1
|
Sissoko A, Othmene YB, Buffet P. Splenic filtration of red blood cells in physiology, malaria and sickle cell disease. Curr Opin Hematol 2024; 31:307-314. [PMID: 39259191 DOI: 10.1097/moh.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
PURPOSE OF REVIEW The human spleen clears the blood from circulating microorganisms and red blood cells (RBCs) displaying alterations. This review analyzes how generic mechanisms by which the spleen senses RBC, such pitting, trapping and erythrophagocytosis, impact the pathogenesis of two major spleen-related diseases, malaria and sickle cell disease (SCD). RECENT FINDINGS Scintigraphy, functional histology, comparison of circulating and splenic RBC, ex-vivo perfusion of human spleens and in-silico modeling enable relevant exploration of how the spleen retains and processes RBC in health and disease. Iterative cross-validations between medical observations, in-vitro experiments and in-silico modeling point to mechanical sensing of RBC as a central event in both conditions. Spleen congestion is a common pathogenic process explaining anemia and splenomegaly, the latter carrying a risk of severe complications such as acute splenic sequestration crisis and hypersplenism in SCD. Sickling of hemoglobin S-containing RBC may contribute to these complications without necessarily being the trigger. SUMMARY Ongoing progress in the exploration and understanding of spleen-related complications in malaria and SCD open the way to optimized prognosis evaluation and therapeutic applications.
Collapse
Affiliation(s)
| | | | - Pierre Buffet
- Université Paris Cité, Inserm, BIGR
- Assistance publique des hôpitaux de Paris
- Institut Pasteur, Université de Paris Cité, Paris, France
| |
Collapse
|
2
|
Hadjilaou A, Brandi J, Riehn M, Friese MA, Jacobs T. Pathogenetic mechanisms and treatment targets in cerebral malaria. Nat Rev Neurol 2023; 19:688-709. [PMID: 37857843 DOI: 10.1038/s41582-023-00881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/21/2023]
Abstract
Malaria, the most prevalent mosquito-borne infectious disease worldwide, has accompanied humanity for millennia and remains an important public health issue despite advances in its prevention and treatment. Most infections are asymptomatic, but a small percentage of individuals with a heavy parasite burden develop severe malaria, a group of clinical syndromes attributable to organ dysfunction. Cerebral malaria is an infrequent but life-threatening complication of severe malaria that presents as an acute cerebrovascular encephalopathy characterized by unarousable coma. Despite effective antiparasite drug treatment, 20% of patients with cerebral malaria die from this disease, and many survivors of cerebral malaria have neurocognitive impairment. Thus, an important unmet clinical need is to rapidly identify people with malaria who are at risk of developing cerebral malaria and to develop preventive, adjunctive and neuroprotective treatments for cerebral malaria. This Review describes important advances in the understanding of cerebral malaria over the past two decades and discusses how these mechanistic insights could be translated into new therapies.
Collapse
Affiliation(s)
- Alexandros Hadjilaou
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany.
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
| | - Johannes Brandi
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany
| | - Mathias Riehn
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany
| | - Manuel A Friese
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Jacobs
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany
| |
Collapse
|
3
|
Cutts JC, O'Flaherty K, Zaloumis SG, Ashley EA, Chan JA, Onyamboko MA, Fanello C, Dondorp AM, Day NP, Phyo AP, Dhorda M, Imwong M, Fairhurst RM, Lim P, Amaratunga C, Pukrittayakamee S, Hien TT, Htut Y, Mayxay M, Abdul Faiz M, Takashima E, Tsuboi T, Beeson JG, Nosten F, Simpson JA, White NJ, Fowkes FJI. Comparison of antibody responses and parasite clearance in artemisinin therapeutic efficacy studies in Democratic Republic of Congo and Asia. J Infect Dis 2022; 226:324-331. [PMID: 35703955 PMCID: PMC9400417 DOI: 10.1093/infdis/jiac232] [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: 02/10/2022] [Accepted: 06/12/2022] [Indexed: 12/05/2022] Open
Abstract
Background Understanding the effect of immunity on Plasmodium falciparum clearance is essential for interpreting therapeutic efficacy studies designed to monitor emergence of artemisinin drug resistance. In low-transmission areas of Southeast Asia, where resistance has emerged, P. falciparum antibodies confound parasite clearance measures. However, variation in naturally acquired antibodies across Asian and sub-Saharan African epidemiological contexts and their impact on parasite clearance re yet to be quantified. Methods In an artemisinin therapeutic efficacy study, antibodies to 12 pre-erythrocytic and erythrocytic P. falciparum antigens were measured in 118 children with uncomplicated P. falciparum malaria in the Democratic Republic of Congo (DRC) and compared with responses in patients from Asian sites, described elsewhere. Results Parasite clearance half-life was shorter in DRC patients (median, 2 hours) compared with most Asian sites (median, 2–7 hours), but P. falciparum antibody levels and seroprevalences were similar. There was no evidence for an association between antibody seropositivity and parasite clearance half-life (mean difference between seronegative and seropositive, −0.14 to +0.40 hour) in DRC patients. Conclusions In DRC, where artemisinin remains highly effective, the substantially shorter parasite clearance time compared with Asia was not explained by differences in the P. falciparum antibody responses studied.
Collapse
Affiliation(s)
- Julia C Cutts
- Burnet Institute, Melbourne, Victoria 3004, Australia.,Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | | | - Sophie G Zaloumis
- Centre for Epidemiology and Biostatistics, Melbourne, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Elizabeth A Ashley
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom.,Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit, Mahosot Hospital, Vientiane, Lao PDR
| | - Jo Anne Chan
- Burnet Institute, Melbourne, Victoria 3004, Australia.,Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.,Department of Immunology, Monash University, Melbourne Australia
| | - Marie A Onyamboko
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Caterina Fanello
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom.,Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
| | - Nicholas P Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
| | | | - Mehul Dhorda
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom.,Worldwide Antimalarial Resistance Network, Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
| | - Mallika Imwong
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rick M Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Pharath Lim
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Chanaki Amaratunga
- Worldwide Antimalarial Resistance Network, Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
| | | | - Tran Tinh Hien
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ye Htut
- Department of Medical Research, Yangon, Myanmar
| | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom.,Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR.,Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit, Mahosot Hospital, Vientiane, Lao PDR
| | - M Abdul Faiz
- Malaria Research Group & Dev Care Foundation, Chittagong, Bangladesh
| | - Eizo Takashima
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Takafumi Tsuboi
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - James G Beeson
- Burnet Institute, Melbourne, Victoria 3004, Australia.,Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.,Department of Immunology, Monash University, Melbourne Australia
| | - Francois Nosten
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom.,Shoklo Malaria Research Unit, Mae Sot, Thailand
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
| | - Freya J I Fowkes
- Burnet Institute, Melbourne, Victoria 3004, Australia.,Centre for Epidemiology and Biostatistics, Melbourne, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Department of Infectious Diseases and Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
4
|
Forgie EME, Brooks HM, Barton M, Hawkes MT. Pediatric Malaria: Global and North American Perspectives. Pediatr Clin North Am 2022; 69:47-64. [PMID: 34794676 DOI: 10.1016/j.pcl.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Malaria is a leading cause of death in children less than 5 years of age globally, and a common cause of fever in the returning North American traveler. New tools in the fight against malaria have been developed over the past decades: potent artemisinin derivatives; rapid diagnostic tests; long-lasting insecticidal bed nets; and a new vaccine, RTS,S/AS01. Thwarting these advances, parasite and Anopheles vector resistance are emerging. In the meantime, clinicians will continue to see malaria among febrile travelers from the tropics. Early recognition, diagnosis, and treatment can be lifesaving, but rely on the vigilance of frontline clinicians.
Collapse
Affiliation(s)
- Ella M E Forgie
- Department of Anthropology, University of Alberta, Tory Building, 11211 Saskatchewan Drive, Edmonton, Alberta T6G 2H4, Canada
| | - Hannah M Brooks
- Faculty of Nursing, University of Alberta, 5-143 Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada
| | - Michelle Barton
- Department of Paediatrics, Division of Pediatric Infectious Diseases, Schulich School of Medicine, Western University, Children's Health Research Institute, Lawson Health Research Institute, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada
| | - Michael T Hawkes
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada; Department of Medical Microbiology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada; School of Public Health, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada; Women and Children's Health Research Institute, Edmonton, Canada.
| |
Collapse
|
5
|
Elizalde-Torrent A, Trejo-Soto C, Méndez-Mora L, Nicolau M, Ezama O, Gualdrón-López M, Fernández-Becerra C, Alarcón T, Hernández-Machado A, Del Portillo HA. Pitting of malaria parasites in microfluidic devices mimicking spleen interendothelial slits. Sci Rep 2021; 11:22099. [PMID: 34764379 PMCID: PMC8585870 DOI: 10.1038/s41598-021-01568-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/19/2021] [Indexed: 11/09/2022] Open
Abstract
The spleen is a hematopoietic organ that participates in cellular and humoral immunity. It also serves as a quality control mechanism for removing senescent and/or poorly deformable red blood cells (RBCs) from circulation. Pitting is a specialized process by which the spleen extracts particles, including malaria parasites, from within circulating RBCs during their passage through the interendothelial slits (IES) in the splenic cords. To study this physiological function in vitro, we have developed two microfluidic devices modeling the IES, according to the hypothesis that at a certain range of mechanical stress on the RBC, regulated through both slit size and blood flow, would force it undergo the pitting process without affecting the cell integrity. To prove its functionality in replicating pitting of malaria parasites, we have performed a characterization of P. falciparum-infected RBCs (P.f.-RBCs) after their passage through the devices, determining hemolysis and the proportion of once-infected RBCs (O-iRBCs), defined by the presence of a parasite antigen and absence of DAPI staining of parasite DNA using a flow cytometry-based approach. The passage of P.f.-RBCs through the devices at the physiological flow rate did not affect cell integrity and resulted in an increase of the frequency of O-iRBCs. Both microfluidic device models were capable to replicate the pitting of P.f.-RBCs ex vivo by means of mechanical constraints without cellular involvement, shedding new insights on the role of the spleen in the pathophysiology of malaria.
