title: Impact of methylene blue and atorvastatin combination therapy on the apparition of cerebral malaria in a murine model.
abstract: BACKGROUND
  Proveblue®, a methylene blue dye that complies with European Pharmacopoeia and contains limited organic impurities and heavy metals of recognized toxicity, showed in vitro synergy against Plasmodium falciparum when combined with atorvastatin, an inhibitor of 3-hydroxy-3-methylglutaryl-Coenzyme A reductase. The objective of this study was to evaluate the in vivo efficacy of Proveblue® when combined with atorvastatin in a murine model of experimental cerebral malaria.
  
  
  METHODS
  Forty female C57Bl6/N mice were divided into four groups (control, atorvastatin 40 mg/kg for seven days, Proveblue® 10 mg/kg for five days and atorvastatin combined with Proveblue®), infected with Plasmodium berghei ANKA parasites by intraperitoneal inoculation and observed for 45 days.
  
  
  RESULTS
  Treatment with atorvastatin alone did not demonstrate an effect significantly different from no treatment (p = 0.0573). All the mice treated by atorvastatin alone died. Treatment with Proveblue® or a combination of Proveblue® and atorvastatin was significantly increased survival of cerebral malaria (p = 0.0011 and 0.0002, respectively). Although there was only one death in the atorvastatin and Proveblue® combination treatment group (10%) versus two deaths (22%) with Proveblue® treatment, the effect on cerebral malaria was not significant (p = 0.283).
  
  
  CONCLUSIONS
  The present work demonstrated, for the first time, the high efficacy of Proveblue® in preventing cerebral malaria. Atorvastatin alone or in combination appears to possess limited use for preventing cerebral malaria. Combination of atorvastatin with lower doses of Proveblue® (<10 mg/kg/day) should be evaluated to show potential synergistic effects in cerebral malaria prevention.
authors.forename: Jérome
authors.initials: J
authors.lastname: Dormoi
authors.forename: Sébastien
authors.initials: S
authors.lastname: Briolant
authors.forename: Camille
authors.initials: C
authors.lastname: Desgrouas
authors.forename: Bruno
authors.initials: B
authors.lastname: Pradines
mesh_terms: D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D000069059:Atorvastatin; D004195:Disease Models, Animal; D004357:Drug Synergism; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D016779:Malaria, Cerebral / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality / Q000469:parasitology; D008751:Methylene Blue / Q000627:therapeutic use*; D051379:Mice; D008810:Mice, Inbred C57BL; D018512:Parasitemia; D011758:Pyrroles / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin; D008751:Methylene Blue