MANAGEMENT OF CORONAVIRUS DISEASE 2019 (COVID-19) – IS THERE A ROLE FOR COMPLEMENTARY AND HERBAL MEDICINAL PRODUCTS?

Commentar

In vitro study of interaction between quinine and Garcinia kola

Purpose: To investigate the interaction between quinine and Garcinia kola using an in vitro adsorption study.Methods: In vitro interaction between quinine and G. kola was conducted at 37 ± 0.1 °C. Adsorption of quinine (2.5 - 40 μg/ml) to 2.5 % w/v G. kola suspension was studied. Thereafter, quinine desorption process was investigated. The amount of quinine adsorbed and desorbed was quantified using HPLC. A Freundlich isotherm was constructed to describe the resulting data and percentage of quinine desorbedwas determined from the desorption data.Results: An adsorption isotherm of the data gave a Freundlich constant (K) of 52.66 μg/g, with a slope of 0.69 indicating a high capacity and affinity of G. kola to adsorb quinine at a concentration smaller than 2.41 μg/g of G. kola. However the adsorptive capacity of G. kola for quinine at 37 ± 0.1 °C appears to be a saturable process as observed from the isotherm. Quinine desorption from G. kola peaked at 1 hour (37.51 %) and decreased to a constant amount (about 35 %) over the remaining sampling time.Conclusion: Quinine is adsorbed on G. kola in vitro. This suggests that concurrent administration of quinine and G. kola should be avoided, to prevent potential drug interaction and decreased drug bioavailability.Keywords: Quinine, Garcinia kola, Adsorption, Desorption, Drug interactio

Factors affecting the electrocardiographic QT interval in malaria: A systematic review and meta-analysis of individual patient data.

BACKGROUND: Electrocardiographic QT interval prolongation is the most widely used risk marker for ventricular arrhythmia potential and thus an important component of drug cardiotoxicity assessments. Several antimalarial medicines are associated with QT interval prolongation. However, interpretation of electrocardiographic changes is confounded by the coincidence of peak antimalarial drug concentrations with recovery from malaria. We therefore reviewed all available data to characterise the effects of malaria disease and demographic factors on the QT interval in order to improve assessment of electrocardiographic changes in the treatment and prevention of malaria. METHODS AND FINDINGS: We conducted a systematic review and meta-analysis of individual patient data. We searched clinical bibliographic databases (last on August 21, 2017) for studies of the quinoline and structurally related antimalarials for malaria-related indications in human participants in which electrocardiograms were systematically recorded. Unpublished studies were identified by the World Health Organization (WHO) Evidence Review Group (ERG) on the Cardiotoxicity of Antimalarials. Risk of bias was assessed using the Pharmacoepidemiological Research on Outcomes of Therapeutics by a European Consortium (PROTECT) checklist for adverse drug events. Bayesian hierarchical multivariable regression with generalised additive models was used to investigate the effects of malaria and demographic factors on the pretreatment QT interval. The meta-analysis included 10,452 individuals (9,778 malaria patients, including 343 with severe disease, and 674 healthy participants) from 43 studies. 7,170 (68.6%) had fever (body temperature ≥ 37.5°C), and none developed ventricular arrhythmia after antimalarial treatment. Compared to healthy participants, patients with uncomplicated falciparum malaria had shorter QT intervals (-61.77 milliseconds; 95% credible interval [CI]: -80.71 to -42.83) and increased sensitivity of the QT interval to heart rate changes. These effects were greater in severe malaria (-110.89 milliseconds; 95% CI: -140.38 to -81.25). Body temperature was associated independently with clinically significant QT shortening of 2.80 milliseconds (95% CI: -3.17 to -2.42) per 1°C increase. Study limitations include that it was not possible to assess the effect of other factors that may affect the QT interval but are not consistently collected in malaria clinical trials. CONCLUSIONS: Adjustment for malaria and fever-recovery-related QT lengthening is necessary to avoid misattributing malaria-disease-related QT changes to antimalarial drug effects. This would improve risk assessments of antimalarial-related cardiotoxicity in clinical research and practice. Similar adjustments may be indicated for other febrile illnesses for which QT-interval-prolonging medications are important therapeutic options

PROSPECTS OF INTEGRATION OF NANOTECHNOLOGY TO ANTIMALARIAL HERBAL REMEDIES FOR IMPROVED THERAPEUTIC EFFICACY – A CONCISE REVIEW: Antimalarial Herbal Medicines Nanoformulations

