In vivo efficacy of pyrantel pamoate as a post-exposure prophylactic for rat lungworm (Angiostrongylus cantonensis)

Jacob, John; Steel, Argon; Kaluna, Lisa; Hess, Steven C.; Leinbach, Israel L.; Antaky, Carmen; Sugihara, Robert T.; Hamilton, Lindsey; Follett, Peter A.; Howe, Kathleen; Jacquier, Steven; Wongwiwatthananukit, Supakit; Jarvi, Susan I.

doi:10.1016/j.ijpddr.2022.04.002

Cited by 4 publications

(5 citation statements)

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“… 27 , 28 , 45 Treatment with anthelminthics in the 7- to 21-day window post–symptom onset is positively corroborated by experimental studies 67 – 70 and by epidemiology 71 , 72 and is expressly indicated as prophylaxis when known or suspected exposure to a slug or snail occurs in certain endemic regions. 61 , 73 A recent study 62 has demonstrated the in vivo efficacy of pyrantel pamoate (OTC pinworm medicine) as a postexposure prophylactic and has been included in the clinical treatment protocols at Hilo Medical Center, Hilo, HI. From rat studies, we know that after ingestion, the parasite moves quickly from the digestive tract into the bloodstream.…”

Section: Discussionmentioning

confidence: 99%

“… 8 The cryptic nature of exposure (in regions such as Hawaii, where intentional ingestion of raw terrestrial mollusks is rare) and the difficulty in detecting early infection make this disease difficult to prevent, as well as to diagnose early enough to provide prophylaxis, although efforts to provide prophylactic treatment have been identified and implemented in some regions. 61 , 62 An immunodiagnostic tool to identify antibodies to the parasite may help medical practitioners form a diagnosis when PCR is negative in suspected cases.…”

Section: Introductionmentioning

confidence: 99%

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Immunodiagnostic Detection of Angiostrongylus cantonensis Exposure on Hawaii Island Using Isogeographic 31-kDa Antigen

Jarvi

Nakayama

Eamsobhana

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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Angiostrongylus cantonensis is the leading cause of neuroangiostrongyliasis worldwide, and east Hawaii Island is a hotspot for the disease in the United States. A combination of glycoproteins with molecular weight of 31 kDa has been used as antigen to evaluate antibody response in human serum samples in Thailand with high specificity and sensitivity. In a previous pilot study, the Thailand-isolated 31-kDa proteins showed efficacy in dot-blot tests using serum samples from 435 human volunteers on Hawaii Island. However, we hypothesized that native antigen isolated from Hawaii A. cantonensis may exhibit higher specificity than the Thailand-isolated 31-kDa antigen due to potential minor variation in epitopes between isolates. In this study, 31-kDa glycoproteins were isolated by sodium dodecyl-sulfate polyacrylamide gel electrophoresis from adult A. cantonensis nematodes collected from rats captured on east Hawaii Island. The resultant proteins were purified by electroelution, pooled, bioanalyzed, and quantified. A subset of 148 samples from human participants of the original cohort of 435 was consented for this study, including 12 of the original 15 clinically diagnosed participants. Results of ELISA using the Hawaii-isolated 31-kDa antigen were compared with results of the same serum samples previously tested with both crude Hawaii antigen ELISA and Thailand 31-kDa antigen dot blot. This study shows a seroprevalence in the general population of East Hawaii Island of 25.0%, similar to previous findings of 23.8% seroprevalence in this cohort using crude antigen from Hawaii A. cantonensis and 26.5% using Thailand 31-kDa antigen.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immunodiagnostic Detection of Angiostrongylus cantonensis Exposure on Hawaii Island Using Isogeographic 31-kDa Antigen

Jarvi

Nakayama

Eamsobhana

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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“…Although levamisole is a long-established drug and widely used in some developing countries, it causes serious adverse effects its use is now limited in Europe and North America, whereas pyrantel is mainly available in formulations for animals. Interestingly, a recent in vivo study in A. cantonensis- infected rat showed that pyrantel pamoate exhibited significant antiparasitic properties at a dose of 11 mg/kg, with a worm burden reduction of 53%–73%, demonstrating the potential of pyrantel for the treatment of angiostrongyliasis ( Jacob et al, 2022 ). In conclusion, in this study we demonstrated that ivermectin, salamectin, moxidectin, levamisole, pyrantel pamoate, and albendazole have in vitro anthelmintic properties against A. cantonensis L1 in a time- and concentration-dependent manner.…”

