Charlotte Lanteri's research while affiliated with Uniformed Services University of the Health Sciences and other places
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Publications (72)
Background
Understanding the risk of chikungunya virus (CHIKV) infection and rheumatic sequelae across populations, including travelers and the military, is critical. We leveraged the electronic medical records of about 9.5 million U.S. Military Health System (MHS) beneficiaries to identify the risk of post-CHIKV rheumatic sequelae.
Methodology/Pr...
The associations between clinical phenotypes of coronavirus disease 2019 (COVID-19) and the host inflammatory response during the transition from peak illness to convalescence are not yet well understood. Blood plasma samples were collected from 129 adult SARS-CoV-2 positive inpatient and outpatient participants between April 2020 and January 2021,...
Background
The epidemiology of recurrent bacterial bloodstream infections (rBSI) has not been fully characterized. Evaluating rBSI represents opportunities to inform morbidity risk factors and prevention strategies. We describe the clinical and microbiological features of rBSI in the US Military Health System (MHS) in a prospective cohort study, in...
Background
COVID-19 may have deleterious effects on the fitness of active duty US military service members. We seek to understand the long-term functional consequences of SARS-CoV-2 infection in this critical population, and in other military healthcare beneficiaries.
Methods
The Epidemiology, Immunology, and Clinical Characteristics of Emerging I...
Background
The epidemiology of antibiotic-resistant pathogens guides antimicrobial therapy for bacterial bloodstream infections (BSI). We describe changes in antimicrobial-resistant BSI pathogens over time within the US Military Health System (MHS), which prospectively captures clinical and microbiological data from both retired and active-duty US...
The active metabolites of primaquine, in particular 5-hydroxyprimaquine, likely responsible for clearance of dormant hypnozoites, are produced through the hepatic CYP450 2D6 (CYP2D6) enzymatic pathway. With the inherent instability of 5-hydroxyprimaquine, a stable surrogate, 5,6 orthoquinone, can now be detected and measured in the urine as part of...
OBJECTIVES: The relationships between baseline clinical phenotypes and the cytokine milieu of the peak inflammatory phase of coronavirus 2019 (COVID-19) are not yet well understood. We used Topological Data Analysis (TDA), a dimensionality reduction technique to identify patterns of inflammation associated with COVID-19 severity and clinical charac...
Background:
Nasopharyngeal (NP) swabs are the standard for SARS-CoV-2 diagnosis. If less invasive alternatives to NP swabs (eg, oropharyngeal [OP] or nasal swabs [NS]) are comparably sensitive, the use of these techniques may be preferable in terms of comfort, convenience, and safety.
Methods:
This study compared the detection of SARS-CoV-2 in s...
Background
Bloodstream infections (BSI) are associated with inpatient morbidity in the United States. We sought to characterize the epidemiology of common bacterial BSIs in individuals receiving care within the US Military Health System (MHS), which actively prospectively captures clinical and microbiological data from both retired and active-duty...
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections peak during an inflammatory ‘middle’ phase and lead to severe illness predominately among those with certain comorbid noncommunicable diseases (NCDs). We used network machine learning to identify inflammation biomarker patterns associated with COVID-19 among those wi...
Background
The FLU-PRO Plus is a patient-reported outcome data collection instrument assessing symptoms of viral respiratory tract infections across eight body systems. This study evaluated the measurement properties of FLU-PRO Plus in a study enrolling individuals with COVID-19.
Methods
Data from a prospective cohort study (EPICC) in US Military...
Malaria remains a public health problem in Thailand, especially along its borders where highly mobile populations can contribute to persistent transmission. This study aimed to determine resistant genotypes and phenotypes of 112 Plasmodium falciparum isolates from patients along the Thai-Cambodia border during 2013–2015. The majority of parasites h...
Malaria remains a public health problem in Thailand, especially along its borders where highly mobile populations can contribute to persistent transmission. This study aimed to determine resistant genotypes and phenotypes of 112 Plasmodium falciparum isolates from patients along the Thai-Cambodia border during 2013-2015. The majority of parasites h...
Sensitive and specific SARS-CoV-2 antibody assays remain critical for community and hospital-based SARS-CoV-2 sero-surveillance. With the rollout of SARS-CoV-2 vaccines, such assays must be able to distinguish vaccine from natural immunity to SARS-CoV-2 and related human coronaviruses. Here, we developed and implemented multiplex microsphere-based...
