In Vitro Cardiovascular Effects of Dihydroartemisin-Piperaquine Combination Compared with Other Antimalarials

• Published in: Antimicrobial Agents and Chemotherapy Vol. 56; no. 6; pp. 3261 - 3270
• Main Authors: Borsini, Franco, Crumb, William, Pace, Silvia, Ubben, David, Wible, Barb, Yan, Gan-Xin, Funck-Brentano, Christian
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society for Microbiology 01.06.2012
• Subjects: Animals; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimalarials; Antimalarials - pharmacology; Artemisinins; Artemisinins - pharmacology; Biological and medical sciences; Cell Line; chloroquine; combination drug therapy; Electrophysiology; Female; genes; heart; Heart Ventricles; Heart Ventricles - drug effects; Humans; In Vitro Techniques; inhibitory concentration 50; Medical sciences; Pharmacology; Pharmacology. Drug treatments; physiological transport; potassium; Quinolines; Quinolines - pharmacology; Rabbits; risk; sodium; Antimalarial; Piperaquine; Quinoline derivatives; Parasiticide; Circulatory system; In vitro; Comparative study
• ISSN: 0066-4804; 1098-6596
• DOI: 10.1128/AAC.05688-11

The in vitro cardiac properties of dihydroartemisinin (DHA) plus piperaquine phosphate (PQP) were compared with those of other antimalarial compounds. Results with antimalarial drugs, chosen on the basis of their free therapeutic maximum concentration in plasma (Cmax), were expressed as the fold of that particular effect with respect to their Cmax. The following tests were used at 37°C: hERG (human ether-à-go-go-related gene) blockade and trafficking, rabbit heart ventricular preparations, and sodium and slow potassium ion current interference (INa and IKs, respectively). Chloroquine, halofantrine, mefloquine, and lumefantrine were tested in the hERG studies, but only chloroquine, dofetilide, lumefantrine, and the combination of artemether-lumefantrine were used in the rabbit heart ventricular preparations, hERG trafficking studies, and INa and IKs analyses. A proper reference was used in each test. In hERG studies, the high 50% inhibitory concentration (IC50) of halofantrine, which was lower than its Cmax, was confirmed. All the other compounds blocked hERG, with IC50s ranging from 3- to 30-fold their Cmaxs. In hERG trafficking studies, the facilitative effects of chloroquine at about 30-fold its Cmax were confirmed and DHA blocked it at a concentration about 300-fold its Cmax. In rabbit heart ventricular preparations, dofetilide, used as a positive control, revealed a high risk of torsades de pointes, whereas chloroquine showed a medium risk. Neither DHA-PQP nor artemether-lumefantrine displayed an in vitro signal for a significant proarrhythmic risk. Only chloroquine blocked the INa ion current and did so at about 30-fold its Cmax. No effect on IKs was detected. In conclusion, despite significant hERG blockade, DHA-PQP and artemether-lumefantrine do not appear to induce potential torsadogenic effects in vitro, affect hERG trafficking, or block sodium and slow potassium ion currents.