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Pinheiro AAS, Torrecilhas AC, Souza BSDF, Cruz FF, Guedes HLDM, Ramos TD, Lopes‐Pacheco M, Caruso‐Neves C, Rocco PRM. Potential of extracellular vesicles in the pathogenesis, diagnosis and therapy for parasitic diseases. J Extracell Vesicles 2024; 13:e12496. [PMID: 39113589 PMCID: PMC11306921 DOI: 10.1002/jev2.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/11/2024] [Indexed: 08/11/2024] Open
Abstract
Parasitic diseases have a significant impact on human and animal health, representing a major hazard to the public and causing economic and health damage worldwide. Extracellular vesicles (EVs) have long been recognized as diagnostic and therapeutic tools but are now also known to be implicated in the natural history of parasitic diseases and host immune response modulation. Studies have shown that EVs play a role in parasitic disease development by interacting with parasites and communicating with other types of cells. This review highlights the most recent research on EVs and their role in several aspects of parasite-host interactions in five key parasitic diseases: Chagas disease, malaria, toxoplasmosis, leishmaniasis and helminthiases. We also discuss the potential use of EVs as diagnostic tools or treatment options for these infectious diseases.
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Affiliation(s)
- Ana Acacia Sá Pinheiro
- Instituto de Biofísica Carlos Chagas FilhoUniversidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
- Rio de Janeiro Innovation Network in Nanosystems for Health‐NanoSAÚDE/Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)Rio de JaneiroBrazil
| | - Ana Claudia Torrecilhas
- Departamento de Ciências FarmacêuticasDiadema Campus, Instituto de Ciências Ambientais, Químicas e FarmacêuticasUniversidade Federal de São Paulo (UNIFESP)DiademaSão PauloBrazil
| | - Bruno Solano de Freitas Souza
- Center for Biotechnology and Cell TherapySão Rafael HospitalSalvadorBrazil
- D'Or Institute for Research and Education (IDOR)SalvadorBrazil
| | - Fernanda Ferreira Cruz
- Instituto de Biofísica Carlos Chagas FilhoUniversidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
- Rio de Janeiro Innovation Network in Nanosystems for Health‐NanoSAÚDE/Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)Rio de JaneiroBrazil
| | - Herbert Leonel de Matos Guedes
- Instituto de Microbiologia Paulo de Goés (IMPG)Universidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
- Fundação Oswaldo Cruz (FIOCRUZ)Instituto Oswaldo Cruz (IOC)Rio de JaneiroBrazil
| | - Tadeu Diniz Ramos
- Instituto de Microbiologia Paulo de Goés (IMPG)Universidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
- Fundação Oswaldo Cruz (FIOCRUZ)Instituto Oswaldo Cruz (IOC)Rio de JaneiroBrazil
| | - Miqueias Lopes‐Pacheco
- Instituto de Biofísica Carlos Chagas FilhoUniversidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
- Deparment of PediatricsCenter for Cystic Fibrosis and Airway Disease ResearchEmory University School of MedicineAtlantaGeorgiaUSA
| | - Celso Caruso‐Neves
- Instituto de Biofísica Carlos Chagas FilhoUniversidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
- Rio de Janeiro Innovation Network in Nanosystems for Health‐NanoSAÚDE/Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)Rio de JaneiroBrazil
- National Institute of Science and Technology for Regenerative MedicineINCT‐REGENERARio de JaneiroBrazil
| | - Patricia R. M. Rocco
- Instituto de Biofísica Carlos Chagas FilhoUniversidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
- Rio de Janeiro Innovation Network in Nanosystems for Health‐NanoSAÚDE/Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)Rio de JaneiroBrazil
- National Institute of Science and Technology for Regenerative MedicineINCT‐REGENERARio de JaneiroBrazil
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Miura K, Flores-Garcia Y, Long CA, Zavala F. Vaccines and monoclonal antibodies: new tools for malaria control. Clin Microbiol Rev 2024; 37:e0007123. [PMID: 38656211 PMCID: PMC11237600 DOI: 10.1128/cmr.00071-23] [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] [Indexed: 04/26/2024] Open
Abstract
SUMMARYMalaria remains one of the biggest health problems in the world. While significant reductions in malaria morbidity and mortality had been achieved from 2000 to 2015, the favorable trend has stalled, rather significant increases in malaria cases are seen in multiple areas. In 2022, there were 249 million estimated cases, and 608,000 malaria-related deaths, mostly in infants and children aged under 5 years, globally. Therefore, in addition to the expansion of existing anti-malarial control measures, it is critical to develop new tools, such as vaccines and monoclonal antibodies (mAbs), to fight malaria. In the last 2 years, the first and second malaria vaccines, both targeting Plasmodium falciparum circumsporozoite proteins (PfCSP), have been recommended by the World Health Organization to prevent P. falciparum malaria in children living in moderate to high transmission areas. While the approval of the two malaria vaccines is a considerable milestone in vaccine development, they have much room for improvement in efficacy and durability. In addition to the two approved vaccines, recent clinical trials with mAbs against PfCSP, blood-stage vaccines against P. falciparum or P. vivax, and transmission-blocking vaccine or mAb against P. falciparum have shown promising results. This review summarizes the development of the anti-PfCSP vaccines and mAbs, and recent topics in the blood- and transmission-blocking-stage vaccine candidates and mAbs. We further discuss issues of the current vaccines and the directions for the development of next-generation vaccines.
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Affiliation(s)
- Kazutoyo Miura
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Yevel Flores-Garcia
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Malaria Research Institute, Baltimore, Maryland, USA
| | - Carole A Long
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Fidel Zavala
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Malaria Research Institute, Baltimore, Maryland, USA
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Adugna T, Zelalem L, Alelign G. Blood smears examination and prevalence of malaria in Addis Zemen Town, Northwest Ethiopia (2013-2021): a retrospective study. Trop Dis Travel Med Vaccines 2024; 10:12. [PMID: 38745210 PMCID: PMC11095033 DOI: 10.1186/s40794-024-00219-y] [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: 10/26/2022] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION In Ethiopia, malaria is one of the major public health and socioeconomic problems, though tremendous efforts have been made. Currently, the country has a plan to eliminate malaria by 2030. To achieve this plan, epidemiological studies associated with malaria prevalence with gender, age groups, species types, and seasons are essential. Therefore, the aim of this study was to assess the prevalence of malaria from 2013 to 2021 in Addis Zemen town, Northwest Ethiopia. METHODS A retrospective study was conducted at assess the trend of malaria prevalence over the last nine years using recorded blood smear reports in the laboratory logbook from governmental health institutions. Trends in malaria cases and the proportion of genders, age groups, species, and seasons over time were compared. The data were analyzed using the SPSS-23 software package. RESULTS The overall malaria prevalence between 2013 and 2021 was 10.4%. From all confirmed cases, the minimum and maximum prevalence of malaria cases were recorded in 2018 (2%) and 2016 (33.2%) years, respectively. The infectious rate of males (59.3%) was significantly higher than that of females (40.7%) (p < 0.0001). In all survey periods, all age groups were infected by malaria parasites; the majority of the cases were between 15 and 45 years (57%) older than others. Statistically, a greater proportion of P. falciparum (80.1%) was recorded than P. vivax (18.5%) (p < 0.0001). Malaria cases were occurring throughout each month. The relative highest peaks of total malaria cases were observed during the months of September, October, and November. Seasonally, the highest infection rate was observed during spring (40.20%) compared to other seasons. CONCLUSIONS In conclusion, the study revealed that malaria transmission remained high, which affected males more than females and potentially reproductive ages. Two of the most important Plasmodium species were identified and found during all reviewed months and years, though P. falciparum was the most prevalent. Hence, the problem can be alleviated by using season-based long-lasting insecticide treated nets, regularly overseeing ongoing irrigation activity, overseeing the reduction of the water level of the Sheni River, health education, and providing immediate patient treatment.
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Stanley P, Rajkumari N, Sivaradjy M. Molecular detection of antimalarial resistance in Plasmodium vivax isolates from a tertiary care setting in Puducherry. Indian J Med Microbiol 2024; 47:100496. [PMID: 37949233 DOI: 10.1016/j.ijmmb.2023.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/14/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE The study was aimed at detecting the mutation patterns in the drug targets in Plasmodium vivax that confer resistance to the common antimalarial agents used in India. METHODS A total of 27 Plasmodium vivax isolates collected from whole blood samples over a three year period were subjected to PCR amplification followed by sequencing of the genes pvmdr1, pvdhfr, pvdhps and pvk12, which serve as the molecular targets to detect resistance to chloroquine, pyrimethamine, sulfadoxine and artemisinin respectively. RESULTS The study found T958 M F1076L double mutants of pvmdr1 in 52 %(14/27) isolates, S58R S117 N double mutants of pvdhfr in 67 % (18/27) isolates, A383G A553G double mutant pvdhps in 59 % (16/27) isolates and wild type of pvk12 gene in all the isolates. CONCLUSIONS There was a rise in the proportion of double mutants of pvmdr1 and pvdhfr over time. Those cases with double mutant pvmdr1 gene in their isolates were found to have a prolonged hospital stay compared to those without, indicating reduced clinical response to chloroquine.
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Affiliation(s)
- Pheba Stanley
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, 605006, India.
| | - Nonika Rajkumari
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, 605006, India.
| | - Monika Sivaradjy
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, 605006, India; Department of Microbiology, ESIC Medical College& PGIMSR, Chennai, 78, India.
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Ferraboli JW, Soares da Veiga GT, Albrecht L. Plasmodium vivax transcriptomics: What is new? Exp Biol Med (Maywood) 2023; 248:1645-1656. [PMID: 37786955 PMCID: PMC10723030 DOI: 10.1177/15353702231198070] [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] [Indexed: 10/04/2023] Open
Abstract
Malaria is the leading human parasitosis and is transmitted through the bite of anopheline mosquitoes infected with parasites of the genus Plasmodium spp. Among the seven species that cause malaria in humans, Plasmodium vivax is the most prevalent species in Latin America. In recent years, there have been an increasing number of reports of clinical complications caused by P. vivax infections, which were previously neglected and underestimated. P. vivax biology remains with large gaps. The emergence of next-generation sequencing technology has ensured a breakthrough in species knowledge. Coupled with this, the deposition of the P. vivax Sal-1 reference genome allowed an increase in transcriptomics projects by accessing messenger RNA. Thus, the regulation of differential gene expression according to the parasite life stage was verified, and several expressed genes were linked to different biological functions. Today, with the progress associated with RNA sequencing technologies, it is possible to detect nuances and obtain robust results. Discoveries provided by transcriptomic studies allow us to understand topics such as RNA expression and regulation and proteins and metabolic pathways involved during different stages of the parasite life cycle. The information obtained enables a better comprehension of immune system evasion mechanisms; invasion and adhesion strategies used by the parasite; as well as new vaccine targets, potential molecular markers, and others therapeutic targets. In this review, we provide new insights into P. vivax biology by summarizing recent findings in transcriptomic studies.
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Affiliation(s)
- Julia Weber Ferraboli
- Laboratory of Apicomplexan Parasites Research, Carlos Chagas Institute, Oswaldo Cruz Foundation (FIOCRUZ), Curitiba 81310-020, Brazil
| | - Gisele Tatiane Soares da Veiga
- Laboratory of Apicomplexan Parasites Research, Carlos Chagas Institute, Oswaldo Cruz Foundation (FIOCRUZ), Curitiba 81310-020, Brazil
| | - Letusa Albrecht
- Laboratory of Apicomplexan Parasites Research, Carlos Chagas Institute, Oswaldo Cruz Foundation (FIOCRUZ), Curitiba 81310-020, Brazil
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Kumari S, Sinha A. Culture and transfection: Two major bottlenecks in understanding Plasmodium vivax biology. Front Microbiol 2023; 14:1144453. [PMID: 37082177 PMCID: PMC10110902 DOI: 10.3389/fmicb.2023.1144453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/28/2023] [Indexed: 04/07/2023] Open
Abstract
The long term in vitro culture of Plasmodium falciparum was successfully established by Trager and Jensen in 1976; however it largely remains unachieved for P. vivax. The major obstacle associated with Plasmodium vivax in vitro culture is its predilection for invading younger reticulocytes and the complex remodelling of invaded reticulocytes. There are many factors under exploration for this predilection and host–parasite interactions between merozoites and invaded reticulocytes. These include various factors related to parasite, host and environment such as compromised reticulocyte osmotic stability after invasion, abundance of iron in the reticulocytes which makes them favourable for P. vivax growth and propagation and role of a hypoxic environment in P. vivax in vitro growth. P. vivax blood stage transfection represents another major hurdle towards understanding this parasite’s complex biology. Efforts in making this parasite amenable for molecular investigation by genetic modification are limited. Newer approaches in sustaining a longer in vitro culture and thereby help advancing transfection technologies in P. vivax are urgently needed that can be explored to understand the unique biology of this parasite.
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Rai A, Pinto DS, Rai P, Teerthanath S, Karunasagar I, Adiga R. Misidentification of Plasmodium Species by Cross-Reacting Primers and Cerebral Malaria Caused by Plasmodium vivax. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2023. [DOI: 10.1055/s-0043-1761258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Abstract
Introduction The clinical presentation of a case as cerebral malaria with molecular identification confirming it as Plasmodium vivax underlines the importance of using molecular tools to identify the species and type of malaria. The possibility of the relationship between the complication observed during clinical diagnosis and the multifactorial molecular changes could likely be the reason for terming it cerebral malaria.
Methods We report four cases analyzed using the quantitative buffy coat technique followed by classical Giemsa stained thick-film microscopy, and nested polymerase chain reaction for the genus-specific region of Plasmodium targeting 18S rDNA followed by species-specific identification with a different set of primers and products confirmation with sequencing.
Results Primers targeting P. knowlesi generated the expected product size of 153 base pairs that, upon sequencing, matched with the P. vivax sequence reflecting the relatedness of the species. Likewise, primers targeting P. ovale generated a 456 product whose sequence matched the P. vivax sequence.