Background:
Newly emerged mutations within the Plasmodium falciparum chloroquine resistance transporter (PfCRT) can confer piperaquine resistance in the absence of amplified plasmepsin II (pfpm2). In this study, we estimated the prevalence of co-circulating piperaquine resistance mutations in P. falciparum isolates collected in northern Cambodia f...
Background
Bloodstream infections (BSI) are associated with both inpatient mortality and substantial morbidity in the United States. We sought to characterize the epidemiology of BSIs with ESKAPE pathogens on patients served by the United States Military Healthcare System (MHS), which actively prospectively captures clinical and microbiological dat...
Background
Coccidioidomycosis ranges clinically from a self-limited respiratory illness to multi-organ dissemination. Based largely on skin testing from the 1940s, 60% of infections are thought to be asymptomatic. Limited Coccidioides seroincidence data support our understanding of the epidemiology and pathogenicity of this disease.
Methods
This r...
Background
While the majority of illness due to COVID-19 does not require hospitalization, little has been described about the host inflammatory response in the ambulatory setting. Differences in the levels of inflammatory signaling proteins between outpatient and hospitalized populations could identify key maladaptive immune responses during COVID...
Sensitive and specific SARS-CoV-2 antibody assays remain critical for community and hospital-based SARS-CoV-2 surveillance. Here, we developed and applied a multiplex microsphere-based immunoassay (MMIA) for COVD-19 antibody studies that incorporates spike protein trimers of SARS-CoV-2, SARS-CoV-1, MERS-CoV, and the seasonal human betacoronaviruses...
With growing concern of persistent or multiple waves of SARS-CoV-2 in the United States, sensitive and specific SARS-CoV-2 antibody assays remain critical for community and hospital-based SARS-CoV-2 surveillance. Here, we describe the development and application of a multiplex microsphere-based immunoassay (MMIA) for COVD-19 antibody studies, utili...
Background:
In Southeast Asia, people are often coinfected with different species of malaria (Plasmodium falciparum [Pf] and Plasmodium vivax [Pv]) as well as with multiple clones of the same species. Whether particular species or clones within mixed infections are more readily transmitted to mosquitoes remains unknown.
Methods:
Laboratory-reare...
Introduction
The Infectious Disease Clinical Research Program’s (IDCRP) Emerging Infectious Diseases and Antimicrobial Resistance (EIDAR) Research Area is a Department of Defense (DoD) clinical research capability that is responsive and adaptive to emerging infectious disease (EID) threats to US military readiness. Among active-duty and other Milit...
Background
While intensive Plasmodium falciparum multidrug resistance surveillance continues in Cambodia, relatively little is known about Plasmodium vivax drug resistance in Cambodia or elsewhere. To investigate P. vivax anti-malarial susceptibility in Cambodia, 76 fresh P. vivax isolates collected from Oddar Meanchey (northern Cambodia) in 2013–2...
Background:
Amplified copy number in the plasmepsin II/III genes within Plasmodium falciparum has been associated with decreased sensitivity to piperaquine. To examine this association and test whether additional loci might also contribute, we performed a genome-wide association study of ex vivo P. falciparum susceptibility to piperaquine.
Method...
Plasmodium falciparum in western Cambodia has developed resistance to artemisinin and its partner drugs, causing frequent treatment failure. Understanding this evolution can inform the deployment of new therapies. We investigated the genetic architecture of 78 falciparum isolates using whole-genome sequencing, correlating results to in vivo and ex...
Concordance of patient-level infectiousness based on detection of mosquito P. falciparum infection by microscopy vs. PCR.
The tables include membrane-feeding assays conducted on subjects pre and post-treatment. In the upper table, PCR positivity at both Day 9 (oocyst stage) and Day 16 (sporozoite stage) was required for an overall positive determin...
Trends in hemoglobin during follow-up in participants with non-severe G6PD deficiency.
Hemoglobin values during follow-up for the 8 participants with G6PD deficiency Class III (>10% enzyme activity) (A) and the calculated fractional change compared to day 0 pre-treatment in those same subjects (B). Trend lines for the subjects in the primaquine gro...
Study Protocol WRAIR #1877.
(PDF)
Background
Single low dose primaquine (SLD PQ, 0.25mg/kg) is recommended in combination with artemisinin-based combination therapy (ACT) as a gametocytocide to prevent Plasmodium falciparum transmission in areas threatened by artemisinin resistance. To date, no randomized controlled trials have measured primaquine’s effect on infectiousness to Anop...
Schematic of submicroscopic gametocytemia and mosquito infectivity through treatment.
