Subacute therapeutic dosing of artemether-lumefantrine and artesunate-amodiaquine combination preserves plasma cholesterol, renal antioxidant status, and organ weights in rats

Baseline and recurrent exposure to the standard dose of artemisinin-based combination therapies (ACTs) induces oxidative stress and liver damage in mice (BALB/c)

Background

In malaria-endemic countries, repeated intake of artemisinin-based combination therapies (ACTs) is rampant and driven by drug resistance, improper usage, and easy accessibility. Stress effects and potential liver toxicity due to the frequent therapeutic use of ACTs have not been extensively studied. Here, we investigated the effects of repeated treatment with standard doses of the commonly used ACTs artemether/lumefantrine (A/L) and artesunate-amodiaquine (A/A) on oxidative stress and liver function markers in male mice (BALB/c).

Methods

Forty Five mice were divided into three groups: control, A/L, and A/A. The drugs were administered three days in a row per week, and the regimen was repeated every two weeks for a total of six cycles. The levels of oxidative stress and liver function markers were measured in both plasma and liver tissue after initial (baseline) and repeated exposures for the second, third, and sixth cycles.

Results

Exposure to A/L or A/A caused a significant (p < 0.001) increase in plasma malondialdehyde (MDA) levels after the first and repeated exposure periods. However, Hepatic MDA levels increased significantly (p < 0.01) only after the sixth exposure to A/A. Following either single or repeated exposure to A/L or A/A, plasma and liver glutathione peroxidase (GPx) and catalase (CAT) activities, plasma aspartate and alanine transaminase, alkaline phosphatase activity, and bilirubin levels increased, whereas total plasma protein levels decreased significantly (p < 0.001). Varying degrees of hepatocyte degeneration and blood vessel congestion were observed in liver tissues after a single or repeated treatment period.

Conclusion

Irrespective of single or repeated exposure to therapeutic doses of A/L or A/A, plasma oxidative stress and liver damage were observed. However, long-term repeated A/A exposure can led to hepatic stress. Compensatory processes involving GPx and CAT activities may help reduce the observed stress.

Fansidar drug induces cytotoxicity in some vital tissues in a rat model: combination defensive effect of selenium and zinc capsules

AIM

Fansidar (FAN) is widely used as an antimalarial drug, but it may cause hepatoxicity, nephrotoxicity, and neurotoxicity. Hence, the study examines the cytoprotection of selenium (Se) and zinc (Zn) tablets against FAN induced toxicity.

METHOD

Group I was given distilled water. Groups II, III, IV, and V received 50 mg/kg FAN by gavage. Group III was co-treated with a 50 mg/kg Se tablet. Group IV was co-treated with a 50 mg/kg Zn tablet. Group V was co-treated with a 50 mg/kg Se tablet + 50 mg/kg Zn tablet. The exposure lasted for 7 days (sub-acute exposure).

RESULT

FAN causes cytotoxicity through significant (p < 0.05) alteration of antioxidant molecules and hepatic enzymes. It also significantly (p < 0.05) induces renal, hepatocyte, and purkinje cell damage, but no visible lesion on testicular cells. The FAN induced cytotoxicity was significantly (p < 0.05) reversed on treatment with both single and combined antioxidant tablets.

CONCLUSION

Our study supports the view that antioxidant micronutrient (Se and Zn) tablets may be a useful modulator in alleviating FAN induced oxidative stress and cytotoxicity in male rats.

PLAIN LANGUAGE SUMMARY

Combined selenium and zinc capsules: better therapy against cytotoxicity Fansidar was approved by United States' Food and Drug Administration as an anti-malarial drug to treat acute and complicated malaria fever among patients in West Africa; however, its usage elicits toxicity to several organs of the body. It was elucidated that the combination of selenium and zinc capsules promotes organ wellness on co-treatment with Fansidar.