Conclusion Infection with P. vivax can potentially cause cerebral malaria, and P. vivax can cause severe malaria complications alone or mixed with other species and can show cerebral malaria signs, which are typically associated with P. falciparum infections. The sequence relatedness reflects the genome similarity between P. knowlesi and P. ovale with P. vivax. The need to reconfirm with an additional set of newly reported primers is mandatory.
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Affiliation(s)
- Anoopkrishna Rai
- Division of Infectious Diseases, Nitte University Centre for Science Education and Research, Deralakatte, Mangaluru, Karnataka, India
| | - Deepak Sebastian Pinto
- Nitte University Centre for Science Education and Research, Deralakatte, Mangaluru, Karnataka, India
| | - Praveen Rai
- Division of Infectious Diseases, Nitte University Centre for Science Education and Research, Deralakatte, Mangaluru, Karnataka, India
| | - Srinivas Teerthanath
- Department of Pathology, K S Hegde Medical Academy, Deralakatte, Mangaluru, Karnataka, India
| | - Indrani Karunasagar
- Division of Infectious Diseases, Nitte University Centre for Science Education and Research, Deralakatte, Mangaluru, Karnataka, India
| | - Rama Adiga
- Division of Infectious Diseases, Nitte University Centre for Science Education and Research, Deralakatte, Mangaluru, Karnataka, India
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Ortega DC, Cárdenas H, González R, Barreto G. Ancestral reconstruction and correlation of the frequencies of the hemoglobin S allele and the Duffy blood group alleles in human populations. Am J Hum Biol 2023; 35:e23832. [PMID: 36376949 DOI: 10.1002/ajhb.23832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Malaria is an important selective force for human genetic adaptation due to the sustained, lethal impact it has had on populations worldwide. High frequencies of both hemoglobin S and the null allele FYBES of the Duffy blood group have been found in areas where this disease is endemic, attributed to the protective action of the carriers of these variants against malaria infection. The objective of this work was to perform ancestral reconstruction and analyze the correlation of the frequencies of these alleles throughout the phylogeny of 24 human populations. METHODS A tree topology and the allelic frequencies reported in the literature for the 24 populations were used. The ancestral frequencies for the two alleles were reconstructed using the maximum likelihood method and the Brownian model of evolution (CI = 95%), and the correlation analysis was performed using phylogenetically independent contrasts (PICs). Statistical analyses were performed with the statistical software R version 3.4.1. RESULTS For both alleles, a correspondence was found in the reconstruction of the ancestral frequencies, and a significant statistical correlation (p = .001) was observed between the S and FYBES alleles. CONCLUSIONS These results provide evidence of an epistatic relationship between the two alleles, which may influence the fitness of the individuals who present with them when they are subjected to a selective force such as malaria.
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Affiliation(s)
| | - Heiber Cárdenas
- Department of Biology, Universidad del Valle, Cali, Colombia
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da Veiga GTS, Moriggi MR, Vettorazzi JF, Müller-Santos M, Albrecht L. Plasmodium vivax vaccine: What is the best way to go? Front Immunol 2023; 13:910236. [PMID: 36726991 PMCID: PMC9885200 DOI: 10.3389/fimmu.2022.910236] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
Malaria is one of the most devastating human infectious diseases caused by Plasmodium spp. parasites. A search for an effective and safe vaccine is the main challenge for its eradication. Plasmodium vivax is the second most prevalent Plasmodium species and the most geographically distributed parasite and has been neglected for decades. This has a massive gap in knowledge and consequently in the development of vaccines. The most significant difficulties in obtaining a vaccine against P. vivax are the high genetic diversity and the extremely complex life cycle. Due to its complexity, studies have evaluated P. vivax antigens from different stages as potential targets for an effective vaccine. Therefore, the main vaccine candidates are grouped into preerythrocytic stage vaccines, blood-stage vaccines, and transmission-blocking vaccines. This review aims to support future investigations by presenting the main findings of vivax malaria vaccines to date. There are only a few P. vivax vaccines in clinical trials, and thus far, the best protective efficacy was a vaccine formulated with synthetic peptide from a circumsporozoite protein and Montanide ISA-51 as an adjuvant with 54.5% efficacy in a phase IIa study. In addition, the majority of P. vivax antigen candidates are polymorphic, induce strain-specific and heterogeneous immunity and provide only partial protection. Nevertheless, immunization with recombinant proteins and multiantigen vaccines have shown promising results and have emerged as excellent strategies. However, more studies are necessary to assess the ideal vaccine combination and test it in clinical trials. Developing a safe and effective vaccine against vivax malaria is essential for controlling and eliminating the disease. Therefore, it is necessary to determine what is already known to propose and identify new candidates.
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Affiliation(s)
- Gisele Tatiane Soares da Veiga
- Laboratory of Apicomplexan Parasites Research, Carlos Chagas Institute, Oswaldo Cruz Foundation (FIOCRUZ), Curitiba, Brazil,Nitrogen Fixation Laboratory, Department of Biochemistry and Molecular Biology, Federal University of Paraná (UFPR), Curitiba, Brazil
| | | | | | - Marcelo Müller-Santos
- Nitrogen Fixation Laboratory, Department of Biochemistry and Molecular Biology, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Letusa Albrecht
- Laboratory of Apicomplexan Parasites Research, Carlos Chagas Institute, Oswaldo Cruz Foundation (FIOCRUZ), Curitiba, Brazil,*Correspondence: Letusa Albrecht,
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Gualdrón-López M, Díaz-Varela M, Zanghi G, Aparici-Herraiz I, Steel RW, Schäfer C, Cuscó P, Chuenchob V, Kangwangransan N, Billman ZP, Olsen TM, González JR, Roobsoong W, Sattabongkot J, Murphy SC, Mikolajczak SA, Borràs E, Sabidó E, Fernandez-Becerra C, Flannery EL, Kappe SH, del Portillo HA. Mass Spectrometry Identification of Biomarkers in Extracellular Vesicles From Plasmodium vivax Liver Hypnozoite Infections. Mol Cell Proteomics 2022; 21:100406. [PMID: 36030044 PMCID: PMC9520272 DOI: 10.1016/j.mcpro.2022.100406] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/12/2022] [Accepted: 08/20/2022] [Indexed: 01/18/2023] Open
Abstract
Latent liver stages termed hypnozoites cause relapsing Plasmodium vivax malaria infection and represent a major obstacle in the goal of malaria elimination. Hypnozoites are clinically undetectable, and presently, there are no biomarkers of this persistent parasite reservoir in the human liver. Here, we have identified parasite and human proteins associated with extracellular vesicles (EVs) secreted from in vivo infections exclusively containing hypnozoites. We used P. vivax-infected human liver-chimeric (huHEP) FRG KO mice treated with the schizonticidal experimental drug MMV048 as hypnozoite infection model. Immunofluorescence-based quantification of P. vivax liver forms showed that MMV048 removed schizonts from chimeric mice livers. Proteomic analysis of EVs derived from FRG huHEP mice showed that human EV cargo from infected FRG huHEP mice contain inflammation markers associated with active schizont replication and identified 66 P. vivax proteins. To identify hypnozoite-specific proteins associated with EVs, we mined the proteome data from MMV048-treated mice and performed an analysis involving intragroup and intergroup comparisons across all experimental conditions followed by a peptide compatibility analysis with predicted spectra to warrant robust identification. Only one protein fulfilled this stringent top-down selection, a putative filamin domain-containing protein. This study sets the stage to unveil biological features of human liver infections and identify biomarkers of hypnozoite infection associated with EVs.
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Affiliation(s)
- Melisa Gualdrón-López
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain,IGTP, Institute for Health Sciences Trias I Pujol, Barcelona, Spain
| | - Miriam Díaz-Varela
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain,IGTP, Institute for Health Sciences Trias I Pujol, Barcelona, Spain
| | - Gigliola Zanghi
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Iris Aparici-Herraiz
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain,IGTP, Institute for Health Sciences Trias I Pujol, Barcelona, Spain
| | - Ryan W.J. Steel
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Carola Schäfer
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Pol Cuscó
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Vorada Chuenchob
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Niwat Kangwangransan
- Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Zachary P. Billman
- Department of Laboratory Medicine and Pathology, and Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - Tayla M. Olsen
- Department of Laboratory Medicine and Pathology, and Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - Juan R. González
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Wanlapa Roobsoong
- MVRU, Mahidol Vivax Research Unit, Mahidol University, Bangkok, Thailand
| | | | - Sean C. Murphy
- Department of Laboratory Medicine and Pathology, and Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - Sebastian A. Mikolajczak
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Eva Borràs
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Eduard Sabidó
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Carmen Fernandez-Becerra
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain,IGTP, Institute for Health Sciences Trias I Pujol, Barcelona, Spain
| | - Erika L. Flannery
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Stefan H.I. Kappe
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Hernando A. del Portillo
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain,IGTP, Institute for Health Sciences Trias I Pujol, Barcelona, Spain,ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain,For correspondence: Hernando A. del Portillo
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Kar S, Sinha A. Plasmodium vivax Duffy Binding Protein-Based Vaccine: a Distant Dream. Front Cell Infect Microbiol 2022; 12:916702. [PMID: 35909975 PMCID: PMC9325973 DOI: 10.3389/fcimb.2022.916702] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
The neglected but highly prevalent Plasmodium vivax in South-east Asia and South America poses a great challenge, with regards to long-term in-vitro culturing and heavily limited functional assays. Such visible challenges as well as narrowed progress in development of experimental research tools hinders development of new drugs and vaccines. The leading vaccine candidate antigen Plasmodium vivax Duffy Binding Protein (PvDBP), is essential for reticulocyte invasion by binding to its cognate receptor, the Duffy Antigen Receptor for Chemokines (DARC), on the host’s reticulocyte surface. Despite its highly polymorphic nature, the amino-terminal cysteine-rich region II of PvDBP (PvDBPII) has been considered as an attractive target for vaccine-mediated immunity and has successfully completed the clinical trial Phase 1. Although this molecule is an attractive vaccine candidate against vivax malaria, there is still a question on its viability due to recent findings, suggesting that there are still some aspects which needs to be looked into further. The highly polymorphic nature of PvDBPII and strain-specific immunity due to PvDBPII allelic variation in Bc epitopes may complicate vaccine efficacy. Emergence of various blood-stage antigens, such as PvRBP, PvEBP and supposedly many more might stand in the way of attaining full protection from PvDBPII. As a result, there is an urgent need to assess and re-assess various caveats connected to PvDBP, which might help in designing a long-term promising vaccine for P. vivax malaria. This review mainly deals with a bunch of rising concerns for validation of DBPII as a vaccine candidate antigen for P. vivax malaria.
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Aparici Herraiz I, Caires HR, Castillo-Fernández Ó, Sima N, Méndez-Mora L, Risueño RM, Sattabongkot J, Roobsoong W, Hernández-Machado A, Fernandez-Becerra C, Barrias CC, del Portillo HA. Advancing Key Gaps in the Knowledge of Plasmodium vivax Cryptic Infections Using Humanized Mouse Models and Organs-on-Chips. Front Cell Infect Microbiol 2022; 12:920204. [PMID: 35873153 PMCID: PMC9302440 DOI: 10.3389/fcimb.2022.920204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Plasmodium vivax is the most widely distributed human malaria parasite representing 36.3% of disease burden in the South-East Asia region and the most predominant species in the region of the Americas. Recent estimates indicate that 3.3 billion of people are under risk of infection with circa 7 million clinical cases reported each year. This burden is certainly underestimated as the vast majority of chronic infections are asymptomatic. For centuries, it has been widely accepted that the only source of cryptic parasites is the liver dormant stages known as hypnozoites. However, recent evidence indicates that niches outside the liver, in particular in the spleen and the bone marrow, can represent a major source of cryptic chronic erythrocytic infections. The origin of such chronic infections is highly controversial as many key knowledge gaps remain unanswered. Yet, as parasites in these niches seem to be sheltered from immune response and antimalarial drugs, research on this area should be reinforced if elimination of malaria is to be achieved. Due to ethical and technical considerations, working with the liver, bone marrow and spleen from natural infections is very difficult. Recent advances in the development of humanized mouse models and organs-on-a-chip models, offer novel technological frontiers to study human diseases, vaccine validation and drug discovery. Here, we review current data of these frontier technologies in malaria, highlighting major challenges ahead to study P. vivax cryptic niches, which perpetuate transmission and burden.
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Affiliation(s)
- Iris Aparici Herraiz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Hugo R. Caires
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Óscar Castillo-Fernández
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain
| | - Núria Sima
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Lourdes Méndez-Mora
- Department of Condensed Matter Physics, University of Barcelona (UB), Barcelona, Spain
| | - Ruth M. Risueño
- Josep Carreras Leukaemia Research Institute (IJC), Barcelona, Spain
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wanlapa Roobsoong
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Aurora Hernández-Machado
- Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain
- Department of Condensed Matter Physics, University of Barcelona (UB), Barcelona, Spain
- Centre de Recerca Matemàtica (CRM), Barcelona, Spain
| | - Carmen Fernandez-Becerra
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Cristina C. Barrias
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB – Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
- ICBAS – Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Hernando A. del Portillo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- *Correspondence: Hernando A. del Portillo,
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Abstract
"The Primate Malarias" book has been a uniquely important resource for multiple generations of scientists, since its debut in 1971, and remains pertinent to the present day. Indeed, nonhuman primates (NHPs) have been instrumental for major breakthroughs in basic and pre-clinical research on malaria for over 50 years. Research involving NHPs have provided critical insights and data that have been essential for malaria research on many parasite species, drugs, vaccines, pathogenesis, and transmission, leading to improved clinical care and advancing research goals for malaria control, elimination, and eradication. Whilst most malaria scientists over the decades have been studying Plasmodium falciparum, with NHP infections, in clinical studies with humans, or using in vitro culture or rodent model systems, others have been dedicated to advancing research on Plasmodium vivax, as well as on phylogenetically related simian species, including Plasmodium cynomolgi, Plasmodium coatneyi, and Plasmodium knowlesi. In-depth study of these four phylogenetically related species over the years has spawned the design of NHP longitudinal infection strategies for gathering information about ongoing infections, which can be related to human infections. These Plasmodium-NHP infection model systems are reviewed here, with emphasis on modern systems biological approaches to studying longitudinal infections, pathogenesis, immunity, and vaccines. Recent discoveries capitalizing on NHP longitudinal infections include an advanced understanding of chronic infections, relapses, anaemia, and immune memory. With quickly emerging new technological advances, more in-depth research and mechanistic discoveries can be anticipated on these and additional critical topics, including hypnozoite biology, antigenic variation, gametocyte transmission, bone marrow dysfunction, and loss of uninfected RBCs. New strategies and insights published by the Malaria Host-Pathogen Interaction Center (MaHPIC) are recapped here along with a vision that stresses the importance of educating future experts well trained in utilizing NHP infection model systems for the pursuit of innovative, effective interventions against malaria.
