Historical chemical annotations of Cinchona bark collections are comparable to results from current day high-pressure liquid chromatography technologies.

ETHNOPHARMACOLOGICAL RELEVANCE: Species of the genus Cinchona (Rubiaceae) have been used in traditional medicine, and as a source for quinine since its discovery as an effective medicine against malaria in the 17th century. Despite being the sole cure of malaria for almost 350 years, little is known about the chemical diversity between and within species of the antimalarial alkaloids found in the bark. Extensive historical Cinchona bark collections housed at the Royal Botanic Gardens, Kew, UK, and in other museums may shed new light on the alkaloid chemistry of the Cinchona genus and the history of the quest for the most effective Cinchona barks. AIM OF THE STUDY: We used High-Pressure Liquid Chromatography (HPLC) coupled with fluorescence detection (FLD) to reanalyze a set of Cinchona barks originally annotated for the four major quinine alkaloids by John Eliot Howard and others more than 150 years ago. MATERIALS AND METHODS: We performed an archival search on the Cinchona bark collections in the Economic Botany Collection housed in Kew, focusing on those with historical alkaloid content information. Then, we performed HPLC analysis of the bark samples to separate and quantify the four major quinine alkaloids and the total alkaloid content using fluorescence detection. Correlations between historic and current annotations were calculated using Spearman's rank correlation coefficient, before paired comparisons were performed using Wilcox rank sum tests. The effects of source were explored using generalized linear modelling (GLM), before the significance of each parameter in predicting alkaloid concentrations were assessed using chi-square tests as likelihood ratio testing (LRT) models. RESULTS: The total alkaloid content estimation obtained by our HPLC analysis was comparatively similar to the historical chemical annotations made by Howard. Additionally, the quantity of two of the major alkaloids, quinine and cinchonine, and the total content of the four alkaloids obtained were significantly similar between the historical and current day analysis using linear regression. CONCLUSIONS: This study demonstrates that the historical chemical analysis by Howard and current day HPLC alkaloid content estimations are comparable. Current day HPLC analysis thus provide a realistic estimate of the alkaloid contents in the historical bark samples at the time of sampling more than 150 years ago. Museum collections provide a powerful but underused source of material for understanding early use and collecting history as well as for comparative analyses with current day samples.

Exploring Structure-Activity Relationship in Tacrine-Squaramide Derivatives as Potent Cholinesterase Inhibitors.

Tacrine was the first drug to be approved for Alzheimer's disease (AD) treatment, acting as a cholinesterase inhibitor. The neuropathological hallmarks of AD are amyloid-rich senile plaques, neurofibrillary tangles, and neuronal degeneration. The portfolio of currently approved drugs for AD includes acetylcholinesterase inhibitors (AChEIs) and N-methyl-d-aspartate (NMDA) receptor antagonist. Squaric acid is a versatile structural scaffold capable to be easily transformed into amide-bearing compounds that feature both hydrogen bond donor and acceptor groups with the possibility to create multiple interactions with complementary sites. Considering the relatively simple synthesis approach and other interesting properties (rigidity, aromatic character, H-bond formation) of squaramide motif, we combined this scaffold with different tacrine-based derivatives. In this study, we developed 21 novel dimers amalgamating squaric acid with either tacrine, 6-chlorotacrine or 7-methoxytacrine representing various AChEIs. All new derivatives were evaluated for their anti-cholinesterase activities, cytotoxicity using HepG2 cell line and screened to predict their ability to cross the blood-brain barrier. In this contribution, we also report in silico studies of the most potent AChE and BChE inhibitors in the active site of these enzymes.

Surface-anchored counterions on weak chiral anion-exchangers accelerate separations and improve their compatibility for mass-spectrometry-hyphenation.