Collapse
Affiliation(s)
- Aleix Elizalde-Torrent
- ISGlobal Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,IrsiCaixa AIDS Research Institute, Badalona, Spain
| | - Claudia Trejo-Soto
- Instituto de Física, Pontificia Universidad Católica de Valparaíso, 4059, Casilla, Chile
| | - Lourdes Méndez-Mora
- Department of Condensed Matter Physics, University of Barcelona (UB), Barcelona, Spain
| | - Marc Nicolau
- ISGlobal Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Oihane Ezama
- Department of Condensed Matter Physics, University of Barcelona (UB), Barcelona, Spain
| | - Melisa Gualdrón-López
- ISGlobal Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,IGTP Institut d'Investigació Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Carmen Fernández-Becerra
- ISGlobal Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,IGTP Institut d'Investigació Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Tomás Alarcón
- ICREA: Catalan Institution for Research and Advanced Studies, Barcelona, Spain.,Centre de Recerca Matemàtica (CRM), Bellaterra, Barcelona, Spain.,Departament de Matemàtiques, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Aurora Hernández-Machado
- Department of Condensed Matter Physics, University of Barcelona (UB), Barcelona, Spain. .,Centre de Recerca Matemàtica (CRM), Bellaterra, Barcelona, Spain. .,Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona (UB), Barcelona, Spain.
| | - Hernando A Del Portillo
- ISGlobal Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. .,IGTP Institut d'Investigació Germans Trias I Pujol, Badalona, Barcelona, Spain. .,ICREA: Catalan Institution for Research and Advanced Studies, Barcelona, Spain.
| |
Collapse
|
6
|
Raja TN, Hu TH, Kadir KA, Mohamad DSA, Rosli N, Wong LL, Hii KC, Simon Divis PC, Singh B. Naturally Acquired Human Plasmodium cynomolgi and P. knowlesi Infections, Malaysian Borneo. Emerg Infect Dis 2021; 26:1801-1809. [PMID: 32687020 PMCID: PMC7392409 DOI: 10.3201/eid2608.200343] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To monitor the incidence of Plasmodium knowlesi infections and determine whether other simian malaria parasites are being transmitted to humans, we examined 1,047 blood samples from patients with malaria at Kapit Hospital in Kapit, Malaysia, during June 24, 2013–December 31, 2017. Using nested PCR assays, we found 845 (80.6%) patients had either P. knowlesi monoinfection (n = 815) or co-infection with other Plasmodium species (n = 30). We noted the annual number of these zoonotic infections increased greatly in 2017 (n = 284). We identified 6 patients, 17–65 years of age, with P. cynomolgi and P. knowlesi co-infections, confirmed by phylogenetic analyses of the Plasmodium cytochrome c oxidase subunit 1 gene sequences. P. knowlesi continues to be a public health concern in the Kapit Division of Sarawak, Malaysian Borneo. In addition, another simian malaria parasite, P. cynomolgi, also is an emerging cause of malaria in humans.
Collapse
|
7
|
Ascoli Bartoli T, Lepore L, D'Abramo A, Adamo G, Corpolongo A, Scorzolini L, Giancola ML, Bevilacqua N, Palazzolo C, Mariano A, Ippolito G, Buffet P, Nicastri E. Systematic analysis of direct antiglobulin test results in post-artesunate delayed haemolysis. Malar J 2021; 20:206. [PMID: 33926462 PMCID: PMC8082776 DOI: 10.1186/s12936-021-03735-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Post-artesunate delayed haemolysis (PADH) is common after severe malaria episodes. PADH is related to the “pitting” phenomenon and the synchronous delayed clearance of once-infected erythrocytes, initially spared during treatment. However, direct antiglobulin test (DAT) positivity has been reported in several PADH cases, suggesting a contribution of immune-mediated erythrocyte clearance. The aim of the present study was to compare clinical features of cases presenting a positive or negative DAT. Methods Articles reporting clinical data of patients diagnosed with PADH, for whom DAT had been performed, were collected from PubMed database. Data retrieved from single patients were extracted and univariate analysis was performed in order to identify features potentially related to DAT results and steroids use. Results Twenty-two studies reporting 39 PADH cases were included: median baseline parasitaemia was 20.8% (IQR: 11.2–30) and DAT was positive in 17 cases (45.5%). Compared to DAT-negative individuals, DAT-positive patients were older (49.5 vs 31; p = 0.01), had a higher baseline parasitaemia (27% vs 17%; p = 0.03) and were more commonly treated with systemic steroids (11 vs 3 patients, p = 0.002). Depth and kinetics of delayed anaemia were not associated with DAT positivity. Conclusions In this case series, almost half of the patients affected by PADH had a positive DAT. An obvious difference between the clinical courses of patients presenting with a positive or negative DAT was lacking. This observation suggests that DAT result may not be indicative of a pathogenic role of anti-erythrocytes antibodies in patients affected by PADH, but it may be rather a marker of immune activation. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03735-w.
Collapse
Affiliation(s)
- Tommaso Ascoli Bartoli
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Luciana Lepore
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Alessandra D'Abramo
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy.
| | - Giovanna Adamo
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Angela Corpolongo
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Laura Scorzolini
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Maria Letizia Giancola
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Nazario Bevilacqua
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Claudia Palazzolo
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Andrea Mariano
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Giuseppe Ippolito
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Pierre Buffet
- UMRS 1134, Inserm, Université de Paris, 75015, Paris, France.,Laboratory of Excellence GREx, 75015, Paris, France
| | - Emanuele Nicastri
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| |
Collapse
|
8
|
The Human Spleen in Malaria: Filter or Shelter? Trends Parasitol 2020; 36:435-446. [PMID: 32298631 DOI: 10.1016/j.pt.2020.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/10/2020] [Accepted: 03/04/2020] [Indexed: 12/18/2022]
Abstract
The human spleen is an immune sentinel and controls red blood cell (RBC) quality. By mechanically retaining subsets of infected RBCs, the spleen may reduce the pace at which the parasite biomass increases before the adaptive immune response operates. Conversely, the spleen may contribute to malaria pathogenesis, particularly anemia that is associated with splenomegaly. Large spleens may also shelter parasites in chronic carriers. Upon treatment with artemisinins, the spleen clears circulating parasites by pitting and releases 'once-infected' RBCs in circulation. This triggers postartesunate delayed hemolysis and explains the long post-treatment positivity of histidine-rich protein 2 (HRP2)-based dipsticks. Importantly, splenic retention of RBCs also applies to gametocytes, the clearance of which may be enhanced by stiffening them with drugs, a potential way to block malaria transmission.
Collapse
|
9
|
Poti KE, Balaban AE, Pal P, Kobayashi T, Goldberg DE, Sinnis P, Sullivan DJ. In vivo compartmental kinetics of Plasmodium falciparum histidine-rich protein II in the blood of humans and in BALB/c mice infected with a transgenic Plasmodium berghei parasite expressing histidine-rich protein II. Malar J 2019; 18:78. [PMID: 30866956 PMCID: PMC6416945 DOI: 10.1186/s12936-019-2712-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background The Plasmodium falciparum histidine-rich protein II (PfHRP2) is a common biomarker used in malaria rapid diagnostic tests (RDTs), but can persist in the blood for up to 40 days following curative treatment. The persistence of PfHRP2 presents a false positive limitation to diagnostic interpretation. However, the in vivo dynamics and compartmentalization underlying PfHRP2 persistence have not been fully characterized in the plasma and erythrocyte (RBC) fraction of the whole blood. Methods The kinetics and persistence of PfHRP2 in the plasma and RBC fractions of the whole blood were investigated post-treatment in human clinical samples and samples isolated from BALB/c mice infected with a novel transgenic Plasmodium berghei parasite engineered to express PfHRP2 (PbPfHRP2). Results PfHRP2 levels in human RBCs were consistently 20–40 times greater than plasma levels, even post-parasite clearance. PfHRP2 positive, DNA negative, once-infected RBCs were identified in patients that comprised 0.1–1% of total RBCs for 6 and 12 days post-treatment, even post-atovaquone–proguanil regimens. Transgenic PbPfHRP2 parasites in BALB/c mice produced and exported tgPfHRP2 to the RBC cytosol similar to P. falciparum. As in humans, tgPfHRP2 levels were found to be approximately 20-fold higher within the RBC fraction than the plasma post-treatment. RBC localized tgPfHRP2 persisted longer than tgPfHRP2 in the plasma after curative treatment. tgPfHRP2 positive, but DNA negative once-infected RBCs were also detected in mouse peripheral blood for 7–9 days after curative treatment. Conclusions The data suggest that persistence of PfHRP2 is due to slower clearance of protein from the RBC fraction of the whole blood. This appears to be a result of the presence PfHRP2 in previously infected, pitted cells, as opposed to PfHRP2 binding naïve RBCs in circulation post-treatment. The results thus confirm that the extended duration of RDT positivity after parasite clearance is likely due to pitted, once-infected RBCs that remain positive for PfHRP2. Electronic supplementary material The online version of this article (10.1186/s12936-019-2712-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kristin E Poti
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda E Balaban
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Priya Pal
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tamaki Kobayashi
- Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel E Goldberg
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Photini Sinnis
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
10
|
Abstract
Malaria is a major cause of anaemia in tropical areas. Malaria infection causes haemolysis of infected and uninfected erythrocytes and bone marrow dyserythropoiesis which compromises rapid recovery from anaemia. In areas of high malaria transmission malaria nearly all infants and young children, and many older children and adults have a reduced haemoglobin concentration as a result. In these areas severe life-threatening malarial anaemia requiring blood transfusion in young children is a major cause of hospital admission, particularly during the rainy season months when malaria transmission is highest. In severe malaria, the mortality rises steeply below an admission haemoglobin of 3 g/dL, but it also increases with higher haemoglobin concentrations approaching the normal range. In the management of severe malaria transfusion thresholds remain uncertain. Prevention of malaria by vector control, deployment of insecticide-treated bed nets, prompt and accurate diagnosis of illness and appropriate use of effective anti-malarial drugs substantially reduces the burden of anaemia in tropical countries.