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Affiliation(s)
- Mary R Galinski
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
- Emory Vaccine Center, Emory University, Atlanta, GA, USA.
- Emory National Primate Research Center (Yerkes National Primate Research Center), Emory University, Atlanta, GA, USA.
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Abstract
The hypervariable residues that compose the major part of proteins’ surfaces are generally considered outside evolutionary control. Yet, these “nonconserved” residues determine the outcome of stochastic encounters in crowded cells. It has recently become apparent that these encounters are not as random as one might imagine, but carefully orchestrated by the intracellular electrostatics to optimize protein diffusion, interactivity, and partner search. The most influential factor here is the protein surface-charge density, which takes different optimal values across organisms with different intracellular conditions. In this study, we examine how far the net-charge density and other physicochemical properties of proteomes will take us in terms of distinguishing organisms in general. The results show that these global proteome properties not only follow the established taxonomical hierarchy, but also provide clues to functional adaptation. In many cases, the proteome–property divergence is even resolved at species level. Accordingly, the variable parts of the genes are not as free to drift as they seem in sequence alignment, but present a complementary tool for functional, taxonomic, and evolutionary assignment.
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Daher A, Pinto DP, da Fonseca LB, Pereira HM, da Silva DMD, da Silva LDSFV, Esteves AL, Soares Medeiros JJ, Mendonça JS. Pharmacokinetics of chloroquine and primaquine in healthy volunteers. Malar J 2022; 21:16. [PMID: 34998391 PMCID: PMC8742557 DOI: 10.1186/s12936-021-04035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Vivax malaria is a neglected disease. There is an irrefutable need for better treatments with higher acceptability and efficacy. The treatment efficacy is influenced by many factors, including bioavailability. Hence, a straightforward strategy to improve vivax malaria treatment efficacy is the deployment of good quality formulations of primaquine and chloroquine. As these treatments were developed more than 70 years ago, many of the available data on blood levels of both drugs are based on obsolete analytical methodologies or pharmaceutical formulations, which are not available anymore. Herein, the results of three bioequivalence studies are presented, providing individual pharmacokinetic data on chloroquine and primaquine of more than a hundred healthy volunteers and using up-to-date analytical methods. Methods Three trials were designed as a single centre, randomized, single dose, open label, fasting, crossover bioequivalence studies comparing a new coated chloroquine tablet to the uncoated tablet, and 5 and 15 mg primaquine formulations to either an international reference product or the currently distributed tablets. Plasma concentrations of chloroquine and primaquine were measured using a validated HPLC–MS/MS method in accordance with current international regulatory requirements for bio-analytical methods. Results In total, a hundred eleven healthy volunteers of both genders were included in the three studies (n = 32; 30 and 56 respectively). No serious adverse events occurred. Drugs levels were measured in 5,520 blood samples. The estimated ratio of the geometric means of Cmax, AUC0-t and AUC0-inf of test and reference drugs and their 90% CI for chloroquine 150 mg, primaquine 15 mg and primaquine 5 mg were: 95.33% (89.18; 101.90), 86. 85% (82.61; 91.31), and 84.45% (76.95; 92.67); 93.28% (81.76; 106.41), 94.52% (86.13; 103.73) and 93.93% (85.83; 102.79); 97.44% (90.60; 104.78), 93.70% (87.04; 100.87) and 91.36% (85.27; 97.89), respectively. As Cmax and AUC0-t 90% CI were within the acceptance interval of 80–125% in all cases, the formulations tested were bioequivalent. Conclusions In conclusion, the three studies provided detailed chloroquine and primaquine pharmacokinetic data in accordance with current regulatory standards. Together with other open data initiatives, this individual data may increase the accuracy of pharmacokinetic models guiding best dose, new combinations, regimens and formulations to optimize the current chloroquine and primaquine treatments for vivax malaria. The data presented here may support the deployment of high-quality drugs and evidence-based public health policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-04035-z.
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Affiliation(s)
- André Daher
- Vice-Presidency of Research and Biological Collections, Oswaldo Cruz Foundation (FIOCRUZ), Avenida Brasil, 4036, Manguinhos, Rio de Janeiro, Brazil.
| | - Douglas Pereira Pinto
- Laboratory of Pharmacokinetics (SEFAR), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Laís Bastos da Fonseca
- Laboratory of Pharmacokinetics (SEFAR), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Heliana Martins Pereira
- Laboratory of Pharmacokinetics (SEFAR), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | | | | | | | - Juliana J Soares Medeiros
- Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Jorge Souza Mendonça
- Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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Bhowmick IP, Nirmolia T, Pandey A, Subbarao SK, Nath A, Senapati S, Tripathy D, Pebam R, Nag S, Roy R, Dasgupta D, Debnath J, Gogoi K, Gogoi K, Borah L, Chanda R, Borgohain A, Mog C, Sarkar U, Gogoi P, Debnath B, Debbarma J, Ranjan Bhattacharya D, Joshi PL, Kaur H, Narain K. Dry Post Wintertime Mass Surveillance Unearths a Huge Burden of P. vivax, and Mixed Infection with P. vivax P. falciparum, a Threat to Malaria Elimination, in Dhalai, Tripura, India. Pathogens 2021; 10:pathogens10101259. [PMID: 34684207 PMCID: PMC8541100 DOI: 10.3390/pathogens10101259] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
With India aiming to achieve malaria elimination by 2030, several strategies have been put in place. With that aim, mass surveillance is now being conducted in some malaria-endemic pockets. As dry season mass surveillance has been shown to have its importance in targeting the reservoir, a study was undertaken to assess the parasite load by a sensitive molecular method during one of the mass surveys conducted in the dry winter period. It was executed in two malaria-endemic villages of Dhalai District, Tripura, in northeast India, also reported as P. falciparum predominated area. The present study found an enormous burden of Rapid Diagnostic Test negative malaria cases with P. vivax along with P. vivax and P. falciparum mixed infections during the mass surveillance from febrile and afebrile cases in dry winter months (February 2021–March 2021). Of the total 150 samples tested, 72 (48%) were positive and 78 (52%) negative for malaria by PCR. Out of the 72 positives, 6 (8.33%) were P. falciparum, 40 (55.55%) P. vivax, and 26 (36.11%) mixed infections. Out of 78 malaria negative samples, 6 (7.7%) were with symptoms, while among the total malaria positive, 72 cases 7 (9.8%) were with symptoms, and 65 (90.2%) were asymptomatic. Out of 114 samples tested by both microscopy and PCR, 42 samples turned out to be submicroscopic with 4 P. falciparum, 23 P. vivax, and 15 mixed infections. Although all P. vivax submicroscopic infections were asymptomatic, three P. falciparum cases were found to be febrile. Evidence of malaria transmission was also found in the vectors in the winter month. The study ascertained the use of molecular diagnostic techniques in detecting the actual burden of malaria, especially of P. vivax, in mass surveys. As Jhum cultivators in Tripura are at high risk, screening for the malarial reservoirs in pre-Jhum months can help with malaria control and elimination.
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Affiliation(s)
- Ipsita Pal Bhowmick
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
- Correspondence:
| | - Tulika Nirmolia
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Apoorva Pandey
- Indian Council of Medical Research (ICMR), Ramalingaswami Bhavan, Delhi 110029, India; (A.P.); (H.K.)
| | - Sarala K. Subbarao
- Formerly National Institute of Malaria Research-ICMR, Delhi 110077, India;
| | - Aatreyee Nath
- Northeastern Space Applications Centre, Department of Space, Government of India, Umiam 793103, India; (A.N.); (R.P.); (A.B.)
| | - Susmita Senapati
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Debabrata Tripathy
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Rocky Pebam
- Northeastern Space Applications Centre, Department of Space, Government of India, Umiam 793103, India; (A.N.); (R.P.); (A.B.)
| | - Suman Nag
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Rajashree Roy
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Dipanjan Dasgupta
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Jayanta Debnath
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Kongkona Gogoi
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Karuna Gogoi
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Lakhyajit Borah
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | | | - Arup Borgohain
- Northeastern Space Applications Centre, Department of Space, Government of India, Umiam 793103, India; (A.N.); (R.P.); (A.B.)
| | - Chelapro Mog
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Ujjwal Sarkar
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Phiroz Gogoi
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Bishal Debnath
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Jyotish Debbarma
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Dibya Ranjan Bhattacharya
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
| | - Pyare Lal Joshi
- Formerly National Vector Borne Disease Control Program (NVBDCP), Delhi 110054, India;
| | - Harpreet Kaur
- Indian Council of Medical Research (ICMR), Ramalingaswami Bhavan, Delhi 110029, India; (A.P.); (H.K.)
| | - Kanwar Narain
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (T.N.); (S.S.); (D.T.); (S.N.); (R.R.); (D.D.); (J.D.); (K.G.); (K.G.); (L.B.); (C.M.); (U.S.); (P.G.); (B.D.); (J.D.); (D.R.B.); (K.N.)
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Adhikari B, Awab GR, von Seidlein L. Rolling out the radical cure for vivax malaria in Asia: a qualitative study among policy makers and stakeholders. Malar J 2021; 20:164. [PMID: 33757538 PMCID: PMC7987122 DOI: 10.1186/s12936-021-03702-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Wide-spread implementation of treatment regimens for the radical cure of vivax malaria is hindered by a range of factors. This has resulted in an increase in the relative proportion of vivax malaria and is an important obstacle in the achievement of global malaria elimination by 2030. The main objective of this study was to explore the current policies guiding the treatment plans on vivax malaria, and the factors affecting the implementation of radical cure in South/South East Asian and Asian Pacific countries. METHODS This was a qualitative study among respondents who represented national malaria control programmes (NMCPs) or had a role and influence in the national malaria policies. 33 respondents from 17 countries in South/South East Asia and Asia Pacific participated in interviews between October 15 and December 15, 2020. Semi-structured interviews were conducted virtually except for two face to face interviews and audio-recorded. Transcribed audio-records underwent thematic analysis using QSR NVivo. RESULTS Policies against vivax malaria were underprioritized, compared with the focus on falciparum malaria and, in particular, drug resistant Plasmodium falciparum strains. Despite the familiarity with primaquine (PQ) as the essential treatment to achieve the radical cure, the respondents contested the need for G6PD testing. Optional G6PD testing was reported to have poor adherence. The fear of adverse events led health workers to hesitate prescribing PQ. In countries where G6PD was mandatory, respondents experienced frequent stockouts of G6PD rapid diagnostic kits in peripheral health facilities, which was compounded by a short shelf life of these tests. These challenges were echoed across participating countries to various degrees. Most respondents agreed that a shorter treatment regimen, such as single dose tafenoquine could resolve these problems but mandatory G6PD testing will be needed. The recommendation of shorter regimens including tafenoquine or high dose PQ requires operational evidence demonstrating the robust performance of point of care G6PD tests (biosensors). CONCLUSION There was sparse implementation and low adherence to the radical cure in South/South East Asian and Asian pacific countries. Shorter treatment regimens with appropriate point of care quantitative G6PD tests may resolve the current challenges. Operational evidence on point of care quantitative G6PD tests that includes the feasibility of integrating such tests into the radical cure regimen are critical to ensure its implementation.
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Affiliation(s)
- Bipin Adhikari
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Ghulam Rhahim Awab
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nangarhar Medical Faculty, Nangarhar University, Jalalabad, Afghanistan
- Ministry of Higher Education, Kabul, Afghanistan
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Biomarkers of disease severity in vivax malaria. Parasitol Res 2021; 120:1437-1446. [PMID: 33532947 DOI: 10.1007/s00436-021-07065-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Severe complications have been observed and established for Plasmodium falciparum as well as P. vivax infections worldwide. Although P. vivax infection is not fully acknowledged as malignant malaria, recently life-threatening complications have been reported to occur in many studies. The recognition of biomarkers with excellent sensitivity and reliability plays a prime role in disease management. Acute inflammatory response and oxidative stress are observed in malaria due to the production of reactive oxygen species. Lipid and protein oxidative injuries are prospective biomarkers for disease severity owing to the damage caused by the parasite. We have tried to find out whether protein carbonylation (PC), lipid peroxidation (LPO) and superoxide dismutase (SOD) could suffice as a biomarker for severe vivax malaria or not. Blood samples were collected from the individuals attending Jawaharlal Nehru Medical College of Aligarh Muslim University during the wet season of malaria transmission. Microscopy and rapid diagnostic kits were used as a tool for malaria diagnosis. A total of 214 subjects were enrolled for the study: 30 febrile controls and 184 subjects with vivax malaria. Protein carbonylation and lipid peroxidation were found to be directly associated with parasite count and total antioxidant status (TAS). Increase in oxidative stress was also observed in severe vivax malaria patients. Levels of uric acid and bilirubin too were raised in complicated cases. Protein carbonylation was found to be a more reliable indicator of vivax malaria severity than lipid peroxidation.
