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Cortopassi WA, Gunderson E, Annunciato Y, Silva A, dos Santos Ferreira A, Garcia Teles CB, Pimentel AS, Ramamoorthi R, Gazarini ML, Meneghetti MR, Guido R, Pereira DB, Jacobson MP, Krettli AU, Caroline C Aguiar A. Fighting Plasmodium chloroquine resistance with acetylenic chloroquine analogues. Int J Parasitol Drugs Drug Resist 2022; 20:121-128. [PMID: 36375339 PMCID: PMC9771834 DOI: 10.1016/j.ijpddr.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
Malaria is among the tropical diseases that cause the most deaths in Africa. Around 500,000 malaria deaths are reported yearly among African children under the age of five. Chloroquine (CQ) is a low-cost antimalarial used worldwide for the treatment of Plasmodium vivax malaria. Due to resistance mechanisms, CQ is no longer effective against most malaria cases caused by P. falciparum. The World Health Organization recommends artemisinin combination therapies for P. falciparum malaria, but resistance is emerging in Southeast Asia and some parts of Africa. Therefore, new medicines for treating malaria are urgently needed. Previously, our group identified the 4-aminoquinoline DAQ, a CQ analog containing an acetylenic bond in its side chain, which overcomes CQ resistance in K1 P. falciparum strains. In this work, the antiplasmodial profile, drug-like properties, and pharmacokinetics of DAQ were further investigated. DAQ showed no cross-resistance against standard CQ-resistant strains (e.g., Dd2, IPC 4912, RF12) nor against P. falciparum and P. vivax isolates from patients in the Brazilian Amazon. Using drug pressure assays, DAQ showed a low propensity to generate resistance. DAQ showed considerable solubility but low metabolic stability. The main metabolite was identified as a mono N-deethylated derivative (DAQM), which also showed significant inhibitory activity against CQ-resistant P. falciparum strains. Our findings indicated that the presence of a triple bond in CQ-analogues may represent a low-cost opportunity to overcome known mechanisms of resistance in the malaria parasite.
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Affiliation(s)
- Wilian A. Cortopassi
- Department of Pharmaceutical Chemistry, University of California, San Francisco, USA
| | - Emma Gunderson
- Department of Pharmaceutical Chemistry, University of California, San Francisco, USA
| | - Yasmin Annunciato
- Department of Biosciences, Federal University of São Paulo, Santos, SP, Brazil
| | - Antony.E.S. Silva
- Group of Catalysis and Chemical Reactivity Group, Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceió, AL, Brazil
| | | | | | - Andre S. Pimentel
- Department of Chemistry, Pontifical Catholic University of Rio de Janeiro, RJ, Brazil
| | | | - Marcos L Gazarini
- Department of Biosciences, Federal University of São Paulo, Santos, SP, Brazil
| | - Mario R. Meneghetti
- Group of Catalysis and Chemical Reactivity Group, Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceió, AL, Brazil
| | - Rafael.V.C. Guido
- São Carlos Institute of Physics, University of Sao Paulo, Av. João Dagnone, 1100 - Santa Angelina, São Carlos, SP, 13563-120, Brazil
| | - Dhelio B. Pereira
- Research Center in Tropical Medicine of Rondônia, Porto Velho, Rondônia, Brazil
| | - Matthew P. Jacobson
- Department of Pharmaceutical Chemistry, University of California, San Francisco, USA
| | - Antoniana U. Krettli
- Malaria Laboratory, René Rachou Research Center, FIOCRUZ, Belo Horizonte, MG, Brazil,Corresponding author.
| | - Anna Caroline C Aguiar
- Department of Biosciences, Federal University of São Paulo, Santos, SP, Brazil,São Carlos Institute of Physics, University of Sao Paulo, Av. João Dagnone, 1100 - Santa Angelina, São Carlos, SP, 13563-120, Brazil,Corresponding author.Department of Biosciences, Federal University of São Paulo, Santos, SP, Brazil.