In the present work we propose new variants of chiral stationary phases (CSP) with tert-butylcarbamoylquinine (tBuCQN) as chiral selector molecule. Four tBuCQN-CSPs with distinct bonding chemistries are compared in terms of their pH-dependent surface charge by ζ-potential determinations, by achiral and chiral liquid chromatographic tests and LC-ESI-MS hyphenation. In one embodiment tBuCQN was immobilized on 3-mercaptopropylmethylsilyl-modified silica by thiol-ene click reaction (brush type CSP with selector coverage of 0.38mmol/g). In another embodiment, poly-(3-mercaptopropyl)-methylsiloxane was coated onto vinylized silica particles in presence of tBuCQN and radical initiator. The tBuCQN selector was then immobilized onto the polysiloxane film which in turn was crosslinked to the vinyl-surface in a simultaneous double click reaction leading to a CSP with enhanced stability due to multiple linkages (0.29mmol/g tBuCQN). Aliquots of each of the two CSPs were further modified by oxidation of free residual thiol groups to sulfonic acid functionalities to obtain strongly acidic endcapping groups which act as immobilized counterions of the chiral WAX CSPs (0.2mmol/g sulfonic acid co-ligands for brush type CSP). This caused secondary repulsive interactions, hence balanced interactions of the target analytes (chiral acids) at the WAX site and decreased non-specific interactions. Furthermore, this rendered possible the use of milder elution conditions, i.e. lower ionic strength, for acidic compounds. Separation performance was maintained and slightly improved, respectively, when using polar organic or reversed-phase type elution mode in chiral separations which were significantly accelerated (isoeluotropic conditions could be achieved with ca. factor 40 lower counterion concentration in the mobile phase). Thus, LC-ESI-MS enantiomer separations could be readily performed at very low ionic strength conditions (10mM acetate) which is favorable due to less ion suppression. In addition to this the newly developed stationary phases showed complementary retention profiles in RP- and HILIC-mode which make these type of stationary phases also promising tools for achiral applications in pharmaceutical analysis, especially as orthogonal separation principle e.g. in 2D-LC and impurity profiling.

Functional Components from Nature-Derived Drugs for the Treatment of Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic systemic disorder characterized by persistent synovitis and systemic inflammation. Currently, the widely used drugs for the treatment of RA are disease-modifying antirheumatic drugs, biological agents and glucocorticoids. But their clinical use has been limited because of their adverse effects with a high frequency and high cost of treatment. It is essential to find novel candidate agents. Traditional Chinese medicine (TCM) has been used for RA treatment for a long period of time. In recent years, significant amounts of studies have shown that some TCMs and their active ingredients have obvious therapeutic effects on RA. In this review, the compounds in TCMs that have an effect in clinic or animal experiments of RA are critically reviewed and summarized. Moreover, the relationship between chemical structures of the compound and their activities is analyzed. The relevant researches are described from the aspects of source, methods, result, and related mechanism analysis. The existing studies show that most effective compounds in TCM for RA treatment belong to alkaloids, flavonoids, terpenoids, phenols and quinines. It is hoped that the data summarized in this review will be beneficial to the screening of new nature-derived antirheumatic drugs.

Quinine-Based Zwitterionic Chiral Stationary Phase as a Complementary Tool for Peptide Analysis: Mobile Phase Effects on Enantio- and Stereoselectivity of Underivatized Oligopeptides.

Peptide stereoisomer analysis is of importance for quality control of therapeutic peptides, the analysis of stereochemical integrity of bioactive peptides in food, and the elucidation of the stereochemistry of peptides from a natural chiral pool which often contains one or more D-amino acid residues. In this work, a series of model peptide stereoisomers (enantiomers and diastereomers) were analyzed on a zwitterionic ion-exchanger chiral stationary phase (Chiralpak ZWIX(+) 5 µm), in order to investigate the retention and separation performance for such compounds on this chiral stationary phase and elucidate its utility for this purpose. The goal of the study focused on 1) investigations of the effects of the sample matrix used to dissolve the peptide samples; 2) optimization of the mobile phase (enabling deriving information on factors of relevance for retention and separation); and 3) derivation of structure-selectivity relationships. It turned out that small di- and tripeptides can be well resolved under optimized conditions, typically with resolutions larger than 1.5. The optimized mobile phase often consisted of methanol-tetrahydrofuran-water (49:49:2; v/v/v) with 25 mM formic acid and 12.5 mM diethylamine. This work proposes some guidance on which mobile phases can be most efficiently used for peptide stereoisomer separations on Chiralpak ZWIX. Chirality 28:5-16, 2016. © 2015 Wiley Periodicals, Inc.

The impact of individual variations in taste sensitivity on coffee perceptions and preferences.

