1
|
Kong WZ, Zhang HY, Sun YF, Song J, Jiang J, Cui HY, Zhang Y, Han S, Cheng Y. Plasmodium vivax tryptophan-rich antigen reduces type I collagen secretion via the NF-κBp65 pathway in splenic fibroblasts. Parasit Vectors 2024; 17:239. [PMID: 38802961 PMCID: PMC11131192 DOI: 10.1186/s13071-024-06264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The spleen plays a critical role in the immune response against malaria parasite infection, where splenic fibroblasts (SFs) are abundantly present and contribute to immune function by secreting type I collagen (collagen I). The protein family is characterized by Plasmodium vivax tryptophan-rich antigens (PvTRAgs), comprising 40 members. PvTRAg23 has been reported to bind to human SFs (HSFs) and affect collagen I levels. Given the role of type I collagen in splenic immune function, it is important to investigate the functions of the other members within the PvTRAg protein family. METHODS Protein structural prediction was conducted utilizing bioinformatics analysis tools and software. A total of 23 PvTRAgs were successfully expressed and purified using an Escherichia coli prokaryotic expression system, and the purified proteins were used for co-culture with HSFs. The collagen I levels and collagen-related signaling pathway protein levels were detected by immunoblotting, and the relative expression levels of inflammatory factors were determined by quantitative real-time PCR. RESULTS In silico analysis showed that P. vivax has 40 genes encoding the TRAg family. The C-terminal region of all PvTRAgs is characterized by the presence of a domain rich in tryptophan residues. A total of 23 recombinant PvTRAgs were successfully expressed and purified. Only five PvTRAgs (PvTRAg5, PvTRAg16, PvTRAg23, PvTRAg30, and PvTRAg32) mediated the activation of the NF-κBp65 signaling pathway, which resulted in the production of inflammatory molecules and ultimately a significant reduction in collagen I levels in HSFs. CONCLUSIONS Our research contributes to the expansion of knowledge regarding the functional role of PvTRAgs, while it also enhances our understanding of the immune evasion mechanisms utilized by parasites.
Collapse
Affiliation(s)
- Wei-Zhong Kong
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, 214000, China
| | - Hang-Ye Zhang
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, 214000, China
- Case Room, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yi-Fan Sun
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, 214000, China
- Department of Laboratory Medicine, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, People's Republic of China
| | - Jing Song
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jian Jiang
- Wuxi Red Cross Blood Center, Wuxi, 214000, China
| | - Heng-Yuan Cui
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214000, China
| | - Yu Zhang
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214000, China
| | - Su Han
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, 214000, China.
| | - Yang Cheng
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, 214000, China.
| |
Collapse
|
2
|
Duong MC, Pham OKN, Thai TT, Lee R, Nguyen TP, Nguyen VVC, Nguyen HP. Magnitude and patterns of severe Plasmodium vivax monoinfection in Vietnam: a 4-year single-center retrospective study. Front Med (Lausanne) 2023; 10:1128981. [PMID: 37324161 PMCID: PMC10265633 DOI: 10.3389/fmed.2023.1128981] [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: 12/21/2022] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Infection with Plasmodium vivax is a recognized cause of severe malaria including deaths. The exact burden and patterns of severe P. vivax monoinfections is however still not well quantified, especially in P. vivax endemic regions. We examined the magnitude and patterns of severe malaria caused by monoinfections of P. vivax and associated predictors among patients admitted to a tertiary care center for malaria in Vietnam. Methods A retrospective cohort study was conducted based on the patients' medical records at the Hospital for Tropical Diseases from January 2015 to December 2018. Extracted information included demographic, epidemiologic, clinical, laboratory and treatment characteristics. Results Monoinfections with P. vivax were found in 153 (34.5, 95% CI 30.3-39.1%) patients of whom, uncomplicated and severe malaria were documented in 89.5% (137/153, 95% CI 83.7-93.5%) and 10.5% (16/153, 95% CI 6.5-16.3%), respectively. Patterns of severe malaria included jaundice (8 cases), hypoglycemia (3 cases), shock (2 cases), anemia (2 cases), and cerebral malaria (1 case). Among 153 patients, 73 (47.7%) had classic malaria paroxysm, 57 (37.3%) had >7 days of illness at the time of admission, and 40 (26.1%) were referred from other hospitals. A misdiagnosis as having other diseases from malaria cases coming from other hospitals was up to 32.5% (13/40). Being admitted to hospital after day 7th of illness (AOR = 6.33, 95% CI 1.14-35.30, p = 0.035) was a predictor of severe malaria. Severe malaria was statistically associated with longer hospital length of stay (p = 0.035). Early and late treatment failures and recrudescence were not recorded. All patients recovered completely. Discussion This study confirms the emergence of severe vivax malaria in Vietnam which is associated with delayed hospital admission and increased hospital length of stay. Clinical manifestations of P. vivax infection can be misdiagnosed which results in delayed treatment. To meet the goal of malaria elimination by 2030, it is crucial that the non-tertiary hospitals have the capacity to quickly and correctly diagnose malaria and then provide treatment for malaria including P. vivax infections. More robust studies need to be conducted to fully elucidate the magnitude of severe P. vivax in Vietnam.
Collapse
Affiliation(s)
- Minh Cuong Duong
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Thanh Truc Thai
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Rogan Lee
- Centre for Infectious Diseases and Microbiology, Pathology West-ICPMR and Marie Bashir Institute, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | | | - Van Vinh Chau Nguyen
- Department of Health, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Hoan Phu Nguyen
- Medical School, Vietnam National University of Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| |
Collapse
|
3
|
Biswal D, Mirdha BR. A case of atypical vivax malaria with a global review of reports on myriads of morpho-variations in parasitized red blood cells. Access Microbiol 2023; 5:000461.v3. [PMID: 37223061 PMCID: PMC10202396 DOI: 10.1099/acmi.0.000461.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 02/07/2023] [Indexed: 05/25/2023] Open
Abstract
Plasmodium vivax, one of the major species associated with human malaria, continues to be a major public health problem in many parts of the world. Numerous studies related to vivax malaria have described quantitative haematological findings (level of haemoglobin, thrombocytopaenia, haematocrit values), but diverse morphological changes of parasite forms within infected red blood cells (iRBCs) have been mentioned only in few studies. Here we report a case of a 13-year-old boy who presented with fever, significant low platelet counts and hypovolaemia that created a diagnostic dilemma. Detection of microgametocytes by microscopic examinations, further confirmed by multiplex nested PCR assays and response to anti-malarials, helped to make the diagnosis. We present an atypical case of vivax malaria with a review of morpho-variations of iRBCs and have summarized the characteristics that aid in creating increased awareness among laboratory health professionals and public health workers.
Collapse
Affiliation(s)
- Debasish Biswal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bijay Ranjan Mirdha
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
4
|
Zhang H, Shen F, Yu J, Ge J, Sun Y, Fu H, Cheng Y. Plasmodium vivax Protein PvTRAg23 Triggers Spleen Fibroblasts for Inflammatory Profile and Reduces Type I Collagen Secretion via NF-κBp65 Pathway. Front Immunol 2022; 13:877122. [PMID: 35769479 PMCID: PMC9235351 DOI: 10.3389/fimmu.2022.877122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/16/2022] [Indexed: 01/04/2023] Open
Abstract
Plasmodium vivax is the most widespread human malaria parasite. The spleen is one of the most significant immune organs in the course of Plasmodium infection, and it contains splenic fibroblasts (SFs), which supports immunologic function by secreting type I collagen (collagen I). Plasmodium proteins have rarely been found to be involved in collagen alterations in the spleen during infection. Here, we selected the protein P. vivax tryptophan-rich antigen 23 (PvTRAg23), which is expressed by the spleen-dependent gene Pv-fam-a and is a member of the PvTRAgs family of export proteins, suggesting that it might have an effect on SFs. The protein specifically reduced the level of collagen I in human splenic fibroblasts (HSFs) and bound to cells with vimentin as receptors. However, such collagen changes were not mediated by binding to vimentin, but rather activating the NF-κBp65 pathway to produce inflammatory cytokines. Collagen impaired synthesis accompanied by extracellular matrix-related changes occurred in the spleen of mice infected with P. yoelii 17XNL. Overall, this study is the first one to report and verify the role of Plasmodium proteins on collagen in HSF in vitro. Results will contribute to further understanding of host spleen structural changes and immune responses after Plasmodium infection.
Collapse
Affiliation(s)
- Hangye Zhang
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Feihu Shen
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, China
- Lianyungan Center for Disease Control and Prevention, Wuxi, China
| | - Jiali Yu
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Jieyun Ge
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yifan Sun
- Department of Clinical Laboratory, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Haitian Fu
- Department of Nuclear Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yang Cheng
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, China
- *Correspondence: Yang Cheng,
| |
Collapse
|
5
|
Obaldía N, Barahona I, Lasso J, Avila M, Quijada M, Nuñez M, Marti M. Comparison of PvLAP5 and Pvs25 qRT-PCR assays for the detection of Plasmodium vivax gametocytes in field samples preserved at ambient temperature from remote malaria endemic regions of Panama. PLoS Negl Trop Dis 2022; 16:e0010327. [PMID: 35394999 PMCID: PMC9020738 DOI: 10.1371/journal.pntd.0010327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/20/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND As the elimination of malaria in Mesoamerica progresses, detection of Plasmodium vivax using light microscopy (LM) becomes more difficult. Highly sensitive molecular tools have been developed to help determine the hidden reservoir of malaria transmission in low transmission settings. In this study we compare the performance of PvLAP5 and Pvs25 qRT-PCR assays to LM for the detection of Plasmodium vivax gametocytes in field samples preserved at ambient temperature from malaria endemic regions of Panama. METHODS For this purpose, we collected a total of 83 malaria field samples during 2017-2020 preserved in RNAprotect (RNAp) of which 63 (76%) were confirmed P. vivax by LM and selected for further analysis. Additionally, 16 blood samples from local healthy malaria smear negative volunteers, as well as, from 15 malaria naïve lab-bred Aotus monkeys were used as controls. To optimize the assays, we first determined the minimum blood volume sufficient for detection of PvLAP5 and Pv18SrRNA using P. vivax infected Aotus blood that was preserved in RNAp and kept either at ambient temperature for up to 8 days before freezing or was snap-frozen at -80° Celsius at the time of bleeding. We then compared the mean differences in gametocyte detection rates of both qRT-PCR assays to LM and performed a multivariate correlation analysis of study variables. Finally, we determined the sensitivity (Se) and specificity (Sp) of the assays at detecting gametocytes compared to LM. RESULTS Blood volume optimization indicated that a blood volume of at least 60 μL was sufficient for detection of PvLAP5 and Pv18SrRNA and no significant differences were found between RNA storage conditions. Both PvLAP5 and Pvs25 qRT-PCR assays showed a 37-39% increase in gametocyte detection rate compared to LM respectively. Strong positive correlations were found between gametocytemia and parasitemia and both PvLAP5 and Pvs25 gametocyte markers. However, no significant differences were detected in the Se and Sp of the Pvs25 and PvLAP5 qRT-PCR assays, even though data from control samples suggested Pvs25 to be more abundant than PvLAP5. CONCLUSIONS This study shows that the PvLAP5 qRT-PCR assay is as Se and Sp as the gold standard Pvs25 assay and is at least 37% more sensitive than LM at detecting P. vivax gametocytes in field samples preserved in RNAp at ambient temperature from malaria endemic regions of Panama. AUTHOR SUMMARY Plasmodium vivax is one of the five species of malaria (P. falciparum, P. malariae, P. ovale and P. knowlesi) that are transmitted to man by the bite of female anopheles mosquitoes. It causes ~14.3 million cases mainly in Southeast Asia, India, the Western Pacific and the Americas annually. In the Americas, malaria remains a major problem in underdeveloped areas and indigenous communities in the Amazon region and eastern Panama, where it is endemic and difficult to eliminate. As malaria elimination progresses, detection of P. vivax by light microscopy (LM) becomes more difficult. Therefore, highly sensitive molecular tools have been developed that use genetic markers for the parasite to help determine the hidden reservoir of malaria transmission. This study compares the performance of two molecular assays based on the genetic markers of mature gametocytes PvLAP5 and Pvs25 with LM. The study shows that the PvLAP5 qRT-PCR assay is as sensitive and specific as the gold standard Pvs25 assay and is at least 37% more sensitive than LM at detecting P. vivax gametocytes. These data suggest that the PvLAP5 qRT-PCR assay can be a useful tool to help determine the hidden reservoir of transmission in endemic foci approaching elimination.