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Bango ZA, Tawe L, Muthoga CW, Paganotti GM. Past and current biological factors affecting malaria in the low transmission setting of Botswana: A review. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2020; 85:104458. [PMID: 32668367 PMCID: PMC7354381 DOI: 10.1016/j.meegid.2020.104458] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022]
Abstract
Malaria continues to be one of the top infectious agents contributing to morbidity and mortality in sub-Saharan Africa. Annually, Botswana accounts only for a small proportion of cases (<<1%). Despite significantly reduced incidence rate, the country still experiences sporadic outbreaks that hamper the goal of malaria elimination. This review evaluated previous and current biological factors that impact malaria in Botswana, specifically focussing on the vectors, the parasite and the host. This was accomplished via a literature review evaluating these variables in Botswana. Current literature suggests that Anopheles arabiensis is the main malaria vector in the country. Several other potential vectors have been found widely distributed throughout Botswana in high numbers, yet remain largely unstudied with regards to their contribution to the country's malaria burden. We also report the most up to date list of all Anopheles species that have been found in Botswana. Plasmodium falciparum is responsible for the vast majority of symptomatic malaria in the country and some drug resistance markers have been documented for this species. Plasmodium vivax has been reported in asymptomatic subjects, even though a large proportion of the Botswana population appears to be Duffy antigen negative. Very little is known about the true distribution of P. vivax and no point of care testing infrastructure for this species exists in Botswana, making it difficult to tailor treatment to address possible recrudescence or relapse. Due to a genetically diverse population with a substantial Khoisan contribution into the Bantu genetic background, several phenotypes that potentially impact prevalence and severity of malaria exist within the country. These include sickle cell trait, Glucose-6-Phosphate Dehydrogenase deficiency, and Duffy negativity. This review highlights the information that currently exists on malaria in Botswana. It also postulates that a comprehensive understanding of these aforementioned biological factors may help to explain malaria persistence in Botswana.
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Affiliation(s)
| | - Leabaneng Tawe
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | - Giacomo Maria Paganotti
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, PA, USA; Department of Biomedical Sciences, University of Botswana, Gaborone, Botswana.
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Martin Ramírez A, Lombardia González C, Soler Maniega T, Gutierrez Liarte Á, Domingo García D, Lanza Suárez M, Bernal Fernández MJ, Rubio JM. Several Plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome P450 2D6 function. Malar J 2020; 19:259. [PMID: 32680522 PMCID: PMC7368755 DOI: 10.1186/s12936-020-03326-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022] Open
Abstract
Background Plasmodium vivax malaria is characterized by the presence of dormant liver-stage parasites, called hypnozoites, which can cause malaria relapses after an initial attack. Primaquine, which targets liver hypnozoites, must be used in combination with a schizonticidal agent to get the radical cure. However, relapses can sometimes occur in spite of correct treatment, due to different factors such as a diminished metabolization of primaquine. Case presentation In January 2019, a 21 years old woman with residence in Madrid, returning from a trip to Venezuela with clinical symptoms compatible with malaria infection, was diagnosed with vivax malaria. Chloroquine for 3 days plus primaquine for 14 days was the elected treatment. Two months later and after a second trip to Venezuela, the patient presented a second P. vivax infection, which was treated as the previous one. A third P. vivax malaria episode was diagnosed 2 months later, after returning from a trip to Morocco, receiving chloroquine for 3 days but increasing to 28 days the primaquine regimen, and with no more relapses after 6 months of follow up. The genotyping of P. vivax in the three malaria episodes revealed that the same strain was present in the different relapses. Upon confirmation of correct adherence to the treatment, non-description of resistance in the infection area and the highly unlikely re-infection on subsequent trips or stays in Spain, a possible metabolic failure was considered. CYP2D6 encodes the human cytochrome P450 isoenzyme 2D6 (CYP2D6), responsible for primaquine activation. The patient was found to have a CYP2D6*4/*1 genotype, which turns out in an intermediate metabolizer phenotype, which has been related to P. vivax relapses. Conclusions The impairment in CYP2D6 enzyme could be the most likely cause of P. vivax relapses in this patient. This highlights the importance of considering the analysis of CYP2D6 gene polymorphisms in cases of P. vivax relapses after a correct treatment and, especially, it should be considered in any study of dosage and duration of primaquine treatment.
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Affiliation(s)
- Alexandra Martin Ramírez
- Malaria and Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Tamara Soler Maniega
- Microbiology and Parasitology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Diego Domingo García
- Microbiology and Parasitology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Marta Lanza Suárez
- Malaria and Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - María Josefa Bernal Fernández
- Malaria and Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - José Miguel Rubio
- Malaria and Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain.
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A micro-epidemiological report on the unstable transmission of malaria in Aligarh, India. Parasite Epidemiol Control 2020; 11:e00161. [PMID: 32642569 PMCID: PMC7334815 DOI: 10.1016/j.parepi.2020.e00161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/14/2020] [Accepted: 06/18/2020] [Indexed: 11/22/2022] Open
Abstract
India contributes approximately 70% to the malaria burden of Southeast Asia. The transmission of disease in the country is generally hypoendemic, seasonal and unstable. Most researchers focus upon the hyperendemic malarious regions with stable malaria transmission. There is paucity of data regarding malaria transmission in hypoendemic regions, here we are presenting an epidemiological picture of clinical manifestations through a hospital-based survey in Aligarh, India, during 2016-18. Two thousand sixty-eight patients were diagnosed with malaria infection in Jawaharlal Nehru Medical College and Hospital (JNMCH), out of which 1104 were enrolled for clinical analysis. Ninety per cent of the cases were reported during July-November, and the rest in the dry season. A progressive increase in the prevalence rate was observed during the study period, i.e. 4.8, 7.57 and 8.7% in 2016, 2017 and 2018, respectively. Of the total cases, 75.77% had vivax malaria, while rest suffered from falciparum malaria. The risk of disease was significantly higher in the age group 0-15 years compared to all other age groups (p < .0001). The infection rate was higher in males (61%) compared to females (39%) p < .0001. Overall 8.6% of the patients had severe malaria who fulfilled the WHO criteria. The increasing rate of malaria infection during the study period and a considerable no. of severe vivax malaria cases warrant an efficient disease monitoring system, pointing towards the need to carry out micro-epidemiological studies in order to estimate the real burden of malaria in the country.
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Dash M, Pande V, Sinha A. Putative circumsporozoite protein (CSP) of Plasmodium vivax is considerably distinct from the well-known CSP and plays a role in the protein ubiquitination pathway. Gene 2020; 721S:100024. [PMID: 32550551 PMCID: PMC7285988 DOI: 10.1016/j.gene.2019.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/21/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022]
Abstract
Amidst technical challenges which limit successful culture and genetic manipulation of P. vivax parasites, we used a computational approach to identify a critical target with evolutionary significance. The putative circumsporozoite protein on chromosome 13 of P. vivax (PvpuCSP)is distinct from the well-known vaccine candidate PfCSP. The aim of this study was to understand the role of PvpuCSP and its relatedness to the well-known CSP. The study revealed PvpuCSP as a membrane bound E3 ubiquitin ligase involved in ubiquitination. It has a species-specific tetra-peptide unit which is differentially repeated in various P. vivax strains. The PvpuCSP is different from CSP in terms of stage-specific expression and function. Since E3 ubiquitin ligases are known antimalarial drug targets targeting the proteasome pathway, PvpuCSP, with evolutionary connotation and a key role in orchestrating protein degradation in P. vivax, can be explored as a potential drug target. PvpuCSP is predicted as E3 ubiquitin ligase, a part of ubiquitination pathway. Tetra-peptide tandem repeat at C terminal of PvpuCSP is exclusive to P. vivax. Moderately expressed during all parasitic stages in host and vector Partially disordered protein with both structured domains and two distinct IDRs A transmembrane protein with highly conserved functional domain across Apicomplexa
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Affiliation(s)
- Manoswini Dash
- Division of Epidemiology and Clinical Research, ICMR-National Institute of Malaria Research, New Delhi, India
| | - Veena Pande
- Department of Biotechnology, Bhimtal Campus, Kumaun University, Nainital, Uttarakhand, India
| | - Abhinav Sinha
- Division of Epidemiology and Clinical Research, ICMR-National Institute of Malaria Research, New Delhi, India
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Plasmodium vivax spleen-dependent genes encode antigens associated with cytoadhesion and clinical protection. Proc Natl Acad Sci U S A 2020; 117:13056-13065. [PMID: 32439708 PMCID: PMC7293605 DOI: 10.1073/pnas.1920596117] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In spite of low peripheral blood parasitemia, vivax malaria causes severe disease. This conundrum finds an explanation from reports suggesting that the spleen is a place for parasite sequestration. We performed a global transcriptional analysis of parasites that grew in the presence or absence of the spleen in a nonhuman primate model. We identified 67 spleen-dependent genes, including multigene variant families, and functionally demonstrated specific adherence to human spleen fibroblasts by a member of such families. Moreover, we further demonstrated that spleen-dependent Plasmodium vivax genes code for immunogenic proteins during natural infections. Our results indicate that this organ plays an important function in P. vivax malaria and call for deeper studies of the role of spleen in P. vivax infections. Plasmodium vivax, the most widely distributed human malaria parasite, causes severe clinical syndromes despite low peripheral blood parasitemia. This conundrum is further complicated as cytoadherence in the microvasculature is still a matter of investigations. Previous reports in Plasmodium knowlesi, another parasite species shown to infect humans, demonstrated that variant genes involved in cytoadherence were dependent on the spleen for their expression. Hence, using a global transcriptional analysis of parasites obtained from spleen-intact and splenectomized monkeys, we identified 67 P. vivax genes whose expression was spleen dependent. To determine their role in cytoadherence, two Plasmodium falciparum transgenic lines expressing two variant proteins pertaining to VIR and Pv-FAM-D multigene families were used. Cytoadherence assays demonstrated specific binding to human spleen but not lung fibroblasts of the transgenic line expressing the VIR14 protein. To gain more insights, we expressed five P. vivax spleen-dependent genes as recombinant proteins, including members of three different multigene families (VIR, Pv-FAM-A, Pv-FAM-D), one membrane transporter (SECY), and one hypothetical protein (HYP1), and determined their immunogenicity and association with clinical protection in a prospective study of 383 children in Papua New Guinea. Results demonstrated that spleen-dependent antigens are immunogenic in natural infections and that antibodies to HYP1 are associated with clinical protection. These results suggest that the spleen plays a major role in expression of parasite proteins involved in cytoadherence and can reveal antigens associated with clinical protection, thus prompting a paradigm shift in P. vivax biology toward deeper studies of the spleen during infections.
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Lee SM, Kim MS, Hayat F, Shin D. Recent Advances in the Discovery of Novel Antiprotozoal Agents. Molecules 2019; 24:E3886. [PMID: 31661934 PMCID: PMC6864685 DOI: 10.3390/molecules24213886] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/15/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022] Open
Abstract
Parasitic diseases have serious health, social, and economic impacts, especially in the tropical regions of the world. Diseases caused by protozoan parasites are responsible for considerable mortality and morbidity, affecting more than 500 million people worldwide. Globally, the burden of protozoan diseases is increasing and is been exacerbated because of a lack of effective medication due to the drug resistance and toxicity of current antiprotozoal agents. These limitations have prompted many researchers to search for new drugs against protozoan parasites. In this review, we have compiled the latest information (2012-2017) on the structures and pharmacological activities of newly developed organic compounds against five major protozoan diseases, giardiasis, leishmaniasis, malaria, trichomoniasis, and trypanosomiasis, with the aim of showing recent advances in the discovery of new antiprotozoal drugs.
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Affiliation(s)
- Seong-Min Lee
- College of Pharmacy, Gachon University, 191 Hambakmoe-ro, Yeonsu-gu, Incheon 21936, Korea.
| | - Min-Sun Kim
- College of Pharmacy, Gachon University, 191 Hambakmoe-ro, Yeonsu-gu, Incheon 21936, Korea.
| | - Faisal Hayat
- College of Pharmacy, Gachon University, 191 Hambakmoe-ro, Yeonsu-gu, Incheon 21936, Korea.
| | - Dongyun Shin
- College of Pharmacy, Gachon University, 191 Hambakmoe-ro, Yeonsu-gu, Incheon 21936, Korea.
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Abstract
The technical genesis and practice of 8-aminoquinoline therapy of latent malaria offer singular scientific, clinical, and public health insights. The 8-aminoquinolines brought revolutionary scientific discoveries, dogmatic practices, benign neglect, and, finally, enduring promise against endemic malaria. The clinical use of plasmochin-the first rationally synthesized blood schizontocide and the first gametocytocide, tissue schizontocide, and hypnozoitocide of any kind-commenced in 1926. Plasmochin became known to sometimes provoke fatal hemolytic crises. World War II delivered a newer 8-aminoquinoline, primaquine, and the discovery of glucose-6-phosphate dehydrogenase (G6PD) deficiency as the basis of its hemolytic toxicity came in 1956. Primaquine nonetheless became the sole therapeutic option against latent malaria. After 40 years of fitful development, in 2018 the U.S. Food and Drug Administration registered the 8-aminoquinoline called tafenoquine for the prevention of all malarias and the treatment of those that relapse. Tafenoquine also cannot be used in G6PD-unknown or -deficient patients. The hemolytic toxicity of the 8-aminoquinolines impedes their great potential, but this problem has not been a research priority. This review explores the complex technical dimensions of the history of 8-aminoquinolines. The therapeutic principles thus examined may be leveraged in improved practice and in understanding the bright prospect of discovery of newer drugs that cannot harm G6PD-deficient patients.
