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Salazar YEAR, Louzada J, Puça MCSDB, Guimarães LFF, Vieira JLF, de Siqueira AM, Gil JP, de Brito CFA, de Sousa TN. Delayed gametocyte clearance in Plasmodium vivax malaria is associated with polymorphisms in the cytochrome P450 reductase (CPR). Antimicrob Agents Chemother 2024; 68:e0120423. [PMID: 38411047 PMCID: PMC10989009 DOI: 10.1128/aac.01204-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/31/2024] [Indexed: 02/28/2024] Open
Abstract
Primaquine (PQ) is the main drug used to eliminate dormant liver stages and prevent relapses in Plasmodium vivax malaria. It also has an effect on the gametocytes of Plasmodium falciparum; however, it is unclear to what extent PQ affects P. vivax gametocytes. PQ metabolism involves multiple enzymes, including the highly polymorphic CYP2D6 and the cytochrome P450 reductase (CPR). Since genetic variability can impact drug metabolism, we conducted an evaluation of the effect of CYP2D6 and CPR variants on PQ gametocytocidal activity in 100 subjects with P. vivax malaria. To determine gametocyte density, we measured the levels of pvs25 transcripts in samples taken before treatment (D0) and 72 hours after treatment (D3). Generalized estimating equations (GEEs) were used to examine the effects of enzyme variants on gametocyte densities, adjusting for potential confounding factors. Linear regression models were adjusted to explore the predictors of PQ blood levels measured on D3. Individuals with the CPR mutation showed a smaller decrease in gametocyte transcript levels on D3 compared to those without the mutation (P = 0.02, by GEE). Consistent with this, higher PQ blood levels on D3 were associated with a lower reduction in pvs25 transcripts. Based on our findings, the CPR variant plays a role in the persistence of gametocyte density in P. vivax malaria. Conceptually, our work points to pharmacogenetics as a non-negligible factor to define potential host reservoirs with the propensity to contribute to transmission in the first days of CQ-PQ treatment, particularly in settings and seasons of high Anopheles human-biting rates.
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Affiliation(s)
- Yanka Evellyn Alves Rodrigues Salazar
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Jaime Louzada
- Universidade Federal de Roraima, Boa Vista, Roraima, Brazil
| | - Maria Carolina Silva de Barros Puça
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Luiz Felipe Ferreira Guimarães
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | | | - André Machado de Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Pedro Gil
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Solna, Sweden
| | - Cristiana Ferreira Alves de Brito
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Tais Nobrega de Sousa
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Solna, Sweden
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2
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Abuter R, Allouche F, Amorim A, Bailet C, Berdeu A, Berger JP, Berio P, Bigioli A, Boebion O, Bolzer ML, Bonnet H, Bourdarot G, Bourget P, Brandner W, Cao Y, Conzelmann R, Comin M, Clénet Y, Courtney-Barrer B, Davies R, Defrère D, Delboulbé A, Delplancke-Ströbele F, Dembet R, Dexter J, de Zeeuw PT, Drescher A, Eckart A, Édouard C, Eisenhauer F, Fabricius M, Feuchtgruber H, Finger G, Förster Schreiber NM, Garcia P, Garcia Lopez R, Gao F, Gendron E, Genzel R, Gil JP, Gillessen S, Gomes T, Gonté F, Gouvret C, Guajardo P, Guieu S, Hackenberg W, Haddad N, Hartl M, Haubois X, Haußmann F, Heißel G, Henning T, Hippler S, Hönig SF, Horrobin M, Hubin N, Jacqmart E, Jocou L, Kaufer A, Kervella P, Kolb J, Korhonen H, Lacour S, Lagarde S, Lai O, Lapeyrère V, Laugier R, Le Bouquin JB, Leftley J, Léna P, Lewis S, Liu D, Lopez B, Lutz D, Magnard Y, Mang F, Marcotto A, Maurel D, Mérand A, Millour F, More N, Netzer H, Nowacki H, Nowak M, Oberti S, Ott T, Pallanca L, Paumard T, Perraut K, Perrin G, Petrov R, Pfuhl O, Pourré N, Rabien S, Rau C, Riquelme M, Robbe-Dubois S, Rochat S, Salman M, Sanchez-Bermudez J, Santos DJD, Scheithauer S, Schöller M, Schubert J, Schuhler N, Shangguan J, Shchekaturov P, Shimizu TT, Sevin A, Soulez F, Spang A, Stadler E, Sternberg A, Straubmeier C, Sturm E, Sykes C, Tacconi LJ, Tristram KRW, Vincent F, von Fellenberg S, Uysal S, Widmann F, Wieprecht E, Wiezorrek E, Woillez J, Zins G. A dynamical measure of the black hole mass in a quasar 11 billion years ago. Nature 2024; 627:281-285. [PMID: 38286342 DOI: 10.1038/s41586-024-07053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024]
Abstract
Tight relationships exist in the local Universe between the central stellar properties of galaxies and the mass of their supermassive black hole (SMBH)1-3. These suggest that galaxies and black holes co-evolve, with the main regulation mechanism being energetic feedback from accretion onto the black hole during its quasar phase4-6. A crucial question is how the relationship between black holes and galaxies evolves with time; a key epoch to examine this relationship is at the peaks of star formation and black hole growth 8-12 billion years ago (redshifts 1-3)7. Here we report a dynamical measurement of the mass of the black hole in a luminous quasar at a redshift of 2, with a look back in time of 11 billion years, by spatially resolving the broad-line region (BLR). We detect a 40-μas (0.31-pc) spatial offset between the red and blue photocentres of the Hα line that traces the velocity gradient of a rotating BLR. The flux and differential phase spectra are well reproduced by a thick, moderately inclined disk of gas clouds within the sphere of influence of a central black hole with a mass of 3.2 × 108 solar masses. Molecular gas data reveal a dynamical mass for the host galaxy of 6 × 1011 solar masses, which indicates an undermassive black hole accreting at a super-Eddington rate. This suggests a host galaxy that grew faster than the SMBH, indicating a delay between galaxy and black hole formation for some systems.
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Affiliation(s)
- R Abuter
- European Southern Observatory, Garching, Germany
| | - F Allouche
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - A Amorim
- Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
- CENTRA - Centro de Astrofísica e Gravitação, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisboa, Portugal
| | - C Bailet
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - A Berdeu
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - J-P Berger
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - P Berio
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - A Bigioli
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | - O Boebion
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - M-L Bolzer
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
- Department of Physics, Technical University Munich, Garching, Germany
- Univ. Lyon, Univ. Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon UMR5574, Saint-Genis-Laval, France
| | - H Bonnet
- European Southern Observatory, Garching, Germany
| | - G Bourdarot
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - P Bourget
- European Southern Observatory, Santiago, Chile
| | - W Brandner
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - Y Cao
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - R Conzelmann
- European Southern Observatory, Garching, Germany
| | - M Comin
- European Southern Observatory, Garching, Germany
| | - Y Clénet
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - B Courtney-Barrer
- European Southern Observatory, Santiago, Chile
- Research School of Astronomy and Astrophysics, College of Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - R Davies
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - D Defrère
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | - A Delboulbé
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | | | - R Dembet
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - J Dexter
- Department of Astrophysical & Planetary Sciences, JILA, University of Colorado Boulder, Boulder, CO, USA
| | | | - A Drescher
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - A Eckart
- Max Planck Institute for Radio Astronomy, Bonn, Germany
- 1st Institute of Physics, University of Cologne, Cologne, Germany
| | - C Édouard
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - F Eisenhauer
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - M Fabricius
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - H Feuchtgruber
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - G Finger
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | | | - P Garcia
- CENTRA - Centro de Astrofísica e Gravitação, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - R Garcia Lopez
- School of Physics, University College Dublin, Belfield, Dublin 4, Ireland
| | - F Gao
- Max Planck Institute for Radio Astronomy, Bonn, Germany
| | - E Gendron
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - R Genzel
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
- Departments of Physics, University of California, Berkeley, Berkeley, CA, USA
- Department of Astronomy, University of California, Berkeley, Berkeley, CA, USA
| | - J P Gil
- European Southern Observatory, Santiago, Chile
| | - S Gillessen
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - T Gomes
- CENTRA - Centro de Astrofísica e Gravitação, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - F Gonté
- European Southern Observatory, Garching, Germany
| | - C Gouvret
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - P Guajardo
- European Southern Observatory, Santiago, Chile
| | - S Guieu
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - W Hackenberg
- European Southern Observatory, Garching, Germany
| | - N Haddad
- European Southern Observatory, Santiago, Chile
| | - M Hartl
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - X Haubois
- European Southern Observatory, Santiago, Chile
| | - F Haußmann
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - G Heißel
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
- Advanced Concepts Team, European Space Agency, TEC-SF, ESTEC, Noordwijk, The Netherlands
| | - Th Henning
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - S Hippler
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - S F Hönig
- School of Physics and Astronomy, University of Southampton, Southampton, UK
| | - M Horrobin
- 1st Institute of Physics, University of Cologne, Cologne, Germany
| | - N Hubin
- European Southern Observatory, Garching, Germany
| | - E Jacqmart
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - L Jocou
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - A Kaufer
- European Southern Observatory, Santiago, Chile
| | - P Kervella
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - J Kolb
- European Southern Observatory, Garching, Germany
| | - H Korhonen
- European Southern Observatory, Santiago, Chile
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - S Lacour
- European Southern Observatory, Garching, Germany
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - S Lagarde
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - O Lai
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - V Lapeyrère
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - R Laugier
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | | | - J Leftley
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - P Léna
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - S Lewis
- European Southern Observatory, Garching, Germany
| | - D Liu
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - B Lopez
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - D Lutz
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - Y Magnard
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - F Mang
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
- Department of Physics, Technical University Munich, Garching, Germany
| | - A Marcotto
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - D Maurel
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - A Mérand
- European Southern Observatory, Garching, Germany
| | - F Millour
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - N More
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - H Netzer
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - H Nowacki
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - M Nowak
- Institute of Astronomy, University of Cambridge, Cambridge, UK
| | - S Oberti
- European Southern Observatory, Garching, Germany
| | - T Ott
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - L Pallanca
- European Southern Observatory, Santiago, Chile
| | - T Paumard
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - K Perraut
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - G Perrin
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - R Petrov
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - O Pfuhl
- European Southern Observatory, Garching, Germany
| | - N Pourré
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - S Rabien
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - C Rau
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - M Riquelme
- European Southern Observatory, Garching, Germany
| | - S Robbe-Dubois
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - S Rochat
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - M Salman
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | - J Sanchez-Bermudez
- Max Planck Institute for Astronomy, Heidelberg, Germany
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - D J D Santos
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - S Scheithauer
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - M Schöller
- European Southern Observatory, Garching, Germany
| | - J Schubert
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - N Schuhler
- European Southern Observatory, Santiago, Chile
| | - J Shangguan
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | | | - T T Shimizu
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany.
