1
|
Fraser M, Curtis B, Phillips P, Yates PA, Lam KS, Netzel O, van Dooren GG, Ingmundson A, Matuschewski K, McLeod MD, Maier AG. Harnessing cholesterol uptake of malaria parasites for therapeutic applications. EMBO Mol Med 2024; 16:1515-1532. [PMID: 38862600 PMCID: PMC11251039 DOI: 10.1038/s44321-024-00087-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/13/2024] Open
Abstract
Parasites, such as the malaria parasite P. falciparum, are critically dependent on host nutrients. Interference with nutrient uptake can lead to parasite death and, therefore, serve as a successful treatment strategy. P. falciparum parasites cannot synthesise cholesterol, and instead source this lipid from the host. Here, we tested whether cholesterol uptake pathways could be 'hijacked' for optimal drug delivery to the intracellular parasite. We found that fluorescent cholesterol analogues were delivered from the extracellular environment to the intracellular parasite. We investigated the uptake and inhibitory effects of conjugate compounds, where proven antimalarial drugs (primaquine and artesunate) were attached to steroids that mimic the structure of cholesterol. These conjugated antimalarial drugs improved the inhibitory effects against multiple parasite lifecycle stages, multiple parasite species, and drug-resistant parasites, whilst also lowering the toxicity to human host cells. Steroids with introduced peroxides also displayed antimalarial activity. These results provide a proof-of-concept that cholesterol mimics can be developed as a drug delivery system against apicomplexan parasites with the potential to improve drug efficacy, increase therapeutic index, and defeat drug resistance.
Collapse
Affiliation(s)
- Merryn Fraser
- Research School of Biology, The Australian National University, Canberra, 2601, Australia
- Department of Molecular Parasitology, Institute of Biology, Humboldt University, Berlin, 10115, Germany
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Blake Curtis
- Research School of Chemistry, The Australian National University, Canberra, 2601, Australia
- Metabolism of Microbial Pathogens, Robert Koch Institute, Berlin, 13353, Germany
| | - Patrick Phillips
- Research School of Biology, The Australian National University, Canberra, 2601, Australia
| | - Patrick A Yates
- Research School of Chemistry, The Australian National University, Canberra, 2601, Australia
| | - Kwong Sum Lam
- Research School of Biology, The Australian National University, Canberra, 2601, Australia
| | - Otto Netzel
- Department of Molecular Parasitology, Institute of Biology, Humboldt University, Berlin, 10115, Germany
| | - Giel G van Dooren
- Research School of Biology, The Australian National University, Canberra, 2601, Australia
| | - Alyssa Ingmundson
- Department of Molecular Parasitology, Institute of Biology, Humboldt University, Berlin, 10115, Germany
| | - Kai Matuschewski
- Department of Molecular Parasitology, Institute of Biology, Humboldt University, Berlin, 10115, Germany
| | - Malcolm D McLeod
- Research School of Chemistry, The Australian National University, Canberra, 2601, Australia.
| | - Alexander G Maier
- Research School of Biology, The Australian National University, Canberra, 2601, Australia.
| |
Collapse
|
2
|
Marcos LA, Vorkas CK, Mann I, Garry E, Lamba P, Pham SK, Spector R, Papamanoli A, Krivacsy S, Lum M, Zahra A, Hou W, Spitzer ED. Reduced Cholesterol Levels during Acute Human Babesiosis. Pathogens 2023; 12:pathogens12040613. [PMID: 37111499 PMCID: PMC10144092 DOI: 10.3390/pathogens12040613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Babesiosis, an intra-erythrocytic protozoan disease, is an emerging zoonotic parasitic disease worldwide. Cholesterol levels are correlated with severe infections, such as sepsis and COVID-19, and anecdotal reports suggest that high-density lipoprotein (HDL) cholesterol declines during acute babesiosis. Our aim was to describe the cholesterol levels in patients with acute babesiosis diagnosed in an endemic area in New York, hypothesizing that HDL levels correlate with the severity of infection. METHODS We reviewed the medical records of adult patients with babesiosis diagnosed by identification of Babesia parasites on a thin blood smear and confirmed by polymerase chain reaction from 2013 to 2018, who also had available a lipid profile drawn at the time of clinical presentation. Additional lipid profile levels were considered as "baseline" if they were drawn within 2 months before or after the infection as part of routine care. RESULTS A total of 39 patients with babesiosis had a lipid profile drawn on presentation. The patients were divided into two groups for comparison based on the treating physician's clinical decision: 33 patients who were admitted to the hospital and 8 patients who were evaluated as outpatients. A history of hypertension was more common in admitted patients (37% vs. 17%, p = 0.02). The median levels of low-density lipoprotein (LDL) and HDL were significantly reduced in admitted patients compared to non-admitted patients (46 vs. 76 mg/dL, p = 0.04; and 9 vs. 28.5 mg/dL, p = 0.03, respectively). In addition, LDL and HDL levels returned to baseline values following resolution of acute babesiosis. CONCLUSION LDL and HDL levels are significantly reduced during acute babesiosis, suggesting that cholesterol depletion may predict disease severity. Pathogen and host factors may contribute to a reduction in serum cholesterol levels during acute babesiosis.
