Efficacy and Safety of Fosmidomycin-Piperaquine as Nonartemisinin-Based Combination Therapy for Uncomplicated Falciparum Malaria: A Single-Arm, Age De-escalation Proof-of-Concept Study in Gabon.

Background: Fosmidomycin-piperaquine is being developed as nonartemisinin-based combination therapy to meet the challenge of emerging artemisinin resistance. Methods: The study was a phase 2, single-arm, proof-of-concept study of the efficacy, tolerability, and safety of fosmidomycin-piperaquine for the treatment of uncomplicated Plasmodium falciparum monoinfection in Gabon. Adults and children of both sexes with initial parasite counts between 1000 and 150000/µL received oral treatment with fosmidomycin (twice daily doses of 30 mg/kg) and piperaquine (once daily dose of 16 mg/kg) for 3 days and followed-up for 63 days. The primary efficacy endpoint was the per-protocol polymerase chain reaction (PCR)-corrected day 28 adequate clinical and parasitological response (ACPR). Results: One hundred patients were enrolled. The PCR-corrected day 28 ACPR rate was 83/83, or 100% (95% confidence interval, 96-100). Fourteen patients had asexual parasitaemia between day 28 and day 63; all were typed by PCR as new infections. Fosmidomycin-piperaquine therapy led to rapid parasite clearance (median, 36 hours; interquartile range [IQR], 6-60) and fever clearance time (median, 12 hours; IQR, 6-48). The electrocardiogram assessments showed 2 patients with prolonged QT interval >500 msec following study drug administration. The majority of adverse events affected the gastrointestinal and respiratory tracts and were transient and mild to moderate in severity. Conclusions: This is the first report of the use of the combination fosmidomycin-piperaquine. The combination appeared to have high efficacy and be safe and well tolerated despite observed transient changes in electrocardiogram with prolongation of the QT interval. Clinical Trials Registration. NCT02198807.

Linking mutagenic activity to micropollutant concentrations in wastewater samples by partial least square regression and subsequent identification of variables.

We deployed multivariate regression to identify compounds co-varying with the mutagenic activity of complex environmental samples. Wastewater treatment plant (WWTP) effluents with a large share of industrial input of different sampling dates were evaluated for mutagenic activity by the Ames Fluctuation Test and chemically characterized by a screening for suspected pro-mutagens and non-targeted software-based peak detection in full scan data. Areas of automatically detected peaks were used as predictor matrix for partial least squares projections to latent structures (PLS) in combination with measured mutagenic activity. Detected peaks were successively reduced by the exclusion of all peaks with lowest variable importance until the best model (high R(2) and Q(2)) was reached. Peaks in the best model co-varying with the observed mutagenicity showed increased chlorine, bromine, sulfur, and nitrogen abundance compared to original peak set indicating a preferential selection of anthropogenic compounds. The PLS regression revealed four tentatively identified compounds, newly identified 4-(dimethylamino)-pyridine, and three known micropollutants present in domestic wastewater as co-varying with the mutagenic activity. Co-variance between compounds stemming from industrial wastewater and mutagenic activity supported the application of "virtual" EDA as a statistical tool to separate toxicologically relevant from less relevant compounds.