| | - A Sevin
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - F Soulez
- Univ. Lyon, Univ. Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon UMR5574, Saint-Genis-Laval, France
| | - A Spang
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - E Stadler
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - A Sternberg
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
- Center for Computational Astrophysics, Flatiron Institute, New York, NY, USA
| | - C Straubmeier
- 1st Institute of Physics, University of Cologne, Cologne, Germany
| | - E Sturm
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - C Sykes
- School of Physics and Astronomy, University of Southampton, Southampton, UK
| | - L J Tacconi
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | | | - F Vincent
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | | | - S Uysal
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - F Widmann
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - E Wieprecht
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - E Wiezorrek
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - J Woillez
- European Southern Observatory, Garching, Germany
| | - G Zins
- European Southern Observatory, Garching, Germany
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Thapar MM, Ursing J, Ashton M, Bergqvist Y, Gil JP, Björkman A. Ketoconazole increases atovaquone exposure following concomitant administration with Malarone® in healthy subjects. J Travel Med 2022; 29:6582523. [PMID: 35532299 DOI: 10.1093/jtm/taac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Mita M Thapar
- Principal PK Scientist, Quantitative Pharmacology & Pharmacometrics, Early Phase Services, ICON Clinical Research, Reading, UK
| | - Johan Ursing
- Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden
| | - Michael Ashton
- Unit for Pharmacokinetics and Drug Metabolism, Department of Pharmacology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | | | - José Pedro Gil
- Division of Parasitology, Department of Microbiology Tumour and Cell Biology (MTC), Karolinska Institute, Stockholm, Sweden
| | - Anders Björkman
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institute, Stockholm, Sweden
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Pernaute-Lau L, Camara M, Nóbrega de Sousa T, Morris U, Ferreira MU, Gil JP. An update on pharmacogenetic factors influencing the metabolism and toxicity of artemisinin-based combination therapy in the treatment of malaria. Expert Opin Drug Metab Toxicol 2022; 18:39-59. [PMID: 35285373 DOI: 10.1080/17425255.2022.2049235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Artemisinin-based combination therapies (ACTs) are recommended first-line antimalarials for uncomplicated Plasmodium falciparum malaria. Pharmacokinetic/pharmacodynamic variation associated with ACT drugs and their effect is documented. It is accepted to an extent that inter-individual variation is genetically driven, and should be explored for optimized antimalarial use. AREAS COVERED We provide an update on the pharmacogenetics of ACT antimalarial disposition. Beyond presently used antimalarials, we also refer to information available for the most notable next-generation drugs under development. The bibliographic approach was based on multiple Boolean searches on PubMed covering all recent publications since our previous review. EXPERT OPINION The last 10 years have witnessed an increase in our knowledge of ACT pharmacogenetics, including the first clear examples of its contribution as an exacerbating factor for drug-drug interactions. This knowledge gap is still large and is likely to widen as a new wave of antimalarial drug is looming, with few studies addressing their pharmacogenetics. Clinically useful pharmacogenetic markers are still not available, in particular, from an individual precision medicine perspective. A better understanding of the genetic makeup of target populations can be valuable for aiding decisions on mass drug administration implementation concerning region-specific antimalarial drug and dosage options.
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Affiliation(s)
- Leyre Pernaute-Lau
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Solna, Sweden.,Faculty of Sciences, BioISI - Biosystems & Integrative Sciences Institute, University of Lisbon, Lisbon, 1749-016, Portugal
| | - Mahamadou Camara
- Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, Malaria Research and Training Center, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Taís Nóbrega de Sousa
- Molecular Biology and Malaria Immunology Research Group, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Brasil
| | - Ulrika Morris
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Solna, Sweden
| | - Marcelo Urbano Ferreira
- Faculty of Sciences, BioISI - Biosystems & Integrative Sciences Institute, University of Lisbon, Lisbon, 1749-016, Portugal.,Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - José Pedro Gil
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Solna, Sweden.,Faculty of Sciences, BioISI - Biosystems & Integrative Sciences Institute, University of Lisbon, Lisbon, 1749-016, Portugal.,Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Portugal
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Baptista V, Costa MS, Calçada C, Silva M, Gil JP, Veiga MI, Catarino SO. The Future in Sensing Technologies for Malaria Surveillance: A Review of Hemozoin-Based Diagnosis. ACS Sens 2021; 6:3898-3911. [PMID: 34735120 DOI: 10.1021/acssensors.1c01750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/22/2022]
Abstract
Early and effective malaria diagnosis is vital to control the disease spread and to prevent the emergence of severe cases and death. Currently, malaria diagnosis relies on optical microscopy and immuno-rapid tests; however, these require a drop of blood, are time-consuming, or are not specific and sensitive enough for reliable detection of low-level parasitaemia. Thus, there is an urge for simpler, prompt, and accurate alternative diagnostic methods. Particularly, hemozoin has been increasingly recognized as an attractive biomarker for malaria detection. As the disease proliferates, parasites digest host hemoglobin, in the process releasing toxic haem that is detoxified into an insoluble crystal, the hemozoin, which accumulates along with infection progression. Given its magnetic, optical, and acoustic unique features, hemozoin has been explored for new label-free diagnostic methods. Thereby, herein, we review the hemozoin-based malaria detection methods and critically discuss their challenges and potential for the development of an ideal diagnostic device.
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Affiliation(s)
- Vitória Baptista
- Microelectromechanical Systems Research Unit (CMEMS-UMinho), School of Engineering, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- ICVS/3B’s − PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
| | - Mariana S. Costa
- Microelectromechanical Systems Research Unit (CMEMS-UMinho), School of Engineering, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal
| | - Carla Calçada
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- ICVS/3B’s − PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, 3004-504 Coimbra, Portugal
| | - Miguel Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- ICVS/3B’s − PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
| | - José Pedro Gil
- Stockholm Malaria Center, Department of Microbiology and Tumour Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Maria Isabel Veiga
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- ICVS/3B’s − PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
| | - Susana O. Catarino
- Microelectromechanical Systems Research Unit (CMEMS-UMinho), School of Engineering, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal
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6
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Abstract
The capacity of the lethal Plasmodium falciparum parasite to develop resistance against anti-malarial drugs represents a central challenge in the global control and elimination of malaria. Historically, the action of drug transporters is known to play a pivotal role in the capacity of the parasite to evade drug action. MRPs (Multidrug Resistance Protein) are known in many phylogenetically diverse groups to be related to drug resistance by being able to handle a large range of substrates, including important endogenous substances as glutathione and its conjugates. P. falciparum MRPs are associated with in vivo and in vitro altered drug response, and might be important factors for the development of multi-drug resistance phenotypes, a latent possibility in the present, and future, combination therapy environment. Information on P. falciparum MRPs is scattered in the literature, with no specialized review available. We herein address this issue by reviewing the present state of knowledge.