Despite a few relationships between fungiform papillae (FP) density and 6-n-propylthiouracil (PROP) taster status have been reported for sensory qualities within foods, the impact on preferences remains relatively unclear. The present study investigated responses of FP number and PROP taster groups to different bitter compounds and how these affect coffee perception, consumption and liking. Subjects (Ss) with higher FP numbers (HFP) gave higher liking ratings to coffee samples than those with lower FP numbers (LFP), but only for sweetened coffee. Moreover, HFP Ss added more sugar to the samples than LFP Ss. Significant differences between FP groups were also found for the sourness of the coffee samples, but not for bitterness and astringency. However, HFP Ss rated bitter taste stimuli as stronger than did LFP Ss. While coffee liking was unrelated to PROP status, PROP non-tasters (NTs) added more sugar to the coffee samples than did super-tasters (STs). In addition, STs rated sourness, bitterness and astringency as stronger than NTs, both in coffee and standard solutions. These results confirm that FP density and PROP status play a significant role in taste sensitivity for bitter compounds in general and also demonstrate that sugar use is partly a function of fundamental individual differences in physiology.

New antimalarial hits from Dacryodes edulis (Burseraceae)--part I: isolation, in vitro activity, in silico "drug-likeness" and pharmacokinetic profiles.

The aims of the present study were to identify the compounds responsible for the anti-malarial activity of Dacryoedes edulis (Burseraceae) and to investigate their suitability as leads for the treatment of drug resistant malaria. Five compounds were isolated from ethyl acetate and hexane extracts of D. edulis stem bark and tested against 3D7 (chloroquine-susceptible) and Dd2 (multidrug-resistant) strains of Plasmodium falciparum, using the parasite lactate dehydrogenase method. Cytotoxicity studies were carried out on LLC-MK2 monkey kidney epithelial cell-line. In silico analysis was conducted by calculating molecular descriptors using the MOE software running on a Linux workstation. The "drug-likeness" of the isolated compounds was assessed using Lipinski criteria, from computed molecular properties of the geometry optimized structures. Computed descriptors often used to predict absorption, distribution, metabolism, elimination and toxicity (ADMET) were used to assess the pharmacokinetic profiles of the isolated compounds. Antiplasmodial activity was demonstrated for the first time in five major natural products previously identified in D. edulis, but not tested against malaria parasites. The most active compound identified was termed DES4. It had IC50 values of 0.37 and 0.55 µg/mL, against 3D7 and Dd2 respectively. In addition, this compound was shown to act in synergy with quinine, satisfied all criteria of "Drug-likeness" and showed considerable probability of providing an antimalarial lead. The remaining four compounds also showed antiplasmodial activity, but were less effective than DES4. None of the tested compounds was cytotoxicity against LLC-MK2 cells, suggesting their selective activities on malaria parasites. Based on the high in vitro activity, low toxicity and predicted "Drug-likeness" DES4 merits further investigation as a possible drug lead for the treatment of malaria.

Cuantificación de quinina en extractos de Cinchona pubescens y evaluación de la actividad antiplasmodial y citotóxica / Quantification of quinine in extracts from stems Cinchona pubescens and evaluation of antiplasmodial and cytotoxic activity

Plants belonging to the genus Cinchona L. (Rubiaceae), whose active ingredient is quinine, was used for centuries to treat malaria. Plants of this genus are a potential source of new structural templates in the search for new antimalarial candidates. This study aimed to the identification, quantification of quinine and other metabolites present in extracts of different polarity of the stems of Cinchona pubescens Vahl. , oxoquinovic acid isolation, antiplasmodial activity, and measuring its cytotoxic effect. The results show a high activity to antiplasmodial alkaloids extract (IC50 = 2.20 +/- 0.0325 ug/mL), cytotoxicity (CC50 = 80.2 +/- 12.2 ug/mL), and a quinine content of 21.3+/-0.0247 ppm. The compound known as acid antiplasmodial activity oxoquinovic presented in IC50 = 11.3 +/- 0.741 ug/mL, and cytotoxicity CC50 = 72.4 +/- 3.85 ug/mL. These results motivate phytochemical studies in the search for active structural analogues quinine and quinolinic core as a source of new antimalarial agents.

