In VitroCardiovascular Effects of Dihydroartemisin-Piperaquine Combination Compared with Other Antimalarials

Abstract

ABSTRACTThein vitrocardiac properties of dihydroartemisinin (DHA) plus piperaquine phosphate (PQP) were compared with those of other antimalarial compounds. Results with antimalarial drugs, chosen on the basis of their free therapeutic maximum concentration in plasma (Cmax), were expressed as the fold of that particular effect with respect to theirCmax. The following tests were used at 37°C: hERG (human ether-à-go-go-related gene) blockade and trafficking, rabbit heart ventricular preparations, and sodium and slow potassium ion current interference (INaand IKs, respectively). Chloroquine, halofantrine, mefloquine, and lumefantrine were tested in the hERG studies, but only chloroquine, dofetilide, lumefantrine, and the combination of artemether-lumefantrine were used in the rabbit heart ventricular preparations, hERG trafficking studies, and INaand IKsanalyses. A proper reference was used in each test. In hERG studies, the high 50% inhibitory concentration (IC50) of halofantrine, which was lower than itsCmax, was confirmed. All the other compounds blocked hERG, with IC50s ranging from 3- to 30-fold theirCmaxs. In hERG trafficking studies, the facilitative effects of chloroquine at about 30-fold itsCmaxwere confirmed and DHA blocked it at a concentration about 300-fold itsCmax. In rabbit heart ventricular preparations, dofetilide, used as a positive control, revealed a high risk of torsades de pointes, whereas chloroquine showed a medium risk. Neither DHA-PQP nor artemether-lumefantrine displayed anin vitrosignal for a significant proarrhythmic risk. Only chloroquine blocked the INaion current and did so at about 30-fold itsCmax. No effect on IKswas detected. In conclusion, despite significant hERG blockade, DHA-PQP and artemether-lumefantrine do not appear to induce potential torsadogenic effectsin vitro, affect hERG trafficking, or block sodium and slow potassium ion currents.