The cardiovascular effects of amodiaquine and structurally related antimalarials: An individual patient data meta-analysis

BackgroundAmodiaquine is a 4-aminoquinoline antimalarial similar to chloroquine that is used extensively for the treatment and prevention of malaria. Data on the cardiovascular effects of amodiaquine are scarce, although transient effects on cardiac electrophysiology (electrocardiographic QT interval prolongation and sinus bradycardia) have been observed. We conducted an individual patient data meta-analysis to characterise the cardiovascular effects of amodiaquine and thereby support development of risk minimisation measures to improve the safety of this important antimalarial.Methods and findingsStudies of amodiaquine for the treatment or prevention of malaria were identified from a systematic review. Heart rates and QT intervals with study-specific heart rate correction (QTcS) were compared within studies and individual patient data pooled for multivariable linear mixed effects regression.The meta-analysis included 2,681 patients from 4 randomised controlled trials evaluating artemisinin-based combination therapies (ACTs) containing amodiaquine (n = 725), lumefantrine (n = 499), piperaquine (n = 716), and pyronaridine (n = 566), as well as monotherapy with chloroquine (n = 175) for uncomplicated malaria. Amodiaquine prolonged QTcS (mean = 16.9 ms, 95% CI: 15.0 to 18.8) less than chloroquine (21.9 ms, 18.3 to 25.6, p = 0.0069) and piperaquine (19.2 ms, 15.8 to 20.5, p = 0.0495), but more than lumefantrine (5.6 ms, 2.9 to 8.2, p < 0.001) and pyronaridine (−1.2 ms, −3.6 to +1.3, p < 0.001). In individuals aged ≥12 years, amodiaquine reduced heart rate (mean reduction = 15.2 beats per minute [bpm], 95% CI: 13.4 to 17.0) more than piperaquine (10.5 bpm, 7.7 to 13.3, p = 0.0013), lumefantrine (9.3 bpm, 6.4 to 12.2, p < 0.001), pyronaridine (6.6 bpm, 4.0 to 9.3, p < 0.001), and chloroquine (5.9 bpm, 3.2 to 8.5, p < 0.001) and was associated with a higher risk of potentially symptomatic sinus bradycardia (≤50 bpm) than lumefantrine (risk difference: 14.8%, 95% CI: 5.4 to 24.3, p = 0.0021) and chloroquine (risk difference: 8.0%, 95% CI: 4.0 to 12.0, p < 0.001). The effect of amodiaquine on the heart rate of children aged <12 years compared with other antimalarials was not clinically significant. Study limitations include the unavailability of individual patient-level adverse event data for most included participants, but no serious complications were documented.ConclusionsWhile caution is advised in the use of amodiaquine in patients aged ≥12 years with concomitant use of heart rate–reducing medications, serious cardiac conduction disorders, or risk factors for torsade de pointes, there have been no serious cardiovascular events reported after amodiaquine in widespread use over 7 decades. Amodiaquine and structurally related antimalarials in the World Health Organization (WHO)-recommended dose regimens alone or in ACTs are safe for the treatment and prevention of malaria.

In this meta-analysis, Xin Hui Supanee Chan and colleagues investigate the cardiovascular effects of amodiaquine and structurally-related antimalarials using individual patient data from trials.     

Amplification of transcription of separate mitochondrial genes in human and monkey B-cell non-Hodgkin's lymphoma

Mitochondrial genes that are overexpressed in human and monkey B-cell non-Hodgkin lymphomas (B-NHLs) were sought via subtraction hybridization, cloning, and differential screening of the resulting cDNA libraries. The cDNAs of mitochondrial genes made an appreciable proportion of all lymphoma-specific cDNAs. Lymphomogenesis was associated with overexpression of a mitochondrial gene set which varied with lymphoma type and always included NADHIV. A possible association between overexpression of certain mitochondrial genes and cell malignant transformation is discussed.     

Formation of an extracellular system of enzymes during growth of Geotrichum candidum 3C on cell walls isolated from cereal grain capsules

The activities of extracellular systems of hemicellulases, pectinases, and cellulases was studied during a 72-h cultivation of Geotrichum candidum 3C. The culture was grown on a medium containing 3% cell walls isolated from wheat grain capsules, which served as the sole carbon source. Enzymes catalyzing the degradation of pectin substances (beet pectin, alpha-L-arabinan, and 1,4-beta-D-galactan), as well as beta-D-galactosidase and alpha-L-arabinofuranosidase involved in their hydrolysis, were formed first (4 h after the beginning of cultivation). Enzymes hydrolyzing 4-O-methyl-alpha-D-glucurono-beta-D-xylan and sodium carboxymethyl xylan were also found in the culture liquid after 4 h of fungal growth. The contents of pectin-degrading and xylanolytic enzymes reached their maximum levels after 52-56 and 72 h of growth, respectively. Cellulolytic enzymes were detected after 8-28 h of cultivation. Enzymes degrading alpha-D-galacto-beta-D-mannan were found 24 h after the beginning of growth; their content was maximum after 72 h of cultivation.     

Complex analysis of the state of sinusoid vessels of the liver after disturbance of innervation

By means of light, electron microscopy and morphometry, the state of the sinusoid vessels and cells of their lining has been investigated in 7, 14, 30, 60 and 90 days after bilateral subdiaphragmal vagotomy. In the days mentioned the cross section area of the sinusoid vessels and amount of active labelled Kupffer cells significantly increase (except day 90 ). By the end of the 3d month these parameters decrease, but they do not reach the control level. Ultrastructure of the endothelial cells and Kupffer cells is changed, phagocytic activity of the latter is increased. The greatest destructive changes take place in Kupffer cells, especially during first two months. By the end of the 3d month there is certain tendency to normalization.     

Characteristics of liver regeneration after vagotomy

Peculiarities of a reparative process in the hepatic parenchyma have been studied after toxic effect of CCl4, at vagotomy in 1, 2 and 4 weeks after the operation. Appearance of a more massive lesion and decreasing regeneration of the vagotomized liver have been revealed. The proliferative activity of hepatocytes, normal and after vagotomy has a principally similar character and is described as a curve with two picks, having its maximum on the 2nd and the 5th-6th days after xenobiotic administration. The intensity of the hepatocyte proliferative activity in the denervated liver essentially surpasses that in the control and decreases, as the area of the parenchymal lesion decreases in the latest time after the operation.     

Evaluation of the functional state of the hepatocyte monooxygenase system in rats with damaged innervation of the liver

Cytochrome P-450 content measured spectrophotometrically 14 and 25 days after bilateral subdiaphragmal vagotomy in hepatocyte microsomes of inbred male rats was considerably reduced. The rate of aminopyrine demethylation and oxygen consumption decreased, while the duration of hexenal-induced sleep was prolonged. Monoxygenase responsible for p-hydroxylation of aniline proved relatively resistant to vagotomy.     

Effect of the antihypoxic agent ionol on the morphofunctional state of the air-blood barrier of the lungs in hypoxic anoxia

It is shown that antihypoxic ionol has promoted normalization of the air-blood lung barrier ultrastructure, activation of the surfactant system under acute hypoxic hypoxia effect as well as compensatory redistribution of the thickness of separate barrier layers due to intensified synthesis of phospholipids which are the components of cytoplasmic membranes and pulmonary surfactant.     

Effects of ethidium bromide on the viscosity of chromatin secreted by rat liver in normal state and after denervation

The paper studies structural state of chromatin secreted from the rat's liver. For this purpose the authors studied the dependence of relative viscosity of chromatin preparations secreted from the liver of rats and three groups of animals being in different terms of postdenervation process.