Collapse
Affiliation(s)
- Nicanor Obaldía
- Departamento de Investigaciones en Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá, Republic of Panamá
- Department of Immunology and Infectious Diseases, Harvard T.H. CHAN School of Public Health, Boston, Massachusetts, United States of America
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Itza Barahona
- Departamento de Control de Vectores, Dirección General de Salud Pública, Ministerio de Salud de Panamá, Panamá, Republic of Panamá
| | - José Lasso
- Departamento de Control de Vectores, Dirección General de Salud Pública, Ministerio de Salud de Panamá, Panamá, Republic of Panamá
| | - Mario Avila
- Departamento de Control de Vectores, Dirección General de Salud Pública, Ministerio de Salud de Panamá, Panamá, Republic of Panamá
| | - Mario Quijada
- Departamento de Investigaciones en Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá, Republic of Panamá
| | - Marlon Nuñez
- Departamento de Investigaciones en Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá, Republic of Panamá
| | - Matthias Marti
- Department of Immunology and Infectious Diseases, Harvard T.H. CHAN School of Public Health, Boston, Massachusetts, United States of America
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| |
Collapse
|
6
|
Fu H, Lu J, Zhang X, Wang B, Sun Y, Lei Y, Shen F, Kassegne K, Han ET, Cheng Y. Identification of the Recombinant Plasmodium vivax Surface-Related Antigen as a Possible Immune Evasion Factor Against Human Splenic Fibroblasts by Targeting ITGB1. Front Cell Dev Biol 2021; 9:764109. [PMID: 34938733 PMCID: PMC8685506 DOI: 10.3389/fcell.2021.764109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
Plasmodium vivax-infected erythrocytes can enter the spleen and evade spleen clearance to establish chronic infections. However, the mechanism underlying P. vivax immune evasion in the spleen is still unclear. Human splenic fibroblasts (HSF), also known as barrier cells, play an essential role in the immune function of spleen. A hypothesis holds that P. vivax-infected erythrocytes induce spleen structural remodeling to form barrier cells. Subsequently, these infected erythrocytes can selectively cytoadhere to these barrier cells to escape spleen clearance. In this work, we found that P. vivax surface-related antigen (PvSRA; PlasmoDB ID: PVX_084970), an exported protein on infected erythrocyte membrane, could bind with HSF. Considering the above hypothesis, we speculated that PvSRA might be involved in P. vivax immune evasion by changing HSF cell performance. To investigate this speculation, RNA sequencing, protein microarray, and bioinformatics analysis technologies were applied, and in vitro validations were further performed. The results showed that the recombinant PvSRA attracted HSF migration and interacted with HSF by targeting integrin β1 (ITGB1) along with changes in HSF cell performance, such as focal adhesion, extracellular matrix, actin cytoskeleton, and cell cycle. This study indicated that PvSRA might indeed participate in the immune evasion of P. vivax in the spleen by changing HSF function through PvSRA-ITGB1 axis.
Collapse
Affiliation(s)
- Haitian Fu
- Affiliated Hospital of Jiangnan University, Wuxi, China
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Jiachen Lu
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Xinxin Zhang
- Yantai Center for Disease Control and Prevention, Yantai, China
| | - Bo Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yifan Sun
- Affiliated Hospital of Jiangnan University, Wuxi, China
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yao Lei
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Feihu Shen
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Kokouvi Kassegne
- Chinese Center for Tropical Diseases Research, School of Global Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Eun-Taek Han
- Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Yang Cheng
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| |
Collapse
|
7
|
Santos MLS, Coimbra RS, Sousa TN, Guimarães LFF, Gomes MS, Amaral LR, Pereira DB, Fontes CJF, Hawwari I, Franklin BS, Carvalho LH. The Interface Between Inflammatory Mediators and MicroRNAs in Plasmodium vivax Severe Thrombocytopenia. Front Cell Infect Microbiol 2021; 11:631333. [PMID: 33791239 PMCID: PMC8005714 DOI: 10.3389/fcimb.2021.631333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/17/2021] [Indexed: 11/27/2022] Open
Abstract
Severe thrombocytopenia can be a determinant factor in the morbidity of Plasmodium vivax, the most widespread human malaria parasite. Although immune mechanisms may drive P. vivax-induced severe thrombocytopenia (PvST), the current data on the cytokine landscape in PvST is scarce and often conflicting. Here, we hypothesized that the analysis of the bidirectional circuit of inflammatory mediators and their regulatory miRNAs would lead to a better understanding of the mechanisms underlying PvST. For that, we combined Luminex proteomics, NanoString miRNA quantification, and machine learning to evaluate an extensive array of plasma mediators in uncomplicated P. vivax patients with different degrees of thrombocytopenia. Unsupervised clustering analysis identified a set of PvST-linked inflammatory (CXCL10, CCL4, and IL-18) and regulatory (IL-10, IL-1Ra, HGF) mediators. Among the mediators associated with PvST, IL-6 and IL-8 were critical to discriminate P. vivax subgroups, while CCL2 and IFN-γ from healthy controls. Supervised machine learning spotlighted IL-10 in P. vivax-mediated thrombocytopenia and provided evidence for a potential signaling route involving IL-8 and HGF. Finally, we identified a set of miRNAs capable of modulating these signaling pathways. In conclusion, the results place IL-10 and IL-8/HGF in the center of PvST and propose investigating these signaling pathways across the spectrum of malaria infections.
Collapse
Affiliation(s)
| | - Roney S. Coimbra
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Tais N. Sousa
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | | | - Matheus S. Gomes
- Laboratório de Bioinformática e Análises Moleculares, Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia, Universidade Federal de Uberlândia, Patos de Minas, Brazil
| | - Laurence R. Amaral
- Laboratório de Bioinformática e Análises Moleculares, Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia, Universidade Federal de Uberlândia, Patos de Minas, Brazil
| | - Dhelio B. Pereira
- Dep. Pesquisa Clínica e Medicina Translacional, Centro de Pesquisas em Medicina Tropical, Porto Velho, Brazil
| | - Cor J. F. Fontes
- Departamento de Clínica Médica, Universidade Federal de Mato Grosso, Cuiabá, Brazil
| | - Ibrahim Hawwari
- Medical Faculty, Institute of Innate Immunity, University of Bonn, Bonn, Germany
| | - Bernardo S. Franklin
- Medical Faculty, Institute of Innate Immunity, University of Bonn, Bonn, Germany
| | - Luzia H. Carvalho
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| |
Collapse
|
8
|
Ferluga J, Singh I, Rout S, Al-Qahtani A, Yasmin H, Kishore U. Immune Responses in Malaria and Vaccine Strategies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1313:273-291. [PMID: 34661899 DOI: 10.1007/978-3-030-67452-6_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Malaria is a pandemic with nearly half of global population at risk, caused by parasite Plasmodium species, particularly P. falciparum with a high morbidity and mortality, especially among children. There is an urgent need for development of population protective vaccines, such as in sub-Saharan low-income countries, where P. falciparum malaria is endemic. After years of endeavour with children and adults for safety and efficacy clinical trials, the P. falciparum circumsporozoite protein antigen, is targeted by specific antibodies induced by recombinant vaccine, called TRS,S. TRS,S has been authorized by WHO and Malawi Government to be the first malaria vaccine for up to 2 years of aged children for protection against malaria. Other malaria vaccines in clinical trials are also very promising candidates, including the original live, X-ray attenuated P-sporozoite vaccine, inducing antigen-specific T cell immunity at liver stage. Malaria parasite at blood symptomatic stage is targeted by specific antibodies to parasite-infected erythrocytes, which are important against pathogenic placenta-infected erythrocyte sequestration. Here, the demographic distribution of Plasmodium species and their pathogenicity in infected people are discussed. The role of innate phagocytic cells and malaria antigen specific T cell immunity, as well as that of specific antibody production by B cells are highlighted. The paramount role of cytotoxic CD8+ T cellular immunity in malaria people protection is also included.
Collapse
Affiliation(s)
- Janez Ferluga
- Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Iesha Singh
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sashmita Rout
- Department of Physiology, All-India Institute of Medical Sciences, Bhubaneswar, India
| | - Ahmed Al-Qahtani
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hadida Yasmin
- Immunology and Cell Biology Laboratory, Department of Zoology, Cooch Behar Panchanan Barma University, Cooch Behar, West Bengal, India
| | - Uday Kishore
- Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| |
Collapse
|
9
|
Ghanchi N, Khan AA, Raheem A, Beg MA. Plasmodium vivax Mimicking Morphologic Features of Plasmodium falciparum. Cureus 2020; 12:e11406. [PMID: 33312804 PMCID: PMC7725463 DOI: 10.7759/cureus.11406] [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] [Indexed: 11/09/2022] Open
Abstract
Plasmodium vivax (P. vivax) is the most common cause of malaria in Pakistan. Several cases of severe malaria due to P.vivax have been reported from Pakistan and India, however morphological characteristics of the parasite have been mainly ignored. We present two cases of P. vivax mono-infection, which were characterized by multiple infected red blood cells, similar to that seen in Plasmodium falciparum, as observed under microscopy. Both cases were confirmed as mono-infection of P.vivax on Giemsa stained thick and thin films, malaria rapid diagnostic test (RDT) and Polymerase Chain Reaction (PCR). Morphology on peripheral blood smear remains the gold standard for diagnosis of malaria and mimicking morphological features leads to misdiagnosis and mismanagement of patients.
Collapse
Affiliation(s)
- Najia Ghanchi
- Pathology, Aga Khan University Hospital, Karachi, PAK
| | - Adnan A Khan
- Anesthesiology, Aga Khan University Hospital, Karachi, PAK
| | - Ahmed Raheem
- Emergency Medicine, Aga Khan University Hospital, Karachi, PAK
| | | |
Collapse
|
10
|
Rivera-Correa J, Yasnot-Acosta MF, Tovar NC, Velasco-Pareja MC, Easton A, Rodriguez A. Atypical memory B-cells and autoantibodies correlate with anemia during Plasmodium vivax complicated infections. PLoS Negl Trop Dis 2020; 14:e0008466. [PMID: 32687495 PMCID: PMC7392348 DOI: 10.1371/journal.pntd.0008466] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/30/2020] [Accepted: 06/09/2020] [Indexed: 01/01/2023] Open
Abstract
Malaria caused by Plasmodium vivax is a highly prevalent infection world-wide, that was previously considered mild, but complications such as anemia have been highly reported in the past years. In mice models of malaria, anti-phosphatidylserine (anti-PS) autoantibodies, produced by atypical B-cells, bind to uninfected erythrocytes and contribute to anemia. In human patients with P. falciparum malaria, the levels of anti-PS, atypical B-cells and anemia are strongly correlated to each other. In this study, we focused on assessing the relationship between autoantibodies, different B-cell populations and hemoglobin levels in two different cohorts of P. vivax patients from Colombia, South America. In a first longitudinal cohort, our results show a strong inverse correlation between different IgG autoantibodies tested (anti-PS, anti-DNA and anti-erythrocyte) and atypical memory B-cells (atMBCs) with hemoglobin in both P. vivax and P. falciparum patients over time. In a second cross-sectional cohort, we observed a stronger relation between hemoglobin levels, atMBCs and autoantibodies in complicated P. vivax patients compared to uncomplicated ones. Altogether, these data constitute the first evidence of autoimmunity associating with anemia and complicated P. vivax infections, suggesting a role for its etiology through the expansion of autoantibody-secreting atMBCs. Malaria is one of the top global infections causing high mortality and morbidity every year. Plasmodium vivax is the most prevalent malarial infection, particularly in the region of the Americas. Complications associated with P. vivax, such as anemia, are a growing reported phenomenon, but the mechanisms leading to them are poorly understood. Here, we report the first evidence of autoantibodies and Atypical Memory B-cells correlating with anemia in two different cohorts of P. vivax patients, particularly during complicated infections. These findings point to Atypical Memory B-cells as key pathological players, possibly through the secretion of autoantibodies, and attributes a role for autoimmunity in mediating complications during P. vivax infections.
