A randomized feasibility trial comparing four antimalarial drug regimens to induce Plasmodium falciparum gametocytemia in the controlled human malaria infection model.


Reuling, IJ; van de Schans, LA; Coffeng, LE; Lanke, K; Meerstein-Kessel, L; Graumans, W; van Gemert, GJ; Teelen, K; Siebelink-Stoter, R; van de Vegte-Bolmer, M; de Mast, Q; van der Ven, AJ; Ivinson, K; Hermsen, CC; de Vlas, S; Bradley, J; Collins, KA; Ockenhouse, CF; McCarthy, J; Sauerwein, RW; Bousema, T; (2018) A randomized feasibility trial comparing four antimalarial drug regimens to induce Plasmodium falciparum gametocytemia in the controlled human malaria infection model. eLife, 7. ISSN 2050-084X DOI: https://doi.org/10.7554/eLife.31549

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Abstract

<b>Background</b> Malaria elimination strategies require a thorough understanding of parasite transmission from human to mosquito. A clinical model to induce gametocytes to understand their dynamics and evaluate transmission-blocking interventions (TBI) is currently unavailable. Here, we explore the use of the well-established Controlled Human Malaria Infection model (CHMI) to induce gametocyte carriage with different antimalarial drug regimens.<b>Methods</b>In a single centre, open-label randomised trial, healthy malaria-naive participants (aged 18-35 years) were infected with<i>Plasmodium falciparum</i>by bites of infected<i>Anopheles</i>mosquitoes (ClinicalTrials.gov, NCT02836002). Participants were randomly allocated to four different treatment arms (n = 4 per arm) comprising low-dose (LD) piperaquine (PIP) or sulfadoxine-pyrimethamine (SP), followed by a curative regimen upon recrudescence. Male and female gametocyte densities were determined by molecular assays.<b>Findings</b>Mature gametocytes were observed in all participants (16/16, 100%). Gametocytes appeared 8.5-12 days after the first detection of asexual parasites. Peak gametocyte densities and gametocyte burden was highest in the LD-PIP/SP arm, and associated with the preceding asexual parasite biomass (p=0.026). Male gametocytes had a mean estimated circulation time of 2.7 days (95% CI 1.5-3.9) compared to 5.1 days (95% CI 4.1-6.1) for female gametocytes. Exploratory mosquito feeding assays showed successful sporadic mosquito infections. There were no serious adverse events or significant differences in the occurrence and severity of adverse events between study arms (p=0.49 and p=0.28).<b>Conclusions</b>The early appearance of gametocytes indicates gametocyte commitment during the first wave of asexual parasites emerging from the liver. Treatment by LD-PIP followed by a curative SP regimen, results in the highest gametocyte densities and the largest number of gametocyte-positive days. This model can be used to evaluate the effect of drugs and vaccines on gametocyte dynamics, and lays the foundation for fulfilling the critical unmet need to evaluate transmission-blocking interventions against<i>falciparum</i>malaria for downstream selection and clinical development.<b>Funding</b>PATH Malaria Vaccine Initiative (MVI).

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
PubMed ID: 29482720
URI: http://researchonline.lshtm.ac.uk/id/eprint/4646813

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