Las plantas pertenecientes al género Cinchona L. (familia Rubiaceae), cuyo principio activo es la quinina, fueron utilizadas durante siglos para tratar la malaria. Este género es una fuente potencial de nuevas plantillas estructurales en la búsqueda de nuevos candidatos antimaláricos. El presente trabajo tuvo como objetivo la identificación y, cuantificación de la quinina y de otros metabolitos presentes en los extractos de diferente polaridad, de los tallos de Cinchona pubescens Vahl. , el aislamiento del ácido oxoquinóvico, la actividad antiplasmodial y, además, la medición de su efecto citotóxico. Los resultados muestran una alta actividad antiplasmodial para el extracto de los alcaloides (IC50 = 2,20 +/- 0,0325 ug/mL), una baja citotoxicidad (CC50 = 80,2 +/- 12,2 ug/mL), y un alto contenido de quinina el cual fue 21,3+/-0,0247 ppm. El compuesto ácido oxoquinóvico presentó una actividad antiplasmodial de IC50 = 11,3 +/- 0.741 ug/mL, y una citotoxicidad de CC50 = 72,4 +/- 3,85 ug/mL. Estos resultados motivan los estudios fitoquímicos en la búsqueda de principios activos y análogos estructurales en diferentes especies de Cinchonas como una fuente de nuevos agentes antimaláricos.

Role of traditional antimalarial plants in the battle against the global malaria burden.

Malaria continues to be a major global public health problem with 3.3 billion people at risk in 106 endemic countries. Globally, over 1000 plants have been used as potential antimalarials in resource-poor settings due to fragile health-care systems and lack of accessibility and affordability of artemisinin-based combination therapies (ACTs). Although many believe that the use of medicinal plants that have folklore reputations for antimalarial properties is relatively safe, many herbs may be potentially toxic due to their intrinsic adverse side effects. Therefore, herbal-derived remedies require powerful and deep assessment of their pharmacological qualities to establish their mode of action, safety, quality, and efficacy. In addition, the evolution of drug resistance also demands new antimalarial agents. This can be achieved by forming a vibrant antimalarial discovery pipeline among all stakeholders, including traditional healers, ethnobotanists, scientists, entomologists, pharmacists, and research institutions, for the isolation and characterization of the bioactive compounds with the ultimate objective of finding novel modes of action antimalarial compounds that can be used to fight against drug-resistant malarial parasites.

Scope of stereoselective Mn-mediated radical addition to chiral hydrazones and application in a formal synthesis of quinine.

Stereocontrolled Mn-mediated addition of alkyl iodides to chiral N-acylhydrazones enables strategic C-C bond constructions at the stereogenic centers of chiral amines. Applying this strategy to quinine suggested complementary synthetic approaches to construct C-C bonds attached at the nitrogen-bearing stereogenic center using multifunctional alkyl iodides 6a-d as radical precursors, or using multifunctional chiral N-acylhydrazones 26a-d as radical acceptors. These were included among Mn-mediated radical additions of various alkyl iodides to a range of chiral N-acylhydrazone radical acceptors, leading to the discovery that pyridine and alkene functionalities are incompatible. In a revised strategy, these functionalities are avoided during the Mn-mediated radical addition of 6d to chiral N-acylhydrazone 22b, which generated a key C-C bond with complete stereochemical control at the chiral amine carbon of quinine. Subsequent elaboration included two sequential cyclizations to complete the azabicyclo[2.2.2]octane ring system. Group selectivity between two 2-iodoethyl groups during the second cyclization favored an undesired azabicyclo[3.2.1]octane ring system, an outcome that was found to be consistent with transition state calculations at the B3LYP/6-31G(d) level. Group differentiation at an earlier stage enabled an alternative regioconvergent pathway; this furnished the desired azabicyclo[2.2.2]octane ring system and afforded quincorine (21b), completing a formal synthesis of quinine.

Synthesis and evaluation of amphiphilic cationic quinine-derived for antibacterial activity against methicillin-resistant Staphylococcus aureus.

Several representative amphiphilic cationic quinine-derived have been synthesized and evaluated against methicillin- resistant Staphylococcus aureus. This is the first reported antibacterial activity of this class of compounds. In vitro the minimal inhibitory concentration values of the best compound Q7 ranged from 0.4 to 1.6 microg/mL (MBC<3.2 microg/mL).

Skin permeation enhancement potential of Aloe Vera and a proposed mechanism of action based upon size exclusion and pull effect.

