The effect of sodium bicarbonate on a single dose of diethylcarbamazine therapy in patients with bancroftian filariasis in Kenya

An attempt was made to examine the effect of a combination of diethylcarbamazine citrate (DEC-C) and sodium bicarbonate (NaHCO₃) on the pharmacokinetics of diethylcarbamazine (DEC), side-reactions and reduction of the microfilarial density of patients with Wuchereria bancrofti infection at a hospital in Nairobi, Kenya. The microfilariae carriers received DEC-C at 6 mg/kg or 3 mg/kg with or without NaHCO₃ at 75 mg/kg body weight. The patients treated with a combination of drugs showed alkaline urine for 4 h post-treatment, while patients treated with DEC-C alone showed acidic urine. Although no significant difference was detected in the DEC half-life value and other pharmacokinetic parameters between patients treated with DEC-C (6 mg/kg) plus NaHCO₃ (75 mg/kg) and those treated with DEC-C (6 mg/kg) alone, the general tendency was that in patients receiving NaHCO₃ the first-order elimination rate constant decreased and serum elimination half-life and area under the serum concentration-time curve values increased. There was a significant difference between the mean values of the first-order absorption rate constant, the first-order elimination rate constant, and the time to maximum serum concentrations for the patients receiving DEC-C at 3 mg/kg plus NaHCO₃ at 75 mg/kg and those for the group receiving DEC-C at 6 mg/kg alone. There was no difference in frequency and severity of the side-reactions between patients receiving DEC-C at 6 mg/kg plus NaHCO₃ at 75 mg/kg, DEC-C at 3 mg/kg plus NaHCO₃ at 75 mg/kg, and DEC-C at 6 mg/kg alone. During the initial 5 days post-treatment, there was no significant difference in reduction of microfilarial density among these three groups. In the field, an attempt was made to examine the possibility of increased antifilarial effect using a combination of DEC-C and NaHCO₃. The patients were examined for microfilariae, given DEC-C at 6 mg/kg with or without NaHCO₃ at 75 mg/kg, and examined for microfilariae again 1 year later. Although the cure rate was the same among the groups, the percentage reduction in microfilarial density of the patients receiving DEC-C plus NaHCO₃ was significantly greater than those of patients receiving DEC-C alone. A combination of DEC-C with NaHCO₃ will be of practical value in a single dose of DEC-C for the mass-treatment of bancroftian filariasis.     

Studies on filarial GST as a target for antifilarial drug development-in silico and in vitro inhibition of filarial GST by substituted 1,4-naphthoquinones

Eleven 1,4-naphthoquinone analogues with different amino substitutions at position 3 of the quinone ring earlier reported for macrofilaricidal activity were selected and screened against purified cytosolic GST isolated from the bovine filarial worm Setaria digitata and IC₅₀ values were determined. Of the 11 compounds tested, 8 showed good inhibition against S. digitata GST. The IC₅₀ values of the most effective macrofilaricidal compounds—11 [2-(4-methylpiperazin-1-yl)naphthalene-1,4-dione] and 9 {2-[(1,3-dimethylbutyl)amino]naphthalene -1,4-dione}—were 0.872 and 0.994 mM, respectively. Compounds 9 and 11 were further studied for type of enzyme inhibition and found to exhibit competitive and uncompetitive inhibition kinetics, respectively, with respect to substrate GSH. All 11 compounds were in agreement with Lipinski’s rule of five and passed through the FAFDrugs ADME/tox filter. Molecular docking was carried out using the modeled 3D structure of wbGST PDB ID:1SFM as receptor and substituted naphthoquinones as ligands using AutoDock 4.0. The binding energy of nine compounds varied from −9.15 to −6.58 Kcal mol⁻¹, whereas compounds 8 and 10 did not show any binding to the receptor. Among the compounds studied, compound 7 {2-[3-(diethylamino) propyl]aminonaphthalene-1,4-dione} showed maximum affinity towards wbGST as it exhibited the lowest binding energy, followed by compounds 11 and 9. However compound 7 was not macrofilaricidal while 11 and 9 exhibited macrofilaricidal activity. The results of in silico and in vitro studies with the synthesized 1,4 -naphthoquinone analogues on filarial GST and in vitro macrofilaricidal activity against adult bovine filarial worm S. digitata open up a promising biochemical target for antifilarial drug development.     

