Pro-apoptotic effects of antimalarial drugs do not affect mature human erythrocytes

Evidencing the Role of Erythrocytic Apoptosis in Malarial Anemia

In the last decade it has become clear that, similarly to nucleated cells, enucleated red blood cells (RBCs) are susceptible to programmed apoptotic cell death. Erythrocytic apoptosis seems to play a role in physiological clearance of aged RBCs, but it may also be implicated in anemia of different etiological sources including drug therapy and infectious diseases. In malaria, severe anemia is a common complication leading to death of children and pregnant women living in malaria-endemic regions of Africa. The pathogenesis of malarial anemia is multifactorial and involves both ineffective production of RBCs by the bone marrow and premature elimination of non-parasitized RBCs, phenomena potentially associated with apoptosis. In the present overview, we discuss evidences associating erythrocytic apoptosis with the pathogenesis of severe malarial anemia, as well as with regulation of parasite clearance in malaria. Efforts to understand the role of erythrocytic apoptosis in malarial anemia can help to identify potential targets for therapeutic intervention based on apoptotic pathways and consequently, mitigate the harmful impact of malaria in global public health.

Plasmodium falciparum, but not P. vivax, can induce erythrocytic apoptosis

Background

Apoptosis can occur in red blood cells (RBC) and seems to be involved in hematologic disorders related to many diseases. In malaria it is known that parasitized RBC (pRBC) is involved in the development of anemia and thrombosis; however, non-parasitized RBC (nRBC) apoptosis could amplify these malaria-associated hematologic events. In fact, in experimental malaria, increased levels of apoptosis were observed in nRBC during lethal Plasmodium yoelii 17XL infection, but in human malaria erythrocytic apoptosis has never been studied. The present study was performed to investigate if nRBC apoptosis also occurs in P. vivax and P. falciparum infections.

Findings

Apoptosis of nRBC was evaluated in blood samples of P. vivax malaria patients and clinically healthly individuals living in Manaus, Brazil, both ex vivo and after incubation of RBC for 24 h. Additionally, the capacity of plasma from P. vivax or P. falciparum patients was tested for induction of in vitro apoptosis of normal RBC from a clinically healthy individual living in a non-endemic malaria region. Apoptosis was detected by flow cytometry using annexin V staining. In contrast to experimental malaria that significantly increased the levels of apoptotic nRBC both ex-vivo and after 24 h of incubation, no significant alteration on apoptotic nRBC rates was detected in P. vivax infected patients when compared with non-infected control individuals. Similar results were observed when plasma of these P. vivax patients was incubated with normal RBC. Conversely, plasma from P. falciparum-infected subjects induced significant apoptosis of these cells.

Conclusions

Apoptosis of normal RBC can be induced by plasma from individuals with P. falciparum (but not with P. vivax) malaria. This finding could reflect the existence of erythrocytic apoptosis during infection that could contribute to the pathogenesis of hematological and vascular complications associated with falciparum malaria.

Characterization, comparative genomics, and evolutionary inferences of a human drug metabolizing (NAT2) gene

Aim

The present-day genetic architecture of a species bears much significance to its closely related species. In recent availability of whole genome sequence data for closely related species, it is possible to detect genetic similarities/differences in specific lineages and infer the role of evolutionary forces in bringing such similarities/differences. In this respect, NAT2 gene, responsible for drug metabolism, is conserved across a few taxa and, thus, comparative genomic studies could be useful for better pharmacogenetic realization.

Methods

DNA sequences of human NAT2 gene were retrieved from NCBI and characterized. Comparative and evolutionary analyses were performed with sequences from four mammalian taxa and one avian taxon with different statistical algorithms.

Results

The observed genetic architecture of NAT2 gene was different across the taxa. Phylogenetic inferences revealed that human and chimpanzee are diverged recently and fowl was found to be diverged from rest of the taxa significantly. Also, gene length, microsatellites, Ka/Ks, secondary structure, and distribution of CpG islands were observed across taxa.

Conclusions

The detail architecture of NAT2 gene and its evolutionary history in different taxa show relationships with other taxa. Future population-based study in NAT2 would unravel the correlation between nucleotide changes and differential ability of drug metabolization in humans.