Collapse
Affiliation(s)
- Nicholas J White
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| |
Collapse
|
11
|
Fanello C, Onyamboko M, Lee SJ, Woodrow C, Setaphan S, Chotivanich K, Buffet P, Jauréguiberry S, Rockett K, Stepniewska K, Day NPJ, White NJ, Dondorp AM. Post-treatment haemolysis in African children with hyperparasitaemic falciparum malaria; a randomized comparison of artesunate and quinine. BMC Infect Dis 2017; 17:575. [PMID: 28818049 PMCID: PMC5561573 DOI: 10.1186/s12879-017-2678-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/09/2017] [Indexed: 11/10/2022] Open
Abstract
Background Parenteral artesunate is the treatment of choice for severe malaria. Recently, haemolytic anaemia occurring 1 to 3 weeks after artesunate treatment of falciparum malaria has been reported in returning travellers in temperate countries. Methods To assess these potential safety concerns in African children, in whom most deaths from malaria occur, an open-labelled, randomized controlled trial was conducted in Kinshasa, Democratic Republic of Congo. 217 children aged between 6 months and 14 years with acute uncomplicated falciparum malaria and parasite densities over 100,000/μL were randomly allocated to intravenous artesunate or quinine, hospitalized for 3 days and then followed for 42 days. Results The immediate reduction in haemoglobin was less with artesunate than with quinine: median (IQR) fall at 72 h 1.4 g/dL (0.90–1.95) vs. 1.7 g/dL (1.10–2.40) (p = 0.009). This was explained by greater pitting then recirculation of once infected erythrocytes. Only 5% of patients (in both groups) had a ≥ 10% reduction in haemoglobin after day 7 (p = 0.1). One artesunate treated patient with suspected concomitant sepsis had a protracted clinical course and required a blood transfusion on day 14. Conclusions Clinically significant delayed haemolysis following parenteral artesunate is uncommon in African children hospitalised with acute falciparum malaria and high parasitaemias. Trial registration ClinicalTrials.gov; Identifier: NCT02092766 (18/03/2014) Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2678-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- C Fanello
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - M Onyamboko
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - S J Lee
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - C Woodrow
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - S Setaphan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - K Chotivanich
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - P Buffet
- Institut National de la Transfusion Sanguine, Université Paris Descartes/INSERM UMR_S 1134, Paris, France.,Laboratoire d'Excellence GR-Ex, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre National de Référence du Paludisme, Paris, France
| | - S Jauréguiberry
- Assistance Publique-Hôpitaux de Paris, Centre National de Référence du Paludisme, Paris, France
| | - K Rockett
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - K Stepniewska
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,WorldWide Antimalarial Resistance Network, Oxford, UK
| | - N P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - N J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - A M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
12
|
Claser C, Chang ZW, Russell B, Rénia L. Adaptive immunity is essential in preventing recrudescence ofPlasmodium yoeliimalaria parasites after artesunate treatment. Cell Microbiol 2017; 19. [DOI: 10.1111/cmi.12763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/02/2017] [Accepted: 06/22/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Carla Claser
- Singapore Immunology Network (SIgN); A*STAR; Singapore
| | - Zi Wei Chang
- Singapore Immunology Network (SIgN); A*STAR; Singapore
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore
| | - Bruce Russell
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore
- Department of Microbiology and Immunology; Otago University; Dunedin New Zealand
| | - Laurent Rénia
- Singapore Immunology Network (SIgN); A*STAR; Singapore
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore
| |
Collapse
|
13
|
Abstract
Following anti-malarial drug treatment asexual malaria parasite killing and clearance appear to be first order processes. Damaged malaria parasites in circulating erythrocytes are removed from the circulation mainly by the spleen. Splenic clearance functions increase markedly in acute malaria. Either the entire infected erythrocytes are removed because of their reduced deformability or increased antibody binding or, for the artemisinins which act on young ring stage parasites, splenic pitting of drug-damaged parasites is an important mechanism of clearance. The once-infected erythrocytes returned to the circulation have shortened survival. This contributes to post-artesunate haemolysis that may follow recovery in non-immune hyperparasitaemic patients. As the parasites mature Plasmodium vivax-infected erythrocytes become more deformable, whereas Plasmodium falciparum-infected erythrocytes become less deformable, but they escape splenic filtration by sequestering in venules and capillaries. Sequestered parasites are killed in situ by anti-malarial drugs and then disintegrate to be cleared by phagocytic leukocytes. After treatment with artemisinin derivatives some asexual parasites become temporarily dormant within their infected erythrocytes, and these may regrow after anti-malarial drug concentrations decline. Artemisinin resistance in P. falciparum reflects reduced ring stage susceptibility and manifests as slow parasite clearance. This is best assessed from the slope of the log-linear phase of parasitaemia reduction and is commonly measured as a parasite clearance half-life. Pharmacokinetic-pharmacodynamic modelling of anti-malarial drug effects on parasite clearance has proved useful in predicting therapeutic responses and in dose-optimization.
Collapse
Affiliation(s)
- Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand.
| |
Collapse
|
14
|
Sowunmi A, Akano K, Ntadom G, Ayede AI, Ibironke FO, Aderoyeje T, Adewoye EO, Fatunmbi B, Oguche S, Okafor HU, Watila I, Meremikwu M, Agomo P, Ogala W, Agomo C, Folarin OA, Gbotosho GO, Happi CT. Therapeutic efficacy and effects of artemisinin-based combination treatments on uncomplicated Plasmodium falciparum malaria -associated anaemia in Nigerian children during seven years of adoption as first-line treatments. Infect Dis Poverty 2017; 6:36. [PMID: 28173853 PMCID: PMC5294876 DOI: 10.1186/s40249-016-0217-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Artemisinin-based combination treatments (ACTs) are the first-line treatments of uncomplicated Plasmodium falciparum malaria in many endemic areas but there are few evaluation of their efficacy in anaemic malarious children. METHODS Therapeutic efficacy of 3-day regimens of artesunate-amodiaquine and artemether-lumefantrine was evaluated in 437 anaemic and 909 non-anaemic malarious children following treatment during a seven-year period (2008-2014). Patterns of temporal changes in haematocrit were classified based on haematocrit values <30% and ≥30%. Kinetics of the disposition of the deficit in haematocrit from 30% following treatment were evaluated using a non-compartment model. RESULTS PCR-corrected parasitological efficacy 28 days after start of treatment was significantly higher in artesunate-amodiaquine- compared to artemether-lumefantrine-treated children [97% (95%CI: 92.8-100) versus 96.4% (95%CI: 91.3-99.4), P = 0.02], but it was similar in non-anaemic and anaemic children. Fall in haematocrit/1 000 asexual parasites cleared from peripheral blood was significantly greater at lower compared to higher parasitaemias (P < 0.0001), and in non-anaemic compared to anaemic children (P = 0.007). In anaemic children at presentation, mean anaemia recovery time (AnRT) was 15.4 days (95%CI: 13.3-17.4) and it did not change over the years. Declines in haematocrit deficits from 30% were monoexponential with mean estimated half-time of 1.4 days (95%CI: 1.2-1.6). Anaemia half-time (t½anaemia) correlated positively with AnRT in the same patients (r = 0.69, P < 0.0001). Bland-Altman analysis of 10 multiples of t½anaemia and AnRT showed narrow limit of agreement with insignificant bias (P = 0.07) suggesting both can be used interchangeably in the same patients. CONCLUSIONS Artesunate-amodiaquine and artemether-lumefantrine remain efficacious treatments of uncomplicated P. falciparum infections in non-anaemic and anaemic Nigerian children in the last 7 years of adoption as first-line treatments. These ACTs may also conserve haematocrit at high parasitaemias and in anaemic children. TRIALS REGISTRATION Pan African Clinical Trial Registry PACTR201508001188143 , 3 July 2015; PACTR201510001189370 , 3 July 2015; PACTR201508001191898 , 7 July 2015 and PACTR201508001193368 , 8 July 2015.