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Affiliation(s)
- José Pedro Gil
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Faculty of Sciences, BioISI-Biosystems and Integrative Sciences Institute, University of Lisbon, Lisbon, Portugal.,Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
| | - Cláudia Fançony
- Centro de Investigação em Saúde de Angola (CISA)/Instituto Nacional de Investigação em Saúde (INIS), Caxito, Angola
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7
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Ferreira MU, Nobrega de Sousa T, Rangel GW, Johansen IC, Corder RM, Ladeia-Andrade S, Gil JP. Monitoring Plasmodium vivax resistance to antimalarials: Persisting challenges and future directions. Int J Parasitol Drugs Drug Resist 2020; 15:9-24. [PMID: 33360105 PMCID: PMC7770540 DOI: 10.1016/j.ijpddr.2020.12.001] [Citation(s) in RCA: 25] [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] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022]
Abstract
Emerging antimalarial drug resistance may undermine current efforts to control and eliminate Plasmodium vivax, the most geographically widespread yet neglected human malaria parasite. Endemic countries are expected to assess regularly the therapeutic efficacy of antimalarial drugs in use in order to adjust their malaria treatment policies, but proper funding and trained human resources are often lacking to execute relatively complex and expensive clinical studies, ideally complemented by ex vivo assays of drug resistance. Here we review the challenges for assessing in vivo P. vivax responses to commonly used antimalarials, especially chloroquine and primaquine, in the presence of confounding factors such as variable drug absorption, metabolism and interaction, and the risk of new infections following successful radical cure. We introduce a simple modeling approach to quantify the relative contribution of relapses and new infections to recurring parasitemias in clinical studies of hypnozoitocides. Finally, we examine recent methodological advances that may render ex vivo assays more practical and widely used to confirm P. vivax drug resistance phenotypes in endemic settings and review current approaches to the development of robust genetic markers for monitoring chloroquine resistance in P. vivax populations. Plasmodium vivax resistance to chloroquine may undermine malaria elimination efforts. Plasmodium vivax resistance to schizontocides has been mostly monitored in therapeutic efficacy studies. In vivo studies to determine the anti-relapse efficacy of primaquine are challenging to design and execute. Ex vivo assays to determine Plasmodium vivax resistance to schizontocides remain limited to research settings. Robust molecular markers to monitor Plasmodium vivax drug resistance are currently lacking.
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Affiliation(s)
- Marcelo U Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil; Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal.
| | - Tais Nobrega de Sousa
- Molecular Biology and Malaria Immunology Research Group, René Rachou Institute, Fiocruz, Belo Horizonte, Brazil
| | - Gabriel W Rangel
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA, USA
| | - Igor C Johansen
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rodrigo M Corder
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Simone Ladeia-Andrade
- Laboratory of Parasitic Diseases, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - José Pedro Gil
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Solna, Sweden
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8
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Silva M, Ferreira PE, Otienoburu SD, Calçada C, Ngasala B, Björkman A, Mårtensson A, Gil JP, Veiga MI. Plasmodium falciparum K13 expression associated with parasite clearance during artemisinin-based combination therapy. J Antimicrob Chemother 2020; 74:1890-1893. [PMID: 30869127 DOI: 10.1093/jac/dkz098] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Delayed parasite clearance and, consequently, reduced efficacy of artemisinin-based combination therapies have been linked with Plasmodium falciparum K13 gene SNPs in Southeast Asia. In Africa, significantly prolonged clearance has not yet been observed and the presently restricted variation in parasite clearance cannot be explained by K13 polymorphisms. OBJECTIVES Our aim was to study the in vivo pfK13 transcriptional response in patients treated with artemether-lumefantrine and explore whether the pfk13 transcripts can explain the patients' parasite clearance outcomes. PATIENTS AND METHODS A total of 47 Tanzanian children with microscopically confirmed uncomplicated P. falciparum malaria were hospitalized and received artemether-lumefantrine treatment (clinical trial ID: NCT00336375). RNA was extracted from venous blood samples collected before treatment initiation and at five more timepoints after treatment. cDNA was synthesized and pfk13 transcripts measured by real-time PCR. RESULTS A wide range of pfk13 transcript variation was observed throughout all timepoints after artemether-lumefantrine treatment. Taking parasite clearance data together with the pfk13 transcripts profile, we observed a negative correlation inferring that pfk13 down-regulation is associated with longer parasite clearance time. CONCLUSIONS The findings suggest that a reduced PfK13 transcriptional response may represent a first step towards artemisinin tolerance/resistance.
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Affiliation(s)
- M Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Campus de Gualtar, Braga, Portugal
| | - P E Ferreira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Campus de Gualtar, Braga, Portugal
| | - S D Otienoburu
- Department of Computer Science and Engineering, Johnson C. Smith University, Charlotte, NC, USA
| | - C Calçada
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Campus de Gualtar, Braga, Portugal
| | - B Ngasala
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - A Björkman
- Malaria Research Unit, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - A Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - J P Gil
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.,Division of Pharmacogenetics, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Center for Biodiversity, Functional & Integrative Genomics, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - M I Veiga
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Campus de Gualtar, Braga, Portugal
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9
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Inoue J, Silva M, Fofana B, Sanogo K, Mårtensson A, Sagara I, Björkman A, Veiga MI, Ferreira PE, Djimde A, Gil JP. Plasmodium falciparum Plasmepsin 2 Duplications, West Africa. Emerg Infect Dis 2018; 24. [PMID: 29798744 PMCID: PMC6056108 DOI: 10.3201/eid2408.180370] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Dihydroartemisinin/piperaquine (DHA/PPQ) is increasingly deployed as antimalaria drug in Africa. We report the detection in Mali of Plasmodium falciparum infections carrying plasmepsin 2 duplications (associated with piperaquine resistance) in 7/65 recurrent infections within 2 months after DHA/PPQ treatment. These findings raise concerns about the long-term efficacy of DHA/PPQ treatment in Africa.
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Kiaco K, Rodrigues AS, do Rosário V, Gil JP, Lopes D. The drug transporter ABCB1 c.3435C>T SNP influences artemether-lumefantrine treatment outcome. Malar J 2017; 16:383. [PMID: 28934955 PMCID: PMC5609073 DOI: 10.1186/s12936-017-2006-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 06/19/2017] [Accepted: 08/30/2017] [Indexed: 01/05/2023] Open
Abstract
Malaria treatment performance is potentially influenced by pharmacogenetic factors. This study reports an association study between the ABCB1 c.3435C>T, CYP3A4*1B (g.-392A>G), CYP3A5*3 (g.6986A>G) SNPs and artemether + lumefantrine treatment outcome in 103 uncomplicated malaria patients from Angola. No significant associations with the CYP3A4*1B and CYP3A5*3 were observed, while a significant predominance of the ABCB1 c.3435CC genotype was found among the recurrent infection-free patients (p < 0.01), suggesting a role for this transporter in AL inter-individual performance.
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Affiliation(s)
- Kinanga Kiaco
- Unidade de Parasitologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal. .,Serviços de Saúde das Forças Armadas Angolanas, Estado Maior General das Forças Armadas, Luanda, Angola.
| | - António Sebastião Rodrigues
- Centre for Toxicogenomics and Human Health, Genetics, Oncology and Human Toxicology, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Virgílio do Rosário
- Unidade de Parasitologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - José Pedro Gil
- Drug Resistance Unit, Division of Pharmacogenetics, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Dinora Lopes
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.,Center for Biodiversity, Functional and Integrative Genomics, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
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11
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Vos K, Sciuto CL, Piedade R, Ashton M, Björkman A, Ngasala B, Mårtensson A, Gil JP. MRP2/ABCC2 C1515Y polymorphism modulates exposure to lumefantrine during artemether-lumefantrine antimalarial therapy. Pharmacogenomics 2017. [DOI: 10.2217/pgs-2017-0032] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: To investigate the potential involvement of the hepatic ATP-binding cassette transporters MRP2 and MDR1 in the disposition of lumefantrine (LUM) among patients with uncomplicated Plasmodium falciparum malaria. Materials & methods: The tag SNPs MDR1/ABCB1 C3435T and MRP2/ABCC2 C1515Y were determined in two artemether-LUM clinical trials, including a pharmacokinetic/pharmacodynamic study focused on the treatment phase (72 h), and an efficacy trial where day 7 (D7) LUM levels were measured. Results: The 1515YY genotype was significantly associated with higher (p < 0.01) LUM D7 concentrations (median 1.42 μM), compared with 0.77 μM for 1515CY and 0.59 μM for 1515CC. No significant influence of the MDR1/ABCB1 C3435T was found. Conclusion: LUM body disposition may be influenced by MRP2/ABCC2 genotype.