Collapse
Affiliation(s)
- Luis A Marcos
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Charles Kyriakos Vorkas
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Inderjit Mann
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Evan Garry
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Pooja Lamba
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Sophia K Pham
- Stony Brook Southampton Hospital, Southampton, NY 11968, USA
| | - Rachel Spector
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Aikaterini Papamanoli
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Sara Krivacsy
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Michael Lum
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Aleena Zahra
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Wei Hou
- Division of Epidemiology and Biostatistics, Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Eric D Spitzer
- Department of Pathology, Stony Brook University, Stony Brook, NY 11794, USA
| |
Collapse
|
3
|
Zhang R, Zhang X, Tang X, Tang L, Shang S, Wang X, Wen Y, Feng X, Zhou Q, Su N, Huang Y. The association between diabetes coexisting with low levels of high-density lipoprotein cholesterol and peritoneal dialysis-related peritonitis. Diabetol Metab Syndr 2022; 14:60. [PMID: 35488249 PMCID: PMC9052536 DOI: 10.1186/s13098-022-00832-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low levels of high-density lipoprotein cholesterol (HDL-C) and diabetes are common in patients undergoing peritoneal dialysis (PD). The aim of this study was to investigate the association between the coexistence of diabetes with a low level of HDL-C and the first episode of peritoneal dialysis-related peritonitis (PDRP) in patients with PD. METHODS We retrospectively investigated patients with PD from January 1, 2003, to May 31, 2020, in four PD centers. Patients with PD were divided into four groups: no comorbidities, low HDL-C only, diabetes only, and diabetes plus low HDL-C. The clinical and laboratory baseline data of the four groups were collected and compared. The association between diabetes coexisting with low HDL-C levels and the first episode of PDRP was analyzed by multivariate Cox regression analysis. RESULTS A total of 1013 patients with PD were included in our study. The mean age was 49.94 ± 14.32 years, and 597 (58.99%) patients were males. A total of 301 (29.7%) patients had their first episodes of PDRP, and low HDL-C levels coexisted with diabetes in 72 patients with PD. After adjusting for confounding factors, a low level of HDL-C coexisting with diabetes was significantly associated with the first episode of PDRP in our study (hazard ratio: 2.81, 95% CI 1.32 ~ 4.73, p = 0.005). The associations among HDL-C, diabetes and PDRP were consistent in the following subgroups: sex, age, and pre-existing CVD (all P interaction > 0.05). CONCLUSIONS Patients with both diabetes and low HDL-C levels were at higher risk for PDRP in patients with PD.
Collapse
Affiliation(s)
- Rui Zhang
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Xing Zhang
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Xingming Tang
- Department of Nephrology, The Affiliated Tung Wah Hospital of Sun Yat-Sen University, Dongguan, China
| | - Liwen Tang
- Department of Nephrology, The Affiliated Tung Wah Hospital of Sun Yat-Sen University, Dongguan, China
| | - Sijia Shang
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Univeristy, ZhengZhou, China
| | - Yueqiang Wen
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang No. 1 People's Hospital, Jiujiang, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ning Su
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.
| | - Yajuan Huang
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.