Collapse
Affiliation(s)
- Juan Rivera-Correa
- New York University School of Medicine, New York, United States of America
- * E-mail: (JRC); (AR)
| | | | - Nubia Catalina Tovar
- New York University School of Medicine, New York, United States of America
- Grupo de Investigaciones Microbiológicas y Biomédicas de Córdoba, Universidad de Córdoba, Colombia
- Universidad del Sinú, Montería, Colombia
- Universidad de Cartagena, Bolívar, Colombia
| | | | - Alice Easton
- New York University School of Medicine, New York, United States of America
| | - Ana Rodriguez
- New York University School of Medicine, New York, United States of America
- * E-mail: (JRC); (AR)
| |
Collapse
|
11
|
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
Collapse
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
| |
Collapse
|
12
|
Antonelli LR, Junqueira C, Vinetz JM, Golenbock DT, Ferreira MU, Gazzinelli RT. The immunology of Plasmodium vivax malaria. Immunol Rev 2019; 293:163-189. [PMID: 31642531 DOI: 10.1111/imr.12816] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022]
Abstract
Plasmodium vivax infection, the predominant cause of malaria in Asia and Latin America, affects ~14 million individuals annually, with considerable adverse effects on wellbeing and socioeconomic development. A clinical hallmark of Plasmodium infection, the paroxysm, is driven by pyrogenic cytokines produced during the immune response. Here, we review studies on the role of specific immune cell types, cognate innate immune receptors, and inflammatory cytokines on parasite control and disease symptoms. This review also summarizes studies on recurrent infections in individuals living in endemic regions as well as asymptomatic infections, a serious barrier to eliminating this disease. We propose potential mechanisms behind these repeated and subclinical infections, such as poor induction of immunological memory cells and inefficient T effector cells. We address the role of antibody-mediated resistance to P. vivax infection and discuss current progress in vaccine development. Finally, we review immunoregulatory mechanisms, such as inhibitory receptors, T regulatory cells, and the anti-inflammatory cytokine, IL-10, that antagonizes both innate and acquired immune responses, interfering with the development of protective immunity and parasite clearance. These studies provide new insights for the clinical management of symptomatic as well as asymptomatic individuals and the development of an efficacious vaccine for vivax malaria.
Collapse
Affiliation(s)
- Lis R Antonelli
- Instituto de Pesquisas Rene Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Caroline Junqueira
- Instituto de Pesquisas Rene Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Joseph M Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Douglas T Golenbock
- Division of Infectious Disease and immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Marcelo U Ferreira
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo T Gazzinelli
- Instituto de Pesquisas Rene Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil.,Division of Infectious Disease and immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.,Plataforma de Medicina Translacional, Fundação Oswaldo Cruz, Ribeirão Preto, Brazil
| |
Collapse
|
13
|
Cytotoxic CD8 + T cells recognize and kill Plasmodium vivax-infected reticulocytes. Nat Med 2018; 24:1330-1336. [PMID: 30038217 PMCID: PMC6129205 DOI: 10.1038/s41591-018-0117-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 06/05/2018] [Indexed: 01/02/2023]
Abstract
Plasmodium vivax causes approximately 100 million
clinical malaria cases yearly1,2. The basis of protective
immunity is poorly understood and thought to be mediated by antibodies3,4. Cytotoxic CD8+ T cells (CTLs)
protect against other intracellular parasites by detecting parasite peptides
presented by Human Leukocyte Antigen Class I (HLA-I) on host cells. CTLs kill
parasite-infected mammalian cells and intracellular parasites by releasing their
cytotoxic granules5,6. Perforin (PFN) delivers the
antimicrobial peptide granulysin (GNLY) and death-inducing granzymes (Gzm) into
the host cell, and GNLY then delivers Gzms into the parasite. CTLs were thought
to have no role against Plasmodium spp. blood stages because
red blood cells (RBCs) generally do not express HLA-I7. However, P. vivax
infects reticulocytes (Retics) that retain the protein translation machinery.
Here we show that P. vivax-infected Retics (iRetic) express
HLA-I. Infected patient circulating CD8+ T cells highly
express cytotoxic proteins and recognize and form immunological synapses with
iRetics in an HLA-dependent manner, releasing their cytotoxic granules to kill
both host cell and intracellular parasite, preventing reinvasion. iRetic and
parasite killing is PFN-independent, but depends on GNLY, which generally
efficiently forms pores only in microbial membranes8. We find that P. vivax
depletes cholesterol from the iRetic cell membrane, rendering it
GNLY-susceptible. This unexpected T cell defense might be mobilized to improve
P. vivax vaccine efficacy.
Collapse
|
14
|
Roche B, Rougeron V, Quintana-Murci L, Renaud F, Abbate JL, Prugnolle F. Might Interspecific Interactions between Pathogens Drive Host Evolution? The Case of Plasmodium Species and Duffy-Negativity in Human Populations. Trends Parasitol 2017; 33:21-29. [DOI: 10.1016/j.pt.2016.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/06/2016] [Accepted: 09/23/2016] [Indexed: 12/27/2022]
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Alencar-Filho AC, Ferreira JMBB, Salinas JL, Fabbri C, Monteiro WM, Siqueira AM, Okoshi K, Lacerda MVG, Okoshi MP. Cardiovascular changes in patients with non-severe Plasmodium vivax malaria. IJC HEART & VASCULATURE 2016; 11:12-16. [PMID: 28616519 PMCID: PMC5441355 DOI: 10.1016/j.ijcha.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/04/2016] [Indexed: 11/19/2022]
Abstract
Background Cardiovascular system involvement in patients with Plasmodium vivax malaria has been poorly addressed. The aim of this study was to evaluate cardiac structures and function, and serum markers of cardiovascular injury in patients with the non-severe form of vivax malaria in Manaus, Amazonas State, Brazil. Methods and results We prospectively evaluated 26 patients with vivax malaria in an outpatient referral hospital and compared results with a control group of 25 gender- and age-matched healthy individuals. Patients underwent clinical evaluation, laboratory tests, and transthoracic echocardiography at first evaluation (day zero, D0) and seven days (D7) after malaria diagnosis. At D0 echocardiography showed higher left ventricular (LV) systolic diameter (28.8 ± 2.82 vs 30.9 ± 4.03 mm; p = 0.037) and LV diastolic volume (82.4 ± 12.3 vs 93.8 ± 25.9 ml; p = 0.05), and lower LV ejection fraction (Teicholz method: 73.2 ± 6.59 vs 68.4 ± 4.87%; p = 0.004) in patients compared to controls. Right ventricle (RV) fractional area change (54.7 ± 5.11 vs 50.5 ± 6.71%; p = 0.014) was lower, and RV myocardial performance index (0.21 ± 0.07 vs 0.33 ± 0.19; p = 0.007), and pulmonary vascular resistance (1.13 ± 0.25 vs 1.32 ± 0.26 Woods unit; p = 0.012) were higher in patients than controls. Patients presented higher serum levels of unconjugated bilirubin (0.24 ± 0.15 vs 1.30 ± 0.89 mg/dL; p < 0.001), soluble vascular cell adhesion molecule–1 (sVCAM-1; 453 ± 143 vs 1983 ± 880 ng/mL; p < 0.001), N-terminal prohormone brain natriuretic peptide (0.59 ± 0.86 vs 1.08 ± 0.81 pg/mL; p = 0.045), and troponin T (861 ± 338 vs 1037 ± 264 pg/mL; p = 0.045), and lower levels of plasma nitrite (13.42 ± 8.15 vs 8.98 ± 3.97 μM; p = 0.016) than controls. Most alterations had reversed by D7. Conclusion Patients with non-severe Plasmodium vivax malaria present subclinical reversible cardiovascular changes.
Collapse
Affiliation(s)
| | | | | | - Camila Fabbri
- North University Center, Pharmacy School, Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Amazonas State University (UEA), Manaus, Brazil.,Tropical Disease Center "Dr. Heitor Vieira Dourado", Manaus, Brazil
| | - Andre Machado Siqueira
- National Institute of Infectology Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | | |
Collapse
|
17
|
Abstract
Severe malaria in pregnancy is a large contributor to maternal morbidity and mortality. Intravenous quinine has traditionally been the treatment drug of choice for severe malaria in pregnancy. However, recent randomized clinical trials (RCTs) indicate that intravenous artesunate is more efficacious for treating severe malaria, resulting in changes to the World Health Organization (WHO) treatment guidelines. Artemisinins, including artesunate, are embryo-lethal in animal studies and there is limited experience with their use in the first trimester. This review summarizes the current literature supporting 2010 WHO treatment guidelines for severe malaria in pregnancy and the efficacy, pharmacokinetics, and adverse event data for currently used antimalarials available for severe malaria in pregnancy. We identified ten studies on the treatment of severe malaria in pregnancy that reported clinical outcomes. In two studies comparing intravenous quinine with intravenous artesunate, intravenous artesunate was more efficacious and safe for use in pregnant women. No studies detected an increased risk of miscarriage, stillbirth, or congenital anomalies associated with first trimester exposure to artesunate. Although the WHO recommends using either quinine or artesunate for the treatment of severe malaria in first trimester pregnancies, our findings suggest that artesunate should be the preferred treatment option for severe malaria in all trimesters.
Collapse
|
18
|
Characterization of Plasmodium vivax-associated admissions to reference hospitals in Brazil and India. BMC Med 2015; 13:57. [PMID: 25889040 PMCID: PMC4404636 DOI: 10.1186/s12916-015-0302-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 02/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The benign character formerly attributed to Plasmodium vivax infection has been dismantled by the increasing number of reports of severe disease associated with infection with this parasite, prompting the need for more thorough and comprehensive characterization of the spectrum of resulting clinical complications. Endemic areas exhibit wide variations regarding severe disease frequency. This study, conducted simultaneously in Brazil and India, constitutes, to our knowledge, the first multisite study focused on clinical characterization of P. vivax severe disease. METHODS Patients admitted with P. vivax mono-infection at reference centers in Manaus (Amazon - Brazil) and Bikaner (Rajasthan - India), where P. vivax predominates, were submitted to standard thorough clinical and laboratory evaluations in order to characterize clinical manifestations and identify concurrent co-morbidities. RESULTS In total, 778 patients (88.0% above 12 years old) were hospitalized at clinical discretion with PCR-confirmed P. vivax mono-infection (316 in Manaus and 462 in Bikaner), of which 197 (25.3%) presented at least one severity criterion as defined by the World Health Organization (2010). Hyperlactatemia, respiratory distress, hypoglycemia, and disseminated intravascular coagulation were more frequent in Manaus. Noteworthy, pregnancy status was associated as a risk factor for severe disease (OR = 2.03; 95% CI = 1.2-3.4; P = 0.007). The overall case fatality rate was 0.3/1,000 cases in Manaus and 6.1/1,000 cases in Bikaner, with all deaths occurring among patients fulfilling at least one severity criterion. Within this subgroup, case fatality rates increased respectively to 7.5% in Manaus and 4.4% in Bikaner. CONCLUSION P. vivax-associated severity is not negligible, and although lethality observed for complicated cases was similar, the overall fatality rate was about 20-fold higher in India compared to Brazil, highlighting the variability observed in different settings. Our observations highlight that pregnant women and patients with co-morbidities need special attention when infected by this parasite due to higher risk of complications.
Collapse
|
19
|
Obaldia N. Determinants of low socio-economic status and risk of Plasmodium vivax malaria infection in Panama (2009-2012): a case-control study. Malar J 2015; 14:14. [PMID: 25603818 PMCID: PMC4320569 DOI: 10.1186/s12936-014-0529-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/21/2014] [Indexed: 11/15/2022] Open
Abstract
Background Identification of risk factors is important for the establishment of malaria elimination programmes tailored to specific regions. Type of house construction had been associated with increasing risk of acquiring malaria. This study aimed at establishing the association between determinants of low socio-economic status (SES) and type of house construction with the likelihood of living in a Plasmodium vivax malarious corregimiento (smallest political division) in Panama during 2009–2012. Methods To determine the association between type-2 houses (build with deciduous materials) and other determinants of low SES, with living in a malarious corregimiento, this study analyzed demographic and housing census data (2010), and malaria incidence aggregated at the corregimiento level (2009–2012), using a Spearman’s non-parametric correlation test to explore for associations, followed by a case–control study and a reduced multivariate logistic regression approach for confirmation. Results A descriptive temporal and spatial analysis indicated that P. vivax in Panama was associated with Amerindian reservations. Moreover, this study demonstrated that a strong correlation (deleterious effect) existed between living in a malarious corregimiento and being exposed to a type-2 house (OR = > 1.0) (p < 0.001), while, it showed an inverse correlation for exposure to type-1 houses (protective effect) (build with permanent materials) (OR = < 1.0) (p < 0.001). In the same way, a significant association between exposure to type-2 houses and the outcome of living in a malarious corregimiento was found using a case–control study approach (Chi2 test = p < 0.001), that was confirmed applying a reduced multivariate logistic regression fitted model. Conclusions This study demonstrated that living in a P. vivax malarious corregimiento in Panama during 2009–2012 was strongly correlated with those corregimientos having a high proportion of type-2 houses. A multivariate logistic regression approach at the house and corregimiento level indicated a strong association of type-2 houses, dirt floors and illiteracy with the likelihood of living in a malarious corregimiento. It is expected that these findings will help implement a multi-sectorial approach for the elimination of malaria in poor areas of Panama where malaria is endemic, which emphasizes house improvements such as mosquito-proofing and socio-economic development. Electronic supplementary material The online version of this article (doi:10.1186/s12936-014-0529-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nicanor Obaldia
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA. .,Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama, Panama.
| |
Collapse
|
20
|
Vandekerckhove S, D'hooghe M. Quinoline-based antimalarial hybrid compounds. Bioorg Med Chem 2014; 23:5098-119. [PMID: 25593097 DOI: 10.1016/j.bmc.2014.12.018] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/03/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022]
Abstract
Quinoline-containing compounds, such as quinine and chloroquine, have a long-standing history as potent antimalarial agents. However, the increasing resistance of the Plasmodium parasite against these drugs and the lack of licensed malaria vaccines have forced chemists to develop synthetic strategies toward novel biologically active molecules. A strategy that has attracted considerable attention in current medicinal chemistry is based on the conjugation of two biologically active molecules into one hybrid compound. Since quinolines are considered to be privileged antimalarial building blocks, the synthesis of quinoline-containing antimalarial hybrids has been elaborated extensively in recent years. This review provides a literature overview of antimalarial hybrid molecules containing a quinoline core, covering publications between 2009 and 2014.
