cThe in vitro antimalarial activities of artemisone and artemisone entrapped in Pheroid vesicles were compared, as was their ability to induce dormancy in Plasmodium falciparum. There was no increase in the activity of artemisone entrapped in Pheroid vesicles against multidrug-resistant P. falciparum lines. Artemisone induced the formation of dormant ring stages similar to dihydroartemisinin. Thus, the Pheroid delivery system neither improved the activity of artemisone nor prevented the induction of dormant rings.
Since 2006, artemisinin-based combination treatment (ACT) has been the cornerstone of malaria chemotherapy (1). However, high treatment failure rates with artesunate-mefloquine (AS-MQ) (2) and dihydroartemisinin (DHA)-piperaquine (3) in western Cambodia highlight the urgent need for effective ACTs until more potent replacement drugs can be developed.Although artemisinin and its derivatives are the most potent and rapidly acting drugs for the treatment of Plasmodium falciparum malaria (4), this drug class is associated with high recrudescence. Artemisone (AMS), a new derivative, has potent antiplasmodial activity, good oral bioavailability, and metabolic stability (5) and is well tolerated in humans (6), with an effective curative dose approximately one-third that of artesunate (7). However, use of artemisone alone, as with the other artemisinins, also leads to recrudescence in nonhuman primates (8). A plausible explanation for recrudescence is drug-induced quiescence or dormancy that protects ring-stage parasites against artemisinin exposure (9, 10). The artemisinin-treated ring stages of P. falciparum thereby enter a temporary growth arrest (11, 12), wherein they survive drug treatment, resuming normal growth once drug pressure is removed (13-15).Formulations involving liposomes and self-emulsifying drug delivery systems enhance the efficacy of anti-infective agents, including antimalarial drugs, such as artemisinins (16)(17)(18)(19). A Pheroid delivery system has been shown to increase the in vitro antimalarial activities of azithromycin, mefloquine, and quinine significantly (20,21). Entrapment of artemisone in Pheroid vesicles also has been shown to enhance blood artemisone concentrations in mice (22) and primates (23). We investigated the effect of a Pheroid formulation on the antimalarial activity of artemisone and on dormancy in vitro. If this formulation prevents the induction of dormancy in vitro, it may circumvent recrudescences occurring following artemisinin treatment.Chloroquine diphosphate (CQ) and MQ (Sigma-Aldrich, St. Louis, MO), atovaquone (ATQ) (GlaxoSmithKline, Middlesex, United Kingdom), DHA, and AS (DK Pharma, Hanoi, Vietnam) were used. Artemisone and its metabolite M1 were obtained from the Hong Kong University of Science and Technology. The active M1 metabolite is formed via dehydrogenation in the thiomorpholine-dioxide moiety of artemisone (5, 6). The artemisone-entrapped Pheroid vesicles (AMS-Phe) were prepared by adding 30 mM artemisone to a pro-Pheroid formulation (i.e., oil...