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      A phase I study of intra-anal artesunate (suppositories) to treat anal high-grade squamous intraepithelial lesions

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          Abstract

          Background

          Ablation or surgical excision is the typical treatment of anal high-grade squamous intraepithelial lesions (HSIL). Recurrences are common due to the persistence of underlying human papillomavirus (HPV) infection. Additional well-tolerated and effective non-surgical options for HPV-associated anal disease are needed.

          Methods

          This 3+3 dose escalation Phase I clinical trial evaluated the safety and tolerability of artesunate suppositories in the treatment of patients with biopsy-proven HSIL.

          Results

          The maximal tolerated dose was 400 mg, administered in 3 cycles. All adverse events associated with the use 200- and 400-mg artesunate suppositories were Grade 1. At the 600-mg dose, patients experienced clinically significant nausea.

          Conclusion

          Artesunate suppositories are a safe treatment option for anal HSIL.

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          Most cited references16

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          A medicinal chemistry perspective on artemisinin and related endoperoxides.

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            Treatment of Anal High-Grade Squamous Intraepithelial Lesions to Prevent Anal Cancer

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              Drug-resistant malaria - an insight.

              E. Hyde (2007)
              Despite intensive research extending back to the 1930s, when the first synthetic antimalarial drugs made their appearance, the repertoire of clinically licensed formulations remains very limited. Moreover, widespread and increasing resistance to these drugs contributes enormously to the difficulties in controlling malaria, posing considerable intellectual, technical and humanitarian challenges. A detailed understanding of the molecular mechanisms underlying resistance to these agents is emerging that should permit new drugs to be rationally developed and older ones to be engineered to regain their efficacy. This review summarizes recent progress in analysing the causes of resistance to the major antimalarial drugs and its spread.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                15 December 2023
                2023
                : 18
                : 12
                : e0295647
                Affiliations
                [1 ] Department of Surgery, Oregon Health & Science University, Portland, Oregon, United States of America
                [2 ] Frantz Medical Development, Ltd, Mentor, Ohio, United States of America
                [3 ] Department of Surgery, University of Wisconsin School of Medicine, Madison, Wisconsin, United States of America
                [4 ] Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
                [5 ] Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
                [6 ] Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
                University of Michigan, UNITED STATES
                Author notes

                Competing Interests: The competing interest exists in the fact that Mihaela Plesa became the Director of Research at Frantz Viral Therapeutics when she left Johns Hopkins Hospital. Please note that we had already written the protocol, obtained FDA and IRB approval, and started the study prior to Ms. Plesa leaving Hopkins to join Frantz Viral Therapeutics. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                https://orcid.org/0000-0002-9097-6968
                https://orcid.org/0000-0002-6671-0115
                Article
                PONE-D-23-09503
                10.1371/journal.pone.0295647
                10723659
                38100463
                71f53e87-468f-470b-8ac4-e4bfbd3c0a84
                © 2023 Fang et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 April 2023
                : 15 November 2023
                Page count
                Figures: 2, Tables: 4, Pages: 13
                Funding
                Funded by: Frantz Viral Therapeutics
                Award Recipient :
                Funded by: Frantz Viral Therapeutics, LLC (FVT)
                Award Recipient :
                The first author and principal investigator received funding for salary and research support, from Frantz Viral Therapeutics. Frantz Viral Therapeutics, LLC designed, formulated, and supplied the artesunate suppositories, which they provided free of charge, and provided partial financial support for study management and specimen processing. Dr. Trimble's institution reports grants from Frantz Viral Therapeutics, LLC (FVT), for the conduct of the study. She is on the Scientific Advisory Board for FVT. Ms. Plesa reports personal fees from Frantz Viral Therapeutics, LLC during the conduct of the study. She works full-time as Director of Research Programs for FVT. Ulrike K Buchwald is an employee of Merck Sharp & Dohme LLC., a subsidiary of Merck & Co., Inc., Rahway, NJ, USA and may own stock and/or stock options in Merck & Co., Inc., Rahway, NJ, USA. Please note that while Dr. Buchwald is employed and has stock and/or stock options with Merck, Merck did not fund any portion of the study described in this manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.
                Categories
                Research Article
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Antimalarials
                Artesunate
                Medicine and Health Sciences
                Medical Conditions
                Parasitic Diseases
                Malaria
                Medicine and Health Sciences
                Medical Conditions
                Tropical Diseases
                Malaria
                Medicine and Health Sciences
                Oncology
                Cancer Treatment
                Medicine and Health Sciences
                Urology
                Genitourinary Infections
                Human Papillomavirus Infection
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Sexually Transmitted Diseases
                Human Papillomavirus Infection
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Human Papillomavirus Infection
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Pain
                Abdominal Pain
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Nausea
                Biology and life sciences
                Organisms
                Viruses
                DNA viruses
                Papillomaviruses
                HPV-1
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Papillomaviruses
                HPV-1
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Papillomaviruses
                HPV-1
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Papillomaviruses
                HPV-1
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Anal and Rectal Disorders
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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                Uncategorized

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