title: The effects of quinine and artesunate treatment on plasma tumor necrosis factor levels in malaria-infected patients.
abstract: Tumor necrosis factor-alpha (TNF-alpha) is an endogenous mediator of shock and inflammation including malaria. Many lines of evidence suggest that cytoadherence, the life-threatening pathology associated with complicated and cerebral malaria, results from the overproduction of TNF in response to malarial parasite. Quinine has been shown to inhibit TNF synthesis and cytoadherence in vitro suggesting an additional beneficial effect of quinine on its anti-TNF action. On the other hand, artesunate inhibits cytoadherence better than quinine does not suppress TNF production in vitro. The present study compares the effect of artesunate and quinine on TNF levels of malaria-infected patients. Surprisingly, plasma TNF levels increased dramatically after quinine administration but did not increase after artesunate administration. This difference may be explained by previous observations showing that artesunate kills parasites in vitro and clears parasitemias in vivo for more rapidly than quinine. The rapid clearance of plasma TNF in quinine treated patients might be due to the drug's TNF-suppressive activity.
authors.affiliation: Department of Clinical Microscopy, Faculty of Medical Technology, Siriraj Hospital, Mahidol University, Bangkok, Thailand. mtwit@mahidol.ac.th
authors.forename: W
authors.initials: W
authors.lastname: Ittarat
authors.forename: R
authors.initials: R
authors.lastname: Udomsangpetch
authors.forename: K T
authors.initials: KT
authors.lastname: Chotivanich
authors.forename: S
authors.initials: S
authors.lastname: Looareesuwan
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use*; D037621:Artemisinins; D000077332:Artesunate; D002448:Cell Adhesion / Q000187:drug effects; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D016778:Malaria, Falciparum / Q000097:blood* / Q000188:drug therapy* / Q000276:immunology / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D011803:Quinine / Q000494:pharmacology / Q000627:therapeutic use*; D012717:Sesquiterpenes / Q000494:pharmacology / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis* / Q000187:drug effects*
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D014409:Tumor Necrosis Factor-alpha; D000077332:Artesunate; D011803:Quinine