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Affiliation(s)
- J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Im JH, Chung MH, Durey A, Lee JS, Kim TS, Kwon HY, Baek JH. Subcapsular Splenic Hemorrhage in Vivax Malaria. THE KOREAN JOURNAL OF PARASITOLOGY 2019; 57:405-409. [PMID: 31533407 PMCID: PMC6753294 DOI: 10.3347/kjp.2019.57.4.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
In malaria, splenic rupture is a serious complication potentially leading to death. Subcapsular hemorrhage of spleen is thought to be an impending sign of splenic rupture; however, the characteristics of subcapsular hemorrhage are not well known. We report 3 cases of subcapsular hemorrhage of the spleen in vivax malaria, with varying degrees of severity. Case 1 showed subcapsular hemorrhage without splenic rupture, was treated by antimalarial drug without any procedure. The healing process of the patient's spleen was monitored through 6 computed tomography follow-up examinations, over 118 days. Case 2 presented subcapsular hemorrhage with splenic rupture, treated only with an antimalarial drug. Case 3 showed subcapsular hemorrhage with splenic rupture and hypotension, treated using splenic artery embolization. They all recovered from subcapsular hemorrhage without any other complications. These 3 cases reveal the process of subcapsular hemorrhage leading to rupture and a potentially fatal outcome. The treatment plan of subcapsular hemorrhage should be determined carefully considering the vital signs, changes in hemoglobin, and bleeding tendency.
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Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju 63585, Korea
| | - Areum Durey
- Department of Emergency Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Tong-Soo Kim
- Department of Tropical Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
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Plasmodium Genomics and Genetics: New Insights into Malaria Pathogenesis, Drug Resistance, Epidemiology, and Evolution. Clin Microbiol Rev 2019; 32:32/4/e00019-19. [PMID: 31366610 DOI: 10.1128/cmr.00019-19] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Protozoan Plasmodium parasites are the causative agents of malaria, a deadly disease that continues to afflict hundreds of millions of people every year. Infections with malaria parasites can be asymptomatic, with mild or severe symptoms, or fatal, depending on many factors such as parasite virulence and host immune status. Malaria can be treated with various drugs, with artemisinin-based combination therapies (ACTs) being the first-line choice. Recent advances in genetics and genomics of malaria parasites have contributed greatly to our understanding of parasite population dynamics, transmission, drug responses, and pathogenesis. However, knowledge gaps in parasite biology and host-parasite interactions still remain. Parasites resistant to multiple antimalarial drugs have emerged, while advanced clinical trials have shown partial efficacy for one available vaccine. Here we discuss genetic and genomic studies of Plasmodium biology, host-parasite interactions, population structures, mosquito infectivity, antigenic variation, and targets for treatment and immunization. Knowledge from these studies will advance our understanding of malaria pathogenesis, epidemiology, and evolution and will support work to discover and develop new medicines and vaccines.
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Garrido-Cardenas JA, Cebrián-Carmona J, González-Cerón L, Manzano-Agugliaro F, Mesa-Valle C. Analysis of Global Research on Malaria and Plasmodium vivax. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111928. [PMID: 31159165 PMCID: PMC6603864 DOI: 10.3390/ijerph16111928] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 12/31/2022]
Abstract
Background: Malaria is one of the infectious diseases of greatest interest to the scientific community and of greatest concern to international health authorities. Traditionally, the focus has been on Plasmodium falciparum, the parasite that causes the most severe form of the disease in Africa. However, in the last twenty years, the Plasmodium vivax parasite, responsible for a large number of cases in Latin America, the Middle East, South and Southeast Asia, the Horn of Africa, and Oceania, has also generated enormous interest due, among other things, to the published evidence that it can cause severe malaria. Methods: In this paper, the international scientific publication on malaria and P. vivax has been analyzed using the Scopus database to try to define global trends in this field of study. Results: It has been shown that events such as the emergence of resistance to certain drugs can break a trend. The important role of non-malaria-endemic countries such as the USA or Switzerland in malaria research is also evident. Conclusions: International cooperation will be essential for the eradication of the disease. Moreover, in this sense, the general vision given by the bibliometric analysis of malaria caused by P. vivax is fundamental to paint the picture regarding the current situation and encourage international cooperation and control efforts.
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Affiliation(s)
| | | | - Lilia González-Cerón
- Regional Center for Public Health Research, National Institute of Public Health, Tapachula, Chiapas 30700, Mexico.
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Hawaria D, Getachew H, Zhou G, Demissew A, Habitamu K, Raya B, Lee MC, Yewhalaw D, Yan G. Ten years malaria trend at Arjo-Didessa sugar development site and its vicinity, Southwest Ethiopia: a retrospective study. Malar J 2019; 18:145. [PMID: 31014319 PMCID: PMC6480840 DOI: 10.1186/s12936-019-2777-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The trend analysis of malaria data from health facilities is useful for understanding dynamics of malaria epidemiology and inform for future malaria control planning. Changes in clinical malaria characteristics, like gender and age distribution are good indicators of declining malaria transmission. This study was conducted to determine the malaria trend at Arjo-Didessa sugar development site and its vicinity, southwest Ethiopia, from 2008 to 2017. METHODS Monthly malaria confirmed case data from 2008 to 2017 was extracted from 11 health facilities based on clinical registers at Arjo sugar development site and its vicinity, southwest Ethiopia. Both positivity rate and malaria incidence rate were calculated. Changes in malaria parasite species and seasonality were analysed; age structure and gender distribution were compared between different study periods. Trend in malaria incidence and climatic impact were analysed and past LLIN and IRS campaigns were used as dynamics modifier. RESULTS Over a period of 10 years, 54,020 blood film were collected for malaria diagnosis in the health facilities at the area, of which 18,049 (33.4%) were confirmed malaria cases by both microscopically and RDT. Plasmodium falciparum, Plasmodium vivax, and mixed infection (P. falciparum and P. vivax) accounted for 8660 (48%), 7649 (42.4%), and 1740 (9.6%) of the malaria cases, respectively. The study also revealed that P. vivax was the predominant over P. falciparum for 4 years (2010, 2014, 2015 and 2016). There was a remarkable reduction of overall malaria infection during the 10 years. Malaria has been reported in all age groups, but age distribution showed that vast majority of cases were adults age 15 years and above 13,305 (73.7%). In all age groups, males were more significantly affected than females (χ2 = 133.0, df = 2, P < 0.0001). Moreover, malaria positivity rate showed a strong seasonality (χ2 = 777.55, df = 11, P < 0.0001). However, malaria cases were reported in all seasons across 10 years in the study area. CONCLUSION In general, malaria positivity showed a declining trend over 10 years period in the area. However, current prevalence shows it is public health burden and needs attention for further intensification of interventions. In the study area, both P. falciparum and P. vivax co-exist and P. vivax is more prevalent than P. falciparum in almost half of the years. Therefore, malaria interventions should be strengthened in the study area.
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Affiliation(s)
- Dawit Hawaria
- Yirgalem Hospital Medical College, Yirgalem, Ethiopia
| | - Hallelujah Getachew
- Department of Medical Laboratory Technology, Arbaminch College of Health Sciences, Arbaminch, Ethiopia
| | - Guofa Zhou
- Program in Public Health, University of California at Irvine, Irvine, CA, 92697, USA
| | - Assalif Demissew
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Kasahun Habitamu
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Beka Raya
- Department of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ming-Chieh Lee
- Program in Public Health, University of California at Irvine, Irvine, CA, 92697, USA
| | - Delenasaw Yewhalaw
- Department of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia. .,Tropical and Infectious Diseases Research Center (TIDRC), Jimma University, Jimma, Ethiopia.
| | - Guiyun Yan
- Program in Public Health, University of California at Irvine, Irvine, CA, 92697, USA
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Bourgard C, Albrecht L, Kayano ACAV, Sunnerhagen P, Costa FTM. Plasmodium vivax Biology: Insights Provided by Genomics, Transcriptomics and Proteomics. Front Cell Infect Microbiol 2018; 8:34. [PMID: 29473024 PMCID: PMC5809496 DOI: 10.3389/fcimb.2018.00034] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/25/2018] [Indexed: 12/17/2022] Open
Abstract
During the last decade, the vast omics field has revolutionized biological research, especially the genomics, transcriptomics and proteomics branches, as technological tools become available to the field researcher and allow difficult question-driven studies to be addressed. Parasitology has greatly benefited from next generation sequencing (NGS) projects, which have resulted in a broadened comprehension of basic parasite molecular biology, ecology and epidemiology. Malariology is one example where application of this technology has greatly contributed to a better understanding of Plasmodium spp. biology and host-parasite interactions. Among the several parasite species that cause human malaria, the neglected Plasmodium vivax presents great research challenges, as in vitro culturing is not yet feasible and functional assays are heavily limited. Therefore, there are gaps in our P. vivax biology knowledge that affect decisions for control policies aiming to eradicate vivax malaria in the near future. In this review, we provide a snapshot of key discoveries already achieved in P. vivax sequencing projects, focusing on developments, hurdles, and limitations currently faced by the research community, as well as perspectives on future vivax malaria research.
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Affiliation(s)
- Catarina Bourgard
- Laboratory of Tropical Diseases, Department of Genetics, Evolution, Microbiology and Immunology, University of Campinas - UNICAMP, Campinas, Brazil
| | - Letusa Albrecht
- Laboratory of Tropical Diseases, Department of Genetics, Evolution, Microbiology and Immunology, University of Campinas - UNICAMP, Campinas, Brazil.,Laboratory of Regulation of Gene Expression, Instituto Carlos Chagas, Curitiba, Brazil
| | - Ana C A V Kayano
- Laboratory of Tropical Diseases, Department of Genetics, Evolution, Microbiology and Immunology, University of Campinas - UNICAMP, Campinas, Brazil
| | - Per Sunnerhagen
- Department of Chemistry and Molecular Biology, University of Gothenburg, Gothenburg, Sweden
| | - Fabio T M Costa
- Laboratory of Tropical Diseases, Department of Genetics, Evolution, Microbiology and Immunology, University of Campinas - UNICAMP, Campinas, Brazil
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Daher A, Pereira D, Lacerda MVG, Alexandre MAA, Nascimento CT, Alves de Lima E Silva JC, Tada M, Ruffato R, Maia I, Dos Santos TC, Marchesini P, Santelli AC, Lalloo DG. Efficacy and safety of artemisinin-based combination therapy and chloroquine with concomitant primaquine to treat Plasmodium vivax malaria in Brazil: an open label randomized clinical trial. Malar J 2018; 17:45. [PMID: 29361939 PMCID: PMC5782374 DOI: 10.1186/s12936-018-2192-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
Background There is general international agreement that the importance of vivax malaria has been neglected, and there is a need for new treatment approaches in an effort to progress towards control and elimination in Latin America. This open label randomized clinical trial evaluated the efficacy and safety of three treatment regimens using either one of two fixed dose artemisinin-based combinations or chloroquine in combination with a short course of primaquine (7–9 days: total dose 3–4.2 mg/kg) in Brazil. The primary objective was establishing whether cure rates above 90% could be achieved in each arm. Results A total of 264 patients were followed up to day 63. The cure rate of all three treatment arms was greater than 90% at 28 and 42 days. Cure rates were below 90% in all three treatment groups at day 63, although the 95% confidence interval included 90% for all three treatments. Most of the adverse events were mild in all treatment arms. Only one of the three serious adverse events was related to the treatment and significant drops in haemoglobin were rare. Conclusion This study demonstrated the efficacy and safety of all three regimens that were tested with 42-day cure rates that meet World Health Organization criteria. The efficacy and safety of artemisinin-based combination therapy regimens in this population offers the opportunity to treat all species of malaria with the same regimen, simplifying protocols for malaria control programmes and potentially contributing to elimination of both vivax and falciparum malaria. Trial registration RBR-79s56s Electronic supplementary material The online version of this article (10.1186/s12936-018-2192-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- André Daher
- Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. .,Vice-presidency of Research and Reference Laboratories, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Dhelio Pereira
- Tropical Medicine Research Center of Rondonia (CEPEM), Porto Velho, Brazil.,Federal University of Rondonia (UNIR), Porto Velho, Brazil
| | - Marcus V G Lacerda
- Research Institute Leônidas & Maria Deane, FIOCRUZ, Manaus, Brazil.,Tropical Medicine Foundation Dr Heitor Vieira Dourado, Manaus, Brazil
| | | | | | | | - Mauro Tada
- Tropical Medicine Research Center of Rondonia (CEPEM), Porto Velho, Brazil
| | - Rosilene Ruffato
- Tropical Medicine Research Center of Rondonia (CEPEM), Porto Velho, Brazil
| | - Ivan Maia
- Vice-presidency of Research and Reference Laboratories, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Paola Marchesini
- National Malaria Control Programme, Ministry of Health, Brasília, Brazil
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Newell I, Wiskin C, Anthoney J, Meza G, de Wildt G. Preventing malaria in the Peruvian Amazon: a qualitative study in Iquitos, Peru. Malar J 2018; 17:31. [PMID: 29338719 PMCID: PMC5771103 DOI: 10.1186/s12936-018-2177-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/08/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In Peru, despite decades of concerted control efforts, malaria remains a significant public health burden. Peru has recently exhibited a dramatic rise in malaria incidence, impeding South America's progress towards malaria elimination. The Amazon basin, in particular the Loreto region of Peru, has been identified as a target for the implementation of intensified control strategies, aiming for elimination. No research has addressed why vector control strategies in Loreto have had limited impact in the past, despite vector control elsewhere being highly effective in reducing malaria transmission. This study employed qualitative methods to explore factors limiting the success of vector control strategies in the region. METHODS Twenty semi-structured interviews were conducted among adults attending a primary care centre in Iquitos, Peru, together with 3 interviews with key informants (health care professionals). The interviews focussed on how local knowledge, together with social and cultural attitudes, determined the use of vector control methods. RESULTS Five themes emerged. (a) Participants believed malaria to be embedded within their culture, and commonly blamed this for a lack of regard for prevention. (b) They perceived a shift in mosquito biting times to early evening, rendering night-time use of bed nets less effective. (c) Poor preventive practices were compounded by a consensus that malaria prevention was the government's responsibility, and that this reduced motivation for personal prevention. (d) Participants confused the purpose of space-spraying. (e) Participants' responses also exposed persisting misconceptions, mainly concerning the cause of malaria and best practices for its prevention. CONCLUSION To eliminate malaria from the Americas, region-specific strategies need to be developed that take into account the local social and cultural contexts. In Loreto, further research is needed to explore the potential shift in biting behaviour of Anopheles darlingi, and how this interacts with the population's social behaviours and current use of preventive measures. Attitudes concerning personal responsibility for malaria prevention and long-standing misconceptions as to the cause of malaria and best preventive practices also need to be addressed.