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Affiliation(s)
- Karin Vos
- Drug Resistance Unit, Division of Pharmacogenetics, Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Carlotta Lo Sciuto
- Drug Resistance Unit, Division of Pharmacogenetics, Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Rita Piedade
- Drug Resistance Unit, Division of Pharmacogenetics, Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Michael Ashton
- Unit for Pharmacokinetics & Drug Metabolism, Department of Pharmacology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anders Björkman
- Malaria Research Unit, Department of Microbiology, Tumour & Cell biology, Karolinska Institutet, Stockholm, Sweden
| | - Billy Ngasala
- Department of Parasitology, Muhimbili University of Health & Allied Sciences, Dar-es-Salaam, Tanzania
| | - Andreas Mårtensson
- Department of Women's & Children's Health, International Maternal & Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - José Pedro Gil
- Drug Resistance Unit, Division of Pharmacogenetics, Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Center for Biodiversity, Functional & Integrative Genomics, Faculdade de Ciências, Universidade de Lisboa, Portugal
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12
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13
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Fröberg G, Ferreira PE, Mårtensson A, Ali A, Björkman A, Gil JP. Assessing the cost-benefit effect of a Plasmodium falciparum drug resistance mutation on parasite growth in vitro. Antimicrob Agents Chemother 2013; 57:887-92. [PMID: 23208719 PMCID: PMC3553735 DOI: 10.1128/aac.00950-12] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 05/08/2012] [Accepted: 11/26/2012] [Indexed: 12/13/2022] Open
Abstract
Plasmodium falciparum mutations associated with antimalarial resistance may be beneficial for parasites under drug pressure, although they may also cause a fitness cost. We herein present an in vitro model showing how this combined effect on parasite growth varies with the drug concentration and suggest a calculated drug-specific cost-benefit index, indicating the possible advantage for mutated parasites. We specifically studied the D-to-Y change at position 1246 encoded by the pfmdr1 gene (pfmdr1 D1246Y) in relation to amodiaquine resistance. Susceptibilities to amodiaquine, desethylamodiaquine, and chloroquine, as well as relative fitness, were determined for two modified isogenic P. falciparum clones differing only in the pfmdr1 1246 position. Data were used to create a new comparative graph of relative growth in relation to the drug concentration and to calculate the ratio between the benefit of resistance and the fitness cost. Results were related to an in vivo allele selection analysis after amodiaquine or artesunate-amodiaquine treatment. pfmdr1 1246Y was associated with decreased susceptibility to amodiaquine and desethylamodiaquine but at a growth fitness cost of 11%. Mutated parasites grew less in low drug concentrations due to a predominating fitness cost, but beyond a breakpoint concentration they grew more due to a predominating benefit of increased resistance. The cost-benefit indexes indicated that pfmdr1 1246Y was most advantageous for amodiaquine-exposed parasites. In vivo, a first drug selection of mutant parasites followed by a fitness selection of wild-type parasites supported the in vitro data. This cost-benefit model may predict the risk for selection of drug resistance mutations in different malaria transmission settings.
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Affiliation(s)
- Gabrielle Fröberg
- Malaria Research Group, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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14
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Burk O, Piedade R, Ghebreghiorghis L, Fait JT, Nussler AK, Gil JP, Windshügel B, Schwab M. Differential effects of clinically used derivatives and metabolites of artemisinin in the activation of constitutive androstane receptor isoforms. Br J Pharmacol 2013; 167:666-81. [PMID: 22577882 DOI: 10.1111/j.1476-5381.2012.02033.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Widespread resistance to antimalarial drugs requires combination therapies with increasing risk of pharmacokinetic drug-drug interactions. Here, we explore the capacity of antimalarial drugs to induce drug metabolism via activation of constitutive androstane receptors (CAR) by ligand binding. EXPERIMENTAL APPROACH A total of 21 selected antimalarials and 11 major metabolites were screened for binding to CAR isoforms using cellular and in vitro CAR-coactivator interaction assays, combined with in silico molecular docking. Identified ligands were further characterized by cell-based assays and primary human hepatocytes were used to elucidate induction of gene expression. KEY RESULTS Only two artemisinin derivatives arteether and artemether, the metabolite deoxyartemisinin and artemisinin itself demonstrated agonist binding to the major isoforms CAR1 and CAR3, while arteether and artemether were also inverse agonists of CAR2. Dihydroartemisinin and artesunate acted as weak inverse agonists of CAR1. While arteether showed the highest activities in vitro, it was less active than artemisinin in inducing hepatic CYP3A4 gene expression in hepatocytes. CONCLUSIONS AND IMPLICATIONS Artemisinin derivatives and metabolites differentially affect the activities of CAR isoforms and of the pregnane X receptor (PXR). This negates a common effect of these drugs on CAR/PXR-dependent induction of drug metabolism and further provides an explanation for artemisinin consistently inducing cytochrome P450 genes in vivo, whereas arteether and artemether do not. All these drugs are metabolized very rapidly, but only artemisinin is converted to an enzyme-inducing metabolite. For better understanding of pharmacokinetic drug-drug interaction possibilities, the inducing properties of artemisinin metabolites should be considered.
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Affiliation(s)
- O Burk
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart and University of Tübingen, Germany.
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15
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Cavaco I, Hombhanje FW, Gil JP, Kaneko A. Frequency of the Functionally Relevant Aryl Hydrocarbon Receptor Repressor (AhRR) Pro185Ala SNP in Papua New Guinea. Drug Metab Pharmacokinet 2013; 28:519-21. [DOI: 10.2133/dmpk.dmpk-13-sc-035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Abstract
Amodiaquine (AQ) is a 4-aminoquinoline widely used in the treatment of malaria as part of the artemisinin combination therapy (ACT). AQ is metabolised towards its main metabolite desethylamodiaquine mainly by cytochrome P450 2C8 (CYP2C8). CYP1A1 and CYP1B1 play a minor role in the metabolism but they seem to be significantly involved in the formation of the short-lived quinine-imine. To complete the genetic variation picture of the main genes involved in AQ metabolism in the Zanzibar population, previously characterised for CYP2C8, we analysed in this study CYP1A1 and CYP1B1 main genetic polymorphisms. The results obtained show a low frequency of the CYP1A1*2B/C allele (2.4%) and a high frequency of CYP1B1*6 (approximately 42%) followed by CYP1B1*2 (approximately 27%) in Zanzibar islands. Genotype data for CYP1A1 and CYP1B1 show a low incidence of fast metabolisers, revealing a relatively safe genetic background in Zanzibar's population regarding the appearance of adverse effects.
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Affiliation(s)
- I Cavaco
- Institute of Biotechnology and Bioengineering, Center of Molecular and Structural Biomedicine, University of Algarve, Faro, Portugal.
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17
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Abstract
INTRODUCTION Plasmodium falciparum malaria is one of the world's most lethal infectious diseases, commanding millions of drug administrations per year. The pharmacogenetics of these drugs is poorly known, although its application can be pivotal for the optimized management of this disease. AREAS COVERED The main components of artemisinin combination therapy (ACT), the worldwide main antimalarial strategy, are metabolized by the polymorphic CYP3A4 (mefloquine, artemether, lumefantrine), CYP2C8 (amodiaquine), CYP2A6 (artesunate) and CYP1A1/2 (amodiaquine/desethylamodiaquine), with dihydroartemisinin being acted by Phase II UDP-glucuronosyltransferases. The worldwide adoption of ACT is leading to a large number of antimalarial treatments. Simultaneously, the feared development of parasite drug resistance might drive dosing increases. In these scenarios of increased drug exposure, pharmacogenetics can be a key tool supporting evidence-based medicine aiming for the longest possible useful lifespan of this important chemotherapy. EXPERT OPINION Translation in this moment is not operationally possible at an individual level, but large population studies are achievable for: i) the development of robust pharmacogenetics markers; and ii) the parallel development of a pharmacogenetic cartography of malaria settings. Advances in the understanding of antimalarial pharmacogenetics are urgent in order to protect the exposed populations, enhance the effectiveness of ACT and, consequently, contributing for the long aimed elimination of the disease.