Collapse
Affiliation(s)
- Stéphanie Vandekerckhove
- SynBioC Research Group, Department of Sustainable Organic Chemistry and Technology, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium
| | - Matthias D'hooghe
- SynBioC Research Group, Department of Sustainable Organic Chemistry and Technology, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium.
| |
Collapse
|
21
|
|
22
|
Totino PRR, Magalhães ADD, Alves EB, Costa MRF, de Lacerda MVG, Daniel-Ribeiro CT, Ferreira-da-Cruz MDF. Plasmodium falciparum, but not P. vivax, can induce erythrocytic apoptosis. Parasit Vectors 2014; 7:484. [PMID: 25325923 PMCID: PMC4206708 DOI: 10.1186/s13071-014-0484-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 10/07/2014] [Indexed: 12/20/2022] Open
Abstract
Background Apoptosis can occur in red blood cells (RBC) and seems to be involved in hematologic disorders related to many diseases. In malaria it is known that parasitized RBC (pRBC) is involved in the development of anemia and thrombosis; however, non-parasitized RBC (nRBC) apoptosis could amplify these malaria-associated hematologic events. In fact, in experimental malaria, increased levels of apoptosis were observed in nRBC during lethal Plasmodium yoelii 17XL infection, but in human malaria erythrocytic apoptosis has never been studied. The present study was performed to investigate if nRBC apoptosis also occurs in P. vivax and P. falciparum infections. Findings Apoptosis of nRBC was evaluated in blood samples of P. vivax malaria patients and clinically healthly individuals living in Manaus, Brazil, both ex vivo and after incubation of RBC for 24 h. Additionally, the capacity of plasma from P. vivax or P. falciparum patients was tested for induction of in vitro apoptosis of normal RBC from a clinically healthy individual living in a non-endemic malaria region. Apoptosis was detected by flow cytometry using annexin V staining. In contrast to experimental malaria that significantly increased the levels of apoptotic nRBC both ex-vivo and after 24 h of incubation, no significant alteration on apoptotic nRBC rates was detected in P. vivax infected patients when compared with non-infected control individuals. Similar results were observed when plasma of these P. vivax patients was incubated with normal RBC. Conversely, plasma from P. falciparum-infected subjects induced significant apoptosis of these cells. Conclusions Apoptosis of normal RBC can be induced by plasma from individuals with P. falciparum (but not with P. vivax) malaria. This finding could reflect the existence of erythrocytic apoptosis during infection that could contribute to the pathogenesis of hematological and vascular complications associated with falciparum malaria.
Collapse
Affiliation(s)
- Paulo Renato Rivas Totino
- Laboratório de Pesquisas em Malária, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil. .,Centro de Pesquisa, Diagnóstico e Treinamento em Malária, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brazil.
| | - Aline das Dores Magalhães
- Laboratório de Pesquisas em Malária, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil. .,Centro de Pesquisa, Diagnóstico e Treinamento em Malária, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brazil.
| | | | | | | | - Cláudio Tadeu Daniel-Ribeiro
- Laboratório de Pesquisas em Malária, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil. .,Centro de Pesquisa, Diagnóstico e Treinamento em Malária, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brazil.
| | - Maria de Fátima Ferreira-da-Cruz
- Laboratório de Pesquisas em Malária, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil. .,Centro de Pesquisa, Diagnóstico e Treinamento em Malária, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brazil.
| |
Collapse
|
23
|
Abstract
Splenic infarction is a rare complication of malaria. We report two recent cases of splenic infarction after Plasmodium vivax infection. No systematic review of malaria-induced splenic infarction was available, therefore we conducted a systematic review of the English, French, and Spanish literature in PubMed and KoreaMed for reports of malaria-associated splenic infarction from 1960 to 2012. Of the 40 cases collected on splenic infarction by Plasmodium species, 23 involved P. vivax, 11 Plasmodium falciparum, one Plasmodium ovale, and five a mixed infection of P. vivax and P. falciparum. Of the 40 cases, 2 (5.0%) involved splenectomy and 5 (12.5%) were accompanied by splenic rupture. The median time from symptom onset to diagnosis was 8.5 days (range, 3-90 days). Improved findings after treatment were observed in 8 (88.9%) of 9 patients with splenic infarction on follow-up by computed tomography or ultrasonography. All patients survived after treatment with the exception of one patient with cerebral malaria. Clinicians should consider the possibility of splenic infarction when malaria-infected patients have left upper quadrant pain.
Collapse
Affiliation(s)
- Jeong-Hwan Hwang
- Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Chonbuk National University Hospital, Jeonju, Republic of Korea
| |
Collapse
|
24
|
Affiliation(s)
- Quique Bassat
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Carrer Rosselló 132, 5° 2, 08036 Barcelona, Spain Centro de Investigação em Saúde de Manhiça (CISM), Maputo, CP1929 Mozambique
| |
Collapse
|
25
|
Nunes JK, Woods C, Carter T, Raphael T, Morin MJ, Diallo D, Leboulleux D, Jain S, Loucq C, Kaslow DC, Birkett AJ. Development of a transmission-blocking malaria vaccine: progress, challenges, and the path forward. Vaccine 2014; 32:5531-9. [PMID: 25077422 DOI: 10.1016/j.vaccine.2014.07.030] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/12/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
New interventions are needed to reduce morbidity and mortality associated with malaria, as well as to accelerate elimination and eventual eradication. Interventions that can break the cycle of parasite transmission, and prevent its reintroduction, will be of particular importance in achieving the eradication goal. In this regard, vaccines that interrupt malaria transmission (VIMT) have been highlighted as an important intervention, including transmission-blocking vaccines that prevent human-to-mosquito transmission by targeting the sexual, sporogonic, or mosquito stages of the parasite (SSM-VIMT). While the significant potential of this vaccine approach has been appreciated for decades, the development and licensure pathways for vaccines that target transmission and the incidence of infection, as opposed to prevention of clinical malaria disease, remain ill-defined. This article describes the progress made in critical areas since 2010, highlights key challenges that remain, and outlines important next steps to maximize the potential for SSM-VIMTs to contribute to the broader malaria elimination and eradication objectives.
Collapse
Affiliation(s)
- Julia K Nunes
- PATH Malaria Vaccine Initiative, Washington, DC, USA
| | - Colleen Woods
- PATH Malaria Vaccine Initiative, Washington, DC, USA; PATH Malaria Vaccine Initiative, Seattle, WA, USA
| | | | | | | | | | | | - Sanjay Jain
- PATH Malaria Vaccine Initiative, Washington, DC, USA
| | | | - David C Kaslow
- PATH Malaria Vaccine Initiative, Washington, DC, USA; PATH, Seattle, WA, USA
| | | |
Collapse
|
26
|
Quispe AM, Pozo E, Guerrero E, Durand S, Baldeviano GC, Edgel KA, Graf PCF, Lescano AG. Plasmodium vivax hospitalizations in a monoendemic malaria region: severe vivax malaria? Am J Trop Med Hyg 2014; 91:11-7. [PMID: 24752683 DOI: 10.4269/ajtmh.12-0610] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Severe malaria caused by Plasmodium vivax is no longer considered rare. To describe its clinical features, we performed a retrospective case control study in the subregion of Luciano Castillo Colonna, Piura, Peru, an area with nearly exclusive vivax malaria transmission. Severe cases and the subset of critically ill cases were compared with a random set of uncomplicated malaria cases (1:4). Between 2008 and 2009, 6,502 malaria cases were reported, including 106 hospitalized cases, 81 of which fit the World Health Organization definition for severe malaria. Of these 81 individuals, 28 individuals were critically ill (0.4%, 95% confidence interval = 0.2-0.6%) with severe anemia (57%), shock (25%), lung injury (21%), acute renal failure (14%), or cerebral malaria (11%). Two potentially malaria-related deaths occurred. Compared with uncomplicated cases, individuals critically ill were older (38 versus 26 years old, P < 0.001), but similar in other regards. Severe vivax malaria monoinfection with critical illness is more common than previously thought.
Collapse
Affiliation(s)
- Antonio M Quispe
- Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edwar Pozo
- Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edith Guerrero
- Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Salomón Durand
- Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru
| | - G Christian Baldeviano
- Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kimberly A Edgel
- Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Paul C F Graf
- Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andres G Lescano
- Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
27
|
Gougoutsi A, Karageorgopoulos DE, Dimitriadou A, Melas N, Kranidiotis G, Voutsinas D, Melidonis A. Severe Plasmodium vivax malaria complicated with acute respiratory distress syndrome: a case associated with focal autochthonous transmission in Greece. Vector Borne Zoonotic Dis 2014; 14:378-81. [PMID: 24745658 DOI: 10.1089/vbz.2012.1192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 2011, autochthonous Plasmodium vivax malaria emerged in a focal geographical area in Greece after importation by immigrants from the Indian subcontinent. We report the case of complicated P. vivax malaria in a previously healthy 42-year-old Greek female. The patient presented acute respiratory distress syndrome (ARDS), worsening jaundice, and thrombocytopenia after the administration of antimalarial treatment and despite a decreasing burden of parasitemia. She recovered fully after admission in the intensive care unit and support with mechanical ventilation. We discuss the risks potentially associated with the reappearance of P. vivax malaria in a previously malaria-free area.
Collapse
Affiliation(s)
- Alexandra Gougoutsi
- 1 Department of Internal Medicine, Tzaneio General Hospital , Piraeus, Greece
| | | | | | | | | | | | | |
Collapse
|
28
|
Roucaute E, Pichard G, Faure E, Royer-Carenzi M. Analysis of the causes of spawning of large-scale, severe malarial epidemics and their rapid total extinction in western Provence, historically a highly endemic region of France (1745-1850). Malar J 2014; 13:72. [PMID: 24581282 PMCID: PMC3939818 DOI: 10.1186/1475-2875-13-72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/21/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The two main puzzles of this study are the onset and then sudden stopping of severe epidemics in western Provence (a highly malaria-endemic region of Mediterranean France) without any deliberate counter-measures and in the absence of significant population flux. METHODS Malaria epidemics during the period from 1745 to 1850 were analysed against temperature and rainfall records and several other potentially relevant factors. RESULTS Statistical analyses indicated that relatively high temperatures in early spring and in September/October, rainfall during the previous winter (principally December) and even from November to September and epidemics during the previous year could have played a decisive role in the emergence of these epidemics. Moreover, the epidemics were most likely not driven by other parameters (e.g., social, cultural, agricultural and geographical). Until 1776, very severe malarial epidemics affected large areas, whereas after this date, they were rarer and generally milder for local people and were due to canal digging activities. In the latter period, decreased rainfall in December, and more extreme and variable temperatures were observed. It is known that rainfall anomalies and temperature fluctuations may be detrimental to vector and parasite development. CONCLUSION This study showed the particular characteristics of malaria in historical Provence. Contrary to the situation in most other Mediterranean areas, Plasmodium falciparum was most likely not involved (during the years with epidemics, the mean temperature during the months of July and August, among other factors, did not play a role) and the population had no protective mutation. The main parasite species was Plasmodium vivax, which was responsible for very severe diseases, but contrary to in northern Europe, it is likely that transmission occurred only during the period where outdoor sporogony was possible, and P. vivax sporogony was always feasible, even during colder summers. Possible key elements in the understanding of the course of malaria epidemics include changes in the virulence of P. vivax strains, the refractoriness of anophelines and/or the degree or efficiency of acquired immunity. This study could open new lines of investigation into the comprehension of the conditions of disappearance/emergence of severe malaria epidemics in highly endemic areas.
