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Future Possibilities and Speculations about IPT
by Chris Duffield

Malaria treatment with IPT

        According to the World Health Organization, one fifth of the world's humans are at risk of malaria infection.  Of these, 300 to 500 million people become ill with malaria each year, five times as many as become ill with tuberculosis, HIV/AIDS, measles, and leprosy combined.  One to several million people die from malaria each year, most of them children under five, and most in Africa.

I have only found two references to the use of IPT for treatment of malaria by Dr. Perez Garcia 1.  One is a newspaper article from the time period 1946-1952:

"He stated his belief that still further recoveries from malaria could be accomplished with the combined use of insulin and other medicines.... Remarkable recoveries have been reported, according to Mexican medical authorities, including malaria, typhoid fever, syphilis, peritonitis, and rheumatic fever."

The other is the 1944 Time Magazine article:

"Doctors of the San Diego Naval Hospital went over to Tijuana to hear Dr. Perez Garcia.  They were impressed.  They invited him over to treat a few stubborn cases of malaria and rheumatic fever.  A malaria patient had no more fever after his first shock.  (Dr. Garcia's full course of treatment is usually four shocks, five days apart.)"

        These are clues that IPT may be a dramatically successful and rapid treatment for malaria, one of the major diseases of the developing world.  Millions of people have it, and efforts to eradicate it have been frustrated.  In light of this clue, and the observed ways that IPT can work, I present the following ideas for consideration:

1.  A major problem with malaria is that the parasite that causes it keeps evolving resistance to anti-malarial drugs.  Perhaps IPT will increase the effectiveness of anti-malarial drugs at constant dose, and allow effective treatment at smaller dose, as it does for antibiotics.  And perhaps it will allow much faster treatment.  If so, this may give us a little headway and breathing room in this race between our drug treatment and the parasite's drug resistance.  Perhaps an IPT strategy could be devised to deliver larger concentrations of anti-malarial drugs into the parasites themselves (which may have insulin-like receptors).  If the cellular pumps which eject anti-malarial drugs from the parasites can be blocked or overwhelmed, then even old anti-malarial drugs like quinine or chloroquine can be used again.

2.  Perhaps it will be easier to ensure patient compliance with a full course of treatment if that treatment is quick and decisive.  (Patient noncompliance, it is thought, is a major factor in survival and selection of drug-resistant strains.)  If IPT can treat malaria faster and more effectively, if it can wipe out the parasite in the body completely, then it will actually help us slow the evolution of drug resistance, by ensuring that even resistant strains do not survive treatment.  

3.  In addition to killing the malaria parasite, IPT may aid in treating many of the effects and complications of the disease.  I.e. restoring electrolyte balance, reducing fever, etc.

4.  The most common complication and cause of death in malaria patients is cerebral malaria, where the disease affects the central nervous system (CNS).  Side effects of large doses of malaria drugs may actually help cause it or make it worse.  If IPT can lower the necessary dose, side effects could be reduced or eliminated.  IPT may also be more effective at delivering anti-malarial drugs to the CNS.   Hypoglycemia is a common complication of malaria, and care should be taken not to push hypoglycemia too far with IPT.

5.  A quick experiment could show if insulin followed by glucose can increase uptake of chloroquine and other anti-malarial drugs into erythrocytes (red blood cells) and hepatocytes (liver cells) within which malaria organisms dwell.  If so, then these drugs may be more effective, using IPT, and it could represent a temporary reprieve from development of drug resistance.

        These are just ideas that I place before the experts on malaria.  They will have a better idea of how to approach this disease with IPT.

        Today, June 1, 2000 I had a very interesting meeting with Stanford molecular pharmacology professor emeritus Tag Mansour.  Among other things, he gave me more details about malaria infection (apparently Plasmodium vivax, a less harmful species) being given as a treatment for neurosyphilis patients.  The way it worked was not well understood.  Perhaps immune stimulation.  At any rate, it worked well in most patients, except for a few of African descent.  This is how the resistance to malaria of people with sickle cell anemia  was discovered...

 

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