The aim of this study was to determine in vitro the potential of Aloe Vera juice as a skin permeation enhancer; a secondary aim was to probe the extent to which Aloe Vera itself permeates the skin. Saturated solutions of caffeine, colchicine, mefenamic acid, oxybutynin, and quinine were prepared at 32 degrees C in Aloe Vera juice and water (control) and used to dose porcine ear skin mounted in Franz diffusion cells with water as receptor phase. Receptor phase samples were taken over a 48 h period and permeants determined by reverse-phase HPLC. For caffeine and mefenamic acid no significant enhancements occurred between Aloe Vera and water as vehicles (p>0.05). However, for colchicine, oxybutynin and quinine the presence of Aloe Vera within the formulation provided enhancements (p < or = 0.05). Enhancement potential was dependent upon the molecular weight of the drug in formulation, with the enhancement effect attributable to as yet unidentified components within the Aloe Vera. Colchicine, with a molecular weight of 399.44, achieved the best enhancement with an enhancement ratio of 10.97. No correlation with lipophilicity was apparent. In a further experiment, where freeze-dried Aloe Vera was reconstituted at 200% residue level, permeation of quinine was 2.8 x that from normal Aloe Vera, providing further evidence for the presence of an enhancing factor within Aloe Vera. Certain, although unidentified, components of Aloe Vera readily permeated skin and the relative amount by which they permeated skin was inversely related to the molecular weight of the drug in solution, thus enhancement ratio. A new mechanistic rationale is proposed whereby larger drug solutes inhibit the permeation of Aloe Vera components, but also are then able to interact more effectively with the enhancing factor and be subject to the pull effect.

Bitterness suppression of BCAA solutions by L-ornithine.

The purpose of the present study was to evaluate the bitterness-suppressing effect of L-ornithine (L-Orn) on single or mixed solutions of branched-chain amino acids (BCAAs) using human gustatory sensation tests and an artificial taste sensor. The BCAAs tested (L-isoleucine (L-Ile), L-leucine (L-Leu), and L-valine (L-Val)) are the main components of various enteral nutrients or supplements. The bitterness-suppression effect of L-Orn was also compared with the effect of L-Arg. L-Orn was effective in suppressing the bitterness of single or mixed solutions of BCAAs in human gustatory sensation tests, the effect being similar to or greater than that of L-Arg. The artificial taste sensor was able to predict the bitterness-suppressing effects of L-Orn and L-Arg. The response electric potential patterns of L-Val, L-Leu and L-Ile solutions to which 100 mM L-Arg had been added were quite similar to the sensor response patterns of the 100 mM L-Arg solutions alone. The relative response electric potential patterns of L-Val, L-Leu or L-Ile solutions containing 100 mM L-Orn in channels 5-8 (positively charged) are similar to that of single solution of 100 mM L-Orn.

Analytical studies on the prediction of photosensitive/phototoxic potential of pharmaceutical substances.

PURPOSE: Phototoxic responses after administration of photosensitive pharmaceutics have been recognized as undesirable side effects, and predicting potential hazardous side effects is gaining importance as new drugs are introduced to the market. In this work, we characterize the photochemical/photobiological properties of model compounds to develop an effective screening method for the prediction of phototoxic/photosensitive potential. METHODS: Twenty-one known photosensitive/phototoxic compounds and five weak/nonphototoxic compounds were subjected to ultraviolet (UV) spectral analyses and photochemical evaluation including the determination of produced reactive oxygen species (ROS) and photostability study. The photooxidation of linoleic acid was also monitored in the presence of tested compounds, guided on the formation of thiobarbituric acid reactive substances. RESULTS: Most photosensitive/phototoxic drugs tested, even weak UV absorbers, at a concentration of 200 microM showed significant production of ROS under 18 h light exposure (30,000 lx). On the other hand, ROS generated from weak/nonphototoxic compounds, including strong UV absorber benzocaine, were low or negligible. Although exposure of quinine to light resulted in significant degradation (half-life, t1/2=6.4 h), it was dramatically attenuated by the addition of ROS scavengers, especially sodium azide (t1/2=122.6 h). Furthermore, concomitant exposure of photosensitive/phototoxic compounds (200 microM) and linoleic acid (1 mM) for 18 h led to the marked formation of lipoperoxide. CONCLUSION: Results indicated that known photosensitive/phototoxic compounds tested have the ability to generate ROS under light exposure, and this photochemical reaction could be associated with their photoinstability and/or phototoxic responses. Based on these findings, determination of ROS, generated from photoirradiated compounds, may be an effective predictive model in recognizing their photosensitive/phototoxic potential.

Screening of bitterness-suppressing agents for quinine: the use of molecularly imprinted polymers.

