Salinomycin and other ionophores as a new class of antimalarial drugs with transmission-blocking activity.

The drug target profile proposed by the Medicines for Malaria Venture for a malaria elimination/eradication policy focuses on molecules active on both asexual and sexual stages of Plasmodium, thus with both curative and transmission-blocking activities. The aim of the present work was to investigate whether the class of monovalent ionophores, which includes drugs used in veterinary medicine and that were recently proposed as human anticancer agents, meets these requirements. The activity of salinomycin, monensin, and nigericin on Plasmodium falciparum asexual and sexual erythrocytic stages and on the development of the Plasmodium berghei and P. falciparum mosquito stages is reported here. Gametocytogenesis of the P. falciparum strain 3D7 was induced in vitro, and gametocytes at stage II and III or stage IV and V of development were treated for different lengths of time with the ionophores and their viability measured with the parasite lactate dehydrogenase (pLDH) assay. The monovalent ionophores efficiently killed both asexual parasites and gametocytes with a nanomolar 50% inhibitory concentration (IC50). Salinomycin showed a fast speed of kill compared to that of standard drugs, and the potency was higher on stage IV and V than on stage II and III gametocytes. The ionophores inhibited ookinete development and subsequent oocyst formation in the mosquito midgut, confirming their transmission-blocking activity. Potential toxicity due to hemolysis was excluded, since only infected and not normal erythrocytes were damaged by ionophores. Our data strongly support the downstream exploration of monovalent ionophores for repositioning as new antimalarial and transmission-blocking leads.

Maintaining flippase activity in procoagulant platelets is a novel approach to reducing thrombin generation.

BACKGROUND: During thrombosis, procoagulant platelets expose phosphatidylserine (PS), which enhances local thrombin generation. Reducing platelet PS exposure could be a novel anti-thrombotic approach. PS is confined to the inner leaflet of the plasma membrane in unstimulated platelets by ATP-dependent "flippase" activity. Ca2+ ionophores trigger all platelets to expose a high level of PS by activating a scramblase protein and inactivating the flippase. Although R5421 was previously shown to reduce Ca2+ ionophore-induced PS exposure, its mechanism of action is unknown. OBJECTIVES: To determine the mechanism by which R5421 reduces platelet PS exposure. METHODS: Washed human platelets were stimulated with the Ca2+ ionophore, A23187, to induce procoagulant platelet formation while bypassing proximal receptor signalling. Platelets PS exposure was detected using annexin V or lactadherin in flow cytometry. NBD (7-nitro-2-1,3-benzoxadiazol-4-yl)-PS was used to assess scramblase and flippase activity. Thrombin generation was monitored using a fluorogenic substrate. RESULTS AND CONCLUSIONS: R5421 reduced the extent of A23187-stimulated platelet PS exposure, as demonstrated with annexin V or lactadherin binding. R5421 also maintained flippase activity in procoagulant platelets. Although R5421 appeared to inhibit scramblase activity in procoagulant platelets, it did not once the flippase had been inhibited, demonstrating that scramblase activity is not directly inhibited. Furthermore, R5421 inhibited the contribution of A23187-stimulated platelets to thrombin generation. Together these data demonstrate that R5421 reduces the extent of PS exposure in procoagulant platelets by maintaining flippase activity. Maintaining flippase activity in procoagulant platelets is a novel and effective approach to reducing thrombin generation.

Evidence of nigericin as a potential therapeutic candidate for cancers: A review.

Emerging studies have shown that nigericin, an H+, K+ and Pb2+ ionophore, has exhibited a promising anti-cancer activity in various cancers. However, its anti-cancer mechanisms have not been fully elucidated. In this review, the recent progresses on the use of nigericin in human cancers have been summarized. By exchanging H+ and K+ across cell membranes, nigericin shows promising anti-cancer activities in in vitro and in vivo as a single agent or in combination with other anti-cancer drugs through decreasing intracellular pH (pHi). The underlying mechanisms of nigericin also include the inactivation of Wnt/ß-catenin signals, blockade of Androgen Receptor (AR) signaling, and activation of Stress-Activated Protein Kinase/c-Jun N-terminal Kinase (SAPK/JNK) signaling pathways. In many cancers, nigericin is proved to specifically target putative Cancer Stem Cells (CSCs), and its synergistic effects on photodynamic therapy are also reported. Other mechanisms of nigericin including influencing the mitochondrial membrane potentials, inducing an increase in drug accumulation and autophagy, controlling insulin accumulation in nuclei, and increasing the cytotoxic activity of liposome-entrapped drugs, are also discussed. Notably, the potential adverse effects such as teratogenic effects, insulin resistance and eryptosis shall not be ignored. Taken together, these reports suggest that treatment of cancer cells with nigericin may offer a novel therapeutic strategy and future potential of translation to clinics.