| |
Collapse
|
4
|
Laudanski K. Persistence of Lipoproteins and Cholesterol Alterations after Sepsis: Implication for Atherosclerosis Progression. Int J Mol Sci 2021; 22:ijms221910517. [PMID: 34638860 PMCID: PMC8508791 DOI: 10.3390/ijms221910517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Sepsis is one of the most common critical care illnesses with increasing survivorship. The quality of life in sepsis survivors is adversely affected by several co-morbidities, including increased incidence of dementia, stroke, cardiac disease and at least temporary deterioration in cognitive dysfunction. One of the potential explanations for their progression is the persistence of lipid profile abnormalities induced during acute sepsis into recovery, resulting in acceleration of atherosclerosis. (2) Methods: This is a targeted review of the abnormalities in the long-term lipid profile abnormalities after sepsis; (3) Results: There is a well-established body of evidence demonstrating acute alteration in lipid profile (HDL-c ↓↓, LDL-C -c ↓↓). In contrast, a limited number of studies demonstrated depression of HDL-c levels with a concomitant increase in LDL-C -c in the wake of sepsis. VLDL-C -c and Lp(a) remained unaltered in few studies as well. Apolipoprotein A1 was altered in survivors suggesting abnormalities in lipoprotein metabolism concomitant to overall lipoprotein abnormalities. However, most of the studies were limited to a four-month follow-up and patient groups were relatively small. Only one study looked at the atherosclerosis progression in sepsis survivors using clinical correlates, demonstrating an acceleration of plaque formation in the aorta, and a large metanalysis suggested an increase in the risk of stroke or acute coronary event between 3% to 9% in sepsis survivors. (4) Conclusions: The limited evidence suggests an emergence and persistence of the proatherogenic lipid profile in sepsis survivors that potentially contributes, along with other factors, to the clinical sequel of atherosclerosis.
Collapse
Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA 19104, USA; ; Tel.: +1-215-662-8200
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard Davis Institute of Healthcare Economics, Philadelphia, PA 19104, USA
| |
Collapse
|
5
|
Hayakawa EH, Kato H, Nardone GA, Usukura J. A prospective mechanism and source of cholesterol uptake by Plasmodium falciparum-infected erythrocytes co-cultured with HepG2 cells. Parasitol Int 2020; 80:102179. [PMID: 32853776 DOI: 10.1016/j.parint.2020.102179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/23/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
Plasmodium falciparum (P. falciparum) parasites still cause lethal infections worldwide, especially in Africa (https://www.who.int/publications/i/item/world-malaria-report-2019). During P. falciparum blood-stage infections in humans, low-density lipoprotein, high-density lipoprotein and cholesterol levels in the blood become low. Because P. falciparum lacks a de novo cholesterol synthesis pathway, it must import cholesterol from the surrounding environment. However, the origin of the cholesterol and how it is taken up by the parasite across the multiple membranes that surround it is not fully understood. To answer this, we used a cholesterol synthesis inhibiter (simvastatin), a cholesterol transport inhibitor (ezetimibe), and an activating ligand of the peroxisome proliferator-activated receptor α, called ciprofibrate, to investigate the effects of these agents on the intraerythrocytic growth of P. falciparum, both with and without HepG2 cells as the lipoprotein feeders. P. falciparum growth was inhibited in the presence of ezetimibe, but ezetimibe was not very effective at inhibiting P. falciparum growth when used in the co-culture system, unlike simvastatin, which strongly promoted parasite growth in this system. Ezetimibe is known to inhibit cholesterol absorption by blocking the activity of Niemann-Pick C1 like 1 (NPC1L1) protein, and simvastatin is known to enhance NPC1L1 expression in the human body's small intestine. Collectively, our results support the possibility that cholesterol import by P. falciparum involves hepatocytes, and cholesterol uptake into the parasite occurs via NPC1L1 protein or an NPC1L1 homolog during the erythrocytic stages of the P. falciparum lifecycle.
Collapse
Affiliation(s)
- Eri H Hayakawa
- Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan.
| | - Hirotomo Kato
- Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan
| | - Glenn A Nardone
- Research Technology Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-5766, USA
| | - Jiro Usukura
- Institute of Material and Systems for Sustainability, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| |
Collapse
|