Collapse
Affiliation(s)
- Akintunde Sowunmi
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Institute for Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
| | - Kazeem Akano
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Godwin Ntadom
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
| | | | - Folasade O. Ibironke
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
| | - Temitope Aderoyeje
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
| | | | - Bayo Fatunmbi
- World Health Organization, Regional Office for the Western Pacific, Khan Daun Penh, Phnom Penh Cambodia
| | - Stephen Oguche
- Department of Paediatrics, University of Jos, Jos, Nigeria
| | - Henrietta U. Okafor
- Department of Paediatrics, Institute of Child Health, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Ismaila Watila
- Department of Paediatrics, Specialist Hospital, Maiduguri, Borno Sate Nigeria
| | - Martin Meremikwu
- Department of Paediatrics, University of Calabar, Calabar, Cross Rivers State Nigeria
| | - Philip Agomo
- Nigeria Institute of Medical Research, Yaba, Lagos, Nigeria
| | - William Ogala
- Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
| | - Chimere Agomo
- Nigeria Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Onikepe A. Folarin
- Department of Biological Sciences, Redeemer’s University, Ede, Osun State Nigeria
| | - Grace O. Gbotosho
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Institute for Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christian T. Happi
- Department of Biological Sciences, Redeemer’s University, Ede, Osun State Nigeria
| |
Collapse
|
15
|
Sowunmi A, Akano K, Ayede AI, Ntadom G, Aderoyeje T, Adewoye EO, Fatunmbi B. Clinical illness and outcomes in Nigerian children with late-appearing anaemia after artemisinin-based combination treatments of uncomplicated falciparum malaria. BMC Infect Dis 2016; 16:240. [PMID: 27246468 PMCID: PMC4888541 DOI: 10.1186/s12879-016-1565-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background Late-appearing anaemia (LAA) following treatment with artemisinins for severe malaria has been reported and well described, but there are limited clinical and parasitological data on LAA in African children with uncomplicated falciparum malaria following oral artemisinin-based combination therapies (ACTs). Methods This was an open label study with the main objectives of evaluating the clinical features, the risk factors for, the temporal changes in haematocrit and the outcomes of a LAA in malarious children treated with artesunate-amodiaquine (AA), artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHP). The diagnosis of LAA was made using the criteria: clearance of parasitaemia, fever and other symptoms within 1 week of commencing treatment; adequate clinical and parasitological response at 4–6 weeks after treatment began; haematocrit ≥30 % 1 and/or 2 weeks after treatment began; and haematocrit <30 %, parasite negativity by microscopy and polymerase chain reaction and absence of concomitant illness 3–6 weeks after treatment began. Results LAA occurred in 84 of 609 children, was mild, moderate or severe in 77, 6 or 1 child, respectively and was relatively asymptomatic. Mean time elapsing from commencement of treatment to LAA was 27.1 days (95 % CI 25.3–28.9). In a multivariate analysis, an age <3 years (adjusted odd ratio [AOR] = 2.6, 95 % CI 1.3–5.2, P = 0.005), fever 1 day after treatment began (AOR = 3.8, 95 % CI 1.8–8.2, P < 0.0001), haematocrit <25 % at presentation (AOR = 2.2, 95 % CI 1.3–3.7, P = 0.003), haematocrit <30 % 1 day after treatment began (AOR = 2.1, 95 % CI 1.0–4.3, P = 0.04), parasite reduction ratio >104 2 days after treatment began (AOR = 2.1, 95 % CI 1.1–3.9, P = 0.03) and spleen enlargement at presentation (AOR = 2.0, 95 % CI 1.1–3.9, P < 0.0001) were independent predictors of LAA. During 6 weeks of follow-up, uneventful recovery from anaemia occurred in 56 children [mean recovery time of 11.8 days (95 % CI 10.3–13.3)]. The only independent predictor of failure of recovery was LAA occurring 4 weeks after starting treatment (AOR = 7.5, 95 % CI 2.5–22.9, P < 0.0001). Conclusion A relatively asymptomatic LAA with uneventful recovery can occur in young malarious children following ACTs. Its occurrence may have implications for case and community management of anaemia and for anaemia control efforts in sub–Saharan Africa where ACTs have become first-line antimalarials. Trials registration Pan African Clinical Trial Registry PACTR201508001188143, 3 July 2015; PACTR201510001189370, 3 July 2015; PACTR201508001191898, 7 July 2015 and PACTR201508001193368, 8 July 2015 http://www.pactr.org.
Collapse
Affiliation(s)
- Akintunde Sowunmi
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria. .,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria. .,Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria.
| | - Kazeem Akano
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | | | - Godwin Ntadom
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Temitope Aderoyeje
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
| | - Elsie O Adewoye
- Department of Physiology, University of Ibadan, Ibadan, Nigeria
| | - Bayo Fatunmbi
- World Health Organization, Regional Office for the Western Pacific, Phnom Penh, Cambodia
| |
Collapse
|
16
|
Mbengue B, Niang B, Niang MS, Varela ML, Fall B, Fall MM, Diallo RN, Diatta B, Gowda DC, Dieye A, Perraut R. Inflammatory cytokine and humoral responses to Plasmodium falciparum glycosylphosphatidylinositols correlates with malaria immunity and pathogenesis. Immun Inflamm Dis 2016; 4:24-34. [PMID: 27042299 PMCID: PMC4768067 DOI: 10.1002/iid3.89] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/08/2015] [Accepted: 10/13/2015] [Indexed: 12/31/2022] Open
Abstract
Pro-inflammatory cytokines induced by glycosylphosphatidylinositols (GPIs) of Plasmodium falciparum contribute to malaria pathogenesis and hence, the naturally acquired anti-GPI antibody thought to provide protection against severe malaria (SM) by neutralizing the stimulatory activity of GPIs. In previous studies, the anti-GPI antibody levels increased with age in parallel with the development of acquired immunity, and high levels of anti-GPI antibodies were associated with mild malaria (MM) cases. In the present study, the relationship between the levels of pro-inflammatory cytokines and anti-GPI IgG antibody responses, parasitemia, and the clinical outcomes were evaluated in SM and mild malaria (MM) patients. Sera from a total of 110 SM and 72 MM cases after excluding of ineligible patients were analyzed for the levels of anti-GPI antibodies, IgG subclasses, and cytokine responses by ELISA. While the total anti-GPI antibody levels were similar in overall SM and MM groups, they were significantly higher in surviving SM patients than in fatal SM cases. In the case of cytokines, the TNF-α and IL-6 levels were significantly higher in SM compared to MM, whereas the IL-10 levels were similar in both groups. The data presented here demonstrate that high levels of the circulatory pro-inflammatory, TNF-α, and IL-6, are indicators of malaria severity, whereas anti-inflammatory cytokine IL-10 level does not differentiate SM and MM cases. Further, among SM patients, relatively low levels of anti-GPI antibodies are indicators of fatal outcomes compared to survivors, suggesting that anti-GPI antibodies provide some level of protection against SM fatality.
Collapse
Affiliation(s)
- Babacar Mbengue
- Service d'Immunologie Université Cheikh Anta Diop de DakarUCADDakarSenegal
- Unité d'ImmunogénétiqueInstitut Pasteur de Dakar, IPDDakarSenegal
| | - Birahim Niang
- Service de RéanimationHôpital Principal de Dakar, HPDDakarSenegal
| | | | | | - Becaye Fall
- Fédération des laboratoiresHôpital Principal de Dakar, HPDDakarSenegal
| | | | | | - Bacary Diatta
- Service de RéanimationHôpital Principal de Dakar, HPDDakarSenegal
| | - D. Channe Gowda
- Department of Biochemistry and Molecular BiologyPennsylvania State University College of Medicine, Milton S. Hershey Medical Center PennsylvaniaHersheyUSA
| | - Alioune Dieye
- Service d'Immunologie Université Cheikh Anta Diop de DakarUCADDakarSenegal
- Unité d'ImmunogénétiqueInstitut Pasteur de Dakar, IPDDakarSenegal
| | - Ronald Perraut
- Unité d'ImmunologieInstitut Pasteur de Dakar, IPDDakarSenegal
| |
Collapse
|
17
|
Sowunmi A, Akano K, Ayede AI, Ntadom G, Fatunmbi B, Aderoyeje T, Adewoye EO. Temporal changes in haematocrit following artemisinin-based combination treatments of uncomplicated falciparum malaria in children. BMC Infect Dis 2015; 15:454. [PMID: 26502714 PMCID: PMC4620624 DOI: 10.1186/s12879-015-1219-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 10/14/2015] [Indexed: 11/20/2022] Open
Abstract
Background Artemisinin-based combination treatments (ACTs) or intravenous artesunate are used in over 100 countries for uncomplicated or severe falciparum malaria. Although intravenous artesunate may cause delayed haemolytic anaemia, there is little evaluation of the temporal changes in haematocrit following ACTs. Methods Clinical and parasitological parameters were measured before and following treatment of uncomplicated falciparum malaria in children with artesunate-amodiaquine (AA) or artemether-lumefantrine (AL) over 6-weeks. Changes in haematocrit were characterized in individual patients based on a haematocrit <30 % or ≥30 % before and following treatment. Kinetics of the deficit in haematocrit from <30 % until attainment of ≥30 % were estimated by a non-compartment model. Results In 248 of 1180 children eligible for evaluation, common temporal patterns were: no change or increase in haematocrit from ≥ 30 % [50 % of patients], haematocrit >30 % at presentation declining to <30 % within 2 weeks (early monophasic fall) [19 % of patients], and haematocrit <30 % at presentation increasing to ≥ 30 % [23 % of patients]. Haematocrit >30 % at presentation declining to <30 %, 3–5 weeks later (late monophasic fall) occurred in 7 children (3 %). Fall in haematocrit ≥5 units following treatment occurred in 57 children [23 %] between 14 and 28 days after treatment began. Baseline parasitaemia and proportion with > 100,000μL-1 asexual forms were significantly higher in children with ≥5 units compared to <5 units fall in haematocrit 21 or 28 days after treatment began. Irrespective of pattern, declines in haematocrit deficit from <30 % were mono-exponential, with similar half-times for AA- and AL-treated children (1.32 d versus 1.14 d). Anaemia half-time correlated significantly positively with anaemia recovery time in the same patients (r = 0.55, P < 0.0001). Bland-Altman analysis of 9 or 10 multiples of anaemia half-time and anaemia recovery times showed narrow limit of agreement with insignificant biases (P = 0.19 or 0.63, respectively). Conclusions In uncomplicated falciparum malaria, increases or falls in haematocrit are common following ACTs. Falls in haematocrit ≥ 5 units are common and may or may not result in early or late anaemia. In children who recovered from acute falciparum malaria-associated anaemia following ACTs, decline in haematocrit deficit is mono-exponential. Trials registration Pan African Clinical Trial Registry PACTR201508001188143, 3 July 2015; PACTR201508001191898, 7 July 2015 http://www.pactr.org. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1219-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Akintunde Sowunmi
- Department of Pharmacology & Therapeutics, University of Ibadan, Ibadan, Nigeria. .,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria.