Background: The therapeutic utility of herbal medicinal products including antimalarial herbal remedies has been hampered by some unfavorable biopharmaceutical properties of the bioactive constituents such as low aqueous solubility, poor oral bioavailability, poor intestinal permeability and large molecular size. Al these biopharmaceutical issues are responsible for observed reduced in vivo efficacy of some herbal products compared to their in vitro efficacy. These drawbacks can by countered by the integration of nanotechnology. The present article identified the various documented nanosystems and examined the recent efforts in the deployment of nanotechnology in formulations of antimalarial herbal medicines for improved therapeutic efficacies. Also safety considerations in clinical applications of nanoformulations were highlighted. Methods: The information was acquired from an extensive literature searching of electronic  databases such as  Science-Direct, PubMed, and Google-Scholar to obtain appropriate articles made in the English language which were published up to 2022, using a combination of relevant keywords. Results:  Only very few herbal antimalarial remedies such as extracts of Azadirachta indica, Momordica charantia, Curcuma longa, and Artemisia species have been nanoformulated and evaluated for antimalarial efficacy.   In all these studies, the drug-loaded nanoformulations exhibited significantly higher in vitro and/or in vivo antimalarial efficacy. The different nanoformulations of antimalarial herbal remedies that have been reported include nanoparticles of lipid-based, cyclodextrin, chitosan/lecithin , liposomes,  nanosuspension,  nanoemulsions, and metal-based nanoparticles.. Conclusion: Different types of nanoformulations of herbal antimalarial drugs have been reportedly prepared by different techniques and these offer advantages of improved efficacies. Safety concerns present a hurdle to clinical applications

Chemotherapeutic Interaction Between Khaya Grandifoliola (Welw) Cdc Stem Bark Extract And Two Anti-Malarial Drugs In Mice

In malarial endemic countries especially in the tropics, conventional antimalarial drugs are used with herbal remedies either concurrently or successively. Khaya grandifoliola is one of such popular herbs used in the treatment of malaria. Various doses of ethanol extract of K. grandifoliola stem bark (50-400 mg/kg/day) were administered orally to Swiss albino mice infected with Plasmodium yoelii nigerense. A dose of 100 mg/kg/day of the extract was also combined with 2.5 mg/kg/day of chloroquine or 6.25 mg/kg/day of halofantrine in both early and established malaria infection test models. The results showed that in the early malaria infection test, K. grandifoliola in combination with chloroquine or halofantrine elicited enhanced antiplasmodial effect in the established infection, there was significantly greater parasite clearance following administration of the combination when compared to the effects of K. grandifoliola or the conventional drugs alone. The mean survival period of parasitized animals was also enhanced by the extract/halofantrine combination. Lower therapeutic doses of halofantrine may be required to potentiate parasite clearance when used in combination with K. grandifoliola. This may constitute great advantage to halofantrine which is associated with cardiotoxicity at high doses

Factors affecting the electrocardiographic QT interval in malaria: A systematic review and meta-analysis of individual patient data.

BACKGROUND:Electrocardiographic QT interval prolongation is the most widely used risk marker for ventricular arrhythmia potential and thus an important component of drug cardiotoxicity assessments. Several antimalarial medicines are associated with QT interval prolongation. However, interpretation of electrocardiographic changes is confounded by the coincidence of peak antimalarial drug concentrations with recovery from malaria. We therefore reviewed all available data to characterise the effects of malaria disease and demographic factors on the QT interval in order to improve assessment of electrocardiographic changes in the treatment and prevention of malaria. METHODS AND FINDINGS:We conducted a systematic review and meta-analysis of individual patient data. We searched clinical bibliographic databases (last on August 21, 2017) for studies of the quinoline and structurally related antimalarials for malaria-related indications in human participants in which electrocardiograms were systematically recorded. Unpublished studies were identified by the World Health Organization (WHO) Evidence Review Group (ERG) on the Cardiotoxicity of Antimalarials. Risk of bias was assessed using the Pharmacoepidemiological Research on Outcomes of Therapeutics by a European Consortium (PROTECT) checklist for adverse drug events. Bayesian hierarchical multivariable regression with generalised additive models was used to investigate the effects of malaria and demographic factors on the pretreatment QT interval. The meta-analysis included 10,452 individuals (9,778 malaria patients, including 343 with severe disease, and 674 healthy participants) from 43 studies. 7,170 (68.6%) had fever (body temperature ≥ 37.5°C), and none developed ventricular arrhythmia after antimalarial treatment. Compared to healthy participants, patients with uncomplicated falciparum malaria had shorter QT intervals (-61.77 milliseconds; 95% credible interval [CI]: -80.71 to -42.83) and increased sensitivity of the QT interval to heart rate changes. These effects were greater in severe malaria (-110.89 milliseconds; 95% CI: -140.38 to -81.25). Body temperature was associated independently with clinically significant QT shortening of 2.80 milliseconds (95% CI: -3.17 to -2.42) per 1°C increase. Study limitations include that it was not possible to assess the effect of other factors that may affect the QT interval but are not consistently collected in malaria clinical trials. CONCLUSIONS:Adjustment for malaria and fever-recovery-related QT lengthening is necessary to avoid misattributing malaria-disease-related QT changes to antimalarial drug effects. This would improve risk assessments of antimalarial-related cardiotoxicity in clinical research and practice. Similar adjustments may be indicated for other febrile illnesses for which QT-interval-prolonging medications are important therapeutic options