Do cognitive measures and brain circuitry predict outcomes of exercise in Parkinson Disease: a randomized clinical trial

BACKGROUND

There is emerging research detailing the relationship between balance/gait/falls and cognition. Imaging studies also suggest a link between structural and functional changes in the frontal lobe (a region commonly associated with cognitive function) and mobility. People with Parkinson's disease have important changes in cognitive function that may impact rehabilitation efficacy. Our underlying hypothesis is that cognitive function and frontal lobe connections with the basal ganglia and brainstem posture/locomotor centers are responsible for postural deficits in people with Parkinson's disease and play a role in rehabilitation efficacy. The purpose of this study is to 1) determine if people with Parkinson's disease can improve mobility and/or cognition after partaking in a cognitively challenging mobility exercise program and 2) determine if cognition and brain circuitry deficits predict responsiveness to exercise rehabilitation.

METHODS/DESIGN

This study is a randomized cross-over controlled intervention to take place at a University Balance Disorders Laboratory. The study participants will be people with Parkinson's disease who meet inclusion criteria for the study. The intervention will be 6 weeks of group exercise (case) and 6 weeks of group education (control). The exercise is a cognitively challenging program based on the Agility Boot Camp for people with PD. The education program is a 6-week program to teach people how to better live with a chronic disease. The primary outcome measure is the MiniBESTest and the secondary outcomes are measures of mobility, cognition and neural imaging.

DISCUSSION

The results from this study will further our understanding of the relationship between cognition and mobility with a focus on brain circuitry as it relates to rehabilitation potential.

TRIAL REGISTRATION

This trial is registered at clinical trials.gov (NCT02231073).

Older adults can improve compensatory stepping with repeated postural perturbations

The ability to respond quickly and accurately to an external perturbation with a stepping response is critical to avoid falls and this ability is impaired in older, compared to young adults. However, little is known about whether young and older adults improve compensatory stepping responses similarly with practice. This study compares the extent to which young and older adults can improve, retain, and generalize postural compensatory steps in response to external perturbations. Centre of mass displacement, step characteristics and lower leg muscle activation latencies were measured during one training session of compensatory stepping in response to large surface translations in 13 young and 12 older adults. Retention was tested 24 h later. Older adults decreased their center of mass displacements over repeated exposure to large surface translations in both the anterior and posterior directions and retained these improvements. In contrast, young adults only showed adaptation and retention of forward stepping responses. Neither group was able to generalize improvements in stepping responses across directions. These results suggest step training may be beneficial for older adults, however additional, multidirectional training may be necessary to facilitate generalization of postural stepping responses for any direction of a slip or trip.

Dual-task interference and brain structural connectivity in people with Parkinson's disease who freeze

BACKGROUND

Freezing of gait in people with Parkinson's disease (PD) is likely related to attentional control (ie, ability to divide and switch attention). However, the neural pathophysiology of altered attentional control in individuals with PD who freeze is unknown. Structural connectivity of the pedunculopontine nucleus has been related to freezing and may play a role in altered attentional control; however, this relationship has not been investigated. We measured whether dual-task interference, defined as the reduction in gait performance during dual-task walking, is more pronounced in individuals with PD who freeze, and whether dual-task interference is associated with structural connectivity and/or executive function in this population.

METHODS

We measured stride length in 13 people with PD with and 12 without freezing of gait during normal and dual-task walking. We also assessed asymmetry of pedunculopontine nucleus structural connectivity via diffusion tensor imaging and performance on cognitive tests assessing inhibition and set-shifting, cognitive domains related to freezing.

RESULTS

Although stride length was not different across groups, change in stride length between normal and dual-task gait (ie, dual-task interference) was more pronounced in people with PD who freeze compared to non-freezers. Further, in people with PD who freeze, dual-task interference was correlated with asymmetry of pedunculopontine nucleus structural connectivity, Go-NoGo target accuracy (ability to release a response) and simple reaction time.

CONCLUSIONS

These results support the hypothesis that freezing is related to altered attentional control during gait, and suggest that differences in pedunculopontine nucleus connectivity contribute to poorer attentional control in people with PD who freeze.

