title: Developmental toxicity of artesunate in the rat: comparison to other artemisinins, comparison of embryotoxicity and kinetics by oral and intravenous routes, and relationship to maternal reticulocyte count.
abstract: BACKGROUND
  The antimalarial, artesunate, is teratogenic and embryolethal in rats, with peak sensitivity on Days 10 and 11 postcoitum (pc).
  
  
  METHODS
  We compared the developmental toxicity of structurally related artemisinins, dihdyroartemisinin (DHA), artemether (ARTM), and arteether (ARTE) to that of artesunate after oral administration to rats on Day 10 pc. In separate studies, embryolethality was characterized after single intravenous (IV) administration of artesunate on Day 11 pc, and toxicokinetic parameters following oral and IV administration were compared. Lastly, to determine whether maternal hematologic effects occurred at doses that affect embryonic erythroblasts, artesunate was orally administered on Day 11 pc at a dose that caused 100% embryolethality.
  
  
  RESULTS
  All artemisinins caused the same pattern of embryolethality and fetal cardiovascular and skeletal abnormalities as previously shown for artesunate. In the IV study, marked postimplantation loss occurred at 1.5 and 3 mg/kg artesunate, but not at 0.75 mg/kg. Among the toxicokinetic parameters evaluated, only the DHA AUC(0-t) was similar at embryolethal oral and IV doses of artesunate. An embryolethal dose of artesunate caused a 15% decrease in maternal reticulocyte counts and no other hematologic effects.
  
  
  CONCLUSIONS
  Several structurally related artemisinins cause similar developmental toxicity, suggesting an artemisinin class effect. Equally embryotoxic oral and IV treatments of one artemisinin compound (artesunate) produced similar systemic exposure to the artesunate metabolite, DHA, suggesting that DHA may be the proximate developmental toxicant. Embryolethal doses of artesunate only caused minor changes in maternal reticulocyte counts indicating that adult hematology parameters are not as sensitive as embryonic erythroblasts.
authors.affiliation: GlaxoSmithKline, King of Prussia, Pennsylvania 19406-0939, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Clark
authors.forename: Steven A
authors.initials: SA
authors.lastname: Lerman
authors.forename: Estella M
authors.initials: EM
authors.lastname: Cox
authors.forename: William E
authors.initials: WE
authors.lastname: Gristwood
authors.forename: Tacey E K
authors.initials: TE
authors.lastname: White
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000077549:Artemether; D037621:Artemisinins / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics* / Q000633:toxicity*; D000077332:Artesunate; D002585:Cesarean Section; D004333:Drug Administration Routes; D020964:Embryo Loss / Q000139:chemically induced; D004622:Embryo, Mammalian / Q000187:drug effects*; D005260:Female; D005333:Fetus / Q000187:drug effects; D007275:Injections, Intravenous; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000097:blood* / Q000139:chemically induced; D051381:Rats; D017701:Reticulocyte Count; D012156:Reticulocytes / Q000166:cytology / Q000187:drug effects*
chemical_list: D037621:Artemisinins; D000077332:Artesunate; C031327:artemisinin; D000077549:Artemether; C055141:artemotil