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Determination of the Plasma Protein Binding of Liraglutide Using the EScalate Equilibrium Shift Assay. J Pharm Sci 2019; 108:1309-1314. [DOI: 10.1016/j.xphs.2018.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/22/2022]
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Devineni D, Polidori D. Clinical Pharmacokinetic, Pharmacodynamic, and Drug–Drug Interaction Profile of Canagliflozin, a Sodium-Glucose Co-transporter 2 Inhibitor. Clin Pharmacokinet 2015; 54:1027-41. [DOI: 10.1007/s40262-015-0285-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Weiss HM, Gatlik E. Equilibrium Gel Filtration to Measure Plasma Protein Binding of Very Highly Bound Drugs. J Pharm Sci 2014; 103:752-9. [DOI: 10.1002/jps.23818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/22/2013] [Accepted: 11/22/2013] [Indexed: 12/25/2022]
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6
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Penrod LE, Allen JB, Cabacungan LR. Warfarin resistance and enteral feedings: 2 case reports and a supporting in vitro study. Arch Phys Med Rehabil 2001; 82:1270-3. [PMID: 11552202 DOI: 10.1053/apmr.2001.23848] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study investigated whether an interaction between common enteral feeding products and warfarin exists. Two clinical cases of apparent interaction spurred a supporting in vitro study. Both the clinical cases and the in vitro study showed that several enteral feeding products bind warfarin, reducing the bioavailability of the drug. The binding appears to occur between warfarin and the protein component of the feeding product. This clinically important interaction is likely when warfarin and enteral feeding products are used concurrently. Clinicians should be aware of this potential interaction and monitor the therapy closely, particularly when enteral feeding is discontinued.
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Affiliation(s)
- L E Penrod
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine. PA 15213, USA.
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White RH, Zhou H, Romano P, Mungall D. Changes in plasma warfarin levels and variations in steady-state prothrombin times. Clin Pharmacol Ther 1995; 58:588-93. [PMID: 7586953 DOI: 10.1016/0009-9236(95)90179-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine the relative contribution of changes in the plasma warfarin level to variation in the serial steady-state prothrombin times. METHODS This was a prospective observational cohort study performed at two outpatient anticoagulation clinics. Serial prothrombin times and paired plasma total warfarin levels were determined in a convenience sample of otherwise healthy patients who required long-term oral anticoagulation therapy with warfarin. RESULTS Serial measurements were obtained from 129 patients, 60 of whom provided three or more serial samples. Analysis of covariance showed a highly significant (p = 0.0001) relationship between the anticoagulant effect and the logarithm of the warfarin concentration (R2 = 0.75), with 15.3% of the total variance attributable to the effect of warfarin and 31.1% attributable to individual variation in sensitivity to warfarin. In an analysis of the subjects who had three or more serial measurements, the mean weighted correlation coefficient for the relationship between the logarithm of the warfarin concentration and the anticoagulant response varied widely, from strongly negative to strongly positive, and as the range of observed prothrombin times increased, stronger positive correlation was observed. CONCLUSIONS In this cohort, the plasma warfarin level was a strong predictor of observed changes in serial prothrombin time measurements. However, the correlation between clotting times and warfarin levels varied widely among subjects, particularly when the range of observed prothrombin times was moderate. This suggests that in these subjects, other factors, such as measurement error or pharmacodynamic changes, played a major role.
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Affiliation(s)
- R H White
- University of California, Davis, USA
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Joshi AS, Pieniaszek HJ, Quon CY, King SY. Plasma protein binding of highly bound drugs: implications of radiochemical impurities. J Pharm Sci 1994; 83:1187-8. [PMID: 7983608 DOI: 10.1002/jps.2600830823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Chan E, McLachlan AJ, Rowland M. Warfarin metabolites: stereochemical aspects of protein binding and displacement by phenylbutazone. Chirality 1993; 5:610-5. [PMID: 8305289 DOI: 10.1002/chir.530050808] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The in vitro human serum albumin binding characteristics of the enantiomers of the major metabolites of warfarin [6-hydroxywarfarin (6-HW), 7-hydroxywarfarin (7-HW), (S)-warfarin alcohols [(S,S)- and (S,R)-WA], and (R,S)-warfarin alcohol [(R,S)-WA]] have been studied, using a stereospecific HPLC assay. Warfarin metabolites are less bound both within plasma and a 40 g/liter solution of human serum albumin than the enantiomers of warfarin. The reduced warfarin metabolites have a lower fraction unbound [1.33% for (S,R)-WA, 2.09% for (S,S)-WA, and 1.04% for (R,S)-WA] than hydroxylated metabolites [3.24% for (R)-6-HW, 4.26% (S)-6-HW, 4.49% for (R)-7-HW and 4.27% for (S)-7-HW] to HSA. Phenylbutazone produced a concentration-dependent increase in the unbound fraction of all metabolites. It was possible to predict the unbound fraction of warfarin metabolites based on the unbound fraction of warfarin enantiomers.