| | - Kazeem Akano
- Department of Pharmacology & Therapeutics, University of Ibadan, Ibadan, Nigeria.
| | | | | | - Bayo Fatunmbi
- World Health Organization, Regional Office for the Western Pacific, Khan Daun Penh, Phnom Penh, Cambodia.
| | - Temitope Aderoyeje
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria.
| | - Elsie O Adewoye
- Department of Physiology, University of Ibadan, Ibadan, Nigeria.
| |
Collapse
|
18
|
Hawkes MT, Forgie S, Brophy J, Crockett M. Artesunate treatment of severe pediatric malaria: A review of parasite clearance kinetics and clinical implications. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2015; 26:237-40. [PMID: 26600806 PMCID: PMC4644001 DOI: 10.1155/2015/736159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Michael T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
- School of Public Health, University of Alberta, Edmonton, Alberta
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta
| | - Sarah Forgie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Jason Brophy
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario
| | - Maryanne Crockett
- Departments of Pediatrics and Child Health, Medical Microbiology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| |
Collapse
|
19
|
Suresh S, Spatz J, Mills JP, Micoulet A, Dao M, Lim CT, Beil M, Seufferlein T. Reprint of: Connections between single-cell biomechanics and human disease states: gastrointestinal cancer and malaria. Acta Biomater 2015; 23 Suppl:S3-15. [PMID: 26235344 DOI: 10.1016/j.actbio.2015.07.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Revised: 09/02/2004] [Accepted: 09/02/2004] [Indexed: 11/16/2022]
Abstract
We investigate connections between single-cell mechanical properties and subcellular structural reorganization from biochemical factors in the context of two distinctly different human diseases: gastrointestinal tumor and malaria. Although the cell lineages and the biochemical links to pathogenesis are vastly different in these two cases, we compare and contrast chemomechanical pathways whereby intracellular structural rearrangements lead to global changes in mechanical deformability of the cell. This single-cell biomechanical response, in turn, seems to mediate cell mobility and thereby facilitates disease progression in situations where the elastic modulus increases or decreases due to membrane or cytoskeleton reorganization. We first present new experiments on elastic response and energy dissipation under repeated tensile loading of epithelial pancreatic cancer cells in force- or displacement-control. Energy dissipation from repeated stretching significantly increases and the cell's elastic modulus decreases after treatment of Panc-1 pancreatic cancer cells with sphingosylphosphorylcholine (SPC), a bioactive lipid that influences cancer metastasis. When the cell is treated instead with lysophosphatidic acid, which facilitates actin stress fiber formation, neither energy dissipation nor modulus is noticeably affected. Integrating recent studies with our new observations, we ascribe these trends to possible SPC-induced reorganization primarily of keratin network to perinuclear region of cell; the intermediate filament fraction of the cytoskeleton thus appears to dominate deformability of the epithelial cell. Possible consequences of these results to cell mobility and cancer metastasis are postulated. We then turn attention to progressive changes in mechanical properties of the human red blood cell (RBC) infected with the malaria parasite Plasmodium falciparum. We present, for the first time, continuous force-displacement curves obtained from in-vitro deformation of RBC with optical tweezers for different intracellular developmental stages of parasite. The shear modulus of RBC is found to increase up to 10-fold during parasite development, which is a noticeably greater effect than that from prior estimates. By integrating our new experimental results with published literature on deformability of Plasmodium-harbouring RBC, we examine the biochemical conditions mediating increases or decreases in modulus, and their implications for disease progression. Some general perspectives on connections among structure, single-cell mechanical properties and biological responses associated with pathogenic processes are also provided in the context of the two diseases considered in this work.
Collapse
Affiliation(s)
- S Suresh
- Department of Materials Science and Engineering, and Division of Bioengineering, Massachusetts Institute of Technology, Room 8-309, 77 Massachusetts Ave., Cambridge, MA 02139-4307, USA; Division of Biological Engineering and Affiliated Faculty of the Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139-4307, USA.
| | - J Spatz
- Institute for Physical Chemistry, Biophysical Chemistry, University of Heidelberg, INF 253, 69120 Heidelberg, Germany
| | - J P Mills
- Department of Materials Science and Engineering, and Division of Bioengineering, Massachusetts Institute of Technology, Room 8-309, 77 Massachusetts Ave., Cambridge, MA 02139-4307, USA
| | - A Micoulet
- Institute for Physical Chemistry, Biophysical Chemistry, University of Heidelberg, INF 253, 69120 Heidelberg, Germany
| | - M Dao
- Department of Materials Science and Engineering, and Division of Bioengineering, Massachusetts Institute of Technology, Room 8-309, 77 Massachusetts Ave., Cambridge, MA 02139-4307, USA
| | - C T Lim
- Division of Bioengineering and Department of Mechanical Engineering, National University of Singapore, Singapore 117576, Singapore
| | - M Beil
- Department of Internal Medicine I and Department of Physical Chemistry, University of Ulm, 89071 Ulm, Germany
| | - T Seufferlein
- Department of Internal Medicine I and Department of Physical Chemistry, University of Ulm, 89071 Ulm, Germany
| |
Collapse
|
20
|
Plewes K, Haider MS, Kingston HWF, Yeo TW, Ghose A, Hossain MA, Dondorp AM, Turner GDH, Anstey NM. Severe falciparum malaria treated with artesunate complicated by delayed onset haemolysis and acute kidney injury. Malar J 2015; 14:246. [PMID: 26081927 PMCID: PMC4470092 DOI: 10.1186/s12936-015-0760-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/02/2015] [Indexed: 11/10/2022] Open
Abstract
Background Severe falciparum malaria may be complicated by haemolysis after parasite clearance, however the mechanisms remain unclear. Recent reports describe a pattern of delayed onset haemolysis among non-immune travellers with hyperparasitaemia treated with intravenous artesunate, termed post-artesunate delayed haemolysis (PADH). The occurrence and clinical impact of PADH following severe malaria infections in areas of unstable transmission are unknown. Case A 45-year-old Bangladeshi male was initially admitted to a local hospital with severe falciparum malaria complicated by hyperparasitaemia and treated with intravenous artesunate. Twenty days from his first presentation he was readmitted with delayed onset haemolytic anaemia and acute kidney injury. Multiple blood transfusions and haemodialysis were required. Renal biopsy revealed acute tubular injury and haem pigment nephropathy. His haemoglobin and renal function recovered to baseline after 62 days from his second admission. Discussion This case highlights the differential diagnosis of post-malaria delayed onset haemolysis, including the recently described syndrome of post-artemisinin delayed haemolysis. The pathophysiology contributing to acute kidney injury in this patient and the limited treatment options are discussed. Conclusions This report describes PADH complicated by acute kidney injury in an adult patient living in a malaria hypoendemic region who subsequently required blood transfusions and haemodialysis. This case emphasizes the importance of routine follow up of haemoglobin and renal function in artesunate-treated patients who have recovered from severe malaria.
Collapse
Affiliation(s)
- Katherine Plewes
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. .,Division of Infectious Diseases, Department of Medicine, University of British Columbia Clinical Investigator Program, Vancouver, Canada.
| | - Md Shafiul Haider
- Department of Medicine, Chittagong Medical College Hospital, Chittagong, Bangladesh.
| | - Hugh W F Kingston
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.
| | - Tsin W Yeo
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.
| | - Aniruddha Ghose
- Department of Medicine, Chittagong Medical College Hospital, Chittagong, Bangladesh.
| | - Md Amir Hossain
- Department of Medicine, Chittagong Medical College Hospital, Chittagong, Bangladesh.