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Affiliation(s)
- Rita Piedade
- Karolinska Institute, Division of Pharmacogenetics, Department of Physiology and Pharmacology, Stockholm, Sweden
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18
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Ferreira PE, Holmgren G, Veiga MI, Uhlén P, Kaneko A, Gil JP. PfMDR1: mechanisms of transport modulation by functional polymorphisms. PLoS One 2011; 6:e23875. [PMID: 21912647 PMCID: PMC3164660 DOI: 10.1371/journal.pone.0023875] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [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: 06/06/2011] [Accepted: 07/27/2011] [Indexed: 01/22/2023] Open
Abstract
ATP-Binding Cassette (ABC) transporters are efflux pumps frequently associated with multidrug resistance in many biological systems, including malaria. Antimalarial drug-resistance involves an ABC transporter, PfMDR1, a homologue of P-glycoprotein in humans. Twenty years of research have shown that several single nucleotide polymorphisms in pfmdr1 modulate in vivo and/or in vitro drug susceptibility. The underlying physiological mechanism of the effect of these mutations remains unclear. Here we develop structural models for PfMDR1 in different predicted conformations, enabling the study of transporter motion. Such analysis of functional polymorphisms allows determination of their potential role in transport and resistance. The bacterial MsbA ABC pump is a PfMDR1 homologue. MsbA crystals in different conformations were used to create PfMDR1 models with Modeller software. Sequences were aligned with ClustalW and analysed by Ali2D revealing a high level of secondary structure conservation. To validate a potential drug binding pocket we performed antimalarial docking simulations. Using aminoquinoline as probe drugs in PfMDR1 mutated parasites we evaluated the physiology underlying the mechanisms of resistance mediated by PfMDR1 polymorphisms. We focused on the analysis of well known functional polymorphisms in PfMDR1 amino acid residues 86, 184, 1034, 1042 and 1246. Our structural analysis suggested the existence of two different biophysical mechanisms of PfMDR1 drug resistance modulation. Polymorphisms in residues 86/184/1246 act by internal allosteric modulation and residues 1034 and 1042 interact directly in a drug pocket. Parasites containing mutated PfMDR1 variants had a significant altered aminoquinoline susceptibility that appears to be dependent on the aminoquinoline lipophobicity characteristics as well as vacuolar efflux by PfCRT. We previously described the in vivo selection of PfMDR1 polymorphisms under antimalarial drug pressure. Now, together with recent PfMDR1 functional reports, we contribute to the understanding of the specific structural role of these polymorphisms in parasite antimalarial drug response.
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Veiga MI, Ferreira PE, Schmidt BA, Ribacke U, Björkman A, Tichopad A, Gil JP. Antimalarial exposure delays Plasmodium falciparum intra-erythrocytic cycle and drives drug transporter genes expression. PLoS One 2010; 5:e12408. [PMID: 20811640 PMCID: PMC2928296 DOI: 10.1371/journal.pone.0012408] [Citation(s) in RCA: 24] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 08/04/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multi-drug resistant Plasmodium falciparum is a major obstacle to malaria control and is emerging as a complex phenomenon. Mechanisms of drug evasion based on the intracellular extrusion of the drug and/or modification of target proteins have been described. However, cellular mechanisms related with metabolic activity have also been seen in eukaryotic systems, e.g. cancer cells. Recent observations suggest that such mechanism may occur in P. falciparum. METHODOLOGY/PRINCIPAL FINDINGS We therefore investigated the effect of mefloquine exposure on the cell cycle of three P. falciparum clones (3D7, FCB, W2) with different drug susceptibilities, while investigating in parallel the expression of four genes coding for confirmed and putative drug transporters (pfcrt, pfmdr1, pfmrp1 and pfmrp2). Mefloquine induced a previously not described dose and clone dependent delay in the intra-erythrocytic cycle of the parasite. Drug impact on cell cycle progression and gene expression was then merged using a non-linear regression model to determine specific drug driven expression. This revealed a mild, but significant, mefloquine driven gene induction up to 1.5 fold. CONCLUSIONS/SIGNIFICANCE Both cell cycle delay and induced gene expression represent potentially important mechanisms for parasites to escape the effect of the antimalarial drug.
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Affiliation(s)
- Maria Isabel Veiga
- Malaria Research Lab, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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20
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Abstract
Some of the largest therapeutic drug exposures in the planet involve drugs employed against malaria and TB, two main global infectious diseases. Amodiaquine for malaria and isoniazid for TB are two pivotal drugs in the management of these diseases. Both drugs have been associated with severe adverse events. Amodiaquine and isoniazid are metabolized polymorphically by CYP2C8 and N-acetyltransferase 2, respectively. The polymorphic genes coding for these enzymes presently represent the best candidates for the application of personal pharmacogenetics for these diseases. We review the main reasons for this view, while asking the pivotal question of whether it is presently possible for pharmacogenetic-based personalized medicine to be applied in the malaria and TB settings of the Developing World.
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Affiliation(s)
- Pedro Eduardo Ferreira
- Malaria Research, Department of Medicine, Karolinska Institutet, Rätzius väg 10, plan 5, 171 77 Stockholm, Sweden. .,Institute of Biotechnology and Bioengineering, Centre of Molecular and Structural Biomedicine, University of Algarve, Portugal
| | - Isa Cavaco
- Institute of Biotechnology and Bioengineering, Centre of Molecular and Structural Biomedicine, University of Algarve, Portugal.,Section of Pharmacogenetics, Department of Physiology and Pharmacology, Karolinska Institutet, Sweden
| | - José Pedro Gil
- Malaria Research, Department of Medicine, Karolinska Institutet, Rätzius väg 10, plan 5, 171 77 Stockholm, Sweden. .,Institute of Biotechnology and Bioengineering, Centre of Molecular and Structural Biomedicine, University of Algarve, Portugal
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Dahlström S, Veiga MI, Ferreira P, Mårtensson A, Kaneko A, Andersson B, Björkman A, Gil JP. Diversity of the sarco/endoplasmic reticulum Ca(2+)-ATPase orthologue of Plasmodium falciparum (PfATP6). Infect Genet Evol 2008; 8:340-5. [PMID: 18359278 DOI: 10.1016/j.meegid.2008.02.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 02/11/2008] [Indexed: 11/18/2022]
Abstract
The sarco/endoplasmic reticulum Ca(2+)-ATPase orthologue of Plasmodium falciparum (PfATP6) has been suggested to be involved in the mechanism of action and resistance to artemisinins, the main constituent of artemisinin-based combination therapy (ACT). In previous studies only six single-nucleotide polymorphisms (SNPs) have been described in clinical samples and field isolates. Our aim was to sequence a large number of clinical samples with different geographical origins to further explore the natural diversity of PfATP6. We sequenced three genetic regions of PfATP6 in 388 samples from 17 countries, mainly Zanzibar and Tanzania, and identified 33 SNPs, of which 29 were non-synonymous and 4 synonymous. To our knowledge 29 of these SNPs have not been described previously. Three mutations were found in high frequency in Zanzibar and Tanzania; E431K, N569K and A630S were present in respectively 31% (95% CI, 26-37%), 36% (95% CI, 30-42%), and 2% (95% CI, 1-5%) of Zanzibar samples and in 39% (95% CI, 29-51%), 29% (95% CI, 16-45%) and 7% (95% CI, 1-22%) of the Tanzania Mainland samples. No variation was found in position 263, suggested to be involved in artemisinin binding to PfATP6, or in position 769, proposed to be related to decreased sensitivity to artemether in vitro. A considerable difference in diversity was observed between the three genetic regions. In conclusion our findings show that PfATP6 is a more diverse gene than previously demonstrated. This natural variation may constitute a starting ground for artemisinin-driven progressive selection of resistant parasites.
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Affiliation(s)
- Sabina Dahlström
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Holmgren G, Hamrin J, Svärd J, Mårtensson A, Gil JP, Björkman A. Selection of pfmdr1 mutations after amodiaquine monotherapy and amodiaquine plus artemisinin combination therapy in East Africa. Infection, Genetics and Evolution 2007; 7:562-9. [PMID: 17467344 DOI: 10.1016/j.meegid.2007.03.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 03/16/2007] [Accepted: 03/27/2007] [Indexed: 10/23/2022]
Abstract
Despite the pharmacodynamic advantages with artemisinin-based combination therapy (ACT) and some potentially opposite molecular mechanisms of tolerance to amodiaquine (AQ)/desethylamodiaquine (DEAQ) and artesunate (ART), there is a risk for rapid decay in efficacy if the two drugs are unable to ensure mutual prevention against a selection and spread of drug-resistant parasites. We have studied if mutations in the pfcrt and pfmdr1 genes selected in recurrent infections after AQ monotherapy are also selected after AQ plus ART combination therapy. Samples for molecular analysis were derived from three clinical trials on children<5 years old with uncomplicated Plasmodium falciparum malaria; one AQ monotherapy study conducted in Kenya 2003 and two AQ plus ART combination therapy studies conducted in Zanzibar 2002-2003 and 2005, respectively. The PCR-adjusted treatment failure rates in the three studies were 19%, 8% and 9%, respectively. After monotherapy there was a significant selection of pfcrt 76T in re-infections (OR not calculable; p=0.048) and of pfmdr1 86Y in recrudescent infections (OR 8.0; p=0.048). No such selection was found after combination therapy. A selection of pfmdr1 1246Y and the pfmdr1 haplotype (a.a 86, 184, 1246) YYY was found in recrudescent infections both after monotherapy (OR 7.6; p=0.009 and OR 3.1; p=0.029) and combination therapy in 2005 (OR 3.6; p=0.017 and OR 5.4; p<0.001). Hence, pfmdr1 1246Y with synergistic or compensatory addition of pfmdr1 86Y and 184Y appears to be involved in AQ/DEAQ resistance and treatment failure. Our results suggest that ART may protect against a selection of these SNPs initially, but maybe not after continuous drug pressure in a population. However, treatment failure rate and spread of pfmdr1 SNPs may remain at a low level because of the suggested opposite selection by ART and the pharmacodynamic advantages with ACT.