Effects of levodopa on vividness of motor imagery in Parkinson disease

INTRODUCTION

Motor imagery during functional magnetic resonance imaging is commonly used to understand the neural underpinnings of complex movements. This approach has recently been applied to individuals with Parkinson disease (PD) to better understand how brain function may relate to movement dysfunction. However, the ability of individuals with PD to imagine movements when "Off" dopamine replacement medication is poorly understood. Therefore, the primary purpose of the current study is to test the ability of people with PD to imagine movements while "On" and "Off" anti-Parkinson medication.

METHODS

Vividness of imagery was assessed in 28 individuals with mild to moderate PD (Hoehn and Yahr stages 1-3) via the Kinesthetic Visual Imagery Questionnaire (KVIQ-20) both "On" and "Off" anti-Parkinson medication. Vividness of imagery of 32 age-matched older adults was also assessed.

RESULTS

No differences in vividness of imagery were observed between "Off" and "On" medication states (p = 0.15). Imagery was similar between controls and PD both "Off" (p = 0.25) and "On" (p = 0.46) anti-Parkinson medication. A significant correlation was observed between imagery and disease severity while "On" anti-Parkinson medication (r = -0.49; p = 0.008).

DISCUSSION AND CONCLUSIONS

Vividness of movement imagery was not different between "Off" and "On" anti-Parkinson medications or between PD and controls. These results suggest that people with PD are able to imagine similarly to older adults both when "On" and "Off" anti-Parkinson medication, and supports the use of motor imagery in the "Off" medication state.

Motor imagery of gait tasks in individuals with Parkinson disease

We developed a questionnaire to assess motor imagery (MI) of gait and administered it to 33 controls and 28 individuals with PD. Our goals were: 1) compare gait MI in individuals with and without PD, 2) determine whether walking performance relates to gait MI and 3) compare gait MI in individuals with PD with and without freezing of gait. Gait MI was not different between PD and controls. There was no correlation between walking performance and gait MI, and no difference in gait MI between freezers and nonfreezers. The gait imagery questionnaire may be useful for imaging studies involving imagined gait.

Brain activity during complex imagined gait tasks in Parkinson disease

OBJECTIVE

Motor imagery during functional magnetic resonance imaging (fMRI) allows assessment of brain activity during tasks, like walking, that cannot be completed in an MRI scanner. We used gait imagery to assess the neural pathophysiology of locomotion in Parkinson disease (PD).

METHODS

Brain activity was measured in five locomotor regions (supplementary motor area (SMA), globus pallidus (GP), putamen, mesencephalic locomotor region, cerebellar locomotor region) during simple (forward) and complex (backward, turning) gait imagery. Brain activity was correlated to overground walking velocity.

RESULTS

Across tasks, PD exhibited reduced activity in the globus pallidus compared to controls. People with PD, but not controls, exhibited more activity in the SMA during imagined turning compared to forward or backward walking. In PD, walking speed was correlated to brain activity in several regions.

CONCLUSIONS

Altered SMA activity in PD during imagined turning may represent compensatory neural adaptations during complex gait. The lowered activity and positive correlation to locomotor function in GP suggests reduced activity in this region may relate to locomotor dysfunction.

SIGNIFICANCE

This study elucidates changes in neural activity during gait in PD, underscoring the importance of testing simple and complex tasks. Results support a positive relationship between activity in locomotor regions and walking ability.

Gait-related brain activity in people with Parkinson disease with freezing of gait

Approximately 50% of people with Parkinson disease experience freezing of gait, described as a transient inability to produce effective stepping. Complex gait tasks such as turning typically elicit freezing more commonly than simple gait tasks, such as forward walking. Despite the frequency of this debilitating and dangerous symptom, the brain mechanisms underlying freezing remain unclear. Gait imagery during functional magnetic resonance imaging permits investigation of brain activity associated with locomotion. We used this approach to better understand neural function during gait-like tasks in people with Parkinson disease who experience freezing--"FoG+" and people who do not experience freezing--"FoG-". Nine FoG+ and nine FoG- imagined complex gait tasks (turning, backward walking), simple gait tasks (forward walking), and quiet standing during measurements of blood oxygen level dependent (BOLD) signal. Changes in BOLD signal (i.e. beta weights) during imagined walking and imagined standing were analyzed across FoG+ and FoG- groups in locomotor brain regions including supplementary motor area, globus pallidus, putamen, mesencephalic locomotor region, and cerebellar locomotor region. Beta weights in locomotor regions did not differ for complex tasks compared to simple tasks in either group. Across imagined gait tasks, FoG+ demonstrated significantly lower beta weights in the right globus pallidus with respect to FoG-. FoG+ also showed trends toward lower beta weights in other right-hemisphere locomotor regions (supplementary motor area, mesencephalic locomotor region). Finally, during imagined stand, FoG+ exhibited lower beta weights in the cerebellar locomotor region with respect to FoG-. These data support previous results suggesting FoG+ exhibit dysfunction in a number of cortical and subcortical regions, possibly with asymmetric dysfunction towards the right hemisphere.