Section: Discussionmentioning

confidence: 99%

Susceptibility of Angiostrongylus cantonensis Larvae to Anthelmintic Drugs

et al. 2022

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Human helminthiasis affects approximately one in five people in the world and disproportionally affects the poorest and most deprived communities. Human angiostrongyliasis, caused by nematode Angiostrongylus cantonensis, is a neglected emerging disease with escalating importance worldwide. Chemotherapy is the main control method for helminthiasis, but the therapeutic arsenal is limited. This study aimed to evaluate the antiparasitic and molecular properties of the major available anthelmintic drugs against A. cantonensis in vitro. The first-stage larvae (L1), isolated from feces of an A. cantonensis-infected rat, were exposed to a set of 12 anthelmintic drugs in vitro. The larvae were monitored, and the concentration- and time-dependent viability alterations were determined. From 12 anthelmintic drugs, six (ivermectin, salamectin, moxidectin, pyrantel pamoate, albendazole and levamisole) were identified to affect the viability of A. cantonensis. The macrocyclic lactones (ivermectin, salamectin, moxidectin) and the imidazothiazole levamisole, were the most effective drugs, with IC50 ranging from 2.2 to 2.9 µM and a rapid onset of action. Albendazole, the most widely used anthelmintic in humans, had a slower onset of action, but an IC50 of 11.3 µM was achieved within 24 h. Molecular properties studies suggest that a less lipophilic character and low molecular weight could be favorable for the biological activity of the non-macrocyclic molecules. Collectively, our study revealed that macrocyclic lactones, levamisole, pyrantel pamoate, and albendazole are important anthelmintic agents against A. cantonensis. The results of this in vitro study also suggest that A. cantonensis L1 may be a particularly sensitive and useful model for anthelmintic studies.

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“…Pyrantel pamoate’s potential efficacy against A. cantonensis has warranted discussion in previous studies [ 15 , 17 , 26 ], and the in vivo efficacy of this drug has recently been evaluated in an experimental rat model [ 27 ]. The findings suggest pyrantel pamoate to be an effective post-exposure prophylactic against neuroangiostrongyliasis by reducing the worm burden as well as delaying the establishment of infection, thus providing time for the administration of albendazole [ 27 ]. However, it should be emphasized that pyrantel pamoate is a luminal drug with activity limited to the gastrointestinal tract (GIT) and is only efficacious while the parasite is within the GIT.…”

Section: Introductionmentioning

confidence: 99%

“…Pyrantel pamoate is available over the counter (OTC) from most pharmacies with an estimated cost ranging between USD 10–20 per dose. Since the prophylactic activity of pyrantel pamoate against A. cantonensis is a recent discovery [ 27 ], clinical data are not yet available.…”

Section: Introductionmentioning

confidence: 99%

Management of Rat Lungworm Disease (Neuroangiostrongyliasis) Using Anthelmintics: Recent Updates and Recommendations

et al. 2022

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While there have been legitimate concerns in the past regarding the use of anthelmintics for the management of neuroangiostrongyliasis (rat lungworm disease), recent studies demonstrate that they can be considered safe and efficacious, particularly albendazole, which is regarded as the choice anthelmintic for its management. However, physician hesitancy to prescribe, as well as problems of availability persist, at least in Hawaii, which is considered the epicenter of this disease in the US. As a result, many patients suffer a diminished quality of life or even death. Here, we discuss recent studies that provide insights into new treatments and preventative interventions, which can be more rigorously used for the management of neuroangiostrongyliasis. In summary, results from recent studies suggest that albendazole and avermectins are beneficial for post-exposure management, pyrantel pamoate is beneficial as a post-exposure prophylactic, and levamisole is deserving of further study for the treatment of neuroangiostrongyliasis.

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In vivo efficacy of pyrantel pamoate as a post-exposure prophylactic for rat lungworm (Angiostrongylus cantonensis)

Cited by 4 publications

References 24 publications

Immunodiagnostic Detection of Angiostrongylus cantonensis Exposure on Hawaii Island Using Isogeographic 31-kDa Antigen

Immunodiagnostic Detection of Angiostrongylus cantonensis Exposure on Hawaii Island Using Isogeographic 31-kDa Antigen

Susceptibility of Angiostrongylus cantonensis Larvae to Anthelmintic Drugs

Management of Rat Lungworm Disease (Neuroangiostrongyliasis) Using Anthelmintics: Recent Updates and Recommendations

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