Role of arteether in the treatment of malaria and plans for further development.

Arteether has potent antimalarial activity in vitro against drug resistant Plasmodium falciparum. Preclinical studies of arteether injection have been completed, and phase I safety, tolerance and pharmacokinetic studies are in progress in The Netherlands. No intolerance has yet been observed. Production has been established in a pilot scale in The Netherlands by A.C.F. Beheer BV. Toxicity studies have been conducted in rats and dogs: 3 mg/kg/d for 28 d had no effect. At higher dosages, toxic effects on heart, brain, bone marrow, kidney and liver were observed. Cardiotoxicity is characterized in the dog by a dose-related prolongation of the QTc interval and inversion of the T-wave in some animals. Arrhythmias have not been observed. Electrocardiographic changes returned to baseline values after cessation of daily drug administration. Neuronal toxicity was observed in dogs given daily doses of 6.75 or 15 mg/kg/d intramuscularly for 28 d. Signs of lethargy, incoordination, and abnormal responses appeared in the fourth week. Electroencephalograms exhibited no abnormality. Neuronal degeneration and subsequent myelin degeneration, particularly affecting the cerebellum and other portions of the mid- and hind-brain, were observed. Clinical signs of neurotoxicity did not resolve completely within 30 d after cessation of dosing, and histopathological damage in the brain was still evident. Behavioural and histological evidence of neurotoxicity was also observed in rats. The neurotoxic effects of arteether and artemether in rats and dogs were similar.

A comparison of the in vitro activities of amodiaquine and desethylamodiaquine against isolates of Plasmodium falciparum.

The antimalarial activities of amodiaquine, the desethyl metabolite of amodiaquine, chloroquine, and mefloquine were evaluated against 35 field isolates of Plasmodium falciparum collected from eastern Thailand, October-December 1985, to define patterns of cross-resistance among these compounds. The assay system was based on the in vitro inhibition of schizont maturation. The parasites were generally sensitive to mefloquine (mean 50%-inhibitory concentrations = 9.98 nM) and highly resistant to chloroquine (IC50 = 313 nM). The mean in vitro activity of desethylamodiaquine (67.5 nM) was approximately 3.5 times lower than that of amodiaquine (18.2 nM). There was a significant rank-order correlation between the IC50S of desethylamodiaquine and chloroquine, but not between amodiaquine and chloroquine, which suggests that the apparent cross-resistance between chloroquine and amodiaquine observed in clinical studies may be more closely related to the cross-resistance between chloroquine and the metabolite rather than between chloroquine and the parent compound. Isolates with IC50 values of amodiaquine greater than 20 nM demonstrated a high degree of correlation with values of desethylamodiaquine; however, it was not possible to accurately predict the sensitivity to desethylamodiaquine of isolates which had IC50 values of amodiaquine of less than 20 nM.

Reversal of chloroquine resistance in malaria parasite Plasmodium falciparum by desipramine.

Desipramine and several other tricyclic antidepressant drugs reverse chloroquine resistance in Plasmodium falciparum in vitro at concentrations observed in the plasma of human patients treated for depression. Reversal of resistance is associated with increased chloroquine accumulation in the parasite, probably because of inhibition of a putative chloroquine efflux pump. When owl monkeys (Aotus lemurinus lemurinus) infected with chloroquine-resistant Plasmodium falciparum were treated with chloroquine plus desipramine, their parasitemias were rapidly suppressed. Desipramine was found to be one of the most effective compounds yet described for the reversal of chloroquine resistance both in vitro and in vivo.

Desferrioxamine suppresses Plasmodium falciparum in Aotus monkeys.

Clinical observation has suggested that iron deficiency may be protective in malaria, and we have found that desferrioxamine (DF), an iron-specific chelating agent, inhibited Plasmodium falciparum growth in vitro. It was difficult to be confident that DF would be effective in an intact animal, however, because continuous exposure to DF was required in vitro and, in vivo, DF is rapidly excreted. Also, the in vitro effect of DF was overcome by addition of iron to the culture and in vivo there are potentially high local iron concentrations when iron is absorbed from the diet or released from reticuloendothelial cells. We now show that DF given by constant subcutaneous infusion does suppress parasitemia in P. falciparum-infected Aotus monkeys.