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Affiliation(s)
- E Chan
- Department of Pharmacy, University of Manchester, England
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Riley D, Koves E. HPLC Identification and Quantitation of Warfarin in Postmortem Blood. CANADIAN SOCIETY OF FORENSIC SCIENCE JOURNAL 1992. [DOI: 10.1080/00085030.1992.10757010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Moulds RF, Fullinfaw RO, Bury RW, Plehwe WE, Jacka N, McGrath KM, Martin FI. Ponalrestat does not cause a protein binding interaction with warfarin in diabetic patients. Br J Clin Pharmacol 1991; 31:715-8. [PMID: 1907841 PMCID: PMC1368588 DOI: 10.1111/j.1365-2125.1991.tb05601.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Ponalrestat (Statil, ICI; Prodiax, Merck Sharp and Dohme) is an aldose reductase inhibitor which is highly protein bound. Ponalrestat markedly displaced warfarin from its protein binding in vitro at a concentration of 500 micrograms ml-1, but not at a concentration of 50 or 100 micrograms ml-1. Twelve diabetic patients (six males), age range 38-65 years, in receipt of chronic stable warfarin therapy, were given ponalrestat (600 mg daily) for 2 weeks in an open trial. A matching placebo tablet was administered for 1 week before and after the active treatment period. Patients were seen ten times (four times during the ponalrestat phase), and during the ponalrestat phase, plasma samples were also taken before and at 3 h after the daily dose of ponalrestat. At none of the visits was there any significant change in prothrombin ratio (INR), plasma total or unbound warfarin concentrations, or percentage protein binding of warfarin. No clinical complications of combination treatment were detected. The maximum ponalrestat concentration observed in the patients was approximately 100 micrograms ml-1. We conclude that no significant interaction between these drugs occurs at the doses of ponalrestat studied.
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Affiliation(s)
- R F Moulds
- Department of Clinical Pharmacology, Royal Melbourne Hospital, Victoria, Australia
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de Vries JX, Völker U. Determination of the plasma protein binding of the coumarin anticoagulants phenprocoumon and its metabolites, warfarin and acenocoumarol, by ultrafiltration and high-performance liquid chromatography. JOURNAL OF CHROMATOGRAPHY 1990; 529:479-85. [PMID: 2229265 DOI: 10.1016/s0378-4347(00)83858-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J X de Vries
- Abteilung für Klinische Pharmakologie, Universität Heidelberg, F.R.G
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Savell VH, Valente EJ, Eggleston DS. Synthesis of 13C warfarin labelled at the hemiketal carbon, and its resolution. J Labelled Comp Radiopharm 1989. [DOI: 10.1002/jlcr.2580270605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Levitt MD, Kneip JM, Levitt DG. Use of laminar flow and unstirred layer models to predict intestinal absorption in the rat. J Clin Invest 1988; 81:1365-9. [PMID: 3366899 PMCID: PMC442565 DOI: 10.1172/jci113464] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Carbon monoxide (CO) and [14C]warfarin were used to measure the preepithelial diffusion resistance resulting from poor luminal stirring (RL) in the constantly perfused rat jejunum at varying degrees of distension (0.05, 0.1, and 0.2 ml/cm). RL was much greater than epithelial cell resistance, indicating that poor stirring was the limiting factor in absorption and that an appropriate model of stirring should accurately predict absorption. A laminar flow model accurately predicted the absorption rate of both probes at all levels of gut distension, as well as the absorption of glucose when RL was the rate-limiting factor in absorption. In contrast, an unstirred layer model would not have predicted that gut distension would have little influence on absorption, and would have underestimated [14C]warfarin absorption relative to CO. We concluded that in the perfused rat jejunum, laminar flow accurately models luminal stirring and an unstirred layer should be considered to be a unit of resistance in laminar flow, rather than a model of luminal stirring.
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Affiliation(s)
- M D Levitt
- Research Service, Veterans Administration Medical Center, Minneapolis, Minnesota 55417
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Honoré B. Protein binding studies with radiolabeled compounds containing radiochemical impurities. Equilibrium dialysis versus dialysis rate determination. Anal Biochem 1987; 162:80-8. [PMID: 3605598 DOI: 10.1016/0003-2697(87)90012-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The influence of radiochemical impurities in dialysis experiments with high-affinity ligands is investigated. Albumin binding of labeled decanoate (97% pure) is studied by two dialysis techniques. It is shown that equilibrium dialysis is very sensitive to the presence of impurities resulting in erroneously low estimates of the binding affinity and in inconsistent results at varying albumin concentrations. Dialysis rate determination (R. Brodersen et al. (1982) Anal. Biochem. 121, 395-408) is less sensitive to impurities.