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Affiliation(s)
- Gabrielle Holmgren
- Malaria Research Laboratory, Unit of Infectious Diseases, Division of Medicine, Karolinska Institute, Stockholm, Sweden.
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Ursing J, Kofoed PE, Rodrigues A, Rombo L, Gil JP. Plasmodium falciparum genotypes associated with chloroquine and amodiaquine resistance in Guinea-Bissau. Am J Trop Med Hyg 2007; 76:844-8. [PMID: 17488902] [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: 05/15/2023] Open
Abstract
Chloroquine is the most commonly used antimalarial in Guinea-Bissau and high doses are routinely prescribed. Blood from 497 patients treated with different doses of chloroquine or amodiaquine were genotyped. Pfcrt and pfmdr1 polymorphisms were identified. Pfmsp2 analysis identified recrudescent infections. The pfcrt 72-76 haplotypes were CVIET and CVMNK. The pfcrt 76T prevalence was 23% at day 0 and 96%, 83% and 100% at recrudescence following treatment with 25 mg/kg and 50 mg/kg of chloroquine and 15 mg/kg of amodiaquine respectively. When treating pfcrt 76T carrying P. falciparum the efficacy of 50 mg/kg and 25 mg/kg of chloroquine was 78% and 34% respectively (P = 0.007). The genetic basis of chloroquine resistance is probably the same in Guinea-Bissau as in the rest of Africa. The low pfcrt 76T prevalence suggests that resistance to normal dose chloroquine does not confer a major advantage to falciparum in Bissau and could be a result of treatment with high-dose chloroquine.
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Affiliation(s)
- Johan Ursing
- Malaria Research Unit, Department of Infectious Diseases, Division of Medicine, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden.
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Ursing J, Schmidt BA, Lebbad M, Kofoed PE, Dias F, Gil JP, Rombo L. Chloroquine resistant P. falciparum prevalence is low and unchanged between 1990 and 2005 in Guinea-Bissau: an effect of high chloroquine dosage? Infect Genet Evol 2007; 7:555-61. [PMID: 17467343 DOI: 10.1016/j.meegid.2007.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 03/22/2007] [Accepted: 03/27/2007] [Indexed: 11/21/2022]
Abstract
Chloroquine resistant malaria was first reported in Guinea-Bissau in 1990 but chloroquine remains the most commonly used antimalarial in the country. Since 1990, we have conducted nearly annual standardized WHO in vitro micro-tests to assess chloroquine resistance. We have identified pfcrt 76T and other genetic polymorphisms in samples from 1992, 1993, 1995, 2004 and 2005. We have also monitored drug prescriptions for febrile illnesses. The mean proportion of in vitro tests indicating chloroquine resistance was 33% (range 14-54%) with the exception of an outlying value year 2000. The proportion of chloroquine resistant P. falciparum detected by in vitro testing did not increase over time. Pfcrt 76T was associated with chloroquine resistance but pfmdr1 86Y was not. The mean pfcrt 76T prevalence varied between 13% and 38%. The prevalence of SNPs at Pfcrt positions 76, 271, 326 and pfmdr1 position 86 did not change significantly between 1992 and 2005. In a health centre the median chloroquine dose prescribed for febrile illnesses between 1994 and 2003 was 63mg/kg. The genetic basis of chloroquine resistance appears to be the same in Guinea-Bissau as in other countries. Despite that, the prevalence of chloroquine resistant P. falciparum has not gradually increased between 1990 and 2005 in Guinea-Bissau. Chloroquine is commonly prescribed at more than double the normal dose in Guinea Bissau. It has previously been hypothesized that treatment with high doses of chloroquine may be effective. We discuss the possibility that the delayed spread of chloroquine resistant P. falciparum in Guinea-Bissau is the result of treatment with high and effective doses of chloroquine.
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Affiliation(s)
- Johan Ursing
- Malaria Research Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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Abstract
Malaria is a major infectious disease. In the last 10 years it has killed more than 20 million people, mainly small children in Africa. The highly efficacious artemisinine combination therapy is being launched globally, constituting the main hope for fighting the disease. Amodiaquine is a main partner in these combinations. Amodiaquine is almost entirely metabolized by the polymorphic cytochrome P450 (CYP) isoform 2C8 to the pharmacologically active desethylamodiaquine. The question remains whether the efficacy of amodiaquine is affected by the gene polymorphism. Genotype-inferred low metabolizers are found in 1-4% of African populations, which corresponds to millions of expected exposures to the drug. In vivo pharmacokinetic data on amodiaquine is limited. By combining it with published in vitro pharmacodynamic and drug metabolism information, we review and predict the possible relevance, or lack of, of CYP2C8 polymorphisms in the present and future efficacy of amodiaquine. Chloroquine and dapsone, both substrates of CYP2C8, are also discussed in the same context.
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Affiliation(s)
- J P Gil
- Karolinska Institute, Malaria Research Unit, Division of Infectious Diseases, Department of Medicine, Karolinska University Hospital, M9:02, KS 17176 Stockholm, Sweden.
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Abstract
OBJECTIVES Many countries are now adopting artemisinin-based combination therapy (ACT) for treatment of Plasmodium falciparum malaria. In multi-drug resistant areas in South East Asia amplifications of the pfmdr1 gene are frequent and tentatively associated with reduced susceptibility to the common quinoline partner drugs mefloquine and lumefantrine. In Africa where amodiaquine is one of the favoured quinoline partner drugs in ACT, studies on multi-drug resistance associated pfmdr1 gene amplifications are urgent. Our aim was to determine the current prevalence of pfmdr1 gene amplifications and a possible association between pfmdr1 gene copy number and amodiaquine treatment outcome in Kenya. METHODS Seventy-two children with Plasmodium falciparum infection in Kenya were treated with amodiaquine monotherapy and followed for 21 days. Possible amplification of the pfmdr1 gene was assessed from blood-spotted filterpaper by TaqMan probe based real-time polymerase chain reaction. RESULTS The recrudescent rate was 14 of 72 (19%). All children had single pfmdr1 copy infections, with the exception of one child who had an infection with two pfmdr1 copies. This child had an adequate treatment response. CONCLUSION Pfmdr1 amplifications do exist in Kenya but at a very low frequency. Yet, the substantial number of children with recrudescent infections implies that amodiaquine resistance is not related to pfmdr1 gene amplifications in Kenya.
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Affiliation(s)
- Gabrielle Holmgren
- Malaria Research Unit, Division of Infectious Diseases, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
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Veiga MI, Ferreira PE, Björkman A, Gil JP. Multiplex PCR–RFLP methods for pfcrt, pfmdr1 and pfdhfr mutations in Plasmodium falciparum. Mol Cell Probes 2006; 20:100-4. [PMID: 16460912 DOI: 10.1016/j.mcp.2005.10.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [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: 09/20/2005] [Accepted: 10/26/2005] [Indexed: 10/25/2022]
Abstract
Plasmodium falciparum drug resistance is a major factor for the death toll of malaria. Resistance has been associated with specific single nucleotide polymorphisms (SNPs) in the parasite genes pfmdr1 (N86Y) and pfcrt (K76T) associated with quionoline antimalarial resistance, and pfdhfr (N51I, C59R, S108N) correlated with resistance of the antifolate combination sulfadoxine-pyrimethamine. These SNPs constitute the basis for the surveillance of drug resistance through high sensitive molecular methods in malaria endemic countries. In this work, we developed a multiplex PCR-RFLP protocols for the diagnosis of these molecular markers, leading to significant decreases in reagent costs, time, number of manipulations and hence human resources.