Collapse
Affiliation(s)
| | | | - Eric Faure
- Aix Marseille Université, CNRS, Centrale Marseille, I2M, UMR 7373, 13453 Marseille, France
| | - Manuela Royer-Carenzi
- Aix Marseille Université, CNRS, Centrale Marseille, I2M, UMR 7373, 13453 Marseille, France
| |
Collapse
|
29
|
Small molecule Plasmodium FKBP35 inhibitor as a potential antimalaria agent. Sci Rep 2014; 3:2501. [PMID: 23974147 PMCID: PMC3752609 DOI: 10.1038/srep02501] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
Malaria parasite strains have emerged to tolerate the therapeutic effects of the prophylactics and drugs presently available. This resistance now poses a serious challenge to researchers in the bid to overcome malaria parasitic infection. Recent studies have shown that FK520 and its analogs inhibit malaria parasites growth by binding to FK506 binding proteins (FKBPs) of the parasites. Structure based drug screening efforts based on three-dimensional structural information of FKBPs from Plasmodium falciparum led us to identify new chemical entities that bind to the parasite FKBP35 and inhibit its growth. Our experimental results verify that this novel compound (D44) modulate the PPIase activity of Plasmodium FKBP35 and demonstrate the stage-specific growth inhibition of Plasmodium falciparum strains. Here, we present the X-ray crystallographic structures of FK506 binding domains (FKBDs) of PfFKBP35 and PvFKBP35 in complex with the newly identified inhibitor providing molecular insights into its mode of action.
Collapse
|
30
|
Machado Filho AC, da Costa EP, da Costa EP, Reis IS, Fernandes EAC, Paim BV, Martinez-Espinosa FE. Effects of vivax malaria acquired before 20 weeks of pregnancy on subsequent changes in fetal growth. Am J Trop Med Hyg 2014; 90:371-6. [PMID: 24420773 DOI: 10.4269/ajtmh.13-0285] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The resistance index (RI), pulsatility index (PI), fetal biometry, fetal heart rate (FHR), placental thickness, and hemoglobin levels were compared in 30 Plasmodium vivax-infected women between 14 and 20 weeks of pregnancy and a control group. Evaluations were performed at the moment of the malaria diagnosis and 26 weeks of pregnancy. The malaria group had lower levels of hemoglobin and greater placental thickness in both assessments, higher FHR in the first evaluation, and lower values on fetal biometry in the second assessment. There were no differences when comparing RI and PI on umbilical arteries between the two groups. Birth weight and height were lower in newborns in the malaria group than the control group. The results suggest that P. vivax infections at an earlier gestational age do not affect umbilical arteries blood flow but do affect fetal biometry in the second trimester of pregnancy and at birth.
Collapse
Affiliation(s)
- Amantino C Machado Filho
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Instituto Leônidas e Maria Deane, FIOCRUZ, Amazônia, Brazil
| | | | | | | | | | | | | |
Collapse
|
31
|
Stanisic DI, Javati S, Kiniboro B, Lin E, Jiang J, Singh B, Meyer EVS, Siba P, Koepfli C, Felger I, Galinski MR, Mueller I. Naturally acquired immune responses to P. vivax merozoite surface protein 3α and merozoite surface protein 9 are associated with reduced risk of P. vivax malaria in young Papua New Guinean children. PLoS Negl Trop Dis 2013; 7:e2498. [PMID: 24244763 PMCID: PMC3828159 DOI: 10.1371/journal.pntd.0002498] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 09/10/2013] [Indexed: 11/19/2022] Open
Abstract
Background Plasmodium vivax is the most geographically widespread human malaria parasite. Cohort studies in Papua New Guinea have identified a rapid onset of immunity against vivax-malaria in children living in highly endemic areas. Although numerous P. vivax merozoite antigens are targets of naturally acquired antibodies, the role of many of these antibodies in protective immunity is yet unknown. Methodology/Principal Findings In a cohort of children aged 1–3 years, antibodies to different regions of Merozoite Surface Protein 3α (PvMSP3α) and Merozoite Surface Protein 9 (PvMSP9) were measured and related to prospective risk of P. vivax malaria during 16 months of active follow-up. Overall, there was a low prevalence of antibodies to PvMSP3α and PvMSP9 proteins (9–65%). Antibodies to the PvMSP3α N-terminal, Block I and Block II regions increased significantly with age while antibodies to the PvMSP3α Block I and PvMSP9 N-terminal regions were positively associated with concurrent P. vivax infection. Independent of exposure (defined as the number of genetically distinct blood-stage infection acquired over time (molFOB)) and age, antibodies specific to both PvMSP3α Block II (adjusted incidence ratio (aIRR) = 0.59, p = 0.011) and PvMSP9 N-terminus (aIRR = 0.68, p = 0.035) were associated with protection against clinical P. vivax malaria. This protection was most pronounced against high-density infections. For PvMSP3α Block II, the effect was stronger with higher levels of antibodies. Conclusions These results indicate that PvMSP3α Block II and PvMSP9 N-terminus should be further investigated for their potential as P. vivax vaccine antigens. Controlling for molFOB assures that the observed associations are not confounded by individual differences in exposure. Plasmodium vivax is the most geographically widespread human malaria parasite. In highly endemic areas such as Papua New Guinea, a very rapid onset of immunity against vivax-malaria is observed. Although it is known that numerous P. vivax merozoite antigens are targets of naturally acquired antibodies, the role of many of these antibodies in protective immunity is yet unknown. In a cohort of 183 children aged 1–3 years, we now show that the presence of antibodies to Merozoite Surface Protein 3α (PvMSP3α) and Merozoite Surface Protein 9 (PvMSP9) are associated with a significant reduction in the burden P. vivax malaria. Antibodies increased with age and in the presence of concurrent P. vivax infections. After adjusting for both age and individual differences in exposure, the strongest reductions in risk were seen in children with antibodies to PvMSP3α Block II (41% reduction, p = 0.001) and PvMSP9 N-terminal region. (32% reduction, p = 0.035). These results indicate that PvMSP3α Block II and PvMSP9 N-terminus should be further investigated for their potential as P. vivax vaccine antigens.
Collapse
Affiliation(s)
- Danielle I. Stanisic
- Walter and Eliza Hall Institute, Parkville, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
- * E-mail: (DIS); (IM)
| | - Sarah Javati
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Benson Kiniboro
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Enmoore Lin
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Jianlin Jiang
- Emory Vaccine Center, Yerkes National Primate Research Centre, Emory University, Atlanta, Georgia, United States of America
| | - Balwan Singh
- Emory Vaccine Center, Yerkes National Primate Research Centre, Emory University, Atlanta, Georgia, United States of America
| | - Esmeralda V. S. Meyer
- Emory Vaccine Center, Yerkes National Primate Research Centre, Emory University, Atlanta, Georgia, United States of America
| | - Peter Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Cristian Koepfli
- Walter and Eliza Hall Institute, Parkville, Australia
- Swiss Tropical Institute and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ingrid Felger
- Swiss Tropical Institute and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mary R. Galinski
- Emory Vaccine Center, Yerkes National Primate Research Centre, Emory University, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Infectious Disease, Emory University, Atlanta, Georgia, United States of America
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
- * E-mail: (DIS); (IM)
| |
Collapse
|
32
|
Pohlit AM, Lima RBS, Frausin G, Silva LFRE, Lopes SCP, Moraes CB, Cravo P, Lacerda MVG, Siqueira AM, Freitas-Junior LH, Costa FTM. Amazonian plant natural products: perspectives for discovery of new antimalarial drug leads. Molecules 2013; 18:9219-40. [PMID: 23917112 PMCID: PMC6270278 DOI: 10.3390/molecules18089219] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 07/14/2013] [Accepted: 07/18/2013] [Indexed: 02/07/2023] Open
Abstract
Plasmodium falciparum and P. vivax malaria parasites are now resistant, or showing signs of resistance, to most drugs used in therapy. Novel chemical entities that exhibit new mechanisms of antiplasmodial action are needed. New antimalarials that block transmission of Plasmodium spp. from humans to Anopheles mosquito vectors are key to malaria eradication efforts. Although P. vivax causes a considerable number of malaria cases, its importance has for long been neglected. Vivax malaria can cause severe manifestations and death; hence there is a need for P. vivax-directed research. Plants used in traditional medicine, namely Artemisia annua and Cinchona spp. are the sources of the antimalarial natural products artemisinin and quinine, respectively. Based on these compounds, semi-synthetic artemisinin-derivatives and synthetic quinoline antimalarials have been developed and are the most important drugs in the current therapeutic arsenal for combating malaria. In the Amazon region, where P. vivax predominates, there is a local tradition of using plant-derived preparations to treat malaria. Here, we review the current P. falciparum and P. vivax drug-sensitivity assays, focusing on challenges and perspectives of drug discovery for P. vivax, including tests against hypnozoites. We also present the latest findings of our group and others on the antiplasmodial and antimalarial chemical components from Amazonian plants that may be potential drug leads against malaria.
Collapse
Affiliation(s)
- Adrian Martin Pohlit
- Instituto Nacional de Pesquisa da Amazônia (INPA), Av. André Araújo, 2936, 69067-375 Manaus, AM, Brazil; E-Mails: (R.B.S.L.); (G.F.); (L.F.R.S.)
| | - Renata Braga Souza Lima
- Instituto Nacional de Pesquisa da Amazônia (INPA), Av. André Araújo, 2936, 69067-375 Manaus, AM, Brazil; E-Mails: (R.B.S.L.); (G.F.); (L.F.R.S.)
| | - Gina Frausin
- Instituto Nacional de Pesquisa da Amazônia (INPA), Av. André Araújo, 2936, 69067-375 Manaus, AM, Brazil; E-Mails: (R.B.S.L.); (G.F.); (L.F.R.S.)
| | - Luiz Francisco Rocha e Silva
- Instituto Nacional de Pesquisa da Amazônia (INPA), Av. André Araújo, 2936, 69067-375 Manaus, AM, Brazil; E-Mails: (R.B.S.L.); (G.F.); (L.F.R.S.)
| | - Stefanie Costa Pinto Lopes
- Departamento de Genética, Evolução e Bioagentes, Universidade Estadual de Campinas-UNICAMP, P.O. Box 6109, 13083-862 Campinas, SP, Brazil; E-Mail:
| | - Carolina Borsoi Moraes
- Laboratório Nacional de Biociências (LNBio) – Centro Nacional de Pesquisa em Energia e Materiais (CNEPM) - P.O. Box 6192, 13083-970 Campinas, SP, Brazil; E-Mails: (C.B.M.); (L.H.F.-J.)
| | - Pedro Cravo
- Programa de Mestrado em Sociedade, Tecnologia e Meio Ambiente. UniEVANGÉLICA-Centro Universitário de Anápolis, 75083-515 Anapólis, GO, Brazil; E-Mail:
- Centro de Malária e Doenças Tropicais, LA/IHMT-Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, 69040-000 Manaus, AM, Brazil; E-Mails: (M.V.G.L.); (A.M.S.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, 69040-000 Manaus, AM, Brazil
| | - André Machado Siqueira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, 69040-000 Manaus, AM, Brazil; E-Mails: (M.V.G.L.); (A.M.S.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, 69040-000 Manaus, AM, Brazil
| | - Lucio H. Freitas-Junior
- Laboratório Nacional de Biociências (LNBio) – Centro Nacional de Pesquisa em Energia e Materiais (CNEPM) - P.O. Box 6192, 13083-970 Campinas, SP, Brazil; E-Mails: (C.B.M.); (L.H.F.-J.)
| | - Fabio Trindade Maranhão Costa
- Departamento de Genética, Evolução e Bioagentes, Universidade Estadual de Campinas-UNICAMP, P.O. Box 6109, 13083-862 Campinas, SP, Brazil; E-Mail:
| |
Collapse
|
33
|
Lauinger IL, Vivas L, Perozzo R, Stairiker C, Tarun A, Zloh M, Zhang X, Xu H, Tonge PJ, Franzblau SG, Pham DH, Esguerra CV, Crawford AD, Maes L, Tasdemir D. Potential of lichen secondary metabolites against Plasmodium liver stage parasites with FAS-II as the potential target. JOURNAL OF NATURAL PRODUCTS 2013; 76:1064-70. [PMID: 23806111 PMCID: PMC4119598 DOI: 10.1021/np400083k] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Chemicals targeting the liver stage (LS) of the malaria parasite are useful for causal prophylaxis of malaria. In this study, four lichen metabolites, evernic acid (1), vulpic acid (2), psoromic acid (3), and (+)-usnic acid (4), were evaluated against LS parasites of Plasmodium berghei. Inhibition of P. falciparum blood stage (BS) parasites was also assessed to determine stage specificity. Compound 4 displayed the highest LS activity and stage specificity (LS IC50 value 2.3 μM, BS IC50 value 47.3 μM). The compounds 1-3 inhibited one or more enzymes (PfFabI, PfFabG, and PfFabZ) from the plasmodial fatty acid biosynthesis (FAS-II) pathway, a potential drug target for LS activity. To determine species specificity and to clarify the mechanism of reported antibacterial effects, 1-4 were also evaluated against FabI homologues and whole cells of various pathogens (S. aureus, E. coli, M. tuberculosis). Molecular modeling studies suggest that lichen acids act indirectly via binding to allosteric sites on the protein surface of the FAS-II enzymes. Potential toxicity of compounds was assessed in human hepatocyte and cancer cells (in vitro) as well as in a zebrafish model (in vivo). This study indicates the therapeutic and prophylactic potential of lichen metabolites as antibacterial and antiplasmodial agents.
