title: In vivo-in vitro model for the assessment of clinically relevant antimalarial cross-resistance.
abstract: Cross-resistance may be considered one of the most important factors leading to decreased drug susceptibility of Plasmodium falciparum. The study aimed to determine whether clinically relevant cross-sensitivity of P. falciparum existed between artemisinin and mefloquine. Seventy-six patients with falciparum malaria were admitted and treated with artemisinin derivatives. Treatment response parameters were assessed and in vitro drug sensitivity tests were performed with artemisinin, mefloquine, quinine, and chloroquine. Distinct in vitro cross-sensitivity between artemisinin and mefloquine was observed (p = 0.604; P < 0.001). To assess the relevance of this finding for clinical cross-resistance, we used an analytical model based on the relation of in vivo treatment response parameters (fever, parasite and symptom clearance) to a single reference drug with in vitro drug sensitivity data of several other drugs. Artemisinin (R = 0.554; P = 0.009) and mefloquine (R = 0.615; P = 0.002) in vitro drug sensitivities were equally well reflected in the in vivo treatment response to artemisinin, thereby suggesting the clinical relevance of in vitro cross-sensitivity.
authors.affiliation: Department of Specific Prophylaxis and Tropical Medicine, Institute of Pathophysiology, University of Vienna, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Noedl
authors.forename: W H
authors.initials: WH
authors.lastname: Wernsdorfer
authors.forename: S
authors.initials: S
authors.lastname: Krudsood
authors.forename: P
authors.initials: P
authors.lastname: Wilairatana
authors.forename: P
authors.initials: P
authors.lastname: Viriyavejakul
authors.forename: H
authors.initials: H
authors.lastname: Kollaritsch
authors.forename: G
authors.initials: G
authors.lastname: Wiedermann
authors.forename: S
authors.initials: S
authors.lastname: Looareesuwan
mesh_terms: D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D037621:Artemisinins; D002738:Chloroquine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D003429:Cross Reactions; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D015767:Mefloquine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D008954:Models, Biological; D021261:Parasitic Sensitivity Tests; D010963:Plasmodium falciparum / Q000187:drug effects*; D011803:Quinine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D012008:Recurrence; D012717:Sesquiterpenes / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D002738:Chloroquine; C031327:artemisinin; D011803:Quinine; D015767:Mefloquine