j.molbiopara.2006.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Revised: 03/03/2006] [Accepted: 03/06/2006] [Indexed: 11/24/2022]
Abstract
Threonine-peptidases of the T1-family are multi-subunit complexes with broad substrate specificity. In eukaryotes, at least 14 genes encode subunits of the prototypic T1 threonine-peptidase, the proteasome. The proteasome determines the turnover of most proteins and thereby plays a fundamental role in diverse processes such as protein quality control, signal transduction, and cell cycle regulation. While eukaryotes and archaea possess a proteasome, bacteria generally express a second member of the T1-family, the proteasomal predecessor ClpQ/hslV that has a similar structure but is encoded by only one gene. The plasmodial genome is an exception because it encodes proteasomal subunits as well as a ClpQ/hslV-orthologe (Plasmodium falciparum-hslV; PfhslV). Structure, expression, and function of both types of peptidase-complex in P. falciparum are presently unknown. Our aim was to analyze both the coding sequences and derived proteins of both peptidase-complexes because highly specific and potent inhibitors can be designed against this class of enzymes. The proteasome was found expressed throughout the cell cycle, whereas PfhslV was detectable in schizonts and merozoites only. Treatment of P. falciparum with the threonine-peptidase inhibitor epoxomicin blocked two of three catalytically active proteasome subunits. This led to the accumulation of ubiquitinated proteins and, finally, to parasite death. In conclusion, we provide the first functional analysis of plasmodial threonine-peptidase-complexes and identify a lead compound for the development of a novel class of antimalarial drugs.
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Kreidenweiss A, Mordmüller B, Krishna S, Kremsner PG. Antimalarial activity of a synthetic endoperoxide (RBx-11160/OZ277) against Plasmodium falciparum isolates from Gabon. Antimicrob Agents Chemother 2006; 50:1535-7. [PMID: 16569877 PMCID: PMC1426938 DOI: 10.1128/aac.50.4.1535-1537.2006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OZ277 is a newly developed, fully synthetic endoperoxide antimalarial that we tested against field isolates from Gabon. A comparison of activities of OZ277 with artesunate, mefloquine, and chloroquine showed OZ277 to be highly active against all parasite isolates. Artesunate and mefloquine also showed potent antiparasitic activity, but all isolates were chloroquine resistant.
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Affiliation(s)
- Andrea Kreidenweiss
- Medical Research Laboratory, Albert Schweitzer Hospital, Lambaréné, Gabon, and Department of Parasitology, University of Tübingen, Wilhelmstr. 27, D-72074 Tübingen, Germany
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