Collapse
Affiliation(s)
- Ina L. Lauinger
- Department of Pharmaceutical and Biological Chemistry, School of Pharmacy, University of London, London WC1N 1AX, UK
| | - Livia Vivas
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Remo Perozzo
- School of Pharmaceutical Sciences, University of Geneva, CH-1211 Geneva 4, Switzerland
| | - Christopher Stairiker
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA 152614, USA
| | - Alice Tarun
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA 152614, USA
| | - Mire Zloh
- Department of Pharmaceutical and Biological Chemistry, School of Pharmacy, University of London, London WC1N 1AX, UK
| | - Xujie Zhang
- Institute for Chemical Biology and Drug Discovery, Department of Chemistry, Stony Brook University, NY 11794, USA
| | - Hua Xu
- Institute for Chemical Biology and Drug Discovery, Department of Chemistry, Stony Brook University, NY 11794, USA
| | - Peter J. Tonge
- Institute for Chemical Biology and Drug Discovery, Department of Chemistry, Stony Brook University, NY 11794, USA
| | - Scott G. Franzblau
- Institute for Tuberculosis Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Duc-Hung Pham
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, 3000 Leuven, Belgium
| | - Camila V. Esguerra
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, 3000 Leuven, Belgium
| | - Alexander D. Crawford
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, 3000 Leuven, Belgium
| | - Louis Maes
- Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Deniz Tasdemir
- Department of Pharmaceutical and Biological Chemistry, School of Pharmacy, University of London, London WC1N 1AX, UK
| |
Collapse
|
34
|
Soares IS, Françoso KS, Jampaulo VO, Rodrigues MM. CD8(+) T-cell-mediated immunity against malaria: a novel heterologous prime-boost strategy. Expert Rev Vaccines 2013; 11:1039-41. [PMID: 23151162 DOI: 10.1586/erv.12.82] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recently, a vaccine against malaria was successfully tested in a human Phase III trial. The efficacy of this vaccine formulation, based on the Plasmodium falciparum circumsporozoite protein, was approximately 50% and correlated with the presence of antibodies specific to the infective stages of the malaria parasites. Different strategies are being pursued to improve vaccine efficacy levels. One such strategy is the induction of specific cytotoxic T cells that can destroy the intracellular hepatocyte stages of the malaria parasite. In this study, a novel vaccination protocol was developed to elicit strong immune responses mediated by CD8(+) cytotoxic cells specific to the circumsporozoite protein. As proof-of-concept, the authors used the rodent malaria Plasmodium yoelii parasite. The vaccination strategy consisted of a heterologous prime-boost vaccination regimen involving porcine parvovirus-like particles for priming and the modified vaccinia virus Ankara for the booster immunization, both of which expressed the immunodominant CD8 epitope of the P. yoelii circumsporozoite protein. Results from this experimental model were extremely meaningful. This vaccination strategy led to a significant T-cell immune response mediated by CD8(+) multifunctional T effector and effector-memory cells. However, most importantly for the malaria vaccine development was the fact that following a sporozoite challenge, immunized mice eliminated more than 97% of the malaria parasites during the hepatocyte stages. These results confirm and extend a vast body of knowledge showing that a heterologous prime-boost vaccination strategy can elicit strong CD8(+) T-cell-mediated protective immunity and may increase the efficacy of malaria vaccines.
Collapse
Affiliation(s)
- Irene S Soares
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, Av. Prof. Lineu Prestes 580, São Paulo, 05508-900, Brazil.
| | | | | | | |
Collapse
|
35
|
Marín-Menéndez A, Bardají A, Martínez-Espinosa FE, Bôtto-Menezes C, Lacerda MV, Ortiz J, Cisteró P, Piqueras M, Felger I, Müeller I, Ordi J, del Portillo H, Menéndez C, Wahlgren M, Mayor A. Rosetting in Plasmodium vivax: a cytoadhesion phenotype associated with anaemia. PLoS Negl Trop Dis 2013; 7:e2155. [PMID: 23593522 PMCID: PMC3617122 DOI: 10.1371/journal.pntd.0002155] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 02/20/2013] [Indexed: 11/24/2022] Open
Abstract
Background Plasmodium vivax can potentially lead to life-threatening episodes but the mechanisms underlying severe disease remain poorly defined. Cytoadhesion of infected erythrocytes may contribute to P. vivax sequestration and organ injury although its physiological impact is still unknown. Here, we aimed to describe clinically-relevant cytoadhesive phenotypes of P. vivax isolates. Methodology/Principal findings Rosetting and adhesion to CSA, CD36, ICAM1, placental and brain cryosections were determined in P. vivax peripheral isolates from 12 pregnant women, 24 non-pregnant women and 23 men from Manaus (Brazil). P. falciparum co-infection was excluded by PCR and P. vivax isolates were genotyped by assessing the size polymorphism of microsatellites ms2, ms20 and msp1F3 through capillary electrophoresis of PCR products. P. vivax monoinfection was confirmed by PCR in 59 isolates, with 50 (85%) of them being single-clone infections. One P. vivax haplotype was more frequently found among pregnant women (33%) than in non-pregnant women (0%) and men (4%; p = 0.010). Rosetting was observed in 64% of the isolates, adhesion to CSA in 15%, to ICAM1 in 12% and to placental cryosections in 9%, being similar among pregnant and non-pregnant groups. Intensity of rosetting was higher among anaemic individuals compared to non-anaemic (p = 0.010) and decreased with increasing haematocrit (p = 0.033) and haemoglobin levels (p = 0.015). Conclusions/Significance P. vivax peripheral isolates from pregnant women do not exhibit a prominent adhesion to CSA, although other parasite phenotypes still unknown may increase the propagation of certain P. vivax clones observed among pregnant hosts. Rosetting is a frequent cytoadhesive phenotype in P. vivax infections that may contribute to the development of anaemia. Despite being considered a relatively benign disease, Plasmodium vivax infection has been recently associated with fatal outcomes. The mechanisms contributing to severe disease in P. vivax malaria remain largely unknown, although scarce evidences suggests that similarly to P. falciparum, P. vivax may also adhere to host receptors on the vascular endothelium or on uninfected erythrocytes to form ‘rosettes’. Such cytoadhesion phenotypes might contribute to mild sequestration of P. vivax and poor clinical outcomes. The present study aimed to describe clinically relevant cytoadhesive phenotypes of P. vivax infected erythrocytes isolated from peripheral blood of pregnant and non-pregnant patients in the Brazilian Amazon. We did not observe any specific cytoadhesion phenotype associated to pregnancy, although a P. vivax haplotype was more frequent among pregnant women than in non-pregnant hosts. This finding suggests that other parasite phenotypes still unknown may increase the propagation of certain P. vivax clones among pregnant hosts. In addition, we found that rosetting was a frequent cytoadhesive phenotype in P. vivax infections that was associated with an increased risk of anaemia. This study places cytoadhesion and specifically rosetting as a target for the development of new therapies to treat or prevent life-threatening P. vivax malaria.
Collapse
Affiliation(s)
- Alejandro Marín-Menéndez
- Barcelona Centre for International Health Research (CRESIB), Hospital Clinic/Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Azucena Bardají
- Barcelona Centre for International Health Research (CRESIB), Hospital Clinic/Universitat de Barcelona, Barcelona, Spain
| | - Flor E. Martínez-Espinosa
- Gerência de Malária, Fundação de Medicina Tropical do Amazonas Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas e Maria Deane, Fiocruz Amazônia, Manaus, Brazil
| | - Camila Bôtto-Menezes
- Gerência de Malária, Fundação de Medicina Tropical do Amazonas Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Marcus V. Lacerda
- Gerência de Malária, Fundação de Medicina Tropical do Amazonas Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jon Ortiz
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Pau Cisteró
- Barcelona Centre for International Health Research (CRESIB), Hospital Clinic/Universitat de Barcelona, Barcelona, Spain
| | - Mireia Piqueras
- Barcelona Centre for International Health Research (CRESIB), Hospital Clinic/Universitat de Barcelona, Barcelona, Spain
| | - Ingrid Felger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Ivo Müeller
- Barcelona Centre for International Health Research (CRESIB), Hospital Clinic/Universitat de Barcelona, Barcelona, Spain
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Jaume Ordi
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Hernando del Portillo
- Barcelona Centre for International Health Research (CRESIB), Hospital Clinic/Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- Barcelona Centre for International Health Research (CRESIB), Hospital Clinic/Universitat de Barcelona, Barcelona, Spain
| | - Mats Wahlgren
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Alfredo Mayor
- Barcelona Centre for International Health Research (CRESIB), Hospital Clinic/Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| |
Collapse
|
36
|
Douglas NM, John GK, von Seidlein L, Anstey NM, Price RN. Chemotherapeutic strategies for reducing transmission of Plasmodium vivax malaria. ADVANCES IN PARASITOLOGY 2013. [PMID: 23199490 DOI: 10.1016/b978-0-12-397900-1.00005-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Effective use of anti-malarial drugs is key to reducing the transmission potential of Plasmodium vivax. In patients presenting with symptomatic disease, treatment with potent and relatively slowly eliminated blood schizontocidal regimens administered concurrently with a supervised course of 7 mg/kg primaquine over 7-14 days has potential to exert the greatest transmission-blocking benefit. Given the spread of chloroquine-resistant P. vivax strains, the artemisinin combination therapies dihydroartemisinin + piperaquine and artesunate + mefloquine are currently the most assured means of preventing P. vivax recrudescence. Preliminary evidence suggests that, like chloroquine, these combinations potentiate the hypnozoitocidal effect of primaquine, but further supportive evidence is required. In view of the high rate of P. vivax relapse following falciparum infections in co-endemic regions, there is a strong argument for broadening current radical cure policy to include the administration of hypnozoitocidal doses of primaquine to patients with Plasmodium falciparum malaria. The most important reservoir for P. vivax transmission is likely to be very low-density, asymptomatic infections, the majority of which will arise from liver-stage relapses. Therefore, judicious mass administration of hypnozoitocidal therapy will reduce transmission of P. vivax to a greater extent than strategies focused on treatment of symptomatic patients. An efficacious hypnozoitocidal agent with a short curative treatment course would be particularly useful in mass drug administration campaigns.
Collapse
Affiliation(s)
- Nicholas M Douglas
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | | | | | | | | |
Collapse
|
37
|
Anstey NM, Douglas NM, Poespoprodjo JR, Price RN. Plasmodium vivax: clinical spectrum, risk factors and pathogenesis. ADVANCES IN PARASITOLOGY 2013. [PMID: 23199488 DOI: 10.1016/b978-0-12-397900-1.00003-7] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Vivax malaria was historically described as 'benign tertian malaria' because individual clinical episodes were less likely to cause severe illness than Plasmodium falciparum. Despite this, Plasmodium vivax was, and remains, responsible for major morbidity and significant mortality in vivax-endemic areas. Single infections causing febrile illness in otherwise healthy individuals rarely progress to severe disease. Nevertheless, in the presence of co-morbidities, P. vivax can cause severe illness and fatal outcomes. Recurrent or chronic infections in endemic areas can cause severe anaemia and malnutrition, particularly in early childhood. Other severe manifestations include acute lung injury, acute kidney injury and uncommonly, coma. Multiorgan failure and shock are described but further studies are needed to investigate the role of bacterial and other co-infections in these syndromes. In pregnancy, P. vivax infection can cause maternal anaemia, miscarriage, low birth weight and congenital malaria. Compared to P. falciparum, P. vivax has a greater capacity to elicit an inflammatory response, resulting in a lower pyrogenic threshold. Conversely, cytoadherence of P. vivax to endothelial cells is less frequent and parasite sequestration is not thought to be a significant cause of severe illness in vivax malaria. With a predilection for young red cells, P. vivax does not result in the high parasite biomass associated with severe disease in P. falciparum, but a four to fivefold greater removal of uninfected red cells from the circulation relative to P. falciparum is associated with a similar risk of severe anaemia. Mechanisms underlying the pathogenesis of severe vivax syndromes remain incompletely understood.