[The use of monensin premix in dairy cows: simple and essential steps for ensuring its proper use]. / L'utilisation du prémélange de monensin chez les vaches laitières: un suivi simple et essentiel pour s'assurer d'une utilisation adéquate.

The use of monensin premix in dairy cows: Simple and essential steps for ensuring its proper use. Dietary monensin, containing monensin sodium as active ingredient, is frequently used on dairy farms in Canada. Although the use of monensin is safe, some overdose situations have been reported following consumption of higher than recommended doses. A regular monitoring of bulk tank milk fat percentage should be performed to ensure quick detection of a potential overdose situation. Diarrhea and sudden drop in dry matter intake are other potential clinical signs of monensin overdose. Quick detection of such cases will allow rapid correction of the situation.(Translated by the authors).

A zwitterionic near-infrared fluorophore for real-time ureter identification during laparoscopic abdominopelvic surgery.

Iatrogenic injury of the ureters is a feared complication of abdominal surgery. Zwitterionic near-infrared fluorophores are molecules with geometrically-balanced, electrically-neutral surface charge, which leads to renal-exclusive clearance and ultralow non-specific background binding. Such molecules could solve the ureter mapping problem by providing real-time anatomic and functional imaging, even through intact peritoneum. Here we present the first-in-human experience of this chemical class, as well as the efficacy study in patients undergoing laparoscopic abdominopelvic surgery. The zwitterionic near-infrared fluorophore ZW800-1 is safe, has pharmacokinetic properties consistent with an ideal blood pool agent, and rapid elimination into urine after a single low-dose intravenous injection. Visualization of structure and function of the ureters starts within minutes after ZW800-1 injection and lasts several hours. Zwitterionic near-infrared fluorophores add value during laparoscopic abdominopelvic surgeries and could potentially decrease iatrogenic urethral injury. Moreover, ZW800-1 is engineered for one-step covalent conjugatability, creating possibilities for developing novel targeted ligands.

Safety, efficacy, and biomarker findings of PBT2 in targeting Abeta as a modifying therapy for Alzheimer's disease: a phase IIa, double-blind, randomised, placebo-controlled trial.

BACKGROUND: PBT2 is a metal-protein attenuating compound (MPAC) that affects the Cu2(+)-mediated and Zn2(+)-mediated toxic oligomerisation of Abeta seen in Alzheimer's disease (AD). Strong preclinical efficacy data and the completion of early, clinical safety studies have preceded this phase IIa study, the aim of which was to assess the effects of PBT2 on safety, efficacy, and biomarkers of AD. METHODS: Between December 6, 2006, and September 21, 2007, community-dwelling patients over age 55 years were recruited to this 12-week, double-blind, randomised trial of PBT2. Patients were randomly allocated to receive 50 mg PBT2, 250 mg PBT2, or placebo. Inclusion criteria were early AD (mini-mental state examination [MMSE] score between 20 and 26 points or Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) score between 10 and 25 points), taking a stable dose of acetylcholinesterase inhibitor (donepezil, galantamine, or rivastigmine) for at least 4 months, a modified Hachinski score of 4 points or less, and CT or MRI results that were consistent with AD. The principal outcomes were safety and tolerability. Secondary outcomes were plasma and CSF biomarkers and cognition. Analysis was intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00471211. FINDINGS: 78 patients were randomly assigned (29 to placebo, 20 to PBT2 50 mg, and 29 to PBT2 250 mg) and 74 (95%) completed the study. 42 (54%) patients had at least one treatment emergent adverse event (10 [50%] on PBT2 50 mg, 18 [62%] on PBT2 250 mg, and 14 [48%] on placebo). No serious adverse events were reported by patients on PBT2. Patients treated with PBT2 250 mg had a dose-dependent (p=0.023) and significant reduction in CSF Abeta(42) concentration compared with those treated with placebo (difference in least squares mean change from baseline was -56.0 pg/mL, 95% CI -101.5 to -11.0; p=0.006). PBT2 had no effect on plasma biomarkers of AD or serum Zn(2+) and Cu(2+) concentrations. Cognition testing included ADAS-cog, MMSE, and a neuropsychological test battery (NTB). Of these tests, two executive function component tests of the NTB showed significant improvement over placebo in the PBT2 250 mg group: category fluency test (2.8 words, 0.1 to 5.4; p=0.041) and trail making part B (-48.0 s, -83.0 to -13.0; p=0.009). INTERPRETATION: The safety profile is favourable for the ongoing development of PBT2. The effect on putative biomarkers for AD in CSF but not in plasma is suggestive of a central effect of the drug on Abeta metabolism. Cognitive efficacy was restricted to two measures of executive function. Future trials that are larger and longer will establish if the effects of PBT2 on biomarkers and cognition that are reported here translate into clinical effectiveness.