Treatment of co-infection with bancroftian filariasis and onchocerciasis: a safety and efficacy study of albendazole with ivermectin compared to treatment of single infection with bancroftian filariasis

BACKGROUND: In order to use a combination of ivermectin and albendazole for the elimination of lymphatic filariasis, it is important to assess the potential risk of increased adverse events in individuals infected with both lymphatic filariasis and onchocerciasis. We compared the safety and efficacy of albendazole (400 mg) in combination with ivermectin (150 micrograms/kg), for the treatment of co-infections of Wuchereria bancrofti and Onchocerca volvulus with single infection of W. bancrofti. METHODS: The safety study on co-infections was a crossover, double blind design, while for the single infection of bancroftian filariasis an open design comparing two treatments was used. For co-infection, one group was allocated a single dose of ivermectin (150 micrograms/kg) plus albendazole (400 mg) (Group A). The other group received placebo (Group B). Five days later the treatment regime was reversed, with the Group A receiving placebo and Group B receiving treatment. For the single bancroftian filariasis infection, one group received a single dose of albendazole (400 mg) plus ivermectin (150 microg/kg) (Group C) while the other group received a single dose of albendazole (400 mg) alone (Group D). Blood and skin specimens were collected on admission day, day 0, and on days 2, 3, and 7 to assess drug safety and efficacy. Thereafter, blood and skin specimens were collected during the 12 months follow up for the assessment of drug efficacy. Study individuals were clinically monitored every six hours during the first 48 hours following treatment, and routine clinical examinations were performed during the hospitalisation period and follow-up. RESULTS: In individuals co-infected with bancroftian filariasis and onchocerciasis, treatment with ivermectin and albendazole was safe and tolerable. Physiological indices showed no differences between groups with co-infection (W. bancrofti and O. volvulus) or single infection (W. bancrofti). The frequency of adverse events in co-infected individuals was 63% (5/8, Group A, albendazole + ivermectin) and 57% (4/7, Group B, placebo) and of mild or moderate intensity. In single W. bancrofti infection the frequency of adverse events was 50% (6/12, Group C, albendazole + ivermectin) and 38% (5/13, Group D, albendazole) and of a similar intensity to those experienced with co-infection. There were no differences in adverse events between treatment groups. There was no significant difference in the reduction of microfilaraemia following treatment with albendazole and ivermectin in groups with single or co-infection. CONCLUSION: Our findings suggest that ivermectin plus albendazole is a safe and tolerable treatment for co-infection of bancroftian filariasis and onchocerciasis.     

Effects of a single dose of menadione on the intestinal calcium absorption and associated variables

The effect of a single large dose of menadione on intestinal calcium absorption and associated variables was investigated in chicks fed a normal diet. The data show that 2.5 micro mol of menadione/kg of b.w. causes inhibition of calcium transfer from lumen-to-blood within 30 min. This effect seems to be related to oxidative stress provoked by menadione as judged by glutathione depletion and an increment in the total carbonyl group content produced at the same time. Two enzymes presumably involved in calcium transcellular movement, such as alkaline phosphatase, located in the brush border membrane, and Ca(2+)- pump ATPase, which sits in the basolateral membrane, were also inhibited. The enzyme inhibition could be due to alterations caused by the appearance of free hydroxyl groups, which are triggered by glutathione depletion. Addition of glutathione monoester to the duodenal loop caused reversion of the menadione effect on both intestinal calcium absorption and alkaline phosphatase activity. In conclusion, menadione shifts the balance of oxidative and reductive processes in the enterocyte towards oxidation causing deleterious effects on intestinal Ca(2+) absorption and associated variables, which could be prevented by administration of oral glutathione monoester.     