Collapse
Affiliation(s)
- Nicholas M Anstey
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | | | | | | |
Collapse
|
38
|
Transgenic fluorescent Plasmodium cynomolgi liver stages enable live imaging and purification of Malaria hypnozoite-forms. PLoS One 2013; 8:e54888. [PMID: 23359816 PMCID: PMC3554669 DOI: 10.1371/journal.pone.0054888] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 12/17/2012] [Indexed: 01/29/2023] Open
Abstract
A major challenge for strategies to combat the human malaria parasite Plasmodium vivax is the presence of hypnozoites in the liver. These dormant forms can cause renewed clinical disease after reactivation through unknown mechanisms. The closely related non-human primate malaria P. cynomolgi is a frequently used model for studying hypnozoite-induced relapses. Here we report the generation of the first transgenic P. cynomolgi parasites that stably express fluorescent markers in liver stages by transfection with novel DNA-constructs containing a P. cynomolgi centromere. Analysis of fluorescent liver stages in culture identified, in addition to developing liver-schizonts, uninucleate persisting parasites that were atovaquone resistant but primaquine sensitive, features associated with hypnozoites. We demonstrate that these hypnozoite-forms could be isolated by fluorescence-activated cell sorting. The fluorescently-tagged parasites in combination with FACS-purification open new avenues for a wide range of studies for analysing hypnozoite biology and reactivation.
Collapse
|
39
|
Pérez BC, Teixeira C, Albuquerque IS, Gut J, Rosenthal PJ, Gomes JRB, Prudêncio M, Gomes P. N-Cinnamoylated Chloroquine Analogues as Dual-Stage Antimalarial Leads. J Med Chem 2013; 56:556-67. [DOI: 10.1021/jm301654b] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bianca C. Pérez
- Departamento
de Química
e Bioquímica, Faculdade de Ciências, Centro de Investigação
em Química da Universidade do Porto, Universidade do Porto, R. do Campo Alegre 687, P-4169-007 Porto,
Portugal
| | - Cátia Teixeira
- Departamento
de Química
e Bioquímica, Faculdade de Ciências, Centro de Investigação
em Química da Universidade do Porto, Universidade do Porto, R. do Campo Alegre 687, P-4169-007 Porto,
Portugal
- Departamento de
Química,
CICECO, Universidade de Aveiro, Campus
Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - Inês S. Albuquerque
- Instituto de Medicina Molecular,
Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Jiri Gut
- Department of Medicine, San Francisco General Hospital, University of California, San Francisco,
California 94143-0811, United States
| | - Philip J. Rosenthal
- Department of Medicine, San Francisco General Hospital, University of California, San Francisco,
California 94143-0811, United States
| | - José R. B. Gomes
- Departamento de
Química,
CICECO, Universidade de Aveiro, Campus
Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - Miguel Prudêncio
- Instituto de Medicina Molecular,
Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Paula Gomes
- Departamento
de Química
e Bioquímica, Faculdade de Ciências, Centro de Investigação
em Química da Universidade do Porto, Universidade do Porto, R. do Campo Alegre 687, P-4169-007 Porto,
Portugal
| |
Collapse
|
40
|
Baird JK. Tropical Health and Sustainability. Infect Dis (Lond) 2013. [DOI: 10.1007/978-1-4614-5719-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
41
|
Leoratti FMDS, Trevelin SC, Cunha FQ, Rocha BC, Costa PAC, Gravina HD, Tada MS, Pereira DB, Golenbock DT, do Valle Antonelli LR, Gazzinelli RT. Neutrophil paralysis in Plasmodium vivax malaria. PLoS Negl Trop Dis 2012; 6:e1710. [PMID: 22745844 PMCID: PMC3383745 DOI: 10.1371/journal.pntd.0001710] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 05/13/2012] [Indexed: 12/03/2022] Open
Abstract
Background The activation of innate immune responses by Plasmodium vivax results in activation of effector cells and an excessive production of pro-inflammatory cytokines that may culminate in deleterious effects. Here, we examined the activation and function of neutrophils during acute episodes of malaria. Materials and Methods Blood samples were collected from P. vivax-infected patients at admission (day 0) and 30–45 days after treatment with chloroquine and primaquine. Expression of activation markers and cytokine levels produced by highly purified monocytes and neutrophils were measured by the Cytometric Bead Assay. Phagocytic activity, superoxide production, chemotaxis and the presence of G protein-coupled receptor (GRK2) were also evaluated in neutrophils from malaria patients. Principal Findings Both monocytes and neutrophils from P. vivax-infected patients were highly activated. While monocytes were found to be the main source of cytokines in response to TLR ligands, neutrophils showed enhanced phagocytic activity and superoxide production. Interestingly, neutrophils from the malaria patients expressed high levels of GRK2, low levels of CXCR2, and displayed impaired chemotaxis towards IL-8 (CXCL8). Conclusion Activated neutrophils from malaria patients are a poor source of pro-inflammatory cytokines and display reduced chemotactic activity, suggesting a possible mechanism for an enhanced susceptibility to secondary bacterial infection during malaria. Plasmodium vivax is responsible for approximately 60–80% of the malaria cases in the world, and contributes to significant social and economic instability in the developing countries of Latin America and Asia. The pathogenesis of P. vivax malaria is a consequence of host derived inflammatory mediators. Hence, a better understanding of the mechanisms involved in induction of systemic inflammation during P. vivax malaria is critical for the clinical management and prevention of severe disease. The innate immune receptors recognize Plasmodium sp. and initiate a broad spectrum of host defense mechanisms that mediate resistance to infection. However, the innate immune response is the classic “two-edged sword”, and clinical malaria is associated with high levels of circulating pro-inflammatory cytokines. Our findings show that both monocytes and neutrophils are highly activated during malaria. Monocytes produced high levels of IL-1β, IL-6 and TNF-α during acute malaria. On the other hand, neutrophils were a poor source of cytokines, but displayed an enhanced phagocytic activity and superoxide production. Unexpectedly, we noticed an impaired chemotaxis of neutrophils towards an IL-8 (CXCL8) gradient. We proposed that neutrophil paralysis is in part responsible for the enhanced susceptibility to bacterial infection observed in malaria patients.
Collapse
Affiliation(s)
| | - Silvia Cellone Trevelin
- Departamento de Farmacologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Queiroz Cunha
- Departamento de Farmacologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Bruno Coelho Rocha
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Pedro Augusto Carvalho Costa
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Humberto Doriguêtto Gravina
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mauro Shugiro Tada
- Centro de Pesquisas em Medicina Tropical de Rondônia, Porto Velho, Rondônia, Brazil
| | | | - Douglas Taylor Golenbock
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Lis Ribeiro do Valle Antonelli
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo T. Gazzinelli
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
42
|
Liver-stage malaria parasites vulnerable to diverse chemical scaffolds. Proc Natl Acad Sci U S A 2012; 109:8511-6. [PMID: 22586124 DOI: 10.1073/pnas.1118370109] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Human malaria infection begins with a one-time asymptomatic liver stage followed by a cyclic symptomatic blood stage. All high-throughput malaria drug discovery efforts have focused on the cyclic blood stage, which has limited potential for the prophylaxis, transmission blocking, and eradication efforts that will be needed in the future. To address these unmet needs, a high-throughput phenotypic liver-stage Plasmodium parasite screen was developed to systematically identify molecules with liver-stage efficacy. The screen recapitulates liver-stage infection by isolating luciferase-expressing Plasmodium berghei parasites directly from the salivary glands of infected mosquitoes, adding them to confluent human liver cells in 384-well plates, and measuring luciferase activity after a suitable incubation period. Screening 5,375 known bioactive compounds identified 37 liver-stage malaria inhibitors with diverse modes of action, as shown by inhibition time course experiments. Further analysis of the hits in the Food and Drug Administration-approved drug subset revealed compounds that seem to act specifically on the liver stage of infection, suggesting that this phase of the parasite's life cycle presents a promising area for new drug discovery. Notably, many active compounds in this screen have molecular structures and putative targets distinctly different from those of known antimalarial agents.
Collapse
|
43
|
Douglas NM, Anstey NM, Buffet PA, Poespoprodjo JR, Yeo TW, White NJ, Price RN. The anaemia of Plasmodium vivax malaria. Malar J 2012; 11:135. [PMID: 22540175 PMCID: PMC3438072 DOI: 10.1186/1475-2875-11-135] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 04/17/2012] [Indexed: 12/22/2022] Open
Abstract
Plasmodium vivax threatens nearly half the world's population and is a significant impediment to achievement of the millennium development goals. It is an important, but incompletely understood, cause of anaemia. This review synthesizes current evidence on the epidemiology, pathogenesis, treatment and consequences of vivax-associated anaemia. Young children are at high risk of clinically significant and potentially severe vivax-associated anaemia, particularly in countries where transmission is intense and relapses are frequent. Despite reaching lower densities than Plasmodium falciparum, Plasmodium vivax causes similar absolute reduction in red blood cell mass because it results in proportionately greater removal of uninfected red blood cells. Severe vivax anaemia is associated with substantial indirect mortality and morbidity through impaired resilience to co-morbidities, obstetric complications and requirement for blood transfusion. Anaemia can be averted by early and effective anti-malarial treatment.
Collapse
Affiliation(s)
- Nicholas M Douglas
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Nicholas M Anstey
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Pierre A Buffet
- INSERM - UPMC, (Paris 6 University) UMRs945, F-75013, Paris, France
- Department of Parasitology, Pitié-Salpétrière Hospital, Assistance Publique – Hôpitaux de Paris, F-75013, Paris, France
- Institut Pasteur, Unité d’Immunologie Moléculaire des Parasites, Département de Parasitologie Mycologie, F-75015, Paris, France
| | - Jeanne R Poespoprodjo
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Mimika District Health Authority, Timika, Papua, Indonesia
- Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Tsin W Yeo
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Nicholas J White
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ric N Price
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| |
Collapse
|
44
|
Lança EFC, Magalhães BML, Vitor-Silva S, Siqueira AM, Benzecry SG, Alexandre MAA, O'Brien C, Bassat Q, Lacerda MVG. Risk factors and characterization of Plasmodium vivax-associated admissions to pediatric intensive care units in the Brazilian Amazon. PLoS One 2012; 7:e35406. [PMID: 22523591 PMCID: PMC3327677 DOI: 10.1371/journal.pone.0035406] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 03/15/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Plasmodium vivax is responsible for a significant proportion of malaria cases worldwide and is increasingly reported as a cause of severe disease. The objective of this study was to characterize severe vivax disease among children hospitalized in intensive care units (ICUs) in the Western Brazilian Amazon, and to identify risk factors associated with disease severity. METHODS AND FINDINGS In this retrospective study, clinical records of 34 children, 0-14 years of age hospitalized in the 11 public pediatric and neonatal ICUs of the Manaus area, were reviewed. P. falciparum monoinfection or P. falciparum/P. vivax mixed infection was diagnosed by microscopy in 10 cases, while P. vivax monoinfection was confirmed in the remaining 24 cases. Two of the 24 patients with P. vivax monoinfection died. Respiratory distress, shock and severe anemia were the most frequent complications associated with P. vivax infection. Ninety-one children hospitalized with P. vivax monoinfections but not requiring ICU were consecutively recruited in a tertiary care hospital for infectious diseases to serve as a reference population (comparators). Male sex (p = 0.039), age less than five years (p = 0.028), parasitemia greater than 500/mm(3) (p = 0.018), and the presence of any acute (p = 0.023) or chronic (p = 0.017) co-morbidity were independently associated with ICU admission. At least one of the WHO severity criteria for malaria (formerly validated for P. falciparum) was present in 23/24 (95.8%) of the patients admitted to the ICU and in 17/91 (18.7%) of controls, making these criteria a good predictor of ICU admission (p = 0.001). The only investigated criterion not associated with ICU admission was hyperbilirubinemia (p = 0.513)]. CONCLUSIONS Our study points to the importance of P. vivax-associated severe disease in children, causing 72.5% of the malaria admissions to pediatric ICUs. WHO severity criteria demonstrated good sensitivity in predicting severe P. vivax infection in this small case series.