The Therapeutic Effect of Artemisinin and Its Derivatives in Kidney Disease

Artemisinin (ARS) and its derivatives (ARSs) are recommended as the first-line antimalarial drugs for the treatment of malaria. Besides antimalarial function, its potent anti-inflammatory and immunoregulatory properties, as well as the ability to regulate oxidative stress have brought them to a prominent position. As researchers around the world are continually exploring the unknown biological activities of ARS derivatives, experimental studies have shown much progress in renal therapy. This review aims to give a brief overview of the current research on ARSs applications for kidney treatment with the evaluation of therapeutic properties and potential molecular mechanisms.

Chemotherapeutic and prophylactic antimalarial drugs induce cell death through mitochondrial-mediated apoptosis in murine models

Malaria is a parasitic disease that has defied many treatment plans. This study was carried out to investigate the host mitochondrial response to malarial infection and selected antimalarial chemotherapy using murine models. The effects of artesunate (ART) and proguanil (PRG) on mitochondrial Permeability Transition (mPT), mitochondrial ATPase (mATPase), level of malondialdehyde (MDA) and activities of antioxidant enzymes; catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), Xanthine oxidase (XO), glutathione S-transferase (GST) and reduced glutathione (GSH) were estimated in Plasmodium berghei-infected mice treated with ART and PRG. Besides, apoptotic markers, such as caspases 3, 9 and DNA fragmentation were estimated. Unparasitised (NORMAL) and parasitized but untreated (PU) animals were used as controls. The mPT pore opening fold of 9 (ART), 3 (PRG), and 4 (PU) were observed relative to calcium (23) for in vivo study. In vitro, graded concentrations (20, 40, 80 and 160 μg/mL) of ART gave mPT induction folds of 1, 21, 23 and 25, respectively, relative to calcium (9) while PRG did not have effect in the absence of calcium. In vivo, ART significantly (p < 0.001) enhanced mATPase activity than PRG. The PRG and ART increased the MDA levels in vivo. Oral administration of ART and PRG altered antioxidant enzymes status, Caspases 3 and 9 were significantly activated in PRG-treated groups; there was significant increase in DNA fragmentation in PU and PRG groups compared with the normal control. The results obtained showed that malaria parasite and antimalarial drugs cause mitochondrial-mediated apoptosis.

Comparative analysis of the safety and tolerability of fixed-dose artesunate/amodiaquine versus artemether/lumefantrine combinations for uncomplicated falciparum malaria in pregnancy: a randomized open label study

A comparative clinical study was conducted to evaluate the safety and tolerability of two commonly used fixed dose artemisinin-based combinations for the treatment of uncomplicated Plasmodium falciparum malaria in the second and third trimester of pregnancy. To achieve this, a total of 155 participants were recruited for the study. Eighty of these were drawn from pregnant women who came for routine antenatal care while 40 nonpregnant participants were recruited from apparently healthy females in the community. Eighty pregnant participants with uncomplicated P. falciparum malaria were randomized into artesunate/amodiaquine (AA) and artemether/lumefantrine (AL) treatment arms while 40 nonpregnant and 35 nonmalarious pregnant women were used as control. The interventional groups received standard fixed dose combinations of AA (100/270 mg) daily or AL (20/120 mg) twice daily for 3 days. Blood samples were collected on day 4 and patients were followed-up closely to ascertain the safety of the drugs. The study showed a significant (p<0.0001) elevation of alkaline phosphatase in the AA and AL group compared to the nonpregnant control and a significant (p<0.05) elevation of alanine transaminase and aspartate transaminase level in the AL combination group when compared with the AA group. The elevated hepatic enzymes were within the normal range for pregnancy and were not clinically significant. Adverse event rate was higher in the AA group (n=28 [70%]) when compared to the AL group (n=4 [10%]) although the drugs were well-tolerated in both treatment arms. In conclusion, the use of these combinations is safe in the second and third trimester of pregnancy. However, we recommend active pharmacovigilance and spontaneous drug reporting of the agents in order to continuously monitor safety in the vastly heterogeneous population.