Effect of diethylcarbamazine, butylated hydroxy anisole and methyl substituted chalcone on filarial parasite Setaria cervi: proteomic and biochemical approaches

For survival, parasite exerts several lines of defense of which drug neutralization is one of the major phenomena. Lack of phase I cytochrome P450 in some of the nematode render them depend on the phase II detoxification system involving GST as a major detoxifying enzymes. In present study, the antifilarial DEC, phenolic compound BHA and methyl chalcone have been evaluated for proteomic and biochemical studies in Setaria cervi. BHA and methyl chalcone showed cytotoxic effect leading to irreversible inhibition in motility and viability of parasites. These drugs showed marked alteration in proteomic profile of S. cervi at 100 μM concentration with 10.82, 8.52 and 6.75% downregulated (<0.5) and 7.64, 31.78 and 24.32% upregulated (>1.5) in DEC, BHA and methyl chalcone treatment respectively. Significant depletion in GSH level with increase in NO production was observed. Amongst these compounds, methyl chalcone demonstrated significant inhibitory effect (p<0.05) on GST, PGHS and PTP activity leading to loss of metabolic homeostasis and parasite death. The cytotoxic response and altered expression profile of major enzymes under drug exposure suggested the oxidative stress induced apoptosis as a major cause of parasite killing which was further supported by DNA fragmentation in BHA and methyl chalcone.     

Adverse drug reactions in the treatment of filarial parasites: Haematological, biochemical, immunological and pharmacological changes in Dirofilaria immitis infected dogs treated with diethylcarbamazine

In order to understand the mechanism of the shock reaction that can occur in Dirofilaria immitis-infected dogs, following treatment with diethylcarbamazine (DEC), a variety of blood parameters were measured. A decrease in red blood cell parameters occurred in reactive dogs, followed by an increase, suggesting a possible sequestration of erythrocytes followed by peripheral vasoconstriction. Changes in leucocytes were consistent with stress reactions. Thrombocytopenia occurred, but no evidence of coagulopathy was seen. Alanine aminotransferase and creatinine phosphokinase (especially CK1 and CK3) concentrations increased suggesting cell damage and possibly liver cell necrosis, possibly due to hypoxia. Complement was not activated during the reaction and there was no increase in circulating immune complexes. No changes in plasma concentrations or histamine, 5-hydroxytryptamine, kininogen or prostaglandin F metabolite were found. Bradycardia was not caused by changes in potassium or calcium ion concentrations. These results suggest that the shock reaction is not an anaphylactic Type 1 reaction and is not caused by mast cell degranulation or by immune complex activation of mediators. The most likely cause of the reaction is that DEC causes the liberation of substances from microfilariae or adult worms which are able to constrict the hepatic vein directly or via its sympathetic innervation.     

Distribution and peroxidative oxidation of 2-t-butyl-4-methoxyphenol in rat tissues after a single intraperitoneal dose

The distribution of 2-t-butyl-4-methoxyphenol (BHA) and its conversion to 2,2'-dihydroxy-3,3'-di-t-butyl-5,5'-dimethoxydiphenyl (di-BHA) in rat tissues at different times (1-96 hr) following the intraperitoneal administration of a single dose of BHA (32 mg kg-1 body weight) were monitored by gas chromatography-mass spectrometry (GC/MS) analysis of both compounds. High BHA levels were found in the intestine and liver persisting up to 24 hours (5.5-20.7 and 1.8-3.3 micrograms g-1 wet weight, respectively). In these tissues, values of the area under the experimental concentration curve (AUC0-24) were 285 and 49 times higher, respectively, than those observed in plasma (945 ng mL-1 hr), AUC0-24 values in kidney, spleen, erythrocytes, and brain were 2-7 times higher, whereas values below those found in plasma were observed in lung and muscle. The metabolite di-BHA could be detected in the intestine, kidney, and spleen, amounting to 5-8% of BHA. These findings indicate that rat intestine is capable of transforming in vivo BHA into di-BHA even when the former compound is administered intraperitoneally and that this capacity is shared by the kidney and spleen.     

Efficacy of sulfadoxine-pyrimethamine in Tanzania after two years as first-line drug for uncomplicated malaria: assessment protocol and implication for treatment policy strategies

Background

Early diagnosis and effective treatment with an appropriate drug form the main components of the World Health Organization's strategy to reduce malaria related mortality. The few available drugs might be safeguarded if combined with artesunate. The addition of artesunate to a standard antimalarial treatment substantially reduces treatment failure, recrudescence and gametocyte carriage.