Gait coordination in Parkinson disease: effects of step length and cadence manipulations

BACKGROUND

Gait impairments are well documented in those with PD. Prior studies suggest that gait impairments may be worse and ongoing in those with PD who demonstrate FOG compared to those with PD who do not.

PURPOSE

Our aim was to determine the effects of manipulating step length and cadence individually, and together, on gait coordination in those with PD who experience FOG, those with PD who do not experience FOG, healthy older adults, and healthy young adults.

METHODS

Eleven participants with PD and FOG, 16 with PD and no FOG, 18 healthy older, and 19 healthy young adults walked across a GAITRite walkway under four conditions: Natural, Fast (+50% of preferred cadence), Small (-50% of preferred step length), and SmallFast (+50% cadence and -50% step length). Coordination (i.e. phase coordination index) was measured for each participant during each condition and analyzed using mixed model repeated measure ANOVAs.

RESULTS

FOG was not elicited. Decreasing step length alone or decreasing step length and increasing cadence together affected coordination. Small steps combined with fast cadence resulted in poorer coordination in both groups with PD compared to healthy young adults and in those with PD and FOG compared to healthy older adults.

CONCLUSIONS

Coordination deficits can be identified in those with PD by having them walk with small steps combined with fast cadence. Short steps produced at high rate elicit worse coordination than short steps or fast steps alone.

High knee valgus in female subjects does not yield higher knee translations during drop landings: a biplane fluoroscopic study

The goal of this study was to determine the effects of peak knee valgus angle and peak knee abductor moment on the anterior, medial, and lateral tibial translations (ATT, MTT, LTT) in the "at risk" female knee during drop landing. Fifteen female subjects performed drop landings from 40 cm. Three-dimension knee motion was simultaneously recorded using a high speed, biplane fluoroscopy system, and a video-based motion analysis system. Valgus knee angles and knee abduction moments were stratified into low, intermediate, and high groups and peak ATT, MTT, and LTT were compared between these groups with ANOVA (α = 0.05). Significant differences were observed between stratified groups in peak knee valgus angle (p < 0.0001) and peak knee abduction moment (p < 0.0001). However, no corresponding differences in peak ATT, LTT, and MTT between groups exhibiting low to high-peak knee valgus angles (ATT: p = 0.80; LTT: p = 0.25; MTT: p = 0.72); or, in peak ATT (p = 0.61), LTT (p = 0.26) and MTT (p = 0.96) translations when stratified according to low to high knee abduction moments, were found. We conclude that the healthy female knee is tightly regulated with regard to translations even when motion analysis derived knee valgus angles and abduction moments are high.

Evidence for a relationship between bilateral coordination during complex gait tasks and freezing of gait in Parkinson's disease

BACKGROUND

Freezing of gait is a debilitating and common gait disturbance observed in individuals with Parkinson's disease (PD). Although the underlying mechanisms of freezing remain unclear, bilateral coordination of steps, measured as a phase coordination index, has been suggested to be related to freezing. Phase coordination index has not, however, been measured during tasks associated with freezing such as turning and backward walking. Understanding how bilateral coordination changes during tasks associated with freezing may improve our understanding of the causes of freezing.

METHODS

Twelve individuals with PD who freeze (freezers), 19 individuals with PD who do not freeze (non-freezers), and 10 healthy, age-matched older adults participated. General motor disease severity and freezing severity were assessed. Phase coordination index was calculated for all subjects during forward walking, backward walking, continuous turning in small radius circles, and turning in large radius circles.