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Affiliation(s)
- Maria Isabel Veiga
- Center of Molecular and Structural Biomedicine, Universidade do Algarve, Gambelas, Portugal
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Ursing J, Zakeri S, Gil JP, Björkman A. Quinoline resistance associated polymorphisms in the pfcrt, pfmdr1 and pfmrp genes of Plasmodium falciparum in Iran. Acta Trop 2006; 97:352-6. [PMID: 16490179 DOI: 10.1016/j.actatropica.2006.01.002] [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: 08/11/2005] [Revised: 12/28/2005] [Accepted: 01/04/2006] [Indexed: 10/25/2022]
Abstract
Plasmodium falciparum resistance to chloroquine (CQ) has been documented in Iran since the early 1980s and has since gradually increased. Iran is therefore reviewing its national drug policy for malaria control. We describe the prevalence of single nucleotide polymorphisms (SNP) associated with quinoline drug resistance in south eastern Iran. Pre-treatment blood from patients with uncomplicated but symptomatic P. falciparum infection was analysed. Polymorphisms at codons 76, 152, 163 and 220 of the pfcrt gene (chloroquine resistance transporter) and at codons 86, 184, 1034, 1042 and 1246 of the pfmdr1 gene (multidrug resistance) were determined by PCR-RFLP and sequencing. In addition, SNPs on a recently described multidrug resistance protein (pfmrp) and a microsatellite (MS-4760) in the pfnhe-1 (sodium hydrogen exchanger) gene associated with quinoline and quinine resistance, respectively, were investigated for the first time in field samples not from Thailand. pfcrt 76T was found in 99% and pfmdr1 86Y in 72% of the samples. pfmrp 191H and 437S associated with decreased quinoline response were found to be absolutely linked at a frequency of 13.6%. The pfnhe-1 MS-4760 one repeat allele associated to quinine response in vitro was also detected. Sequencing of the pfcrt 72-76 haplotype revealed that SVMNT was the most common allele as previously observed in India. This suggests that pfcrt found in the Iranian P. falciparum population may have the same origin as in the P. falciparum populations in India but different from that normally found in south east Asia. In conclusion, the frequencies of quinoline resistance associated gene polymorphisms in this region suggest a population that has been significantly selected for by the long use of CQ.
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Affiliation(s)
- J Ursing
- Malaria Research Unit, Division of Infectious Diseases, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Sweden
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Mariga ST, Gil JP, Wernsdorfer WH, Björkman A. Pharmacodynamic interactions of amodiaquine and its major metabolite desethylamodiaquine with artemisinin, quinine and atovaquone in Plasmodium falciparum in vitro. Acta Trop 2005; 93:221-31. [PMID: 15725382 DOI: 10.1016/j.actatropica.2005.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 03/22/2004] [Revised: 01/03/2005] [Accepted: 01/03/2005] [Indexed: 11/16/2022]
Abstract
The antimalarial in vitro activities of amodiaquine and desethylamodiaquine in combination with atovaquone, quinine and artemisinin against Plasmodium falciparum were investigated in strains F-32, FCR-3 and K-1. These parasitic strains have different sensitivity profiles to the standard antimalarial chloroquine, but all can be considered sensitive to the test drugs, representing the recommended situation for introduction of two partner drugs in combination therapy. Amodiaquine showed marked synergism when combined with each of the three partner compounds at concentration ratios between 90 and 9x10(-7), including the therapeutically relevant range. The interaction profiles of desethylamodiaquine with quinine and artemisinin also showed predominantly synergism over a wide range of concentration ratios between 70 and 9x10(-7). The responses to all combinations exhibited signs of strain-specificity, but such phenomena were usually observed outside the therapeutic range of the concentration ratios. Synergism was generally more marked with increasing EC values, i.e. at concentrations expected to be therapeutically effective and thus clinically relevant. Even trace quantities of amodiaquine were able to potentiate the activity of structurally unrelated antimalarial drugs.
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Affiliation(s)
- S T Mariga
- Department of Infectious Diseases, Malaria Research Laboratory, M9, Karolinska Hospital, Stockholm 17176, Sweden
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Cavaco I, Strömberg-Nörklit J, Kaneko A, Msellem MI, Dahoma M, Ribeiro VL, Bjorkman A, Gil JP. CYP2C8 polymorphism frequencies among malaria patients in Zanzibar. Eur J Clin Pharmacol 2005; 61:15-8. [PMID: 15785959 DOI: 10.1007/s00228-004-0871-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [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: 05/04/2004] [Accepted: 11/07/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The determination of the prevalence of the CYP2C8 main alleles in a typical set of malaria patients in Zanzibar, as these patients represent a typical population exposed to amodiaquine, an antimalarial mainly metabolized by CYP2C8. Also, to determine for the first time the frequencies of CYP2C8 alleles in native African populations. METHODS Polymerase chain reaction-restriction fragment polymorphism for the identification of CYP2C8*1, CYP2C8*2, CYP2C8*3 and CYP2C8*4 on a random population of 165 unrelated malaria patients. RESULTS The allele frequencies found were: CYP2C8*1 (wild type, 83.4%), CYP2C8*2 (13.9%), CYP2C8*3 (2.1%) and CYP2C8*4 (0.6%). In terms of genotypes, 70.4% of the patients showed the CYP2C8*1/ CYP2C8*1 genotypes, while heterozygous between the wild type and other minor alleles were seen in 26.0%. Finally, 3.6% of the patients were homozygous for slow metabolizer alleles. The frequencies observed are equivalent to those documented for African-Americans. CONCLUSIONS CYP2C8 non-wild type alleles have a significant prevalence in the East African population studied. The consequent frequency of 3.6% of patients homozygous for slow metabolizer alleles represent a significant fraction of the population potentially in higher risk of adverse effects due to a less efficient metabolism of amodiaquine. As approximately 10(6) first-line treatments are currently performed in Zanzibar per year, this represents a non-negligible absolute number of amodiaquine exposures. This information constitutes a background for the pharmacovigilance programs presently being employed in Zanzibar.
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Affiliation(s)
- I Cavaco
- Centre for Molecular and Structural Biomedicine, Universidade do Algarve, Campus de Gambelas, Faro, 8000-117, Portugal
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Mariga ST, Gil JP, Sisowath C, Wernsdorfer WH, Björkman A. Synergism between amodiaquine and its major metabolite, desethylamodiaquine, against Plasmodium falciparum in vitro. Antimicrob Agents Chemother 2004; 48:4089-96. [PMID: 15504826 PMCID: PMC525449 DOI: 10.1128/aac.48.11.4089-4096.2004] [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
The in vitro activity of the prodrug amodiaquine and its metabolite monodesethyl-amodiaquine has been studied for three strains of Plasmodium falciparum: LS-2, LS-3, and LS-1. Both compounds showed significant activity against all three strains; the activity of amodiaquine was slightly higher than that of the metabolite. By use of a checkerboard design, interaction studies with both compounds yielded evidence of significant synergism; means of the sums of the fractional inhibitory concentrations were 0.0392 to 0.0746 for strain LS-2, 0.1567 to 0.3102 for strain LS-3, and 0.025 to 0.3369 for strain LS-1. In further investigations, the interaction of amodiaquine with monodesethyl-amodiaquine was tested at clinically relevant concentrations of both compounds. In these studies, involving amodiaquine at picomolar and femtomolar concentrations, the compound was found to exert high potentiating activity on monodesethyl-amodiaquine. This interaction produced mean ratios of observed to expected activity of 0.0505 to 0.0642 for strain LS-2, 0.0882 to 0.3820 for strain LS-3, and 0.0752 to 0.2924 for strain LS-1. The synergistic activity was most marked at monodesethyl-amodiaquine/amodiaquine ratios up to 100,000:1 but was still evident at higher ratios.
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Affiliation(s)
- S T Mariga
- Department of Infectious Diseases, Karolinska Hospital, Stockholm 17176, Sweden
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Cravo P, Figueiredo S, Nogueira F, Lopes D, Ferreira ID, Ferreira C, Gil JP, do Rosario VE. High frequency of the genetic polymorphisms associated with sulfadoxine-pyrimethamine resistance, among Plasmodium falciparum isolates from São Tomé and Príncipe, West Africa. Ann Trop Med Parasitol 2004; 98:293-6. [PMID: 15119975 DOI: 10.1179/000349804225003262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- P Cravo
- Unidade de Biologia Molecular, Centro de Malária e Outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 96, 1349-008, Lisbon, Portugal.