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Affiliation(s)
- Ian Newell
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Connie Wiskin
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - James Anthoney
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Graciela Meza
- Facultad de Medicina Humana, Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
| | - Gilles de Wildt
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Badshah SL, Ullah A, Ahmad N, Almarhoon ZM, Mabkhot Y. Increasing the Strength and Production of Artemisinin and Its Derivatives. Molecules 2018; 23:E100. [PMID: 29301383 PMCID: PMC6017432 DOI: 10.3390/molecules23010100] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/19/2017] [Accepted: 12/28/2017] [Indexed: 12/04/2022] Open
Abstract
Artemisinin is a natural sesquiterpene lactone obtained from the Artemisia annua herb. It is widely used for the treatment of malaria. In this article, we have reviewed the role of artemisinin in controlling malaria, spread of resistance to artemisinin and the different methods used for its large scale production. The highest amount of artemisinin gene expression in tobacco leaf chloroplast leads to the production of 0.8 mg/g of the dry weight of the plant. This will revolutionize the treatment and control of malaria in third world countries. Furthermore, the generations of novel derivatives of artemisinin- and trioxane ring structure-inspired compounds are important for the treatment of malaria caused by resistant plasmodial species. Synthetic endoperoxide-like artefenomel and its derivatives are crucial for the control of malaria and such synthetic compounds should be further explored.
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Affiliation(s)
- Syed Lal Badshah
- Department of Chemistry, Islamia College University Peshawar, Peshawar 25120, Pakistan.
| | - Asad Ullah
- Department of Chemistry, Islamia College University Peshawar, Peshawar 25120, Pakistan.
| | - Nasir Ahmad
- Department of Chemistry, Islamia College University Peshawar, Peshawar 25120, Pakistan.
| | - Zainab M Almarhoon
- Department of Chemistry, College of Sciences, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Yahia Mabkhot
- Department of Chemistry, College of Sciences, King Saud University, Riyadh 11451, Saudi Arabia.
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Baird JK. Tafenoquine for travelers' malaria: evidence, rationale and recommendations. J Travel Med 2018; 25:5150129. [PMID: 30380095 PMCID: PMC6243017 DOI: 10.1093/jtm/tay110] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/17/2018] [Accepted: 10/30/2018] [Indexed: 01/01/2023]
Abstract
Background Endemic malaria occurring across much of the globe threatens millions of exposed travelers. While unknown numbers of them suffer acute attacks while traveling, each year thousands return from travel and become stricken in the weeks and months following exposure. This represents perhaps the most serious, prevalent and complex problem faced by providers of travel medicine services. Since before World War II, travel medicine practice has relied on synthetic suppressive blood schizontocidal drugs to prevent malaria during exposure, and has applied primaquine for presumptive anti-relapse therapy (post-travel or post-diagnosis of Plasmodium vivax) since 1952. In 2018, the US Food and Drug Administration approved the uses of a new hepatic schizontocidal and hypnozoitocidal 8-aminoquinoline called tafenoquine for the respective prevention of all malarias and for the treatment of those that relapse (P. vivax and Plasmodium ovale). Methods The evidence and rationale for tafenoquine for the prevention and treatment of malaria was gathered by means of a standard search of the medical literature along with the package inserts for the tafenoquine products Arakoda™ and Krintafel™ for the prevention of all malarias and the treatment of relapsing malarias, respectively. Results The development of tafenoquine-an endeavor of 40 years-at last brings two powerful advantages to travel medicine practice against the malaria threat: (i) a weekly regimen of causal prophylaxis; and (ii) a single-dose radical cure for patients infected by vivax or ovale malarias. Conclusions Although broad clinical experience remains to be gathered, tafenoquine appears to promise more practical and effective prevention and treatment of malaria. Tafenoquine thus applied includes important biological and clinical complexities explained in this review, with particular regard to the problem of hemolytic toxicity in G6PD-deficient patients.
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Affiliation(s)
- J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta 10430, Indonesia; and Nuffield Department of Medicine, the Centre for Tropical Medicine and Global Health, University of Oxford, UK
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Kumar A, Singh KP, Bali P, Anwar S, Kaul A, Singh OP, Gupta BK, Kumari N, Noor Alam M, Raziuddin M, Sinha MP, Gourinath S, Sharma AK, Sohail M. iNOS polymorphism modulates iNOS/NO expression via impaired antioxidant and ROS content in P. vivax and P. falciparum infection. Redox Biol 2017; 15:192-206. [PMID: 29268202 PMCID: PMC5738204 DOI: 10.1016/j.redox.2017.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 11/30/2017] [Accepted: 12/12/2017] [Indexed: 01/09/2023] Open
Abstract
Nitric oxide (NO) has dicotomic influence on modulating host-parasite interplay, synchronizing physiological orchestrations and diagnostic potential; instigated us to investigate the plausible association and genetic regulation among NO level, components of oxidative stress, iNOS polymorphisms and risk of malaria. Here, we experimentally elucidate that iNOS promoter polymorphisms are associated with risk of malaria; employing mutation specific genotyping, functional interplay using western blot and RT-PCR, quantitative estimation of NO, total antioxidant content (TAC) and reactive oxygen species (ROS). Genotyping revealed significantly associated risk of P. vivax (adjusted OR = 1.92 and 1.72) and P. falciparum (adjusted OR = 1.68 and 1.75) infection with SNP at iNOS-954G/C and iNOS-1173C/T positions, respectively; though vivax showed higher risk of infection. Intriguingly, mutation and infection specific differential upregulation of iNOS expression/NO level was observed and found to be significantly associated with mutant genotypes. Moreover, P. vivax showed pronounced iNOS protein (2.4 fold) and mRNA (2.5 fold) expression relative to healthy subjects. Furthermore, TAC and ROS were significantly decreased in infection; and differentially decreased in mutant genotypes. Our findings endorse polymorphic regulation of iNOS expression, altered oxidant-antioxidant components and evidences of risk association as the hallmark of malaria pathogenesis. iNOS/NO may serve as potential diagnostic marker in assessing clinical malaria. Polymorphism of iNOS revealed significantly associated risk of P. vivax and P. falciparum malaria and vivax showed higher risk of infection. We observed mutation and infection specific differential expression of iNOS/NO cascade. We investigated mutation specific antioxidant and ROS orchestration and observed lower TAC and ROS content in infection. Evaluated the clinical correlation among stratified axillary temperature, NO and haemoglobin content during infection.
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Affiliation(s)
- Amod Kumar
- University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Krishn Pratap Singh
- University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Prerna Bali
- National Institute of Malaria Research, Dawarka, Delhi, India
| | - Shadab Anwar
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Asha Kaul
- National Institute of Malaria Research, Dawarka, Delhi, India
| | - Om P Singh
- National Institute of Malaria Research, Dawarka, Delhi, India
| | - Birendra Kumar Gupta
- University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Nutan Kumari
- Department of Physiology, Patna Medical College and Hospital, Patna, India
| | - Md Noor Alam
- University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | - Mohammad Raziuddin
- University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India
| | | | | | - Ajay Kumar Sharma
- University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India.
| | - Mohammad Sohail
- University Department of Zoology, Vinoba Bhave University, Hazaribag, Jharkhand, India.
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Totino PR, Lopes SC. Insights into the Cytoadherence Phenomenon of Plasmodium vivax: The Putative Role of Phosphatidylserine. Front Immunol 2017; 8:1148. [PMID: 28979260 PMCID: PMC5611623 DOI: 10.3389/fimmu.2017.01148] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/30/2017] [Indexed: 12/11/2022] Open
Abstract
Plasmodium vivax is the most geographically widespread and the dominant human malaria parasite in most countries outside of sub-Saharan Africa and, although it was classically recognized to cause benign infection, severe cases and deaths caused by P. vivax have remarkably been reported. In contrast to Plasmodium falciparum, which well-known ability to bind to endothelium and placental tissue and form rosettes is related to severity of the disease, it has been a dogma that P. vivax is unable to undergo cytoadherent phenomena. However, some studies have demonstrated that red blood cells (RBCs) infected by P. vivax can cytoadhere to host cells, while the molecules participating in this host–parasite interaction are still a matter of speculation. In the present overview, we address the evidences currently supporting the adhesive profile of P. vivax and, additionally, discuss the putative role of phosphatidylserine—a cell membrane phospholipid with cytoadhesive properties that has been detected on the surface of Plasmodium-parasitized RBCs.
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Affiliation(s)
- Paulo Renato Totino
- Laboratory of Malaria Research, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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37
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DARC extracellular domain remodeling in maturating reticulocytes explains Plasmodium vivax tropism. Blood 2017; 130:1441-1444. [PMID: 28754683 DOI: 10.1182/blood-2017-03-774364] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/21/2017] [Indexed: 12/12/2022] Open
Abstract
Plasmodium vivax is the most prevalent parasite species that causes malaria in humans and exclusively infects reticulocytes. Reticulocyte infection is facilitated by P vivax Duffy binding protein (DBP), which utilizes DARC (Duffy antigen receptor for chemokines) as an entry point. However, the selective tropism of P vivax for transferrin receptor (CD71)-positive reticulocytes remained unexplained, given the constitutive expression of DARC during reticulocyte maturation. CD71/RNA double staining of reticulocytes enriched from adult peripheral blood reveals 4 distinct reticulocyte populations: CD71high/RNAhigh (∼0.016%), CD71low/RNAhigh (∼0.059%), CD71neg/RNAhigh (∼0.37%), CD71neg/RNAlow (∼0.55%), and erythrocytes CD71neg/RNAneg (∼99%). We hypothesized that selective association of DBP with a small population of immature reticulocytes could explain the preference of P vivax for reticulocytes. Binding of specific monoclonal anti-DARC antibodies and recombinant DBP to CD71high/RNAhigh reticulocytes was significantly higher compared with other reticulocyte populations and erythrocytes. Interestingly, the total DARC protein throughout reticulocyte maturation was constant. The data suggest that selective exposure of the DBP binding site within DARC is key to the preferential binding of DBP to immature reticulocytes, which is the potential mechanism underlying the preferential infection of a reticulocyte subset by P vivax.
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Tadesse F, Fogarty AW, Deressa W. Prevalence and associated risk factors of malaria among adults in East Shewa Zone of Oromia Regional State, Ethiopia: a cross-sectional study. BMC Public Health 2017; 18:25. [PMID: 28716009 PMCID: PMC5513396 DOI: 10.1186/s12889-017-4577-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/06/2017] [Indexed: 11/17/2022] Open
Abstract
Background Malaria is one of the most important causes of morbidity and mortality in sub-Saharan Africa. The disease is prevalent in over 75% of the country’s area making it the leading public health problems in the country. Information on the prevalence of malaria and its associated factors is vital to focus and improve malaria interventions. Methods A cross-sectional study was carried out from October to November 2012 in East Shewa zone of Oromia Regional State, Ethiopia. Adults aged 16 or more years with suspected malaria attending five health centers were eligible for the study. Logistic regression models were used to examine the effect of each independent variable on risk of subsequent diagnosis of malaria. Results Of 810 suspected adult malaria patients who participated in the study, 204 (25%) had microscopically confirmed malaria parasites. The dominant Plasmodium species were P. vivax (54%) and P. falciparum (45%), with mixed infection of both species in one patient. A positive microscopic result was significantly associated with being in the age group of 16 to 24 years [Adjusted Odds Ratio aOR 6.7; 95% CI: 2.3 to 19.5], 25 to 34 years [aOR 4.2; 95% CI: 1.4 to 12.4], and 35 to 44 years [aOR 3.7; 95% CI: 1.2–11.4] compared to 45 years or older; being treated at Meki health center [aOR 4.1; 95% CI: 2.4 to 7.1], being in Shashemene health center [aOR = 2.3; 95% CI: 1.5 to 4.5], and living in a rural area compared to an urban area [aOR 1.7; 95% CI: 1.1 to 2.6)]. Conclusion Malaria is an important public health problem among adults in the study area with a predominance of P. vivax and P. falciparum infection. Thus, appropriate health interventions should be implemented to prevent and control the disease. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4577-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frew Tadesse
- School of Public Health, College of Health Sciences and Medicine, Jigjiga University, Jigjiga, Ethiopia.
| | - Andrew W Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Yimer M, Hailu T, Mulu W, Abera B, Ayalew W. A 5 year trend analysis of malaria prevalence with in the catchment areas of Felegehiwot referral Hospital, Bahir Dar city, northwest-Ethiopia: a retrospective study. BMC Res Notes 2017; 10:239. [PMID: 28676117 PMCID: PMC5496279 DOI: 10.1186/s13104-017-2560-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is one of the killer diseases in Ethiopia and it is still the first leading cause of death in health facilities. However, there is no information yet regarding the trends of malaria prevalence at health institution and particularly at Felegehiwot referral Hospital. Hence , knowing the trends of malaria prevalence at each health facilities is essential to design appropriate interventions. Therefore, the present study addressed the above gaps. RESULTS Overall, 14,750 blood films were diagnosed for malaria. Of these, 740 (5%) were confirmed with microscope. Plasmodium falciparum and Plasmodium vivax accounted for 397 (53%) and 331 (45%), respectively. Age groups >20 year (p < 0.02) and males (p < 0.025) were significantly affected. CONCLUSIONS In conclusion, P. falciparum was predominant as compared to P. vivax. Hence, it needs close monitoring and intervention measures for control activities.