The purpose of the present study was to examine the possibility of using molecularly imprinted polymers (MIPs) to screen for bitterness-suppressing agents. Quinine was selected as the bitter substance standard. L-arginine (L-Arg), L-ornithine (L-Orn), L-lysine (L-Lys), and L-citrulline (L-Ctr) were tested as bitterness suppressant candidates. In a high-performance liquid chromatography study using a uniformly sized MIP for cinchonidine, which has a very similar structure to quinine, the retention factor (k) of quinine was significantly shortened by the addition of L-Arg or L-Orn to the mobile phase, whereas slight or no decrease was observed when L-Ctr and L-Lys were added. The abilities of these amino acids to decrease the k of quinine were ranked in the following order: L-Arg = (L-Orn >(L-Ctr >>(L-Lys. A linear relationship between the reciprocal of k and the concentration of the amino acids indicated a single competitive model at a single site. The magnitude of the association constants obtained seemed to be directly related to the inhibitory effect of the test substances on the affinity of quinine for the receptor site. Nuclear magnetic resonance and molecular modeling studies suggested a one-to-two hydrogen-bonding-based complex formation of one quinine molecule with two methacrylic acid molecules (Q-2MAA) in chloroform. In the molecular modeling studies, the N--N distance of the quinine molecule in the assumed Q-2MAA complex was calculated to be 5.12 angstroms, similar to the N - N distances of the two amino acid complexes (L-Arg-2MAA, L-Orn-2MAA), which were 4.84 and 5.30 angstroms, respectively. This suggests that L-Arg and L-Orn may compete with the quinine molecule in the cinchonidine-imprinted space. Finally, the results of human gustatory sensation tests correlated well with the MIP data. The proposed method using MIPs seems to have a potential for screening bitterness-suppressing agents for quinine.

Interactions between food components and drugs. Part 8: Effect of pectins and bile acid preparations forming stable mixed micelles on transport of quinine in vitro.

Interactions between quinine and acetylated pectin, amidated pectin and pectin with blockwise arrangement of the free carboxyl groups as well as interactions between quinine and bile salt preparations forming stable mixed bicelles have been investigated. A diffusion cell with two compartments and an artificial lipid membrane and a filter-grown colon carcinoma cell line (Caco-2) have been used. Depending on structural parameters, pectin preparations diminished the rate of permeation of the drug. Above the critical micelle concentration, the bile salt preparations influence the quinine transport stronger than the pectin preparations. The strongest inhibition of the quinine permeation showed a stable mixed micelle preparation consisting of glycodeoxycholate, palmitic acid and lecithin. The Caco-2 cell line appears to be not as suitable as artificial lipid membranes to study drug transport in the presence of the bile salt preparations.

The iron environment in heme and heme-antimalarial complexes of pharmacological interest.

Mössbauer spectroscopy has been utilized to probe the electronic environment of iron in a number of Ferriprotoporphyrin IX complexes of relevance to malaria. The markedly different iron environments found for the complexes of hemin with quinine, chloroquine, and the Chinese herbal antimalarial artesunate suggest that these compounds act by protecting the heme from polymerization to insoluble hemozoin, and by facilitating the transport of the protected heme to the food vacuole membrane where it is able to exercise its cytotoxic redox catalytic activity. Mössbauer parameters determined here for purified malaria pigment and synthetic beta-hematin confirm the chemical identical-ness of these species. The Mössbauer spectra of the complexes are discussed in light of the proposed structures of the complexes.

In vitro and clinical correlates of mefloquine resistance of Plasmodium falciparum in eastern Thailand.

A series of isolates of Plasmodium falciparum from eastern Thailand was collected prior to and after treatment failure with mefloquine. Patterns of drug sensitivity to standard and new antimalarials were characterized by using an in vitro assay based on the inhibition of schizont maturation. In vitro levels of mefloquine sensitivity of isolates were correlated with clinical treatment failures. In vitro parasite resistance to mefloquine is defined as an inhibitory dose-50 value greater than 20 nM. For isolates collected prior to treatment, there was no significant difference in mefloquine sensitivity patterns between subsequent successes and failures, suggesting that mefloquine treatment failures could not be predicted based on in vitro sensitivity of pretreatment isolates. A series of paired isolates were collected both prior to treatment with mefloquine and after recrudescence. Recrudescent isolates showed significant decreases in sensitivity to mefloquine, WR 194965, enpiroline, and halofantrine; no significant changes in sensitivity to amodiaquine, qinghaosu, and pyrimethamine; and an increase in sensitivity to chloroquine.