This figure is similar to Fig 1, but also shows participants who were gametocyte positive by RT-PCR (in gray). Participants in the primaquine and non-primaquine arms are depicted in the same ordered configuration from Day 0 pre-treatment through Week 2 post-treatm...
Consort 2010 Checklist.
(DOCX)
Despite rising resistance, dihydroartemisinin-piperaquine (DP) remains a first line therapy for uncomplicated malaria in many parts of Cambodia. While generally well-tolerated as a 3-day regimen, compressed 2-day regimens were associated with treatment-limiting cardiac repolarization effects in a recent clinical trial. To better estimate the risks...
Significance
In Cambodia, where Plasmodium vivax and Plasmodium falciparum are coendemic and intense multimodal malaria-control interventions have reduced malaria incidence, P . vivax malaria has proven relatively resistant to such measures. We performed comparative genomic analyses of 150 P . vivax and P . falciparum isolates to determine whether...
Background
The recent dramatic decline in dihydroartemisinin-piperaquine (DHA-PPQ) efficacy in northwestern Cambodia has raised concerns about the rapid spread of piperaquine resistance just as DHA-PPQ is being introduced as first-line therapy in neighbouring countries. Methods
Ex vivo parasite susceptibilities were tracked to determine the rate of...
Knowledge of the population genetics and transmission dynamics of Plasmodium vivax is crucial in predicting the emergence of drug resistance, relapse pattern and novel parasite phenotypes, all of which are relevant to the control of vivax infections. The aim of this study was to analyse changes in the genetic diversity of P. vivax genes from field...
Our recent report of dihydroartemisinin-piperaquine failure in Cambodia adds new urgency to finding alternatives. Despite dihydroartemisinin-piperaquine failures, and higher piperaquine IC
50
following reanalysis than previously reported,
P. falciparum
remained sensitive to atovaquone (ATQ)
in vitro
. There were no point mutations in the
P.f.
cytoc...
Though gametocytes are essential for malaria transmission, in Africa, many falciparum-infected persons without smear-detectable
gametocytes still infect mosquitoes. To see whether the same is true in Southeast Asia, we determined the infectiousness of
119 falciparum-infected Cambodian adults to Anopheles dirus mosquitoes by membrane feeding. Just 5...
Background:
There is currently no standardized approach for assessing in vitro anti-malarial drug susceptibility. Potential alterations in drug susceptibility results between fresh immediate ex vivo (IEV) and cryopreserved culture-adapted (CCA) Plasmodium falciparum isolates, as well as changes in parasite genotype during culture adaptation were i...
Background: Polymorphisms in the P. falciparum gene for ATPase6 (pfATPase6) have been proposed as markers for artemisinin resistance, though the precise artemisinin binding pocket has not yet been comprehensively investigated in cases of treatment failure from along the Thai-Cambodian border. Objective: To investigate the specific regions of pfATPa...
Cambodia's first-line artemisinin combination therapy, dihydroartemisinin-piperaquine (DHA-PPQ), is no longer sufficiently curative against multidrug-resistant Plasmodium falciparum malaria at some Thai-Cambodian border regions. We report recent (2008-2013) drug resistance trends in 753 isolates from northern, western, and southern Cambodia, by sur...
Dihydroartemisinin-piperaquine has been adopted as first-line artemisinin combination therapy (ACT) for multidrug-resistant Plasmodium falciparum malaria in Cambodia because of few remaining alternatives. We aimed to assess the efficacy of standard 3 day dihydroartemisinin-piperaquine treatment of uncomplicated P falciparum malaria, with and withou...
Plasmodium vivax infections often recur due to relapse of hypnozoites from the liver. In malaria endemic areas, tools to distinguish relapse from re-infection are needed. We applied amplicon deep sequencing to P. vivax isolates from 78 Cambodian volunteers, nearly one-third of whom suffered recurrence at a median of 68 days. Deep sequencing at a hi...
Primaquine (PQ) remains the sole available drug to prevent relapse of P. vivax malaria after more than 60 years. While administered as a racemic mixture, prior studies suggested a pharmacodynamic advantage based on differential anti-relapse activity and/or toxicities of its enantiomers. Oral primaquine enantiomers prepared using a novel easily scal...
Dihydroartemisinin-piperaquine, the current first-line drug for uncomplicated P. falciparum and P. vivax in Cambodia, was shown previously to be of benefit as malaria chemoprophylaxis when administered as a monthly 3-day regimen. We sought to evaluate the protective efficacy of a compressed monthly two-day treatment course in the Royal Cambodian Ar...