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Affiliation(s)
- Mulat Yimer
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Tadesse Hailu
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondemagegn Mulu
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Bayeh Abera
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Workneh Ayalew
- Amhara National Regional State Health Bureau, Felegehiwot referral Hospital, Bahir Dar, Ethiopia
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Bardají A, Martínez-Espinosa FE, Arévalo-Herrera M, Padilla N, Kochar S, Ome-Kaius M, Bôtto-Menezes C, Castellanos ME, Kochar DK, Kochar SK, Betuela I, Mueller I, Rogerson S, Chitnis C, Hans D, Menegon M, Severini C, del Portillo H, Dobaño C, Mayor A, Ordi J, Piqueras M, Sanz S, Wahlgren M, Slutsker L, Desai M, Menéndez C. Burden and impact of Plasmodium vivax in pregnancy: A multi-centre prospective observational study. PLoS Negl Trop Dis 2017; 11:e0005606. [PMID: 28604825 PMCID: PMC5481034 DOI: 10.1371/journal.pntd.0005606] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 06/22/2017] [Accepted: 04/27/2017] [Indexed: 11/22/2022] Open
Abstract
Background Despite that over 90 million pregnancies are at risk of Plasmodium vivax infection annually, little is known about the epidemiology and impact of the infection in pregnancy. Methodology and principal findings We undertook a health facility-based prospective observational study in pregnant women from Guatemala (GT), Colombia (CO), Brazil (BR), India (IN) and Papua New Guinea PNG). Malaria and anemia were determined during pregnancy and fetal outcomes assessed at delivery. A total of 9388 women were enrolled at antennal care (ANC), of whom 53% (4957) were followed until delivery. Prevalence of P. vivax monoinfection in maternal blood at delivery was 0.4% (20/4461) by microscopy [GT 0.1%, CO 0.5%, BR 0.1%, IN 0.2%, PNG 1.2%] and 7% (104/1488) by PCR. P. falciparum monoinfection was found in 0.5% (22/4463) of women by microscopy [GT 0%, CO 0.5%, BR 0%, IN 0%, PNG 2%]. P. vivax infection was observed in 0.4% (14/3725) of placentas examined by microscopy and in 3.7% (19/508) by PCR. P. vivax in newborn blood was detected in 0.02% (1/4302) of samples examined by microscopy [in cord blood; 0.05% (2/4040) by microscopy, and 2.6% (13/497) by PCR]. Clinical P. vivax infection was associated with increased risk of maternal anemia (Odds Ratio-OR, 5.48, [95% CI 1.83–16.41]; p = 0.009), while submicroscopic vivax infection was not associated with increased risk of moderate-severe anemia (Hb<8g/dL) (OR, 1.16, [95% CI 0.52–2.59]; p = 0.717), or low birth weight (<2500g) (OR, 0.52, [95% CI, 0.23–1.16]; p = 0.110). Conclusions In this multicenter study, the prevalence of P. vivax infection in pregnancy by microscopy was overall low across all endemic study sites; however, molecular methods revealed a significant number of submicroscopic infections. Clinical vivax infection in pregnancy was associated with maternal anemia, which may be deleterious for infant’s health. These results may help to guide maternal health programs in settings where vivax malaria is endemic; they also highlight the need of addressing a vulnerable population such as pregnant women while embracing malaria elimination in endemic countries. More than 90 million pregnancies are exposed to P. vivax infection every year. While it is well known that pregnant women have an increased risk of P. falciparum infection and disease, much less is known on the epidemiology and the impact of P. vivax in pregnancy. A health-facility based observational study was conducted in pregnant women living in five vivax endemic countries aimed to determine the burden of the infection in pregnancy and its impact on the mother and the newborn health. We found that the prevalence of P. vivax malaria in pregnant women attending the routine antenatal clinic visits was overall low across all sites, however submicroscopic infections were unexpectedly high in some areas. Pregnant women with clinical malaria experienced an increased risk of anemia, which may have a deleterious impact on infant health. These findings may be useful for guiding maternal health programs in vivax endemic settings, as well as for malaria elimination activities.
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Affiliation(s)
- Azucena Bardají
- Barcelona Center for International Health Research, CRESIB, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Flor Ernestina Martínez-Espinosa
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas e Maria Deane, FIOCRUZ Amazônia, Manaus, Brazil
| | | | - Norma Padilla
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala, Guatemala
| | - Swati Kochar
- Department of Medicine, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Camila Bôtto-Menezes
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | | | - Sanjay Kumar Kochar
- Department of Medicine, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Inoni Betuela
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Ivo Mueller
- Barcelona Center for International Health Research, CRESIB, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- The Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Stephen Rogerson
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia
| | - Chetan Chitnis
- International Center for Genetic Engineering and Biotechnology, New Delhi, India
| | - Dhiraj Hans
- International Center for Genetic Engineering and Biotechnology, New Delhi, India
| | - Michela Menegon
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Carlo Severini
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Hernando del Portillo
- Barcelona Center for International Health Research, CRESIB, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Carlota Dobaño
- Barcelona Center for International Health Research, CRESIB, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alfredo Mayor
- Barcelona Center for International Health Research, CRESIB, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Jaume Ordi
- Barcelona Center for International Health Research, CRESIB, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Mireia Piqueras
- Barcelona Center for International Health Research, CRESIB, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Sergi Sanz
- Barcelona Center for International Health Research, CRESIB, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Laurence Slutsker
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Clara Menéndez
- Barcelona Center for International Health Research, CRESIB, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Tobón-Castaño A, Barrera Escobar S, Giraldo Castro C. Urinalysis and Clinical Correlations in Patients with P. vivax or P. falciparum Malaria from Colombia. J Trop Med 2017; 2017:7868535. [PMID: 28630631 PMCID: PMC5463173 DOI: 10.1155/2017/7868535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/30/2017] [Accepted: 05/02/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Urinalysis is a poorly reviewed diagnostic tool in malaria patients; its application can show the presence of severe malaria. METHODS Urinalysis was performed in a total of 620 patients diagnosed with malaria by thick blood smear; complications were classified according to WHO major criteria for severity and minor criteria according to the Colombian malaria guideline. RESULTS Severe or moderate clinical complications were diagnosed in 31.1% of patients, hepatic dysfunctions were diagnosed in 25.8%, anemia was diagnosed in 9.8%, thrombocytopenia was diagnosed in 7.7%, renal dysfunction was diagnosed in 4.8%, neurological and pulmonary complications were diagnosed in 2.1% and 2.4%, hypoglycemia was diagnosed in 1.1% of patients with blood glucose analysis, and acidosis was diagnosed in 10 of 25. Bilirubinuria was found in 24.3%, associated with urobilinuria, proteinuria, and increased specific gravity; urobilinuria was found in 30.6% associated with elevated serum bilirubin and alanine aminotransferase; 39.2% had proteinuria, associated with higher blood urea nitrogen, serum bilirubin, aspartate, alanine-transaminase, hematuria, and increased specific gravity. Severe or moderate liver and renal complications were associated with proteinuria and bilirubinuria. Urobilinuria was associated with thrombocytopenia and neurological and hepatic dysfunction. Ketonuria was associated with neurological dysfunctions. CONCLUSIONS The most frequent alterations in the urinalysis were bilirubinuria, proteinuria, urobilinuria, and increased specific gravity, related to thrombocytopenia and liver, kidney, and neurological alterations.
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Affiliation(s)
- Alberto Tobón-Castaño
- Malaria Group, Faculty of Medicine, University of Antioquia, Calle 70, No. 52-21, Medellin, Colombia
| | - Sebastián Barrera Escobar
- Malaria Group, Faculty of Medicine, University of Antioquia, Calle 70, No. 52-21, Medellin, Colombia
- Faculty of Medicine, University of Antioquia, Medellin, Colombia
| | - Cecilia Giraldo Castro
- Malaria Group, Faculty of Medicine, University of Antioquia, Calle 70, No. 52-21, Medellin, Colombia
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Challenges for achieving safe and effective radical cure of Plasmodium vivax: a round table discussion of the APMEN Vivax Working Group. Malar J 2017; 16:141. [PMID: 28381261 PMCID: PMC5382417 DOI: 10.1186/s12936-017-1784-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/18/2017] [Indexed: 01/12/2023] Open
Abstract
The delivery of safe and effective radical cure for Plasmodium vivax is one of the greatest challenges for achieving malaria elimination from the Asia-Pacific by 2030. During the annual meeting of the Asia Pacific Malaria Elimination Network Vivax Working Group in October 2016, a round table discussion was held to discuss the programmatic issues hindering the widespread use of primaquine (PQ) radical cure. Participants included 73 representatives from 16 partner countries and 33 institutional partners and other research institutes. In this meeting report, the key discussion points are presented and grouped into five themes: (i) current barriers for glucose-6-phosphate deficiency (G6PD) testing prior to PQ radical cure, (ii) necessary properties of G6PD tests for wide scale deployment, (iii) the promotion of G6PD testing, (iv) improving adherence to PQ regimens and (v) the challenges for future tafenoquine (TQ) roll out. Robust point of care (PoC) G6PD tests are needed, which are suitable and cost-effective for clinical settings with limited infrastructure. An affordable and competitive test price is needed, accompanied by sustainable funding for the product with appropriate training of healthcare staff, and robust quality control and assurance processes. In the absence of quantitative PoC G6PD tests, G6PD status can be gauged with qualitative diagnostics, however none of the available tests is currently sensitive enough to guide TQ treatment. TQ introduction will require overcoming additional challenges including the management of severely and intermediately G6PD deficient individuals. Robust strategies are needed to ensure that effective treatment practices can be deployed widely, and these should ensure that the caveats are outweighed by the benefits of radical cure for both the patients and the community. Widespread access to quality controlled G6PD testing will be critical.
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Commons R, Thriemer K, Humphreys G, Suay I, Sibley C, Guerin P, Price R. The Vivax Surveyor: Online mapping database for Plasmodium vivax clinical trials. Int J Parasitol Drugs Drug Resist 2017; 7:181-190. [PMID: 28384505 PMCID: PMC5382033 DOI: 10.1016/j.ijpddr.2017.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Recurrent P. vivax infections are associated with significant morbidity and mortality. Although radical cure can reduce recurrent infection, it is confounded by antimalarial resistance and the lack of safe and effective hypnozoitocidal treatment. This study documents the available literature of published clinical trials of P. vivax, providing an up to date, online, open access tool to view and download available information. METHODS A systematic review was conducted according to PRISMA guidelines to identify prospective P. vivax therapeutic clinical trials with at least 28 days follow-up published between 1st January 1960 and 12th October 2016. Treatment arms and evidence of chloroquine resistance were mapped to trial sites. RESULTS Since 1960, a total of 1152 antimalarial clinical trials with a minimum 28 days follow-up have been published, of which 230 (20.0%) enrolled patients with P. vivax and were included. Trials were conducted in 38 countries: 168 (73.0%) in the Asia-Pacific, 13 (5.7%) in Africa and 43 (18.7%) in the Americas. The proportion of antimalarial trials assessing P. vivax rose from 10.7% (12/112) in 1991-1995, to 24.9% (56/225) in 2011-2015. Overall, 188 (81.7%) P. vivax trials included a chloroquine treatment arm, either alone or in combination with primaquine, and 107 (46.5%) trials included a chloroquine treatment arm with early primaquine to assess radical cure. There has been a recent increase in treatment arms with artemisinin derivatives. Of the 131 sites in which chloroquine resistance could be quantified, resistance was present in 59 (45.0%) sites in 15 endemic countries. CONCLUSIONS Over the last 20 years there has been a substantial increase in clinical research on the treatment of P. vivax, which has generated a greater awareness of the global extent of chloroquine resistance. The WWARN open access, online interactive map provides up to date information of areas where drug resistant P. vivax is emerging.
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Affiliation(s)
- R.J. Commons
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia,WorldWide Antimalarial Resistance Network, UK,Corresponding author. Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811, Australia.Global and Tropical Health DivisionMenzies School of Health ResearchCharles Darwin UniversityPO Box 41096CasuarinaNT0811Australia
| | - K. Thriemer
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - G. Humphreys
- WorldWide Antimalarial Resistance Network, UK,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - I. Suay
- WorldWide Antimalarial Resistance Network, UK
| | - C.H. Sibley
- WorldWide Antimalarial Resistance Network, UK,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK,Department of Genome Sciences, University of Washington, Seattle, USA
| | - P.J. Guerin
- WorldWide Antimalarial Resistance Network, UK,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - R.N. Price
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia,WorldWide Antimalarial Resistance Network, UK,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Russo G, Faggioni G, Paganotti GM, Djeunang Dongho GB, Pomponi A, De Santis R, Tebano G, Mbida M, Sanou Sobze M, Vullo V, Rezza G, Lista FR. Molecular evidence of Plasmodium vivax infection in Duffy negative symptomatic individuals from Dschang, West Cameroon. Malar J 2017; 16:74. [PMID: 28196496 PMCID: PMC5309988 DOI: 10.1186/s12936-017-1722-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/06/2017] [Indexed: 12/20/2022] Open
Abstract
Background Plasmodium vivax infection is known to be rare in West/Central Africa, the most accepted explanation being the lack of expression of erythroid Duffy antigen in the local human populations. Duffy negativity prevents the parasite to exploit the entry mechanism on the red blood cell surface. However, there are a growing number of reported vivax infections in Duffy-negative individuals. Data on P. vivax circulation in Cameroon are limited. The aim of the study was to evaluate the P. vivax presence, and its association with the Duffy genotype in West Cameroon. Results Overall, 484 blood samples were collected consecutively from febrile outpatients attending the Dschang’s Hospital (West Cameroon) during a 3-months period. Plasmodium vivax infection was detected by PCR in 5.6% (n = 27/484) of the cases, representing 38.6% (n = 27/70) of all Plasmodium infections detected. All P. vivax infected individuals showed a Duffy-negative genotype, and the frequency of Duffy-positive individuals in the whole tested population was 1.7%. Conclusions The results of this study confirm the circulation of P. vivax in Cameroon, as well as that the lack of expression of Duffy-antigen does not confer full protection against vivax malaria acquisition.