A meta-analysis of the impact of monensin in lactating dairy cattle. Part 3. Health and reproduction.

A meta-analysis of the impact of monensin on health and reproductive outcomes in dairy cattle was conducted. A total of 16 papers were identified with sufficient data and quality to evaluate health and reproductive outcomes for monensin. The available trials provided approximately 9,500 cows with sufficient data for analysis. This provided good statistical power to examine the effects of monensin on health and reproduction. Over all the trials analyzed, monensin decreased the risk of ketosis [relative risk (RR) = 0.75], displaced abomasums (RR = 0.75), and mastitis (RR = 0.91). No significant effects of monensin were found for milk fever, lameness, dystocia, retained placenta, or metritis. Monensin had no effect on first-service conception risk (RR = 0.97) or days to pregnancy (hazard ratio = 0.93). However, the impact of monensin on dystocia, retained placenta, and metritis was heterogeneous for all 3 outcome measures and random effect models were utilized. Causes of the heterogeneity were explored with meta-regression. Days of treatment with monensin before calving increased the risk of dystocia. Delivery method of monensin influenced the incidence of retained placenta and metritis, with risk being lower with controlled release capsule treatment compared with delivery in either topdress or in a total mixed ration. Days of treatment before calving also influenced retained placenta with an increase in risk with more days treated before calving. Improvements in ketosis, displaced abomasums, and mastitis with monensin were achieved. Exposure to prolonged treatment in the dry period with monensin may increase the risk of dystocia and retained placenta.

Effects on health, performance, and tissue residues of the ionophore antibiotic salinomycin in finishing broilers (21 to 38 d).

A study was conducted to evaluate the effects of feeding salinomycin at the recommended prophylactic level, and at 2 and 3 times this level, to finishing male broilers (d 21 to 38). Four treatment groups were given the experimental diets containing 0, 60, 120, or 180 parts per million (ppm) salinomycin from d 21 to 38. Performance, relative organ weights, selected serum enzymes, and salinomycin residues in liver, muscle, and serum were determined. Salinomycin supplementation had no effect on body weight, feed intake, or feed conversion, and caused no overt signs of toxicity. After a week of being fed the salinomycin diets, the serum activity of aspartate aminotransferase was significantly increased in chickens fed 180 ppm compared with controls. These birds also showed microscopic lesions in breast and thigh muscles, but not in cardiac muscle. Salinomycin residues were not detected by high-performance liquid chromatography coupled to tandem mass spectrometry in liver or muscle samples from the birds fed 0, 60, or 120 ppm salinomycin. However, chickens fed 180 ppm salinomycin had detectable levels in liver and muscle above the maximum residue level of 5 µg/kg established by the European Union. All birds fed salinomycin had salinomycin in their sera with levels ranging from N.D. (not detected) in the controls to 24.4 ± 7.9, 61.4 ± 18.9, and 94.5 ± 9.1 µg/L for salinomycin dietary levels of 60, 120, and 180 ppm, respectively. Serum salinomycin concentration was linearly related with salinomycin content in feed (y = 0.584x - 10, r2 = 0.999). The results showed that even at 3 times the prophylactic level, salinomycin does not induce clinical toxicosis or mortality. No salinomycin residues were found in edible tissues at the recommended dietary level or at 2 times this level. However, salinomycin was detected in serum regardless of the dietary level. A simple method for salinomycin determination in serum is described which can be used as a marker of exposure and/or to predict levels in the diet.

Rhabdomyolysis, acute renal failure, and death after monensin ingestion.

We report a case of human monensin intoxication; to our knowledge, this is the first reported case in the medical literature. The patient took a dose of monensin three times higher than a dose considered lethal for cattle and developed a clinical picture similar to that reported in veterinary medicine. There was an early and extremely severe rhabdomyolysis followed by acute renal failure, heart failure, and death. The main changes observed at autopsy were extensive skeletal muscle necrosis, complement deposition at the myocardial level, pulmonary edema, and acute tubular damage.

The Arctic Alzheimer mutation enhances sensitivity to toxic stress in human neuroblastoma cells.