Novel synthetic endoperoxides are being evaluated as new components of artemisinin combination therapies (ACTs) to treat artemisinin-resistant
Plasmodium falciparum malaria. We conducted blinded ex vivo activity testing of fully synthetic (OZ78 and OZ277) and semisynthetic (artemisone, artemiside, artesunate, and dihydroartemisinin)
endoperoxides i...
Emerging antimalarial drug resistance in mobile populations remains a significant public health concern. We compared two regimens of dihydroartemisinin-piperaquine in military and civilians on the Thai-Cambodian border to evaluate national treatment policy.
Efficacy and safety of two and three-day regimens of dihydroartemisinin-piperaquine were com...
The mechanism of massive intravascular haemolysis occurring during the treatment of malaria infection resulting in haemoglobinuria, commonly known as blackwater fever (BWF), remains unknown. BWF is most often seen in those with severe malaria treated with amino-alcohol drugs, including quinine, mefloquine and halofantrine. The potential for drugs c...
Despite widespread coverage of the emergence of artemisinin resistance, relatively little is known about the parasite populations responsible. The use of PCR genotyping around the highly polymorphic Plasmodium falciparum msp1, msp2 and glurp genes has become well established both to describe variability in alleles within a population of parasites,...
A heteroduplex tracking assay used to genotype Plasmodium vivax merozoite surface protein 1 was adapted to a capillary electrophoresis format, obviating the need for radiolabeled probes
and allowing its use in settings where malaria is endemic. This new assay achieved good allelic discrimination and detected
high multiplicities of infection in 63 P...
Performance of the histidine-rich protein-2 enzyme-linked immunosorbent assay (HRP-2 ELISA) and malaria SYBR Green I fluorescence (MSF) drug sensitivity tests were directly compared using Plasmodium falciparum reference strains and fresh ex vivo isolates from Cambodia against a panel of standard anti-malarials. The objective was to determine which...
The clinical use of mefloquine (MQ) has declined due to dose-related neurological events. Next generation quinoline methanols (NGQMs) that do not accumulate in the central nervous system (CNS) to the same extent may have utility. In this study, CNS levels of NGQMs relative to MQ were measured and an early lead chemotype was identified for further o...
Atovaquone is a hydroxy-naphthoquinone that is used to treat parasitic and fungal infections including Plasmodium falciparum (malaria), Pneumocystis jivorecii (pneumonia) and Toxoplasma gondii (toxoplasmosis). It blocks mitochondrial oxidation of ubiquinol in these organisms by binding to the ubiquinol oxidation site of the cytochrome bc(1) complex...
A 1,7-bis(alkylamino)diazachrysene-based small molecule was previously identified as an inhibitor of the botulinum neurotoxin serotype A light chain metalloprotease. Subsequently, a variety of derivatives of this chemotype were synthesized to develop structure-activity relationships, and all are inhibitors of the BoNT/A LC. Three-dimensional analys...
Utilizing mefloquine as a scaffold, a next generation quinoline methanol (NGQM) library was constructed to identify early lead compounds that possess biological properties consistent with the target product profile for malaria chemoprophylaxis while reducing permeability across the blood-brain barrier. The library of 200 analogs resulted in compoun...
Primary screening data and physiochemical properties of next generation quinoline methanols. This EXCEL file contains the structure number for 198 next generation quinoline methanols together with their calculated physiochemical properties, IC90 values against four strains of P. falciparum, and LC50 values against RAW macrophages. The compounds are...
The clinical utility for mefloquine has been eroded due to its association with adverse neurological effects. Better-tolerated alternatives are required. The objective of the present study was the identification of lead compounds that are as effective as mefloquine, but exhibit physiochemical properties likely to render them less susceptible to pas...
The synthesis of the chimeric molecules consisting of two pharmacophores, tetraoxane and 7-chloro-4-aminoquinoline, is reported. The tetraoxanes 2, 4, and 8 show relatively potent in vitro antimalarial activities, with IC90 values for the Plasmodium falciparum strain W2 of 2.26, 12.44, and 10.74 nM, respectively. In addition, two compounds, 2 and 4...
Human African trypanosomiasis (HAT) is a fatal tropical disease caused by infection with protozoans of the species Trypanosoma brucei gambiense and T. b. rhodesiense. An oral prodrug, DB289, is a promising new therapy undergoing phase III clinical trials for early-stage HAT. DB289 is metabolically
converted to the active trypanocidal diamidine DB75...
Malaria is responsible for over 300 million clinical cases annually and claims the lives of approximately 1-2 million. With a disease that has plagued humanity throughout history, one would think that better control measures would be in place to decrease the mortality and morbidity associated with malaria. Due to malaria drug resistance, an increas...