RESULTS

Freezers and non-freezers had similar disease duration and general motor severity. Stepping coordination (measured as phase coordination index) was significantly worse in freezers compared to non-freezers and controls. Turning and backward walking, tasks related to freezing, resulted in worse coordination with respect to forward walking. Coordination was associated with severity of freezing scores such that worse coordination was correlated with more severe freezing.

CONCLUSIONS

These results provide evidence that stepping coordination is related to freezing in people with PD. Identifying variables associated with freezing may provide insights into factors underlying this symptom, and may inform rehabilitative interventions to reduce its occurrence in PD.

Measurements of tibiofemoral kinematics during soft and stiff drop landings using biplane fluoroscopy

BACKGROUND

Previous laboratory studies of landing have defined landing techniques in terms of soft or stiff landings according to the degree of maximal knee flexion angle attained during the landing phase and the relative magnitude of the ground-reaction force. Current anterior cruciate ligament injury prevention programs are instructing athletes to land softly to avoid excessive strain on the anterior cruciate ligament.

PURPOSE

This study was undertaken to measure, describe, and compare tibiofemoral rotations and translations of soft and stiff landings in healthy individuals using biplane fluoroscopy.

STUDY DESIGN

Controlled laboratory study.

METHODS

The in vivo, lower extremity, 3-dimensional knee kinematics of 16 healthy adults (6 male and 10 female) instructed to land softly and stiffly in different trials were collected in biplane fluoroscopy as they performed the landing from a height of 40 cm.

RESULTS

Average and maximum relative anterior tibial translation (average, 2.8 ± 1.2 mm vs 3.0 ± 1.4 mm; maximum, 4.7 ± 1.6 mm vs 4.4 ± 0.8 mm), internal/external rotation (average, 3.7° ± 5.1° vs 2.7° ± 4.3°; maximum, 5.6° ± 5.5° vs 4.9° ± 4.7°), and varus/valgus (average, 0.2° ± 1.2° vs 0.2° ± 1.0°; maximum, 1.7° ± 1.2° vs 1.6° ± 0.9°) were all similar between soft and stiff landings, respectively. The peak vertical ground-reaction force was significantly larger for stiff landings than for soft landings (2.60 ± 1.32 body weight vs 1.63 ± 0.73; P < .001). The knee flexion angle total range of motion from the minimum angle at contact to the maximum angle at peak knee flexion was significantly greater for soft landings than for stiff (55.4° ± 8.8° vs 36.8° ± 11.1°; P < .01).

CONCLUSION

Stiff landings, as defined by significantly lower knee flexion angles and significantly greater peak ground-reaction forces, do not result in larger amounts of anterior tibial translation or knee rotation in either varus/valgus or internal/external rotation in healthy individuals.

CLINICAL RELEVANCE

In healthy knees, the musculature and soft tissues of the knee are able to maintain translations and rotations within a small, safe range during controlled landing tasks of differing demand. The knee kinematics of this healthy population will serve as a comparison for injured knees in future studies. It should be stressed that because the authors did not compare how the loads were distributed over the soft tissues of the knee between the 2 landing styles, the larger ground-reaction forces and more extended knee position observed during stiff landings should still be considered dangerous to the anterior cruciate ligament and other structures of the lower extremities, particularly in competitive settings where movements are often unanticipated.

Knee kinematic profiles during drop landings: a biplane fluoroscopy study

INTRODUCTION

The six degrees of freedom knee motion during dynamic activities is not well understood.

PURPOSE

Biplane fluoroscopy was used to measure the three-dimensional rotations and translations of healthy knees during stiff drop landings and to determine the relationships between three-dimensional rotations and anterior (ATT) and lateral tibial translations (LTT).

METHODS

Six males performed stiff drop landings from 40 cm while being filmed using a high-speed, biplane fluoroscopy system. Initial, peak, and excursions for rotations and translations were calculated, and relationships and changes in these variables were assessed (α = 0.05).