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| | - Gareth D H Turner
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| | - Nicholas M Anstey
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.
| |
Collapse
|
21
|
Dogovski C, Xie SC, Burgio G, Bridgford J, Mok S, McCaw JM, Chotivanich K, Kenny S, Gnädig N, Straimer J, Bozdech Z, Fidock DA, Simpson JA, Dondorp AM, Foote S, Klonis N, Tilley L. Targeting the cell stress response of Plasmodium falciparum to overcome artemisinin resistance. PLoS Biol 2015; 13:e1002132. [PMID: 25901609 PMCID: PMC4406523 DOI: 10.1371/journal.pbio.1002132] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/16/2015] [Indexed: 11/30/2022] Open
Abstract
Successful control of falciparum malaria depends greatly on treatment with artemisinin combination therapies. Thus, reports that resistance to artemisinins (ARTs) has emerged, and that the prevalence of this resistance is increasing, are alarming. ART resistance has recently been linked to mutations in the K13 propeller protein. We undertook a detailed kinetic analysis of the drug responses of K13 wild-type and mutant isolates of Plasmodium falciparum sourced from a region in Cambodia (Pailin). We demonstrate that ART treatment induces growth retardation and an accumulation of ubiquitinated proteins, indicative of a cellular stress response that engages the ubiquitin/proteasome system. We show that resistant parasites exhibit lower levels of ubiquitinated proteins and delayed onset of cell death, indicating an enhanced cell stress response. We found that the stress response can be targeted by inhibiting the proteasome. Accordingly, clinically used proteasome inhibitors strongly synergize ART activity against both sensitive and resistant parasites, including isogenic lines expressing mutant or wild-type K13. Synergy is also observed against Plasmodium berghei in vivo. We developed a detailed model of parasite responses that enables us to infer, for the first time, in vivo parasite clearance profiles from in vitro assessments of ART sensitivity. We provide evidence that the clinical marker of resistance (delayed parasite clearance) is an indirect measure of drug efficacy because of the persistence of unviable parasites with unchanged morphology in the circulation, and we suggest alternative approaches for the direct measurement of viability. Our model predicts that extending current three-day ART treatment courses to four days, or splitting the doses, will efficiently clear resistant parasite infections. This work provides a rationale for improving the detection of ART resistance in the field and for treatment strategies that can be employed in areas with ART resistance. Resistance to artemisinin antimalarial drugs is jeopardizing malaria control. This study shows that proteasome-mediated stress responses can be targeted to overcome artemisinin resistance and suggests alternate therapeutic regimens and monitoring strategies. Resistance to artemisinin antimalarials, some of the most effective antimalarial drugs, has emerged in Southeast Asia, jeopardizing malaria control. We have undertaken a detailed study of artemisinin-sensitive and-resistant strains of Plasmodium falciparum, the parasite responsible for malaria, taken directly from the field in a region where resistance is developing. We compared these strains to lab strains engineered with either mutant or wild-type resistance alleles. We demonstrate that in sensitive P. falciparum, artemisinin induces growth retardation and accumulation of ubiquitinated proteins, indicating that the drugs activate the cellular stress response. Resistant parasites, on the other hand, exhibit reduced protein ubiquitination and delayed onset of cell death following drug exposure. We show that proteasome inhibitors strongly synergize artemisinin activity, offering a means of overcoming artemisinin resistance. We have developed a detailed model of parasite responses and have modelled in vivo clearance profiles. Our data indicate that extending artemisinin treatment from the standard three-day treatment to a four-day treatment will clear resistant parasites, thus preserving the use of this critical therapy in areas experiencing artemisinin resistance.
Collapse
Affiliation(s)
- Con Dogovski
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stanley C Xie
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gaetan Burgio
- John Curtin School of Medical Research, the Australian National University, Canberra, Australian Capital Territory, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Jess Bridgford
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sachel Mok
- School of Biological Sciences, Nanyang Technological University, Singapore
| | - James M McCaw
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Royal Childrens Hospital, Victoria, Australia
| | | | - Shannon Kenny
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nina Gnädig
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, New York, United States of America
| | - Judith Straimer
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, New York, United States of America
| | - Zbynek Bozdech
- School of Biological Sciences, Nanyang Technological University, Singapore
| | - David A Fidock
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, New York, United States of America; Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Arjen M Dondorp
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford, United Kingdom
| | - Simon Foote
- John Curtin School of Medical Research, the Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nectarios Klonis
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leann Tilley
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
22
|
Rolling T, Agbenyega T, Krishna S, Kremsner PG, Cramer JP. Delayed haemolysis after artesunate treatment of severe malaria - review of the literature and perspective. Travel Med Infect Dis 2015; 13:143-9. [PMID: 25812775 DOI: 10.1016/j.tmaid.2015.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
Abstract
Artesunate has replaced quinine as the recommended first-line treatment of severe malaria as it clears parasites faster and lowers mortality. After artesunate's introduction, however, reports of delayed haemolysis have emerged. Typically, this adverse haemolytic event peaks two to three weeks after the acute phase of malaria, and can be severe enough to make blood transfusions necessary in the management of some patients. Delayed haemolysis has been detected in prospective studies in 7-21% of patients treated with artesunate. A confirmed risk factor in travellers is hyperparasitaemia, while additional in malaria-endemic countries young age has been shown to increase risk. The pathophysiology of this phenomenon has not yet been fully elucidated, but may include various combinations of delayed destruction of "pitted" erythrocytes and autoimmune aetiology. All patients treated with parenteral artesunate should be followed up for at least four weeks to detect signs of haemolysis and to allow appropriate symptomatic treatment.
Collapse
Affiliation(s)
- Thierry Rolling
- Department of Internal Medicine, Section Tropical Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
| | - Tsiri Agbenyega
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sanjeev Krishna
- Institute for Infection and Immunity, St George's, University of London, London SW17 0RE, United Kingdom; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Institute of Tropical Medicine, University Medical Centre Tübingen, Tübingen, Germany
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Institute of Tropical Medicine, University Medical Centre Tübingen, Tübingen, Germany
| | - Jakob P Cramer
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| |
Collapse
|
23
|
Fall in hematocrit per 1000 parasites cleared from peripheral blood: a simple method for estimating drug-related fall in hematocrit after treatment of malaria infections. Am J Ther 2014; 21:193-7. [PMID: 22020083 DOI: 10.1097/mjt.0b013e31822119d9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A simple method to estimate antimalarial drug-related fall in hematocrit (FIH) after treatment of Plasmodium falciparum infections in the field is described. The method involves numeric estimation of the relative difference in hematocrit at baseline (pretreatment) and the first 1 or 2 days after treatment begun as numerator and the corresponding relative difference in parasitemia as the denominator, and expressing it per 1000 parasites cleared from peripheral blood. Using the method showed that FIH/1000 parasites cleared from peripheral blood (cpb) at 24 or 48 hours were similar in artemether-lumefantrine and artesunate-amodiaquine-treated children (0.09; 95% confidence interval, 0.052-0.138 vs 0.10; 95% confidence interval, 0.069-0.139%; P = 0.75) FIH/1000 parasites cpb in patients with higher parasitemias were significantly (P < 0.0001) and five- to 10-fold lower than in patients with lower parasitemias suggesting conservation of hematocrit or red cells in patients with higher parasitemias treated with artesunate-amodiaquine or artemether-lumefantrine. FIH/1000 parasites cpb were similar in anemic and nonanemic children. Estimation of FIH/1000 parasites cpb is simple, allows estimation of relatively conserved hematocrit during treatment, and can be used in both observational studies and clinical trials involving antimalarial drugs.