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Gil JP, Nogueira F, Strömberg-Nörklit J, Lindberg J, Carrolo M, Casimiro C, Lopes D, Arez AP, Cravo PV, Rosário VE. Detection of atovaquone and Malarone resistance conferring mutations in Plasmodium falciparum cytochrome b gene (cytb). Mol Cell Probes 2003; 17:85-9. [PMID: 12788029 DOI: 10.1016/s0890-8508(03)00006-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Clinical treatment failures of the hydroxynaphthoquinone atovaquone or its combination with proguanil (Malarone) in Plasmodium falciparum malaria has been recently documented. These events have been associated to single nucleotide polymorphisms (SNPs) in the parasite cytochrome b gene (cytb). In this report we describe a set of nest PCR-RFLP methods developed for the fast detection of all known cytb mutations associated to resistance to these drugs. The methods were successfully applied for the analysis of phenol-chloroform extracted DNA samples from patients not cured by Malarone, and from an established parasite clone. Further, the protocol for the detection of the A803C mutation was applied to 164 DNA field samples extracted through crude methanol-based protocols, originated from several malaria settings. The PCR-RFLP methods here presented can be used as a valuable for the clinical detection and study of Malarone and atovaquone P. falciparum resistance.
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Affiliation(s)
- J P Gil
- UEI Malária, Centro de Malária e outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
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Lopes D, Nogueira F, Gil JP, Ferreira C, do Rosário VE, Cravo P. pfcrt and pfmdr1 mutations and chloroquine resistance in Plasmodium falciparum from São Tomé and Príncipe, West Africa. Ann Trop Med Parasitol 2002; 96:831-4. [PMID: 12625938 DOI: 10.1179/000349802125002284] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- D Lopes
- Centro de Malária e Outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 96, 1349-008, Lisbon, Portugal
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Lopes D, Rungsihirunrat K, Nogueira F, Seugorn A, Gil JP, do Rosário VE, Cravo P. Molecular characterisation of drug-resistant Plasmodium falciparum from Thailand. Malar J 2002; 1:12. [PMID: 12423551 PMCID: PMC149383 DOI: 10.1186/1475-2875-1-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [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: 06/28/2002] [Accepted: 10/14/2002] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The increasing levels of Plasmodium falciparum resistance to chloroquine (CQ) in Thailand have led to the use of alternative antimalarials, which are at present also becoming ineffective. In this context, any strategies that help improve the surveillance of drug resistance, become crucial in overcoming the problem. METHODS In the present study, we have established the in vitro sensitivity to CQ, mefloquine (MF), quinine (QUIN) and amodiaquine (AMQ) of 52 P. falciparum isolates collected in Thailand, and assessed the prevalence of four putative genetic polymorphisms of drug resistance, pfcrt K76T, pfmdr1 N86Y, pfmdr1 D1042N and pfmdr1 Y1246D, by PCR-RFLP. RESULTS The percentage of isolates resistant to CQ, MF, and AMQ was 96% (50/52), 62% (32/52), and 58% (18/31), respectively, while all parasites were found to be sensitive to QUIN. In addition, 41 (79%) of the isolates assayed were resistant simultaneously to more than one drug; 25 to CQ and MF, 9 to CQ and AMQ, and 7 to all three drugs, CQ, MF and AMQ. There were two significant associations between drug sensitivity and presence of particular molecular markers, i) CQ resistance / pfcrt 76T (P = 0.001), and ii) MF resistance / pfmdr1 86N (P < 0.001) CONCLUSIONS i) In Thailand, the high levels of CQ pressure have led to strong selection of the pfcrt 76T polymorphism and ii) pfmdr1 86N appears to be a good predictor of in vitro MF resistance.
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Affiliation(s)
- Dinora Lopes
- Centro de Malária e Outras Doenças Tropicais/IHMT/UNL, Rua da Junqueira, 96, 1349-008, Lisbon, Portugal
| | - Kanchana Rungsihirunrat
- Malaria Research Unit, Institute of Health Research, Chulalongkorn University, Bangkok 10330, Thailand
| | - Fátima Nogueira
- Centro de Malária e Outras Doenças Tropicais/IHMT/UNL, Rua da Junqueira, 96, 1349-008, Lisbon, Portugal
| | - Aree Seugorn
- Malaria Research Unit, Institute of Health Research, Chulalongkorn University, Bangkok 10330, Thailand
| | - José Pedro Gil
- Centro de Malária e Outras Doenças Tropicais/IHMT/UNL, Rua da Junqueira, 96, 1349-008, Lisbon, Portugal
- Present address: Malaria Research Laboratory, Division of Infectious Diseases, Institutionen för Medicin, Karolinska Institutet, Karolinska Sjukhuset, Malaria Research Laboratory L7, Plan 3, 17176 Stockholm, Sweden
| | - Virgilio E do Rosário
- Centro de Malária e Outras Doenças Tropicais/IHMT/UNL, Rua da Junqueira, 96, 1349-008, Lisbon, Portugal
| | - Pedro Cravo
- Centro de Malária e Outras Doenças Tropicais/IHMT/UNL, Rua da Junqueira, 96, 1349-008, Lisbon, Portugal
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Rocha L, Garcia C, de Mendonça A, Gil JP, Bishop DT, Lechner MC. N-acetyltransferase (NAT2) genotype and susceptibility of sporadic Alzheimer's disease. Pharmacogenetics 1999; 9:9-15. [PMID: 10208637] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The importance of environmental aggression and individual susceptibility to develop Alzheimer's Disease (AD) has been suggested by epidemiological studies on both typical familial and sporadic AD cases. In order to elucidate functions that can influence the susceptibility to AD pathogenesis, we genotyped a group of 53 sporadic late-onset AD patients, matched control individuals and a larger randomly selected non-demented population for the N-acetyltransferase (NAT2). We determined the relative frequencies of individual allele combinations that define a broad range of acetylator phenotypes. Inter-individual variability in the cytotoxic and genotoxic responses to a wide diversity of environmental chemicals is known to result from the polymorphism of NAT2 as well as other drug-metabolizing-enzyme genes. The results presented are the first to demonstrate a significant difference in the NAT2 genotype profiles of sporadic AD patients compared with the healthy population. A lower frequency of the recessive alleles NAT2*6 (chi-squared 1 d.f. = 12.56, P < 0.0004) and NAT2*5B (chi-squared 1 d.f. = 6.72, P < 0.01) was found among the AD population compared with control individuals, which was concomitant with a significantly higher number of NAT2*4 fully active allele homozygotes and heterozygotes (chi-squared 1 d.f. = 5.69, P = 0.017). The most notable observation was the absence of NAT2*5B/NAT2*6 heterozygotes among cases while being present in 22.5% of control individuals (chi-squared 1 d.f. = 13.08, P = 0.0003). These observations indicate that NAT2 is a potential low-penetrance gene in AD pathogenesis, determining an individual susceptibility trait predisposing to this degenerative disease.
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Affiliation(s)
- L Rocha
- Molecular Biology Unit, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
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Gil JP, Lechner MC. Increased frequency of wild-type arylamine-N-acetyltransferase allele NAT2*4 homozygotes in Portuguese patients with colorectal cancer. Carcinogenesis 1998; 19:37-41. [PMID: 9472690 DOI: 10.1093/carcin/19.1.37] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [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: 02/06/2023] Open
Abstract
Here we report that colorectal cancer patients show a markedly higher frequency (3-fold) of wild-type NAT2*4 allele homozygotes than the control population. However, a marked difference in NAT2*4/NAT2*4 genotype frequency associated with the patients gender was observed pointing to a male-specific effect of this genotype as a risk factor in colon cancer. The arylamine-N-acetyltransferase (E.C. 2.3.1.5.) NAT2, a phase II detoxification enzyme, has been implicated in procarcinogen activation, namely from food contained arylamines, cigarette smoking, as well as environmental amines of various types. NAT2 is encoded by a polymorphic gene presenting several allelic variants encoding partially inactive enzymes expressed in human liver and colon. Epidemiological studies based on phenotype determination have long indicated the importance of the NAT2 active phenotype as a susceptibility factor in colorectal cancer. In the present study we investigated the NAT2 allelic frequencies and genotype distribution in a group of 114 unrelated colorectal cancer patients, in parallel with 201 healthy Portuguese subjects. We first demonstrate that the frequency of the wild-type NAT2*4 allele in the Portuguese sample population (23.4%) does not significantly differ from the values described for other Europeans. Besides the 3-fold higher frequency of NAT2*4 homozygotes found in colorectal cancer subjects, the NAT2*4/NAT2*5A compound genotype, known to determine a faster acetylator phenotype than other heterozygotic combinations, also increased by the same order of magnitude. These two genotypes represent 32% of the patients population versus 11% of the healthy controls. Taken together, our results strongly indicate that NAT2 genotype, particularly NAT2*4 allele zygosity, constitutes an individual susceptibility trait associated with sporadic colorectal cancer development, probably due to the local dietary habits in Portugal.
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Affiliation(s)
- J P Gil
- Gulbenkian Institute of Sciences, Oeiras and Molecular Biology Unit, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
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