The E693G (Arctic) mutation of the amyloid precursor protein was recently found to lead to early-onset Alzheimer's disease in a Swedish family. In the present study, we report that the Arctic mutation decreases cell viability in human neuroblastoma cells. The cell viability, as measured by the MTT assay and propidium iodide staining, was further compromised following exposure to calcium ionophore A23187, microtubule-binding colchicine or oxidative stress inducer hydrogen peroxide. The manner of cell death was found to be apoptotic. During apoptosis, cells with the Arctic mutation also decreased their secretion of beta-secretase cleaved amyloid precursor protein. The enhanced sensitivity to toxic stress in cells with the Arctic mutation most likely contributes to the pathogenic pathway leading to Alzheimer's disease.

The influence of withdrawal time on the performance of broiler chickens fed semduramicin.

Three 49-d experiments, with a total of 6,528 male broiler chicks in floor pens, were conducted to test the hypothesis that Semduramicin feeding-time affects the body weight gain, feed consumption, and feed conversion ratio of broilers. Semduramicin ionophore was added to corn and soybean meal-based diets at the recommended level, 25 mg/kg for 0,34,39, or 42 d. Thus, three withdrawal times were employed (7, 10, and 15 d) during each experiment. Significant differences among experiments were observed for body weight gain, feed intake, and feed conversion ratio, but no significant differences due to Semduramicin were noted in body weight or feed intake. There was only one treatment by experiment interaction found for 0-to-34-d feed intake (P = 0.028), but it was not evident for 0 to 39 d (P = 0.818) or any other times. Feeding Semduramicin with a 10- or 15-d withdrawal period resulted in an improvement in feed conversion of about 0.04 units.

Effects of the ionophore anticoccidial semduramicin on broiler breeders.

Three experiments were conducted to assess the effects on broiler breeders of contamination of feed with the ionophore anticoccidial semduramicin. In Experiment 1, individually caged females received 0, 12.5, or 25 mg/kg diet for 3 wk from 48 to 50 wk of age. In Experiment 2, males and females in floor pens received 0, 12.5, or 25 mg/kg diet for 3 wk from 63 to 65 wk of age. In Experiment 3, individually caged males and females received 0, 3, 6, or 25 mg/kg diet for 1 wk at 31 wk of age and were mated by artificial insemination. There was a dose-related decrease in cumulative egg production and percentage shell in Experiment 1 after more than 1 wk exposure, but these effects were not observed in the other experiments. There was a decrease in cumulative fertile hatchability and a dose-related decrease after 3 wk exposure due to an increase in early embryonic mortality in Experiment 2, but these changes were not observed during the 1-wk exposure in Experiment 3. The data show that adverse effects of semduramicin require greater than 1 wk of exposure to be evident.

Cardiomyopathy in cattle induced by residues of the coccidiostat maduramicin in poultry litter given as a feedstuff.

An experimental feeding trial was conducted in order to substantiate an hypothesis on the aetiology of a previously unrecorded cardiomyopathic syndrome in beef cattle in Israel. It was believed that residues of the ionophore maduramicin (Cygro; American Cyanamid) in poultry litter fed to cattle, after the maduramicin had been incorporated into broiler feed as a coccidiostat, were the cause of the cardiomyopathy. Three groups of 5 heifers were fed for several weeks (1) poultry litter from a field case, containing 4.8 ppm maduramicin; (2) poultry litter to which maduramicin was added to give a concentration of 12 ppm; (3) poultry litter with no maduramicin (control). Clinical, biochemical, necropsy and histopathological findings showed that maduramicin residues are cardiotoxic, even at the lower level of maduramicin fed, which is commonly encountered in poultry litter in Israel.

A phase I study of the metal ionophore clioquinol in patients with advanced hematologic malignancies.

UNLABELLED: Clioquinol is a small-molecule metal ionophore that inhibits the proteasome through a metal-dependent mechanism. Here, we report a phase I study of clioquinol in patients with refractory hematologic malignancies. Neuropathy and abdominal pain were dose-limiting toxicities. Minimal pharmacodynamic effects were observed, and there were no clinical responses. BACKGROUND: Clioquinol is a small-molecule metal ionophore that inhibits the enzymatic activity of the proteasome and displays preclinical efficacy in hematologic malignancies in vitro and in vivo. Therefore, we conducted a phase I clinical trial of clioquinol in patients with refractory hematologic malignancies to assess its safety and determine its biological activity in this patient population. METHODS: Patients with refractory hematologic malignancies were treated with increasing doses of oral clioquinol twice daily for 15 doses. Plasma and intracellular levels of clioquinol were measured. Enzymatic activity of the proteasome was measured before and after drug administration. RESULTS: Sixteen cycles of clioquinol were administered to 11 patients with 5 patients reenrolled at the next dose level as per the permitted intrapatient dose escalation. Dose-limiting neurotoxicity and abdominal pain were observed at a dose of 1600 mg twice daily. Intracellular drug levels were low. Minimal inhibition of the proteasome was observed. No clinical responses were observed. CONCLUSION: In patients with refractory hematologic malignancies, the maximal tolerated dose of clioquinol was determined. Minimal inhibition of the proteasome was observed at tolerable doses, likely due to low intracellular levels of the drug.