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Affiliation(s)
- Gianluca Russo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 00185, Rome, Italy.
| | - Giovanni Faggioni
- Department of Molecular Biology, Immunology and Experimental Medicine, Army Medical and Veterinary Research Centre, Via di Santo Stefano Rotondo, 00184, Rome, Italy
| | - Giacomo Maria Paganotti
- BUP Core Laboratory, Botswana-University of Pennsylvania Partnership (BUP), P O Box AC 157 ACH, Gaborone, Botswana
| | | | - Alice Pomponi
- Department of Molecular Biology, Immunology and Experimental Medicine, Army Medical and Veterinary Research Centre, Via di Santo Stefano Rotondo, 00184, Rome, Italy
| | - Riccardo De Santis
- Department of Molecular Biology, Immunology and Experimental Medicine, Army Medical and Veterinary Research Centre, Via di Santo Stefano Rotondo, 00184, Rome, Italy
| | - Gianpiero Tebano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 00185, Rome, Italy
| | - Mpoame Mbida
- Department of Biomedical Sciences, University of Dschang, BP 96, Dschang, Cameroon
| | - Martin Sanou Sobze
- Department of Biomedical Sciences, University of Dschang, BP 96, Dschang, Cameroon
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 00185, Rome, Italy
| | - Giovanni Rezza
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Florigio Romano Lista
- Department of Molecular Biology, Immunology and Experimental Medicine, Army Medical and Veterinary Research Centre, Via di Santo Stefano Rotondo, 00184, Rome, Italy
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Howes RE, Battle KE, Mendis KN, Smith DL, Cibulskis RE, Baird JK, Hay SI. Global Epidemiology of Plasmodium vivax. Am J Trop Med Hyg 2016; 95:15-34. [PMID: 27402513 PMCID: PMC5198891 DOI: 10.4269/ajtmh.16-0141] [Citation(s) in RCA: 253] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/19/2016] [Indexed: 01/09/2023] Open
Abstract
Plasmodium vivax is the most widespread human malaria, putting 2.5 billion people at risk of infection. Its unique biological and epidemiological characteristics pose challenges to control strategies that have been principally targeted against Plasmodium falciparum Unlike P. falciparum, P. vivax infections have typically low blood-stage parasitemia with gametocytes emerging before illness manifests, and dormant liver stages causing relapses. These traits affect both its geographic distribution and transmission patterns. Asymptomatic infections, high-risk groups, and resulting case burdens are described in this review. Despite relatively low prevalence measurements and parasitemia levels, along with high proportions of asymptomatic cases, this parasite is not benign. Plasmodium vivax can be associated with severe and even fatal illness. Spreading resistance to chloroquine against the acute attack, and the operational inadequacy of primaquine against the multiple attacks of relapse, exacerbates the risk of poor outcomes among the tens of millions suffering from infection each year. Without strategies accounting for these P. vivax-specific characteristics, progress toward elimination of endemic malaria transmission will be substantially impeded.
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Affiliation(s)
- Rosalind E. Howes
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Katherine E. Battle
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Kamini N. Mendis
- Global Malaria Program, World Health Organization, Geneva, Switzerland
| | - David L. Smith
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
- Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - J. Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Simon I. Hay
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
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Santos-Vega M, Bouma MJ, Kohli V, Pascual M. Population Density, Climate Variables and Poverty Synergistically Structure Spatial Risk in Urban Malaria in India. PLoS Negl Trop Dis 2016; 10:e0005155. [PMID: 27906962 PMCID: PMC5131912 DOI: 10.1371/journal.pntd.0005155] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/02/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The world is rapidly becoming urban with the global population living in cities projected to double by 2050. This increase in urbanization poses new challenges for the spread and control of communicable diseases such as malaria. In particular, urban environments create highly heterogeneous socio-economic and environmental conditions that can affect the transmission of vector-borne diseases dependent on human water storage and waste water management. Interestingly India, as opposed to Africa, harbors a mosquito vector, Anopheles stephensi, which thrives in the man-made environments of cities and acts as the vector for both Plasmodium vivax and Plasmodium falciparum, making the malaria problem a truly urban phenomenon. Here we address the role and determinants of within-city spatial heterogeneity in the incidence patterns of vivax malaria, and then draw comparisons with results for falciparum malaria. METHODOLOGY/PRINCIPAL FINDINGS Statistical analyses and a phenomenological transmission model are applied to an extensive spatio-temporal dataset on cases of Plasmodium vivax in the city of Ahmedabad (Gujarat, India) that spans 12 years monthly at the level of wards. A spatial pattern in malaria incidence is described that is largely stationary in time for this parasite. Malaria risk is then shown to be associated with socioeconomic indicators and environmental parameters, temperature and humidity. In a more dynamical perspective, an Inhomogeneous Markov Chain Model is used to predict vivax malaria risk. Models that account for climate factors, socioeconomic level and population size show the highest predictive skill. A comparison to the transmission dynamics of falciparum malaria reinforces the conclusion that the spatio-temporal patterns of risk are strongly driven by extrinsic factors. CONCLUSION/SIGNIFICANCE Climate forcing and socio-economic heterogeneity act synergistically at local scales on the population dynamics of urban malaria in this city. The stationarity of malaria risk patterns provides a basis for more targeted intervention, such as vector control, based on transmission 'hotspots'. This is especially relevant for P. vivax, a more resilient parasite than P. falciparum, due to its ability to relapse and the operational shortcomings of delivering a "radical cure".
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Affiliation(s)
- Mauricio Santos-Vega
- Department of Ecology and Evolution, University of Chicago, Chicago, United States of America
| | - Menno J Bouma
- London School of Hygiene and Tropical Medicine, University of London, United Kingdom
- Institute for Climate Sciences (IC3), University of Barcelona, Barcelona, Spain
| | - Vijay Kohli
- Ahmedabad Municipal Corporation, Ahmedabad, India
| | - Mercedes Pascual
- Department of Ecology and Evolution, University of Chicago, Chicago, United States of America
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Sanchez JF, Carnero AM, Rivera E, Rosales LA, Baldeviano GC, Asencios JL, Edgel KA, Vinetz JM, Lescano AG. Unstable Malaria Transmission in the Southern Peruvian Amazon and Its Association with Gold Mining, Madre de Dios, 2001-2012. Am J Trop Med Hyg 2016; 96:304-311. [PMID: 27879461 DOI: 10.4269/ajtmh.16-0030] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 09/29/2016] [Indexed: 11/07/2022] Open
Abstract
The reemergence of malaria in the last decade in Madre de Dios, southern Peruvian Amazon basin, was accompanied by ecological, political, and socioeconomic changes related to the proliferation of illegal gold mining. We conducted a secondary analysis of passive malaria surveillance data reported by the health networks in Madre de Dios between 2001 and 2012. We calculated the number of cases of malaria by year, geographic location, intensity of illegal mining activities, and proximity of health facilities to the Peru-Brazil Interoceanic Highway. During 2001-2012, 203,773 febrile cases were identified in Madre de Dios, of which 30,811 (15.1%) were confirmed cases of malaria; all but 10 cases were due to Plasmodium vivax Cases of malaria rose rapidly between 2004 and 2007, reached 4,469 cases in 2005, and then declined after 2010 to pre-2004 levels. Health facilities located in areas of intense illegal gold mining reported 30-fold more cases than those in non-mining areas (ratio = 31.54, 95% confidence interval [CI] = 19.28, 51.60). Finally, health facilities located > 1 km from the Interoceanic Highway reported significantly more cases than health facilities within this distance (ratio = 16.20, 95% CI = 8.25, 31.80). Transmission of malaria in Madre de Dios is unstable, geographically heterogeneous, and strongly associated with illegal gold mining. These findings highlight the importance of spatially oriented interventions to control malaria in Madre de Dios, as well as the need for research on malaria transmission in illegal gold mining camps.
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Affiliation(s)
- Juan F Sanchez
- Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Andres M Carnero
- Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Esteban Rivera
- Dirección Regional de Salud de Madre de Dios, Ministerio de Salud del Perú, Puerto Maldonado, Peru
| | - Luis A Rosales
- Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - G Christian Baldeviano
- Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Jorge L Asencios
- Dirección Regional de Salud de Madre de Dios, Ministerio de Salud del Perú, Puerto Maldonado, Peru
| | - Kimberly A Edgel
- Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Joseph M Vinetz
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, California
| | - Andres G Lescano
- Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru. .,School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Baird JK. Asia-Pacific malaria is singular, pervasive, diverse and invisible. Int J Parasitol 2016; 47:371-377. [PMID: 27836630 PMCID: PMC5482320 DOI: 10.1016/j.ijpara.2016.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/29/2016] [Accepted: 06/01/2016] [Indexed: 12/27/2022]
Abstract
Malaria in the Asia-Pacific region has been targeted for elimination by the year 2030. This article asks the question, "by what means?" in the context of proven technical strategies and tools against key challenges imposed by the distinct character of the Asia-Pacific malaria problem. The misperception of malaria in the Asia-Pacific region as a less serious but otherwise essentially similar problem to African malaria lulls us into rote application of the same tools and strategies. Those now mitigating the harm done by malaria in Africa will not suffice to eliminate malaria in the Asia-Pacific region - these tasks and the problems are fundamentally distinct. This article describes the singular characteristics of Asia-Pacific malaria and the bearing of those upon the technical strategy of malaria elimination. Most of the tools needed for that endeavour do not yet exist and spirited calls for elimination within the next 14years may discourage the patience and investments needed to conceive, optimise and validate them.
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Affiliation(s)
- J Kevin Baird
- Eijkman Oxford Clinical Research Unit, Jakarta, Indonesia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
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Pereira D, Daher A, Zanini G, Maia I, Fonseca L, Pitta L, Ruffato R, Marchesini P, Fontes CJ. Safety, efficacy and pharmacokinetic evaluations of a new coated chloroquine tablet in a single-arm open-label non-comparative trial in Brazil: a step towards a user-friendly malaria vivax treatment. Malar J 2016; 15:477. [PMID: 27639847 PMCID: PMC5027105 DOI: 10.1186/s12936-016-1530-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/09/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Malaria remains a major public health problem, with half the world population at risk of contracting malaria. The effects of Plasmodium vivax on prosperity and longevity have been highlighted in several recent clinical case reports. The first line of vivax treatment drugs has seen no radical innovation for more than 60 years. This study introduces a subtle incremental innovation to vivax treatment: a chloroquine and primaquine co-blister. The co-blister includes a new chloroquine formulation incorporating coated tablets to mask the drug's bitter taste and user-friendly packaging containing tablets of each drug, which may improve patient adherence and facilitate the appropriate use of the drugs. This new formulation will replace the non-coated chloroquine distributed in Brazil. METHODS Patients were orally treated with 150 mg coated chloroquine tablets for 3 days: an initial 450 mg dose, followed by two 300 mg doses. The patients were treated concomitantly with two 15 mg primaquine tablets for 7-9 days, according to their weight. The primary objective of this study was to prove parasitological and clinical cure rates above 90 % by day 28. RESULTS This single-arm open-label non-comparative trial was conducted according to the WHO recommended methodology for the surveillance of anti-malarial drug efficacy in the Brazilian Amazon. On day 28, the parasitological and clinical response was adequate in 98.8 % of patients (CI 95 % 93.4-100 %). The success rate on day 3 was 100 %, and the cumulative success rate by day 28 was 98.8 % (CI 95 % 91.7-99.8 %). There were no serious adverse events, with most adverse events classified as mild. The pharmacokinetic parameters of chloroquine analysed in whole blood dry spot samples showed mean (coefficient of variation) Cmax and AUC0-t values of 374.44 (0.35) and 3700.43 (0.36) ng/mL, respectively. DISCUSSION This study reports an appropriate safety and efficacy profile of a new formulation of coated chloroquine tablets for vivax malaria treatment in the Brazilian Amazon. The cure rates meet the WHO efficacy criteria, supporting current Brazilian guidelines and the use of the formulation for vivax malaria treatment. Nevertheless, further studies should be conducted to address adherence and the effectiveness of the formulation. Trial registration RBR-77q7t3-UTN: U1111-1121-2982. Registered 10th May 2011.
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Affiliation(s)
- Dhelio Pereira
- Tropical Medicine Research Center of Rondônia (CEPEM), Porto Velho, Rondônia, Brazil.,Laboratory of Parasitology, National Institute of Infectious Disease, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Federal University of Rondônia (UNIR), Porto Velho, Rondônia, Brazil
| | - André Daher
- Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. .,Vice-presidency of Research and Reference Laboratories, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Graziela Zanini
- Laboratory of Parasitology, National Institute of Infectious Disease, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ivan Maia
- Vice-presidency of Research and Reference Laboratories, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Lais Fonseca
- Laboratory of Pharmacokinetics (Sefar), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Luciana Pitta
- Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Rosilene Ruffato
- Tropical Medicine Research Center of Rondônia (CEPEM), Porto Velho, Rondônia, Brazil
| | - Paola Marchesini
- National Programme of Malaria Control, Ministry of Health, Brasília, Brazil
| | - Cor Jesus Fontes
- Julio Müller Hospital, Federal University of Mato Grosso, Cuiabá, Brazil
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50
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Faidallah HM, Panda SS, Serrano JC, Girgis AS, Khan KA, Alamry KA, Therathanakorn T, Meyers MJ, Sverdrup FM, Eickhoff CS, Getchell SG, Katritzky AR. Synthesis, antimalarial properties and 2D-QSAR studies of novel triazole-quinine conjugates. Bioorg Med Chem 2016; 24:3527-39. [DOI: 10.1016/j.bmc.2016.05.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/23/2016] [Accepted: 05/28/2016] [Indexed: 10/24/2022]
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