Methods

During late 2004, the efficacy of artesunate (4 mg/kg. day, on days 0–2) plus sulfadoxine-pyrimethamine (25 mg/kg, on day 0) for the treatment of uncomplicated Plasmodium falciparum malaria was investigated in four sentinel areas in Sudan, with different malaria transmission (Damazin, Kassala, Kosti, and Malakal).

Results

Two hundreds and sixty-nine patients completed the 28-day follow-up. On day one, 60 (22.3%) patients were febrile and 15 (5.5%) patients were parasitaemic. On day three, all the patients were afebrile and aparasitaemic. While two patients (0.7%, Kassala) showed late Clinical and Parasitological Failures, the rest (99.3%) of the patients demonstrated Adequate Clinical and Parasitological Response. A gametocytaemia were detected during the follow-up in one patient (0.37%, Kassala). Adverse drug effects were detected in 32 (11.9%) patients

Conclusion

The study showed that AS plus SP is an effective, safe drug in the treatment of uncomplicated P. falciparum malaria in Sudan.     

Impact of two rounds of mass drug administration using diethylcarbamazine combined with albendazole on the prevalence of Brugia timori and of intestinal helminths on Alor Island, Indonesia

Background

Annual mass drug administration (MDA) using diethylcarbamizine (DEC, 6 mg/kg) combined with albendazole (alb, 400 mg) is recommended by the Global Programme to Eliminate Lymphatic Filariasis (GPELF). This strategy has been shown to be efficient in the of control bancroftian filariasis, but data on brugian filariasis as well as on the positive side effects on intestinal helminths are lacking.

Methods

The effect of one selective treatment and two rounds of MDA using DEC and alb on the prevalence and intensity of Brugia timori infection were studied on Alor island using a cross-sectional and a cohort approach. Before the campaign and ten months after each treatment cycle microfilariae (mf) were assessed by filtration of night blood. Before and ten months after MDA, stool samples were collected and the prevalence of intestinal helminths were determined.

Results

In all, the mf-rate dropped from 26.8% before any treatment to 3.8% following the second MDA. Almost all mf-positive, treated individuals showed very low mf densities. The crude prevalence of hookworm dropped from 25.3% to 5.9%. The reduction of prevalence of Ascaris lumbricoides (32.3% to 27.6%) and Trichuris trichiura (9.4% to 8.9%) was less pronounced. Within a cohort of 226 individuals, which was examined annually, the prevalence of A. lumbricoides dropped from 43.8% to 26.5% and of T. trichiura from 12.8% to 6.6%. The results indicate that this MDA approach reduces not only the mf prevalence of B. timori but also the prevalence of hookworm and to a lesser extent also of A. lumbricoides and T. trichiura.

Conclusion

The MDA using DEC and alb as recommended by GPELF is extremely effective for areas with brugian filariasis. The beneficial effect of MDA on intestinal helminths may strengthen the national programme to eliminate lymphatic filariasis in Indonesia and may set resources free which are otherwise used for deworming campaigns of schoolchildren.     

Pragmatic assessment of exercise in routine care using an MDHAQ: associations with changes in RAPID3 and other clinical variables

BackgroundExercise is associated with major benefits in patients with rheumatic diseases for both cardiovascular and rheumatic status. However, information about exercise generally is not collected systematically in routine rheumatology care. A multidimensional health assessment questionnaire (MDHAQ), which was designed for busy clinical settings, includes a query about exercise status. We analyzed possible associations between change in MDHAQ exercise scores and other MDHAQ measures in patients with various rheumatic diseases over one year.MethodsIn one rheumatology clinical setting, all patients, regardless of diagnosis, complete an MDHAQ before seeing a rheumatologist. The MDHAQ includes scores for physical function, pain, and patient global estimate, compiled into an index, routine assessment of patient index data (RAPID3), as well as a self-report joint count and a query about exercise. Patients were classified into four groups according to their exercise status at baseline and one year later as: EXER-Yes (regular exercise), EXER-Yes; EXER-No (no regular exercise), EXER-Yes; EXER-Yes, EXER-No; and EXER-No, EXER-No. These groups were compared using the chi square and Kruskal-Wallis tests and analysis of variance (ANOVA).ResultsPatients who reported regular exercise at baseline were younger, had higher formal education, and better clinical status than other patients. The EXER-No, EXER-Yes group had greater improvement in other MDHAQ variables than patients in the other three groups. By contrast, the EXER-Yes, EXER-No group was the only group with poorer status one year later.ConclusionsThe MDHAQ exercise query indicates that regular exercise is associated with better clinical status. Patients in the EXER-No, EXER-Yes group reported the best clinical improvement, although it is not known whether exercise preceded or followed the improved clinical status.     

