Higher-Dose Primaquine to Prevent Relapse of Plasmodium vivax Malaria.

BACKGROUND: In most of the Americas, the recommended treatment to prevent relapse of Plasmodium vivax malaria is primaquine at a total dose of 3.5 mg per kilogram of body weight, despite evidence of only moderate efficacy. METHODS: In this trial conducted in Brazil, we evaluated three primaquine regimens to prevent relapse of P. vivax malaria in children at least 5 years of age and in adults with microscopy-confirmed P. vivax monoinfection. All the patients received directly observed chloroquine for 3 days (total dose, 25 mg per kilogram). Group 1 received a total primaquine dose of 3.5 mg per kilogram (0.5 mg per kilogram per day) over 7 days with unobserved administration; group 2 received the same regimen as group 1 but with observed administration; and group 3 received a total primaquine dose of 7.0 mg per kilogram over 14 days (also 0.5 mg per kilogram per day) with observed administration. We monitored the patients for 168 days. RESULTS: We enrolled 63 patients in group 1, 96 in group 2, and 95 in group 3. The median age of the patients was 22.4 years (range, 5.4 to 79.8). By day 28, three P. vivax recurrences were observed: 2 in group 1 and 1 in group 2. By day 168, a total of 70 recurrences had occurred: 24 in group 1, 34 in group 2, and 12 in group 3. No serious adverse events were noted. On day 168, the percentage of patients without recurrence was 58% (95% confidence interval [CI], 44 to 70) in group 1, 59% (95% CI, 47 to 69) in group 2, and 86% (95% CI, 76 to 92) in group 3. Survival analysis showed a difference in the day 168 recurrence-free percentage of 27 percentage points (97.5% CI, 10 to 44; P<0.001) between group 1 and group 3 and a difference of 27 percentage points (97.5% CI, 12 to 42; P<0.001) between group 2 and group 3. CONCLUSIONS: The administration of primaquine at a total dose of 7.0 mg per kilogram had higher efficacy in preventing relapse of P. vivax malaria than a total dose of 3.5 mg per kilogram through day 168. (Supported by the U.S. Agency for International Development; ClinicalTrials.gov number, NCT03610399.).

Allele frequency net 2015 update: new features for HLA epitopes, KIR and disease and HLA adverse drug reaction associations.

It has been 12 years since the Allele Frequency Net Database (AFND; http://www.allelefrequencies.net) was first launched, providing the scientific community with an online repository for the storage of immune gene frequencies in different populations across the world. There have been a significant number of improvements from the first version, making AFND a primary resource for many clinical and scientific areas including histocompatibility, immunogenetics, pharmacogenetics and anthropology studies, among many others. The most widely used part of AFND stores population frequency data (alleles, genes or haplotypes) related to human leukocyte antigens (HLA), killer-cell immunoglobulin-like receptors (KIR), major histocompatibility complex class I chain-related genes (MIC) and a number of cytokine gene polymorphisms. AFND now contains >1400 populations from more than 10 million healthy individuals. Here, we report how the main features of AFND have been updated to include a new section on 'HLA epitope' frequencies in populations, a new section capturing the results of studies identifying HLA associations with adverse drug reactions (ADRs) and one for the examination of infectious and autoimmune diseases associated with KIR polymorphisms-thus extending AFND to serve a new user base in these growing areas of research. New criteria on data quality have also been included.

A database for curating the associations between killer cell immunoglobulin-like receptors and diseases in worldwide populations.

The killer cell immunoglobulin-like receptors (KIR) play a fundamental role in the innate immune system, through their interactions with human leucocyte antigen (HLA) molecules, leading to the modulation of activity in natural killer (NK) cells, mainly related to killing pathogen-infected cells. KIR genes are hugely polymorphic both in the number of genes an individual carries and in the number of alleles identified. We have previously developed the Allele Frequency Net Database (AFND, http://www.allelefrequencies.net), which captures worldwide frequencies of alleles, genes and haplotypes for several immune genes, including KIR genes, in healthy populations, covering >4 million individuals. Here, we report the creation of a new database within AFND, named KIR and Diseases Database (KDDB), capturing a large quantity of data derived from publications in which KIR genes, alleles, genotypes and/or haplotypes have been associated with infectious diseases (e.g. hepatitis C, HIV, malaria), autoimmune disorders (e.g. type I diabetes, rheumatoid arthritis), cancer and pregnancy-related complications. KDDB has been created through an extensive manual curation effort, extracting data on more than a thousand KIR-disease records, comprising >50 000 individuals. KDDB thus provides a new community resource for understanding not only how KIR genes are associated with disease, but also, by working in tandem with the large data sets already present in AFND, where particular genes, genotypes or haplotypes are present in worldwide populations or different ethnic groups. We anticipate that KDDB will be an important resource for researchers working in immunogenetics. Database URL: http://www.allelefrequencies.net/diseases/.