Collapse
|
24
|
|
25
|
Oguche S, Okafor HU, Watila I, Meremikwu M, Agomo P, Ogala W, Agomo C, Ntadom G, Banjo O, Okuboyejo T, Ogunrinde G, Odey F, Aina O, Sofola T, Sowunmi A. Efficacy of artemisinin-based combination treatments of uncomplicated falciparum malaria in under-five-year-old Nigerian children. Am J Trop Med Hyg 2014; 91:925-935. [PMID: 25246693 PMCID: PMC4228889 DOI: 10.4269/ajtmh.13-0248] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/10/2014] [Indexed: 11/10/2022] Open
Abstract
The efficacy of 3-day regimens of artemether-lumefantrine and artesunate-amodiaquine were evaluated in 747 children < 5 years of age with uncomplicated malaria from six geographical areas of Nigeria. Fever clearance was significantly faster (P = 0.006) and the proportion of children with parasitemia 1 day after treatment began was significantly lower (P = 0.016) in artesunate-amodiaquine-compared with artemether-lumefantrine-treated children. Parasite clearance times were similar with both treatments. Overall efficacy was 96.3% (95% confidence interval [CI] 94.5-97.6%), and was similar for both regimens. Polymerase chain reaction-corrected parasitologic cure rates on Day 28 were 96.9% (95% CI 93.9-98.2%) and 98.3% (95% CI 96.1-99.3%) for artemether-lumefantrine and artesunate-amodiaquine, respectively. Gametocyte carriage post treatment was significantly lower than pretreatment (P < 0.0001). In anemic children, mean time to recovery from anemia was 10 days (95% CI 9.04-10.9) and was similar for both regimens. Both treatments were well tolerated and are safe and efficacious treatments of uncomplicated falciparum malaria in young Nigerian children.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Akintunde Sowunmi
- Antimalarial Therapeutic Efficacy Monitoring Group, The Federal Ministry of Health, Abuja, Nigeria
| |
Collapse
|
26
|
Kyaw SS, Drake T, Ruangveerayuth R, Chierakul W, White NJ, Newton PN, Lubell Y. Cost of treating inpatient falciparum malaria on the Thai-Myanmar border. Malar J 2014; 13:416. [PMID: 25351915 PMCID: PMC4218997 DOI: 10.1186/1475-2875-13-416] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite demonstrated benefits and World Health Organization (WHO) endorsement, parenteral artesunate is the recommended treatment for patients with severe Plasmodium falciparum malaria in only one fifth of endemic countries. One possible reason for this slow uptake is that a treatment course of parenteral artesunate is costlier than quinine and might, therefore, pose a substantial economic burden to health care systems. This analysis presents a detailed account of the resources used in treating falciparum malaria by either parenteral artesunate or quinine in a hospital on the Thai-Myanmar border. METHODS The analysis used data from four studies, with random allocation of inpatients with falciparum malaria to treatment with parenteral artesunate or quinine, conducted in Mae Sot Hospital, Thailand from 1995 to 2001. Detailed resource use data were collected during admission and unit costs from the 2008 hospital price list were applied to these. Total admission costs were broken down into five categories: 1) medication; 2) intravenous fluids; 3) disposables; 4) laboratory tests; and 5) services. RESULTS While the medication costs were higher for patients treated with artesunate, total admission costs were similar in those treated with quinine, US$ 243 (95% CI: 167.5-349.7) and in those treated with artesunate US$ 190 (95% CI: 131.0-263.2) (P=0.375). For cases classified as severe malaria (59%), the total cost of admission was US$ 298 (95% CI: 203.6-438.7) in the quinine group as compared with US$ 284 (95% CI: 181.3-407) in the artesunate group (P=0.869). CONCLUSION This analysis finds no evidence for a difference in total admission costs for malaria inpatients treated with artesunate as compared with quinine. Assuming this is generalizable to other settings, the higher cost of a course of artesunate should not be considered a barrier for its implementation in the treatment of malaria.
Collapse
Affiliation(s)
- Shwe Sin Kyaw
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Ndour PA, Lopera-Mesa TM, Diakité SAS, Chiang S, Mouri O, Roussel C, Jauréguiberry S, Biligui S, Kendjo E, Claessens A, Ciceron L, Mazier D, Thellier M, Diakité M, Fairhurst RM, Buffet PA. Plasmodium falciparum clearance is rapid and pitting independent in immune Malian children treated with artesunate for malaria. J Infect Dis 2014; 211:290-7. [PMID: 25183768 DOI: 10.1093/infdis/jiu427] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In Plasmodium falciparum-infected patients treated with artemisinins, parasitemia declines through so-called pitting, an innate splenic process that transforms infected red blood cells (iRBCs) into once-infected RBCs (O-iRBCs). METHODS We measured pitting in 83 French travelers and 42 Malian children treated for malaria with artesunate. RESULTS In travelers, O-iRBCs peaked at 107.7% initial parasitemia. In Malian children aged 1.5-4 years, O-iRBCs peaked at higher concentrations than in children aged 9-13 years (91.60% vs 31.95%; P = .0097). The parasite clearance time in older children was shorter than in younger children (P = .0001), and the decline in parasitemia in children aged 1.5-4 years often started 6 hours after treatment initiation, a lag phase generally absent in infants and older children. A 6-hour lag phase in artificial pitting of artesunate-exposed iRBCs was also observed in vitro. The proportion of iRBCs recognized by autologous immunoglobulin G (IgG) correlated with the parasite clearance time (r = -0.501; P = .0006) and peak O-iRBC concentration (r = -0.420; P = .0033). CONCLUSIONS Antimalarial immunity correlates with fast artemisinin-induced parasite clearance and low pitting rates. In nonimmune populations, artemisinin-induced P. falciparum clearance is related to pitting and starts after a 6-hour lag phase. In immune populations, passively and naturally acquired immune mechanisms operating faster than pitting may exist. This mechanism may mitigate the emergence of artemisinin-resistant P. falciparum in Africa.
Collapse
Affiliation(s)
- Papa Alioune Ndour
- Centre d'Immunologie et des Maladies Infectieuses de Paris, INSERM U1135, UPMC CR7, CNRS ERL 8255 Centre National de Référence du Paludisme site Pitié-Salpêtrière Laboratory of Excellence GR-Ex
| | - Tatiana M Lopera-Mesa
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Seidina A S Diakité
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Odonto-stomatology, University of Bamako, Mali
| | - Serena Chiang
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Oussama Mouri
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie-Mycologie et Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Camille Roussel
- Centre d'Immunologie et des Maladies Infectieuses de Paris, INSERM U1135, UPMC CR7, CNRS ERL 8255
| | - Stéphane Jauréguiberry
- Centre National de Référence du Paludisme site Pitié-Salpêtrière AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie-Mycologie et Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Sylvestre Biligui
- Centre d'Immunologie et des Maladies Infectieuses de Paris, INSERM U1135, UPMC CR7, CNRS ERL 8255 Centre National de Référence du Paludisme site Pitié-Salpêtrière
| | - Eric Kendjo
- Centre d'Immunologie et des Maladies Infectieuses de Paris, INSERM U1135, UPMC CR7, CNRS ERL 8255 Centre National de Référence du Paludisme site Pitié-Salpêtrière
| | - Antoine Claessens
- Centre for Immunity, Infection and Evolution, University of Edinburgh, United Kingdom
| | - Liliane Ciceron
- Centre d'Immunologie et des Maladies Infectieuses de Paris, INSERM U1135, UPMC CR7, CNRS ERL 8255 Centre National de Référence du Paludisme site Pitié-Salpêtrière
| | - Dominique Mazier
- Centre d'Immunologie et des Maladies Infectieuses de Paris, INSERM U1135, UPMC CR7, CNRS ERL 8255 Centre National de Référence du Paludisme site Pitié-Salpêtrière AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie-Mycologie et Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Marc Thellier
- Centre d'Immunologie et des Maladies Infectieuses de Paris, INSERM U1135, UPMC CR7, CNRS ERL 8255 Centre National de Référence du Paludisme site Pitié-Salpêtrière AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie-Mycologie et Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Mahamadou Diakité
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Odonto-stomatology, University of Bamako, Mali
| | - Rick M Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Pierre A Buffet
- Centre d'Immunologie et des Maladies Infectieuses de Paris, INSERM U1135, UPMC CR7, CNRS ERL 8255 Centre National de Référence du Paludisme site Pitié-Salpêtrière Laboratory of Excellence GR-Ex AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie-Mycologie et Service des Maladies Infectieuses et Tropicales, Paris, France
| |
Collapse
|
29
|
Postartesunate delayed hemolysis is a predictable event related to the lifesaving effect of artemisinins. Blood 2014; 124:167-75. [PMID: 24859359 DOI: 10.1182/blood-2014-02-555953] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Patients with severe malaria treated with artesunate sometimes experience a delayed hemolytic episode. Artesunate (AS) induces pitting, a splenic process whereby dead parasites are expelled from their host erythrocytes. These once-infected erythrocytes then return to the circulation. We analyzed hematologic parameters in 123 travelers treated with AS for severe malaria. Among 60 nontransfused patients observed for more than 8 days, 13 (22%) had delayed hemolysis. The peak concentration of circulating once-infected erythrocytes was measured during the first week in 21 patients and was significantly higher in 9 patients with delayed hemolysis than in 12 with other patterns of anemia (0.30 vs 0.07; P = .0001). The threshold of 180 million once-infected erythrocytes per liter discriminated patients with delayed hemolysis with 89% sensitivity and 83% specificity. Once-infected erythrocyte morphology analyzed by using ImageStream in 4 patients showed an 8.9% reduction in their projected area, an alteration likely contributing to their shorter lifespan. Delayed clearance of infected erythrocytes spared by pitting during AS treatment is an original mechanism of hemolytic anemia. Our findings consolidate a disease framework for posttreatment anemia in malaria in which delayed hemolysis is a new entity. The early concentration of once-infected erythrocytes is a solid candidate marker to predict post-AS delayed hemolysis.
Collapse
|
30
|
Prudent M, Tissot JD, Lion N. Proteomics of blood and derived products: what’s next? Expert Rev Proteomics 2014; 8:717-37. [DOI: 10.1586/epr.11.58] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
31
|
Huang S, Undisz A, Diez-Silva M, Bow H, Dao M, Han J. Dynamic deformability of Plasmodium falciparum-infected erythrocytes exposed to artesunate in vitro. Integr Biol (Camb) 2013; 5:414-22. [PMID: 23254624 DOI: 10.1039/c2ib20161e] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Artesunate (ART) is widely used for the treatment of malaria, but the mechanisms of its effects on parasitized red blood cells (RBCs) are not fully understood. We investigated ART's influence on the dynamic deformability of ring-stage Plasmodium falciparum infected red blood cells (iRBCs) in order to elucidate its role in cellular mechanobiology. The dynamic deformability of RBCs was measured by passing them through a microfluidic device with repeated bottleneck structures. The quasi-static deformability measurement was performed using micropipette aspiration. After ART treatment, microfluidic experiments showed 50% decrease in iRBC transit velocity whereas only small (~10%) velocity reduction was observed among uninfected RBCs (uRBCs). Micropipette aspiration also revealed ART-induced stiffening in RBC membranes. These results demonstrate, for the first time, that ART reduces the dynamic and quasi-static RBC deformability, which may subsequently influence blood circulation through the microvasculature and spleen cordal meshwork, thus adding a new aspect to artesunate's mechanism of action.