Mefloquine has been one of the more valuable antimalarial drugs but has never reached its full clinical potential due to concerns about its neurologic side effects, its greater expense than that of other antimalarials, and the emergence of resistance. The commercial development of mefloquine superseded that of another quinolinyl methanol, WR030090,...
The quinolinyl methanol drug, mefloquine, is an important antimalarial agent with a long half-life in humans, which allows for its use as an effective single dose treament for malaria and as a once weeky dosing for prophylaxis. However, clinical application of mefloquine is limited by its relative costliness and its debilitating neurological side e...
A novel trypanocide, 2,5-bis(4-amidinophenyl)furan (DB75), in its prodrug amidoxime-derivative form, 2,5-bis(4-amidinophenyl)furan-bis-O-methylamidoxime (DB289), is in trials as the first orally administered drug for human African trypanosomiasis. DB75 is a diamidine. Resistance to some diamidines correlates to loss of uptake via the P2 aminopurine...
The aromatic diamidines represent a class of compounds with broad-spectrum antimicrobial activity; however, their development
is hindered by a lack of understanding of their mechanism of antimicrobial action. DB75 [2,5-bis(4-amidinophenyl)furan] is
a trypanocidal aromatic diamidine that was originally developed as a structural analogue of the antit...
Citations
... Their results pointed to three distinct inflammatory biomarker patterns that could stratify a heterogeneous population and that were associated with comorbid diseases and illness severity of those patients. This exploratory step gave important insights regarding the inclusion of biomarkers in the definition of clinical phenotypes, suggesting that these could be used for a personalized approach to the triage of care and therapeutic indications [27]. ...
... Activity against blood-stage parasites is thought to be independent of CYP-2D6 metabolism, potentially involving interference with heme polymerization, or oxidative mechanisms [36]. The 5,6-orthoquinone Any AE metabolite of primaquine is considered a surrogate marker for active metabolites of primaquine [37]. Although we measured the 5,6-orthoquinone metabolite of tafenoquine, a relationship between its concentration and parasite killing was not observed. ...
... Globally, COVID-19 is associated with significant clinical, public health and economic burden, leading to missed school and work to recover from illness [7,8]. Patient-reported outcomes (PROs) are important in order to fully capture the symptom burden of COVID-19 and assess the effectiveness of treatments [9]. Epidemiological studies show viral respiratory diseases share similar symptom profiles, including fever/chills, cough, shortness of breath, fatigue, sore throat, muscle pain or body aches, headache, vomiting, and diarrhea [10]. ...
... The CVIET haplotype is predominant in many African [21,32] and Southeast Asian countries in which CQ has been withdrawn for at least ten years after [33][34][35]; however, it has also been observed in P. falciparum parasites from South America [36], while SVMNT is dominant in South America and Oceania [37]. In Brazil, the CVIET haplotype was rarely encountered (it was found in only one sample from the municipality of Manaus), as previously seen in isolates from Amazonas and Rondônia [38]. ...
... For the antibody binding assay used for screening at enrollment, serum samples were diluted 1:400 and 1:8000 and screened for immunoglobulin G (IgG) reactivity with SARS-CoV-2 spike protein and nucleocapsid protein (N), and four human coronavirus (HCoV) spike proteins using a multiplex microsphere-based immunoassay, as previously described. 54 Post-infection sera from the EPICC study The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a cohort study of U.S. Military Health System (MHS) beneficiaries that includes enrollment and longitudinal follow up of those with a history of SARS-CoV-2 infection. 55 Eligibility criteria for enrollment included presenting to clinical care with COVID-19-like illness and being tested for SARS-CoV-2 by polymerase chain reaction (PCR) assay (See Tables S1A and S1B). ...
... None of these particular codons could be identified in any of the samples. We did not test for plasmepsin gene amplification in light of the exceptions to its putative association with PPQ resistance that have been reported from genetic experiments and field samples in Southeast Asia and Africa [42][43][44][45]. ...
... These assays use pathogen-specific antigens covalently bonded to fluorophore-loaded carboxyl beads, facilitating simultaneous identification of multiple pathogen-specific antibodies. MMIAs have been used to detect and differentiate antibodies against viral infections such as human herpesviruses and flaviviruses (e.g., Epstein-Barr, West Nile, Zika, and dengue viruses) (25,26), used to identify SARS-CoV-2 IgG seroconversion (27)(28)(29)(30) and proposed for public health use since the early 2000s (31,32). ...