Balanced polymorphism in bottlenecked populations: the case of the CCR5 5' cis-regulatory region in Amazonian Amerindians.

The 5' cis-regulatory region of the CCR5 gene exhibits a strong signature of balancing selection in several human populations. Here we analyze the polymorphism of this region in Amerindians from Amazonia, who have a complex demographic history, including recent bottlenecks that are known to reduce genetic variability. Amerindians show high nucleotide diversity (pi = 0.27%) and significantly positive Tajima's D, and carry haplotypes associated with weak and strong gene expression. To evaluate whether these signatures of balancing selection could be explained by demography, we perform neutrality tests based on empiric and simulated data. The observed Tajima's D was higher than that of other world populations; higher than that found for 18 noncoding regions of South Amerindians, and higher than 99.6% of simulated genealogies, which assume nonequilibrium conditions. Moreover, comparing Amerindians and Asians, the Fst for CCR5 cis-regulatory region was unusually low, in relation to neutral markers. These findings indicate that, despite their complex demographic history, South Amerindians carry a detectable signature of selection on the CCR5 cis-regulatory region.

Long- and short-haired Weimaraner dogs represent two populations of one breed.

Weimaraners represent an old breed of hunting dogs. Today, two coat types are commonly distinguished, the more common short-hair (SH) and the long-hair (LH) variety, the latter having arisen from the SH Weimaraners. In order to analyze genetic variation in the coat varieties, we genotyped nine single nucleotide polymorphisms (SNPs) of the ABCA4 gene locus as well as six highly variable microsatellites scattered over the canine genome in the SH and LH populations. Three out of nine SNPs showed two alleles, allelic frequencies at two of these polymorphic sites differed significantly between SH and LH Weimaraners. Haplotype diversities for the three informative SNPs revealed higher estimates for the SH (0.515) than for the LH variety (0.364). In addition, two of six microsatellite markers showed significant differences in allelic frequencies between SH and LH Weimaraners. Unexpectedly, genetic diversities for all but one microsatellite were greater in LH than in SH Weimaraners. Similarly, the mean intra-individual genetic distance based on microsatellite markers was more pronounced in the LH population (0.62 for SH vs. 0.65 for LH) suggesting again closer genetic relationships among SH than LH Weimaraners. Taken together, the results of SNP analysis can be interpreted as reflections of early breed development whereas microsatellites mirror rather recent breeding strategies in the Weimaraner populations.

Genetic structure of Plasmodium falciparum populations in the Brazilian Amazon region.

After a major increase in incidence between the 1970s and the 1990s, the Brazilian Amazon region now accounts for the most cases of Plasmodium falciparum malaria in the Americas. Polymorphism of 10 microsatellite loci in the P. falciparum genome was studied in 196 isolates obtained from 5 populations in the region. There was significant multilocus linkage disequilibrium, particularly within populations with lower proportions of mixed-genotype infections. However, most multilocus genotypes in different isolates were distinct, and there was no evidence of any recent epidemic expansion of particular clones. Genetic divergence between populations was very substantial but did not fit a simple model of isolation by distance. Thus, different foci of P. falciparum in Brazil are quite independent, with distinct population structures and minimal gene flow, a finding that has implications for strategies to control infection and to contain the spread of drug resistance at a regional level.

The amazonian microcosm

Five hundred years after the arrival of the first Portuguese colonizers, the Brazilian Amazonia is predominantly inhabited by mestizos, formed by the admixture among three main ethnic groups (Amerindians, Europeans and Africans). On the other hand, the region is the habitat of the last culturally autonomous indigenous tribes in Brazil, most of them showing little (<5 percent) or no mixture with other ethnic groups, and also includes several communities founded by escaped African slaves, named quilombos, some of which still remains relatively isolated. Genetical (classic genetic polymorphisms, nuclear DNA and the mtDNA polymorphisms) and genetical-demographic (estimates of interethnic admixture) data have been obtained for these human groups. Estimates of interethnic admixture for urban populations show average values of 41 percent of Indigenous contribution, 12 percent of African contribution and 47 percent of European contribution, the data showing an increase of Indigenous contribution in the direction of Belém to Manaus, followed by the reduction of the African contribution in the same direction. On the other hand, Y-DNA and mtDNA data obtained for the population of Belém demonstrate that the contribution of indigenous females to the formation of the population was 10 times higher than that of indigenous men. Studies performed in Afro-Brazilian communities indicate that although African slaves imported in the northern region have been predominantly from Bantu-speaking Africa, the number of slaves from West Africa, particularly from the Atlantic West, brought to northern Brazil may have been higher than that indicated by historical records. With respect to Amerinds, analysis of classical genetic markers and DNA polymorphisms (tandemly repeated loci) in several Amerindian populations do not coincide, the former indicating that tribes of the northern margin of the Amazon river are less differentiated than those from the southern margin, and that the within-stock genetic differentiation for the Tupi group is higher than that between-stock.