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Holford NH. Clinical pharmacokinetics and pharmacodynamics of warfarin. Understanding the dose-effect relationship. Clin Pharmacokinet 1986; 11:483-504. [PMID: 3542339 DOI: 10.2165/00003088-198611060-00005] [Citation(s) in RCA: 174] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The simplest complete system accounting for the time-course of changes in the prothrombin time induced by warfarin requires the combination of 4 independent models: A pharmacokinetic model for the absorption, distribution, and elimination of warfarin. Warfarin is essentially completely absorbed, reaching a maximum plasma concentration between 2 and 6 hours. It distributes into a small volume of distribution (10 L/70kg) and is eliminated by hepatic metabolism with a very small clearance (0.2 L/h/70kg). The elimination half-life is about 35 hours. A pharmacodynamic model for the effect of warfarin on the synthesis of clotting factors (prothrombin complex). Prothrombin complex synthesis is inhibited 50% at a warfarin concentration of about 1.5 mg/L. Warfarin concentrations associated with therapeutic anticoagulation are of similar magnitude. A physiological model for the synthesis and degradation of the prothrombin complex. The synthesis rate is about 5%/h/70kg and the elimination half-life estimated from changes in prothrombin time is approximately 17 hours. On average it will take 3 days for the anticoagulant effect of warfarin to reach a stable value when warfarin concentrations are constant. A model for the relationship between the activity of prothrombin complex and the prothrombin time. In general there is a hyperbolic relationship between these quantities. Its exact shape depends upon the method used for measuring the prothrombin time. Attempts to integrate these models into a single system have used essentially the same pharmacokinetic, physiological, and prothrombin activity models. Four distinct pharmacodynamic models have been proposed: linear, log-linear, power and Emax. One might be preferred on theoretical grounds (Emax) but its performance is not clearly different from the others. Empirical methods for warfarin dose prediction as well as those based on the combined pharmacokinetic-pharmacodynamic-physiological-prothrombin system have been proposed. Only one (which was also the first) [Sheiner 1969] has been adequately described and compared with the performance of an unaided physician. The programme compared favourably with decisions made by those physicians normally responsible for adjusting warfarin dose, but was not tested prospectively. A sizeable body of theoretical and experimental observations has contributed to our understanding of the warfarin dose-effect relationship. It remains to be demonstrated that any alternative method is superior to the traditional empirical approach to warfarin dose adjustment.
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Steyn JM, van der Merwe HM, de Kock MJ. Reversed-phase high-performance liquid chromatographic method for the determination of warfarin from biological fluids in the low nanogram range. JOURNAL OF CHROMATOGRAPHY 1986; 378:254-60. [PMID: 3733980 DOI: 10.1016/s0378-4347(00)80722-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Mungall DR, Ludden TM, Marshall J, Hawkins DW, Talbert RL, Crawford MH. Population pharmacokinetics of racemic warfarin in adult patients. JOURNAL OF PHARMACOKINETICS AND BIOPHARMACEUTICS 1985; 13:213-27. [PMID: 3841364 DOI: 10.1007/bf01065653] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The population pharmacokinetics of racemic warfarin was evaluated using 613 measured warfarin plasma concentrations from 32 adult hospitalized patients and 131 adult outpatients. Warfarin concentrations were measured in duplicate using a high-performance liquid chromatographic procedure. The pharmacokinetic model used was a one-compartment open model with first-order absorption (absorption rate constant set equal to 47 day-1) and first-order elimination. The extent of availability was assumed to be one. A linear regression model was used to evaluate the influence of various demographic factors on warfarin oral clearance. Age appeared to be an important determinant of warfarin clearance in this adult population. There was about a 1%/year decrease in oral clearance over the age range of 20-70 years. Smoking appeared to result in a 10% increase in warfarin clearance, while coadministration of the inducers phenytoin or phenobarbital yielded about a 30% increase in clearance. This study has yielded a predictive model that, when combined with appropriate pharmacological response data, may be useful in the design and adjustment of warfarin regimens.
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