RESULTS

Knee flexion at contact was 13.9° ± 9.2° (mean ± SD) and increased to a peak of 44.0° ± 17.2° with an excursion of 31.5° ± 14.1°. Knee varus/valgus angle at contact was -0.3° ± 1.8° varus; subjects progressed into a mean peak valgus position of 1.5° ± 0.9° with total excursion of 2.5° ± 0.9°. Four of six subjects landed externally rotated (2.5° ± 3.0°); two landed internally rotated (-4.9° ± 1.5°), yielding a contact angle of -2.4° ± 3.0° of internal rotation, a peak internal rotation of -5.5° ± 6.0°, and excursion of 3.1° ± 5.5°. Peak ATT were 4.3 ± 0.7 mm (excursion = 2.1 ± 0.9 mm), occurring within 50 ms after contact. Peak LTT were 1.5 ± 1.4 mm (excursion = 2.6 ± 1.6 mm). Significant regressions were found between ATT and knee valgus angle (r2 = 0.39, P = 0.006), between LTT and internal rotation (r2 = 0.96, P < 0.0001), and between LTT and knee valgus angle (quadratic, r2 = 0.90, P < 0.0001).

CONCLUSION

This study provides a direct correlation between knee valgus angle with knee ATT and LTT during drop landings.

Effects of age and walking speed on coactivation and cost of walking in healthy adults

Our goal was to determine how age and walking speed affect metabolic cost of walking (C(w)), lower, extremity antagonist coactivation, and relationships between coactivation and C(w) in healthy, active, individuals. Fourteen young (25+/-3 years) and 14 older (71+/-4 years) participants walked on a treadmill at, four speeds (0.89, 1.12, 1.34, and 1.57 m s(-1)) while electromyography (EMG) and oxygen consumption, were measured. Coactivation indices were calculated for musculature about the thigh and shank. C(w), was higher in older adults across all speeds (p<0.001). Coactivation about the thigh was also higher in, older adults (p<0.001), whereas coactivation about the shank was not different between age groups (p=0.60). Total coactivation (thigh coactivation plus shank coactivation) showed significant positive, relationships to C(w) at all walking speeds (r=0.46-0.57). Higher C(w) and coactivation in older adults, along with the positive relationship between C(w) and coactivation implies coactivation contributes to, higher C(w) of older adults.

Plasmodium falciparum-infected Red Blood Cells Selected for Binding to Cultured Syncytiotrophoblast Bind to Chondroitin Sulfate A and Induce Tyrosine Phosphorylation in the Syncytiotrophoblast

An important pathogenic complication of malaria during human pregnancy is sequestration of Plasmodium-infected red blood cells (iRBCs) in the placental intervillous spaces. This sequestration is thought to be mediated in part by binding of the iRBCs to receptors expressed on the syncytiotrophoblast (ST) membrane. We report here the use of a dynamic system to study the consequences of this cytoadherence on ST function using human syncytiotrophoblast and the choriocarcinoma cell line, BeWo. Laboratory isolates of Plasmodium falciparum were selected for their ability to bind to ST and used to investigate binding-induced cellular changes in the ST. Treatment of the ST cells with chondroitinase ABC suggested that the selected parasites bind predominantly to chondroitin sulfate A, but other receptors for parasite binding may be involved. Intracellular signaling in the ST induced by iRBCs binding was investigated by assessing tyrosine phosphorylation of ST proteins following iRBC binding. We demonstrate for the first time that iRBC cytoadherence to syncytiotrophoblast enhances tyrosine phosphorylation of a series of proteins in these cells. This approach will be useful in further studies of ST function in the malaria-infected placenta, the dynamics of selection of syncytiotrophoblast-binding parasites, and the identification of new receptors for parasite cytoadherence in the placenta.

Novel alkyl-modified anionic siloxanes as pseudostationary phases for electrokinetic chromatography: II. Selectivity studied by linear solvation energy relationships

Anionic, water-soluble siloxane polymers modified with different lengths of alkyl chains have very different selectivity than sodium dodecyl sulfate (SDS) micelles when used as pseudostationary phases in electrokinetic chromatography. The siloxanes in this study are random copolymers with side chains bearing sulfonate groups and alkyl groups (C8, C12, or C18), with the proportion of alkyl groups between 10 and 25% of the total. The differences in selectivity have been studied by linear solvation energy relationships (LSERs). The siloxanes in general have been found to be more cohesive, less polar, more able to interact with solutes through n- and pi-electrons, and more able to accept hydrogen bonds than SDS micelles, while the ability to act as hydrogen bond donors is not significantly different than SDS micelles. In addition, the performance in a pH 7.0 Tris buffer has been investigated and the siloxanes were found to have higher methylene selectivities and more variable electrophoretic mobilities than in borate buffers.