Cell resensitization after delivery of a cycle-specific anticancer drug and effect of dose splitting: learning from tumour cords

After a single dose of an anticancer agent, changes due to cell death are expected to occur in the distribution of cells between proliferating and quiescent compartment as well as in the oxygenation and nutritional state of surviving cells. These changes are transient because tumour regrowth tends to restore the pretreatment status. The reoxygenation due to the decrease of oxygen consumption is expected to induce cell recruitment from quiescence into proliferation, and consequently to increase the sensitivity of the cell population to a successive treatment by a cycle-specific drug. In previous papers we proposed a model of the response of tumour cords (cylindrical arrangements of tumour cells growing around a blood vessel of the tumour) to single-dose treatments. The model included the motion of cells and oxygen diffusion and consumption. On the basis of that model suitably extended to better account for the action of anticancer drugs, we study the time course of the oxygenation and of the redistribution of cells between the proliferating and quiescent compartments. By means of simulations of the response to a dose delivered as two spaced equal fractions, we investigate the dependence of tumour response on the spacing between the fractions and on the main parameters of the system. A time window may be found in which the delivery of two fractions is more effective than the delivery of the undivided dose.     

The UK Environmental Change Network after twenty years of integrated ecosystem assessment: Key findings and future perspectives

The UK Environmental Change Network (ECN), the UK's Long-Term Ecosystem Research (LTER) network, has now been operating for over twenty years. It was established in 1992 as a set of terrestrial sites at which sustained observations relevant to a range of ecological indicators and environmental parameters could be made. An additional ECN freshwater network was launched in 1994. In this paper we provide a brief history of the network, and describe its current structure and role within a complementary wider range of UK environmental monitoring and observation programmes that are either more focussed on specific parameters or habitats, or operate at different temporal and spatial scales. We then provide a review of the other papers within this Special Issue, which exemplifies the broad range of environmental concerns that ECN data and sites are helping to address. These include network-wide summaries of environmental and biological trends over the first two decades of monitoring, more site-specific assessment of the ecological impacts of local pressures resulting from changes in management, biological and ecosystem service indicator development, and the testing of new monitoring technologies. We go on to consider: (i) future directions of network development and adaptation in light of recently emerging environmental concerns, dwindling financial resources and the consequent need for greater efficiency; (ii) the desire for tighter integration with other monitoring and observation programmes both nationally internationally; (iii) opportunities raised by recent technological developments; and (iv) the need to process and make available data more rapidly to increase the capacity of ECN sites as early warning systems. In its first two decades of operation the ECN has accumulated a robust set of baseline data that describe environmental and biological variability across a range of habitats in unprecedented detail. With appropriate, informed development, these should prove invaluable in discerning the causes and consequences of environmental change for decades to come.     

Impact of CYP3A5 and MDR-1 gene polymorphisms on the dose and level of tacrolimus among living-donor liver transplanted patients: single center experience

Aim of work: To assess the impact of Cytochrome P450 3A5 (CYP3A5) and multidrug resistance-1 gene (MDR-1) single nucleotide polymorphisms on the dose and blood level of tacrolimus among liver transplanted patients.

Patients and methods: We enrolled a prospective study of 41 liver transplanted patients. Dose-adjusted trough blood concentration (C/D ratio) was calculated. Polymerase chain reaction-restriction fragment length polymorphism followed by sequencing was done for genotyping of CYP3A5*3 (6986A?>?G).

Results: At 1 week, 1 and 3 months C/D ratio were significantly lower in CYP3A5 expressers *1/*1 patients compared to non-expressers *3/*3.

Conclusion: CYP3A5 (6986A?>?G) genotype, rather than MDR-1 (2677G?>?A/T) variant, has an impact on tacrolimus pharmacokinetics.