Oxidative activity of hydroxylated primaquine analogs. Non-toxicity to glucose-6-phosphate dehydrogenase-deficient human red blood cells in vitro.

The individual effects of two putative metabolites of primaquine (5,6-dihydroxyprimaquine and 5,6-dihydroxy-8-aminoquinoline) on the hexose monophosphate shunt (HMS) and on the ATP-dependent proteolytic system which rapidly degrades oxidized erythrocyte protein were measured in intact red blood cells in vitro from two blood donors. In red cells treated with nitrite (1-40 mM) or phenylhydrazine (0.01-10 mM), proteolytic activity was detected only with concentrations (7.5 mM NaNO2 and 0.25 mM phenylhydrazine) causing greater than 15-fold elevation of HMS activity, and glucose-6-phosphate dehydrogenase (G6PD)-deficient (25% of normal activity) red cell suspensions thus treated showed approximately 30% greater proteolysis. G6PD-normal and deficient red cells treated with the primaquine analogs, however, did not experience proteolysis with concentrations (0.25 mM) in excess of those causing 17-fold elevation of HMS activity. Stimulation of the HMS by the primaquine analogs thus appears unrelated to an erythrotoxic oxidative stress. Methylene blue is known to cause an elevation of HMS activity through direct and diaphorase II-dependent oxidation of reduced nicotinamide adenine dinucleotide phosphate (NADPH) which is independent of injurious oxidative stress. It was found that the putative primaquine metabolites also caused direct and diaphorase II-dependent oxidation of NADPH in dilute hemolysate, thus suggesting that the putative primaquine metabolites have a methylene blue-like redox disposition in red blood cells. Results obtained in this study suggest that the hemolytic toxicity of primaquine may be unrelated to processes which lead to oxidative deterioration of red cell protein.

Potential antiradiation drugs containing no nitrogen, and related compounds.

Capabilities are reported of di- and higher sulfides (RSnR') terminated by sulfinate functions [-S(O)O-] for protecting mice against otherwise lethal effects of ionizing radiation. With the use of congeners, structure-activity correlations are developed for the effects of esterification of the sulfinate function, of changing the length of the chain of sulfur atoms, of reduction to a mercapto sulfinate, and of changing the substituents R and R' to chiral and other types of groups. Neither a trisulfide nor a sulfinate by itself was significantly radioprotective. The key requirement for radio-protection in the series appears to be the presence of a sulfur function (-Sn-) from which a thiol can be engendered by a neighboring-group effect of an electron-donating group; sulfoxide functions may afford alternatives to sulfinate functions as such neighboring groups. The relevance of structure-activity relations to the chemical and biological mechanisms involved in the radioprotective activities is discussed.

Comparison of Plasmodium falciparum infections in Panamanian and Colombian owl monkeys.

Parameters of blood-induced infections of the Vietnam Oak Knoll, Vietnam Smith, and Uganda Palo Alto strains of Plasmodium falciparum studied in 395 Panamanian owl monkeys in this laboratory between 1976-1984 were compared with those reported from another laboratory for 665 Colombian owl monkeys, studied between 1968-1975, and, at the time, designated Aotus trivirgatus griseimembra. The virulence of these strains was less in Panamanian than in Colombian owl monkeys, as indicated by lower mortality rates of the Panamanian monkeys during the first 30 days of patency. Maximum parasitemias of the Vietnam Smith and Uganda Palo Alto strain, in Panamanian owl monkeys dying during the first 15 days of patent infection, were significantly higher than in Colombian owl monkeys. Panamanian owl monkeys that survived the primary attack had significantly higher maximum parasitemias than the surviving Colombian owl monkeys. Peak parasitemias were attained significantly earlier after patency in Panamanian than in Colombian owl monkeys, irrespective of the strain of P. falciparum. More Panamanian than Colombian owl monkeys evidenced self-limited infection after the primary attack of either the Vietnam Smith or Uganda Palo Alto strain. The duration of the primary attacks and recrudescences were significantly shorter in Panamanian than in Colombian owl monkeys. Mean peak parasitemias during recrudescence were usually higher in Panamanian owl monkeys than in Colombian monkeys. Differences of infection parameters were probably attributable, in part, to geographical origin of the two monkey hosts and parasite strains.