Surtos de intoxicação por salinomicina em chinchilas (Chinchilla lanigera) / Outbreaks of salinomycin toxicosis in Chinchillas (Chinchilla lanigera)

Quatro surtos de intoxicação por salinomicina são descrito em chinchilas de três municípios do Estado do Rio Grande do Sul. Uma semana após a ingestão de ração contendo 37 ppm de salinomicina, aproximadamente duas mil chinchilas de quatro fazendas expostas diminuíram o consumo da ração. Quatrocentos e vinte sete chinchilas demonstraram apatia. Dessas, duzentos e setenta e sete desenvolveram decúbito esternal e lateral, dispneia e coma, seguidos de morte. As primeiras mortes ocorreram oito dias após a ingestão da ração. A evolução dos sinais clínicos até a morte ou eutanásia foi de 2-5 dias. Os exames bioquímicos do soro sanguíneo em quatro chinchilas revelaram níveis aumentados da alanina aminotransferase, aspartato transaminase, fosfatase alcalina, creatina cinase, glicose, triglicerídeos e colesterol total. Quarenta e cinco chinchilas foram submetidas à necropsia. Os achados macroscópicos consistiam de marcada lipidose hepática em todas as chinchilas necropsiadas; fetos em estado de decomposição em doze chinchilas que estavam prenhes. Microscopicamente, múltiplas fibras musculares esqueléticas estavam hipereosinofílicas, tumefeitas e com perda das estriações. Nas chinchilas que sobreviveram por mais dias era possível observar segmentos fragmentados de miofibras afetadas (necrose flocular) e regeneração de miofibras. No fígado foi observada marcada degeneração gordurosa. Não foram observadas anormalidades microscópicas nos demais órgãos analisados. Análises à procura de aflatoxinas, resíduos de pesticidas e isolamento bacteriano foram negativos. A análise da ração por cromatografia líquida revelou 37ppm de salinomicina na ração. A ração suspeita foi administrada a 12 chinchilas, três das quais (25 por cento) morreram apresentando lesões semelhantes às observadas nas chinchilas com a doença natural. O diagnóstico de intoxicação por salinomicina foi baseado na epidemiologia, lesões histológicas características e na presença de salinomicina na ração administrada nas quatro criações envolvidas.

Four outbreaks of ionophore toxicosis are described in chinchillas from four commercial farms located in three municipalities in the state of Rio Grande do Sul, southern Brazil. Approximately 2,000 chinchillas showed decrease in food intake one week after start ingesting a ration containing 37 ppm of salinomycin. Four hundred and twenty seven chinchillas showed apathy. Of those 277 develop sternal and lateral recumbence, dyspnea and coma followed by death. First deaths occurred eight days after the start on the salinomycin containing ration; clinical course was 2-5 days. Serum chemistry carried out in four chinchillas revealed increased levels of alanine transaminase, aspartate transaminase, alkaline phosphatase, creatinenin kinase, glucose, triglicerids and total cholesterol. Forty five affected chinchillas were necropsied; consistent necropsy findings were marked hepatic lipidosis; additionally twelve pregnant chinchillas had dead decomposing fetuses. Microscopically skeletal muscles had multifocally swollen hypereosinophilic myofibers with loss of cross striations. In those chinchillas that survived longer than a few days, microscopic features in the skeletal muscle included segmental fragmentation of dead fibers (floccular necrosis) and myofiber regeneration. Marked fatty degeneration was observed in the livers of all affected chinchillas. No microscopic changes were observed in other organs. Chemical analysis in the feed consumed by the chinchillas did not detect aflatoxins or pesticides residues; bacterial culture performed in samples of liver and intestinal contents from necropsied chinchillas yielded no significant bacterial growth. Analysis by thin layer chromatography performed in the ration consumed by the chinchillas detected 37 ppm of salinomycin. The suspected ration was fed to 12 chinchillas three of which (25 percent) died with similar lesions to those observed in the natural cases. The diagnosis of salinomycin toxicosis was based in the epidemiology, histology of the lesions, on the detection of significant amounts of salinomycin in the ration used to feed the chinchillas in the four involved farms and on the reproduction of disease by feeding the suspected ration to susceptible chinchillas.