Alkyl modified anionic siloxanes as pseudostationary phases for electrokinetic chromatography. I. Synthesis and characterization

Anionic water soluble siloxane polymers have been synthesized and characterized for electrokinetic chromatography. Siloxane polymers are of interest in electrokinetic chromatography because of the wide variety of chemistries that can be developed based on these backbones, including much of the stationary phase chemistry developed in the last 30 years. The siloxanes in this study have a sulfonate functional group. The siloxanes have different length alkyl chains (C8, C12, C18) attached to the backbone in differing densities. The methylene selectivity generally increases with increasing alkyl chain length and with increasing alkyl chain density. The electrophoretic mobility appears to pass through a maximum as more alkyl chain is added to the siloxane backbone. The efficiency also would seem to pass through a maximum as more alkyl chain is added. The chemical selectivities of the siloxane polymers are very different from sodium dodecyl sulfate but are similar to each other.

Effect of pendant chain lengths and backbone functionalities on the chemical selectivity of sulfonated amphiphilic copolymers as pseudo-stationary phases in electrokinetic chromatography

Amphiphilic copolymers of AMPS (2-acrylamido-2-methyl-1-propanesulfonic acid) and hydrophobic monomers with various chemical structures were synthesized, characterized and used as novel electrokinetic chromatography polymeric pseudo-stationary phases, showing significant chemical selectivity differences from that of the conventional monomeric pseudo-stationary phase, sodium lauryl sulphate. Copolymers of AMPS and methacrylates with different pendant chain lengths (C8, C12 and C18) were investigated and no significant difference in chemical selectivity was observed among them. However, the spacer bonding chemistry was shown to contribute to significant chemical selectivity difference, e.g. poly(AMPS-lauryl methacrylate) showed different chemical selectivity from poly(AMPS-lauryl methacrylamide). Linear solvation energy relationship analysis of 20 solutes by eight different polymeric pseudo-stationary phases was employed to investigate the solute molecule structural contributions to the retention. Hydrogen-bonding properties (described by system constants b and a) of poly(AMPS-alkyl methacrylamide) were found stronger than those of poly(AMPS-alkyl methacrylate).

Synthesis and characterization of novel anionic siloxane polymers as pseudostationary phases for electrokinetic chromatography

Four novel siloxane polymeric pseudostationary phases with three different ionic head groups have been synthesized and characterized for electrokinetic chromatography. Siloxane polymers are of interest in this application because of the wide range of chemistries that can be developed based on these backbones, including much of the chromatographic stationary phase chemistry developed in the last thirty years. All four of the siloxanes studied were synthesized by modification of a single methylhydrosiloxane polymer with highly acidic anionic functionalities. One of the siloxanes had both ionic groups and alkane chains attached to the siloxane backbone. The electrophoretic mobilities varied from being somewhat less than sodium dodecyl sulfate (SDS) to being much greater than SDS. The siloxanes substituted with ionic groups at all of the silicon sites showed significant nonequilibrium band broadening, severely limiting the efficiencies of these polymers. Substitution of 20% of the silicon sites with an alkyl group improved the efficiency of the separations and the peak symmetry. The chemical selectivities of the siloxane polymers are very different from SDS, but are similar to each other.

An anionic siloxane polymer as a pseudostationary phase for electrokinetic chromatography

A novel polymeric pseudostationary phase for electrokinetic chromatography is introduced and characterized. Siloxane polymers are of interest for this application because of the range of chemistries that could be developed based on these backbones, and because successful development of siloxane polymers would make it possible to employ much of the stationary phase chemistry developed in the past thirty years. A commercially available water-soluble siloxane with a hydroxy-terminated alkyl group was converted to the sulfate derivative. This siloxane polymer is water-soluble, effectively eliminating this limitation associated with siloxane polymers. When employed as a pseudostationary phase, this compound provided rapid, efficient, and selective separations. The electrophoretic mobility of the polymer was less than sodium dodecyl sulfate (SDS) and poly(sodium 10-undecenylsulfate), providing a compressed migration time range, which is the main limiting factor for this polymer. The chemical selectivity of the siloxane sulfate was somewhat different than SDS micelles. The siloxane was employed in buffers modified with a large amount of acetonitrile to separate a number of polynuclear aromatic hydrocarbons. The addition of acetonitrile caused an apparent discontinuity in the electrophoretic mobility of the polymer, which may indicate a change in the structure with increasing organic solvent content.