Screening procedure using chicks infected with the sporozoites of Plasmodium gallinaceum in an antimalarial drug development programme.

Of 10 000 compounds tested for tissue schizontocidal activity in a Plasmodium gallinaceum-chick model, 157 were also tested in a definitive mouse test (DMT) and 277 in a rhesus monkey test (RMT). The results in the avian model were 78% and 55% in agreement with those of the DMT and RMT, respectively. This result is not as good as that for a tissue schizontocidal mouse screen previously reported, which showed 93% and 80% agreement with DMT and RMT, respectively. More than three-quarters of the compounds tested in DMT and RMT were 8-aminoquinolines, a chemical class known to have tissue schizontocidal activity.

Sporozoite-induced Plasmodium cynomolgi infections in captive born Macaca fascicularis.

Capability of captive born cynomolgus monkeys to substitute for rhesus in the Plasmodium cynomolgi radical curative antimalarial drug development model was examined. Eighteen monkeys divided into 3 groups were given standard or high doses of sporozoites intravenously. One group of 4 received 0.8 - 1.6 X 10(6) and a second group of 8 received 0.3 - 1.0 X 10(7) sporozoites. The third group of 6 was splenectomized and then received 3.0 - 4.0 X 10(6). The 2 groups of intact monkeys developed a persistent low level parasitemia; however, gametocyte production was poor. The splenectomized group developed a persistent parasitemia with a higher mean, which more closely resembled rhesus parasitemias. A high, post-patent leukocytosis consisting primarily of lymphocytes was observed in this group. Good gametocyte production resulted in the splenectomized group and oocysts were produced from all lots of Anopheles dirus which fed on them. Following clearance of blood forms, relapse potential was demonstrated in the 2 splenectomized monkeys tested. In this study the splenectomized captive born cynomolgus appeared to be capable of supplementing rhesus as an antimalarial drug testing model.

Comparison of in vitro and in vivo antimalarial activities of 9-phenanthrenecarbinols.

Analysis of the antimalarial activity of a selected series of 17 9-phenanthrenecarbinols against cultured strains of Plasmodium falciparum and against P. berghei in mice following oral administration indicated that the rankings of activities within the series were influenced by substituents on the 9-carbinol and the route of administration. Compounds with alkylamino-alkyl groups were ranked as most active by an in vitro screening system which assayed activity against chloroquine-sensitive and chloroquine-resistant strains of cultured P. falciparum by the inhibition of uptake of radiolabelled hypoxanthine. There were few differences in ranking of activities between the two strains. Although there was a significant difference between activities of an erythro- and a threo-racemate, activities of the four optical isomers of this compound were comparable. Among the series, compounds with a 2-piperidyl substituent on the 9-carbinol were ranked most active by the oral route of administration as assayed by the cure rates of mice infected with P. berghei. Correlation of these observations with previously published data on the activity of these compounds against P. falciparum in Owl monkeys and P. berghei in mice following subcutaneous administration suggested that neither species of host nor strains of parasite significantly influenced the ranking of activities of this class of compound.

An in vitro micro-volume procedure for rapid measurement of erythrocytic hexose monophosphate shunt activity.

A radiometric micro-volume procedure for measurement of erythrocytic hexose monophosphate shunt (HMS) activity in intact cells in vitro is described. The procedure is rapid, allowing 200 individual HMS determinations in a single experiment of 5 hr duration. The procedure is reproducible, yielding HMS activity means insignificantly different (P greater than 0.05) between replicate experiments. A profile of sodium nitrite-induced HMS stimulation is reported: HMS was elevated 2-fold (P less than 0.001) between zero and 2.5 mM NaNO2; HMS elevation was more distinct (7-fold) between 2.5 and 5.0 mM NaNO2; maximum activity (22-fold) was observed between 10 and 20 mM NaNO2; greater than 20 mM NaNO2 caused significant (P less than 0.001) diminution of HMS; glucose carbon recycling through the HMS occurred only with greater than 2.5 mM NaNO2 where this process contributed less than or equal to 16% to total HMS activity.

