Toxicity evaluation of artesunate and artelinate in Plasmodium berghei-infected and uninfected rats.

A recent therapeutic index study in rats demonstrated that i.v. artesunate (AS) is safer than artelinate (AL). The present study of acute toxicity illustrated an LD(50) of 177 mg/kg and 488 mg/kg for AL and AS, respectively, following daily i.v. injection for 3 days in Plasmodium berghei-infected rats. In uninfected rats, the LD(50) values were 116 mg/kg and 351 mg/kg after a single dose of AL and AS, respectively. This study showed vascular necrosis in 50% of the animals at 13.5 mg/kg AL and at 42.8 mg/kg AS. Animals also showed moderate signs of renal failure at 40 mg/kg AL and 240 mg/kg AS (100 times higher than the therapeutic dose). Histopathological evaluation demonstrated mild to moderate tubular necrosis in uninfected rats treated with 40 mg/kg AL and 240 mg/kg AS; interestingly, fewer pathological lesions were observed in malaria-infected rats. Renal injury was reversible in all cases by Day 8 after cessation of dosing. No neurotoxicity was seen in any case with all i.v. regimens. In conclusion, AL and AS exhibit less toxic effects in P. berghei-infected rats than in uninfected rats. Both agents caused irreversible vascular irritation, reversible nephrotoxicity and no neurotoxicity at high doses. The data indicate that AS is three times safer than AL in rats.