EBL-1, a putative erythrocyte binding protein of Plasmodium falciparum, maps within a favored linkage group in two genetic crosses

The Duffy binding-like (DBL) superfamily of Plasmodium falciparum encompasses genes which encode ligands for host cell receptors. This superfamily includes two distinct groups of genes, the var genes which encode antigenically variant cytoadherence proteins (PfEMP1), and the eba-175 gene which encodes a glycophorin A binding protein involved in erythrocyte invasion. Here we describe another DBL superfamily member related to eba-175, the ebl-1 gene. Like the eba-175 gene, ebl-1 is a single copy gene encoding DBL domains that have sequences and an overall arrangement distinct from var genes. The inheritance of ebl-1 was found to be strongly favored in two genetic crosses in which one parental clone lacked a chromosome segment carrying the gene. A proliferation phenotype has been previously linked to the same chromosome segment in the first genetic cross. These results suggest that ebl-1 and eba-175 are related members of a multigene family involved in the invasion of erythrocytes by P. falciparum.

Antifolate drug resistance and point mutations in Plasmodium falciparum in Kenya

Due to increased chloroquine resistance, the antifolate/sulpha drug combinations are becoming increasingly important in the chemotherapy of falciparum malaria. However, point mutations in the dihydrofolate reductase gene lead to resistance to the antifolate drugs. We therefore investigated the prevalence of the 6 reported point mutations in this gene among field isolates of Plasmodium falciparum from Kenya, to determine if the mutations correlated with resistance to pyrimethamine and the biguanides cycloguanil and chlorcycloguanil. We used a mutation-specific polymerase chain reaction technique to test for these reported mutations in 21 Kenyan isolates and 4 reference lines. We also amplified and directly sequenced the dihydrofolate reductase coding sequence from these parasites to confirm the results and test for other possible mutations. Of the reported mutations, we found S108N, which is the central mutation of pyrimethamine resistance, and mutations N51I and C59R, which modulate the levels of resistance and may confer decreases in response to cycloguanil that are folate and p-aminobenzoic acid dependent. No isolate possessed the paired point mutations S108T and A16V, or I164L and S108N, which have been associated with cycloguanil resistance in previous studies. These results provided supportive evidence for the combined use of a cycloguanil-class drug (e.g., chlorproguanil) and a sulpha drug (e.g., dapsone) against P.falciparum malaria in Kenya.

Expressed var genes are found in Plasmodium falciparum subtelomeric regions

The antigenic variation and cytoadherence of Plasmodium falciparum-infected erythrocytes are modulated by a family of variant surface proteins encoded by the var multigene family. The var genes occur on multiple chromosomes, often in clusters, and 50 to 150 genes are estimated to be present in the haploid parasite genome. Transcripts from var genes have been previously mapped to internal chromosome positions, but the generality of such assignments and the expression sites and mechanisms that control switches of var gene expression are still in early stages of investigation. Here we describe investigations of closely related var genes that occur in association with repetitive elements near the telomeres of P. falciparum chromosomes. DNA sequence analysis of one of these genes (FCR3-varT11-1) shows the characteristic two-exon structure encoding expected var features, including three variable Duffy binding-like (DBL) domains, a transmembrane sequence, and a carboxy-terminal segment thought to anchor the protein product in knobs at the surface of the parasitized erythrocyte. FCR3-varT11-1 cross-hybridizes with var genes located close to the telomeres of many other P. falciparum chromosomes, including a transcribed gene (FCR3-varT3-1) in chromosome 3 of the P. falciparum FCR3 line. The relatively high level transcription from this gene shows that the polymorphic chromosome ends of P. falciparum, which have been proposed to be transcriptionally silent, can be active expression sites for var genes. The pattern of the FCR3-varT11-1 and FCR3-varT3-1 genes are variable between different P. falciparum lines, presumably due to DNA rearrangements. Thus, recombination events in subtelomeric DNA may have a role in the expression of novel var forms.