Amoscanate as a topically applied chemical for prophylaxis against Schistosoma mansoni infections in mice.

Amoscanate (0.1% w/v) in methanol solution applied to skin by tail immersion 1 day prior to cercarial exposure provided mice with better than 90% protection against mature Schistosoma mansoni infections. Cercariae penetrated and schistosomula migrated from treated skins as readily as in control skins. Lung incubation assays, however, indicated that day 7 lung worm burdens were only about half those of control values. By day 20, worm burdens were reduced further to approximately 15% of those for control mice. The delayed prophylactic activity was apparently not due to percutaneously absorbed compound. Wipe application of amoscanate to the skin was nearly as effective as immersion.

Plasmodium gallinaceum: avian screen for drugs with radical curative properties.

Existing primary screens for radical curative antimalarial drugs fail to adequately detect many compounds which affect the latent, exoerythrocytic hypnozoite, the stage of the parasite responsible for relapse. At the same time, these screens falsely identify a wide range of compounds with no radical curative activity. The avian malaria, Plasmodium gallinaceum, and Aedes aegypti mosquitos were used in a screen which measures the effects of candidate compounds on gametocytes and their development within the mosquito. Sporontocidal and gametocytocidal effects could be differentiated by this screen. In a blind study, those compounds shown to be exclusively gametocytocidal were those same drugs which had previously been shown to have radical curative effects against true relapsing malarias. The chicken malaria gametocyte screen was more sensitive than the rodent screens in detecting useful compounds, with a minimum of false positive identifications.

In vitro assessment of 2-acetylpyridine thiosemicarbazones against chloroquine-resistant Plasmodium falciparum.

A series of 2-acylpyridine thiosemicarbazones was evaluated in vitro against a chloroquine-resistant Plasmodium falciparum strain. Antimalarial activity was assessed by the inhibition of uptake of [G-3H]hypoxanthine by the parasites. Among the mono- and disubstituted derivatives tested, 13 of 17 had 50% inhibitory doses of less than 10 ng/ml. Increasing the size of the ring at N4 from four to five, six, and seven members produced concomitant decreases in activity. Similarly, increasing the size of the aliphatic substituent on the azomethine carbon reduced activity. Selected compounds were also tested against a chloroquine-susceptible strain. The results suggested that the activities of these agents were not modified significantly by resistance to chloroquine. In general, in vitro activities correlate poorly with the in vivo activities in mice infected with Plasmodium berghei.

New tissue schizontocidal antimalarial drugs.

Over 700 causal prophylactic and radical curative antimalarial drugs have been discovered during the screening of approximately 4000 chemical compounds in rodent and simian malaria models. Causal prophylactic activity in the Plasmodium berghei-rodent model was demonstrated by 10 distinct groups of chemicals: 1) tetrahydrofolate dehydrogenase inhibitors, 2) naphthoquinones, 3) dihydroacridinediones, 4) tetrahydrofurans, 5) guanylhydrazones, 6) analogues of clopidol, 7) quinoline esters, 8) dibenzyltetrahydro-pyrimidines, 9) 6-aminoquinolines, 10) 8-aminoquinolines.Of the causal prophylactic compounds, only the 6- and 8-aminoquinolines were capable of curing persistent exoerythrocytic infections of P. cynomolgi in rhesus monkeys. The 6-aminoquinolines were substantially less active than primaquine.This report describes a series of 4-methyl-5-phenoxy-6-methoxy-8-aminoquinolines, which are potent blood schizontocides and radical curative drugs. The most active member of this series, 4-methyl-5-(3-trifluoromethylphenoxy)-6-methoxy-8-[(4-amino-1-methylbutyl)| amino]quinoline succinate (WR 225448), was 5 times more active than primaquine in curing persistent exoerythrocytic infections of P. cynomolgi in rhesus monkeys.As a blood schizontocide, WR 225448 was effective in animal models against P. berghei, P. cynomolgi, P. vivax, and both drug-sensitive and drug-resistant strains of P. falciparum. WR 225448 was also more toxic than primaquine in rats on subacute (28-day) administration.