Collapse
Affiliation(s)
- Ellen Fátima Caetano Lança
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
| | - Belisa Maria Lopes Magalhães
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- National Institute of Science and Technology for Innovation in Neglected Diseases, Rio de Janeiro, Brazil
| | - Sheila Vitor-Silva
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- National Institute of Science and Technology for Innovation in Neglected Diseases, Rio de Janeiro, Brazil
| | - André Machado Siqueira
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- National Institute of Science and Technology for Innovation in Neglected Diseases, Rio de Janeiro, Brazil
| | | | - Márcia Almeida Araújo Alexandre
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade Nilton Lins, Manaus, Amazonas, Brazil
| | - Connor O'Brien
- Columbia University Medical Center, New York, New York, United States of America
| | - Quique Bassat
- Centre de Recerca en Salut Internacional de Barcelona (CRESIB)/Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Marcus Vinícius Guimarães Lacerda
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade Nilton Lins, Manaus, Amazonas, Brazil
- National Institute of Science and Technology for Innovation in Neglected Diseases, Rio de Janeiro, Brazil
- * E-mail:
| |
Collapse
|
45
|
Taylor SM, Parobek CM, Fairhurst RM. Haemoglobinopathies and the clinical epidemiology of malaria: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2012; 12:457-68. [PMID: 22445352 DOI: 10.1016/s1473-3099(12)70055-5] [Citation(s) in RCA: 212] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Haemoglobinopathies can reduce the risk of malaria syndromes. We aimed to quantify the relation between different haemoglobin mutations and malaria protection to strengthen the foundation for translational studies of malaria pathogenesis and immunity. METHODS We systematically searched the Medline and Embase databases for studies that estimated the risk of malaria in patients with and without haemoglobinopathies up to Sept 9, 2011, and identified additional studies from reference lists. We included studies that enrolled mainly children or pregnant women and had the following outcomes: Plasmodium falciparum severe malaria, uncomplicated malaria, asymptomatic parasitaemia, or pregnancy-associated malaria, and Plasmodium vivax malaria. Two reviewers identified studies independently, assessed quality of the studies, and extracted data. We produced odds ratios (ORs; 95% CIs) for case-control studies and incidence rate ratios (IRRs; 95% CIs) for prospective studies. We did the meta-analysis with a random-effects model when equivalent outcomes were reported in more than one study. FINDINGS Of 62 identified studies, 44 reported data for haemoglobin AS, 19 for haemoglobin AC and CC, and 18 for α-thalassaemia. Meta-analysis of case-control studies showed a decreased risk of severe P. falciparum malaria in individuals with haemoglobin AS (OR 0·09, 95% CI 0·06-0·12), haemoglobin CC (0·27, 0·11-0·63), haemoglobin AC (0·83, 0·67-0·96), homozygous α-thalassaemia (0·63, 0·48-0·83), and heterozygous α-thalassaemia (0·83, 0·74-0·92). In meta-analysis of prospective trials only haemoglobin AS was consistently associated with protection from uncomplicated malaria (IRR 0·69, 95% CI 0·61-0·79); no haemoglobinopathies led to consistent protection from asymptomatic parasitaemia. Few clinical studies have investigated β-thalassaemia, haemoglobin E, P. vivax malaria, or pregnancy-associated malaria. INTERPRETATION Haemoglobin AS, CC, and AC genotypes and homozygous and heterozygous α-thalassaemia provide significant protection from severe malaria syndromes, but these haemoglobinopathies differ substantially in the degree of protection provided and confer mild or no protection against uncomplicated malaria and asymptomatic parasitaemia. Through attenuation of severity of malaria, haemoglobinopathies could serve as a model for investigation of the mechanisms of malaria pathogenesis and immunity. FUNDING US National Institute of Allergy and Infectious Diseases.
Collapse
Affiliation(s)
- Steve M Taylor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
| | | | | |
Collapse
|
46
|
Derbyshire ER, Mazitschek R, Clardy J. Characterization of Plasmodium liver stage inhibition by halofuginone. ChemMedChem 2012; 7:844-9. [PMID: 22438279 DOI: 10.1002/cmdc.201200045] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 02/23/2012] [Indexed: 12/21/2022]
Abstract
Malaria is a devastating parasitic disease that afflicts one-third of the world's population. Antimalarial drugs in common use address few targets, and their efficacy is being undermined by parasite resistance. Most therapeutics target blood-stage malaria, whereas only few compounds are active against malaria's liver stage, the first stage of the Plasmodium parasite's life cycle within the human host. The identification of inhibitors active against liver-stage malaria would benefit the development of chemical probes to elucidate the poorly understood biology of this phase of the parasite life cycle and could provide agents to prevent and eliminate the disease. Herein we report the development of a live-cell parasite traversal assay in 384-well format amenable to high-throughput screening that exploits the wounding of liver cells by the parasite. This method identifies small molecules that may inhibit the parasite's actin-myosin motor system. The traversal assay, in addition to established methods, was used to evaluate the activity of halofuginone, a synthetic halogenated derivative of the natural alkaloid febrifugine, against liver-stage Plasmodium berghei parasites. Halofuginone was found to inhibit P. berghei sporozoite load in HepG2 cells with an IC(50) value of 17 nM. While the compound does not affect parasite traversal through human liver cells, an inhibition time course assay indicates that it affects essential processes in both early- and late-stage parasite development.
Collapse
Affiliation(s)
- Emily R Derbyshire
- Department of Biological Chemistry & Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | | | | |
Collapse
|
47
|
Kumar A, Chery L, Biswas C, Dubhashi N, Dutta P, Dua VK, Kacchap M, Kakati S, Khandeparkar A, Kour D, Mahajan SN, Maji A, Majumder P, Mohanta J, Mohapatra PK, Narayanasamy K, Roy K, Shastri J, Valecha N, Vikash R, Wani R, White J, Rathod PK. Malaria in South Asia: prevalence and control. Acta Trop 2012; 121:246-55. [PMID: 22248528 DOI: 10.1016/j.actatropica.2012.01.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/02/2012] [Accepted: 01/02/2012] [Indexed: 11/28/2022]
Abstract
The "Malaria Evolution in South Asia" (MESA) program project is an International Center of Excellence for Malaria Research (ICEMR) sponsored by the US National Institutes of Health. This US-India collaborative program will study the origin of genetic diversity of malaria parasites and their selection on the Indian subcontinent. This knowledge should contribute to a better understanding of unexpected disease outbreaks and unpredictable disease presentations from Plasmodium falciparum and Plasmodium vivax infections. In this first of two reviews, we highlight malaria prevalence in India. In particular, we draw attention to variations in distribution of different human-parasites and different vectors, variation in drug resistance traits, and multiple forms of clinical presentations. Uneven malaria severity in India is often attributed to large discrepancies in health care accessibility as well as human migrations within the country and across neighboring borders. Poor access to health care goes hand in hand with poor reporting from some of the same areas, combining to possibly distort disease prevalence and death from malaria in some parts of India. Corrections are underway in the form of increased resources for disease control, greater engagement of village-level health workers for early diagnosis and treatment, and possibly new public-private partnerships activities accompanying traditional national malaria control programs in the most severely affected areas. A second accompanying review raises the possibility that, beyond uneven health care, evolutionary pressures may alter malaria parasites in ways that contribute to severe disease in India, particularly in the NE corridor of India bordering Myanmar Narayanasamy et al., 2012.
Collapse
Affiliation(s)
- Ashwani Kumar
- National Institute of Malaria Research, Panaji, Goa, India
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Costa FTM, Lopes SCP, Ferrer M, Leite JA, Martin-Jaular L, Bernabeu M, Nogueira PA, Mourão MPG, Fernandez-Becerra C, Lacerda MVG, del Portillo H. On cytoadhesion of Plasmodium vivax: raison d'être? Mem Inst Oswaldo Cruz 2012; 106 Suppl 1:79-84. [PMID: 21881760 DOI: 10.1590/s0074-02762011000900010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 06/10/2011] [Indexed: 11/22/2022] Open
Abstract
It is generally accepted that Plasmodium vivax, the most widely distributed human malaria parasite, causes mild disease and that this species does not sequester in the deep capillaries of internal organs. Recent evidence, however, has demonstrated that there is severe disease, sometimes resulting in death, exclusively associated with P. vivax and that P. vivax-infected reticulocytes are able to cytoadhere in vitro to different endothelial cells and placental cryosections. Here, we review the scarce and preliminary data on cytoadherence in P. vivax, reinforcing the importance of this phenomenon in this species and highlighting the avenues that it opens for our understanding of the pathology of this neglected human malaria parasite.
Collapse
Affiliation(s)
- Fabio T M Costa
- Departamento de Genética, Evolução e Bioagentes, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, SP, Brasil.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Lacerda MVG, Mourão MPG, Alexandre MAA, Siqueira AM, Magalhães BML, Martinez-Espinosa FE, Filho FSS, Brasil P, Ventura AMRS, Tada MS, Couto VSCD, Silva AR, Silva RSU, Alecrim MGC. Understanding the clinical spectrum of complicated Plasmodium vivax malaria: a systematic review on the contributions of the Brazilian literature. Malar J 2012; 11:12. [PMID: 22230294 PMCID: PMC3268102 DOI: 10.1186/1475-2875-11-12] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 01/09/2012] [Indexed: 12/12/2022] Open
Abstract
The resurgence of the malaria eradication agenda and the increasing number of severe manifestation reports has contributed to a renewed interested in the Plasmodium vivax infection. It is the most geographically widespread parasite causing human malaria, with around 2.85 billion people living under risk of infection. The Brazilian Amazon region reports more than 50% of the malaria cases in Latin America and since 1990 there is a marked predominance of this species, responsible for 85% of cases in 2009. However, only a few complicated cases of P. vivax have been reported from this region. A systematic review of the Brazilian indexed and non-indexed literature on complicated cases of vivax malaria was performed including published articles, masters' dissertations, doctoral theses and national congresses' abstracts. The following information was retrieved: patient characteristics (demographic, presence of co-morbidities and, whenever possible, associated genetic disorders); description of each major clinical manifestation. As a result, 27 articles, 28 abstracts from scientific events' annals and 13 theses/dissertations were found, only after 1987. Most of the reported information was described in small case series and case reports of patients from all the Amazonian states, and also in travellers from Brazilian non-endemic areas. The more relevant clinical complications were anaemia, thrombocytopaenia, jaundice and acute respiratory distress syndrome, present in all age groups, in addition to other more rare clinical pictures. Complications in pregnant women were also reported. Acute and chronic co-morbidities were frequent, however death was occasional. Clinical atypical cases of malaria are more frequent than published in the indexed literature, probably due to a publication bias. In the Brazilian Amazon (considered to be a low to moderate intensity area of transmission), clinical data are in accordance with the recent findings of severity described in diverse P. vivax endemic areas (especially anaemia in Southeast Asia), however in this region both children and adults are affected. Finally, gaps of knowledge and areas for future research are opportunely pointed out.
Collapse
Affiliation(s)
- Marcus V G Lacerda
- Fundação de Medicina Tropical Dr, Heitor Vieira Dourado, Av, Pedro Teixeira, 25, 69040-000, Manaus Amazonas, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
The long-standing dearth of knowledge surrounding Plasmodium vivax, the most widely distributed of the malaria species, merits urgent attention. A growing awareness of the true burden of this parasite and its potential to cause severe disease, and the identification of increasing parasite resistance in many areas of the world to chloroquine, the mainstay of vivax treatment, underscores the need to identify new and effective treatment strategies. Artemisinin-based combination therapies (ACTs) have been widely adopted as first-line treatment for P. falciparum malaria and would offer logistic benefits in areas of co-endemicity. However, while ACTs show high and similar efficacy against the blood stages of P. vivax, neither ACTs nor chloroquine are active against vivax hypnozoites and must be complemented with a full course of primaquine to eradicate dormant vivax hypnozoites and prevent relapses. Artemether-lumefantrine (AL), the most commonly deployed ACT, has shown rapid clearance of P. vivax parasitemia and fever. The relatively short half-life of lumefantrine would appear beneficial in terms of reducing risk of resistance when compared to other ACTs. However, it has a shorter capability to suppress vivax relapses or prevent de novo infections, which generally translates into comparatively lower in vivo short-term measures of efficacy (e.g., day 28 or day 42 uncorrected cure rates). Assuming that the different artemisinin derivatives have equivalent efficacy against vivax, differences between AL and other ACTs may be restricted to the duration of plasma therapeutic levels of the partner drug, a variable of limited clinical relevance, particularly in regions with low vivax transmission rates or in cases where primaquine is added to the regimen to prevent relapses. More rigorous assessment of the use of ACTs in general, and AL in particular, for the treatment of P. vivax infections, either alone or in combination with primaquine, is merited. In the meantime, AL treatment of vivax malaria may be a pragmatic choice for areas with chloroquine-resistant P. vivax, and in co-endemic areas where AL is already used routinely against P. falciparum and parasitological differentiation is not routinely performed or only clinical diagnosis is used.
Collapse
Affiliation(s)
- Quique Bassat
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic Universitat de Barcelona, Barcelona, Spain.
| |
Collapse
|