Collapse
Affiliation(s)
- Sha Huang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | | | | | | | | | | |
Collapse
|
32
|
Taylor WRJ, Widjaja H, Basri H, Tjitra E, Ohrt C, Taufik T, Baso S, Hoffman SL, Richie TL. Haemoglobin dynamics in Papuan and non-Papuan adults in northeast Papua, Indonesia, with acute, uncomplicated vivax or falciparum malaria. Malar J 2013; 12:209. [PMID: 23777546 PMCID: PMC3691772 DOI: 10.1186/1475-2875-12-209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 06/05/2013] [Indexed: 12/19/2022] Open
Abstract
Background Haemoglobin (Hb) recovers slowly in malaria and may be influenced by naturally acquired immunity. Hb recovery was compared in malaria immune, indigenous Papuan and non-Papuan adults with limited malaria exposure. Methods Hb concentrations were measured on Days (D) 0, 3, 7, and 28 in 57 Papuans and 105 non-Papuans treated with chloroquine, doxycycline or both drugs for acute, uncomplicated Plasmodium vivax (n?=?64) or Plasmodium falciparum (n?=?98). Results Mean (SD, range) D0 Hb was 12.7 (2.2, 7–21.3) g/dL and was similar in P. falciparum infected Papuans and non-Papuans: 12.2 vs. 12.8 g/dL (P?=?0.15) but significantly lower in: (i) P. vivax-infected Papuans vs. P. vivax-infected non-Papuans: 11.4 vs. 13.47 g/dL [∆?=?−2.07 (95% CI: –3.3 – –0.8), P?=?0.0018], (ii) all patients with splenomegaly (vs. those without splenomegaly): 12.16 vs. 13.01 g/dL [∆?=?−0.85 (−1.6– –0.085), P?=?0.029], and (iii) all females vs. all males: 10.18 vs. 13.01 g/dL [∆?=?−2.82 (−3.97 – –1.67), P?<?0.0001].Multiple regression identified female sex (P?=?0.000), longer illness duration (P?=?0.015) (P. falciparum patients) and Papuan ethnicity (P?=?0.017) (P. vivax patients) as significant factors for a lower D0 Hb. Mean D28 Hb increased to 13.6 g/dL [∆?=?1.01 (0.5-1.5) vs. D0 Hb, P?=?0.0001]. It was: (i) positively correlated with the D0 Hb (adjusted R2?=?0.24, P?=?0.000), and was significantly lower in P. vivax infected Papuans vs. non-Papuans: 12.71 vs. 14.46 g/dL [∆?=?−1.7 (−2.95– –0.5, P?=?0.006). Conclusions Haemoglobin recovery was related to baseline Hb. Vivax-infected malaria immune Papuans had persistently lower Hb concentrations compared to non-Papuans with limited malaria exposure. This haematological disadvantage remains unexplained.
Collapse
Affiliation(s)
- Walter R J Taylor
- The US Navy Medical Research Unit no. 2-NAMRU-2, Jakarta, Indonesia.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Lopera-Mesa TM, Doumbia S, Chiang S, Zeituni AE, Konate DS, Doumbouya M, Keita AS, Stepniewska K, Traore K, Diakite SAS, Ndiaye D, Sa JM, Anderson JM, Fay MP, Long CA, Diakite M, Fairhurst RM. Plasmodium falciparum clearance rates in response to artesunate in Malian children with malaria: effect of acquired immunity. J Infect Dis 2013; 207:1655-63. [PMID: 23448727 PMCID: PMC3636783 DOI: 10.1093/infdis/jit082] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background. Artemisinin resistance, a long parasite clearance half-life in response to artemisinin, has been described in patients with Plasmodium falciparum malaria in southeast Asia. Few baseline half-lives have been reported from Africa, where artemisinins were recently introduced. Methods. We treated P. falciparum malaria in 215 Malian children aged 0.5–15 years with artesunate (0, 24, 48 hours) and amodiaquine (72, 96, 120 hours). We estimated half-life by measuring parasite density every 6 hours until undetectable and evaluated the effects of age, sex, ethnicity, and red blood cell (RBC) polymorphisms on half-life. We quantified the proportion of parasitized RBCs recognized by autologous immunoglobulin G (IgG). Results. The geometric mean half-life was 1.9 hours (95% confidence interval, 1.8–2.0) and did not correlate with parasite ex vivo susceptibility to artemisinins. In a linear model accounting for host factors, half-life decreased by 4.1 minutes for every 1-year increase in age. The proportion of parasitized RBCs recognized by IgG correlated inversely with half-life (r = −0.475; P = .0006). Conclusions. Parasite clearance in response to artesunate is faster in Mali than in southeast Asia. IgG responses to parasitized RBCs shorten half-life and may influence this parameter in areas where age is not an adequate surrogate of immunity and correlates of parasite-clearing immunity have not been identified. Clinical Trials Registration. NCT00669084.
Collapse
Affiliation(s)
- Tatiana M Lopera-Mesa
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
Plasmodium falciparum malaria remains a major cause of mortality throughout the tropical world. Haematological abnormalities are considered a hallmark of malaria, bearing an impact on final outcome and representing indices of prognostic and follow-up value. These include severe anaemia, coagulation disturbances, leukocyte numerical or functional changes and spleen involvement. Anaemia involves red blood cell lysis due to parasite invasion, as well as mechanisms of intravascular haemolysis and decreased erythropoiesis. Exchange or blood transfusion is mainly recommended in the management of these patients. Haemorrhagic complications in severe malaria are relatively rare despite prominent thrombocytopenia and dysfunction in the coagulation pathway. Numerical, as well as functional changes in the white blood cell are less dramatic than other blood cell series, but still, remain a significant index of disease progression and ultimate prognosis. Finally, the role of the spleen in severe malaria is multifactorial. Care and vigilance should be taken against splenic rupture which is fatal and can occur despite appropriate antimalarial prophylaxis and treatment.
Collapse
|
35
|
Kreeftmeijer-Vegter AR, van Genderen PJ, Visser LG, Bierman WFW, Clerinx J, van Veldhuizen CKW, de Vries PJ. Treatment outcome of intravenous artesunate in patients with severe malaria in the Netherlands and Belgium. Malar J 2012; 11:102. [PMID: 22462806 PMCID: PMC3364861 DOI: 10.1186/1475-2875-11-102] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/31/2012] [Indexed: 11/30/2022] Open
Abstract
Background Intravenous (IV) artesunate is the treatment of choice for severe malaria. In Europe, however, no GMP-manufactured product is available and treatment data in European travellers are scarce. Fortunately, artesunate became available in the Netherlands and Belgium through a named patient programme. This is the largest case series of artesunate treated patients with severe malaria in Europe. Methods Hospitalized patients treated with IV artesunate between November 2007 and December 2010 in the Netherlands and Belgium were retrospectively evaluated. Patient characteristics, treatment and clinical outcome were recorded on a standardized form and mortality, parasite clearance times and the occurrence of adverse events were evaluated. Results Of the 68 treated patients, including 55 with severe malaria, two patients died (2/55 = 3.6%). The mean time to 50% parasite clearance (PCT50), 90% and 99% were 4.4 hours (3.9 - 5.2), 14.8 hours (13.0 - 17.2), and 29.5 hours (25.9 - 34.4) respectively. Artesunate was well tolerated. However, an unusual form of haemolytic anaemia was observed in seven patients. The relationship with artesunate remains uncertain. Conclusions Data from the named patient programme demonstrate that IV artesunate is effective and well-tolerated in European travellers lacking immunity. However, increased attention needs to be paid to the possible development of haemolytic anaemia 2-3 weeks after start of treatment. Treatment of IV artesunate should be limited to the period that IV treatment is required and should be followed by a full oral course of an appropriate anti-malarial drug.
Collapse
|
36
|
Use of area under the curve to evaluate the effects of antimalarial drugs on malaria-associated anemia after treatment. Am J Ther 2012; 18:190-7. [PMID: 20683244 DOI: 10.1097/mjt.0b013e3181d169c9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To evaluate the effects of antimalarial drugs on Plasmodium falciparum malaria-associated anemia, we use the area under the curve (AUC) of anemia levels after treatment as an approach to combine their duration and magnitude. The method involves numeric estimation, by trapezoidal rule, of AUC from a plot of deficit in hematocrit levels from 30% (the lower threshold of normal) versus time in anemic children. Using the method, we evaluated, in randomized trials, the effects of artesunate-mefloquine versus mefloquine alone and artemether-lumefantrine versus amodiaquine-artesunate on the time course of recovery from malaria-associated anemia in 109 children. Anemia resolution times were similar (10.9 ± 6.2 [standard deviation] versus 13.3 ± 8.9 days, P = 0.2), but mean AUC was significantly lower in artesunate-mefloquine- compared with mefloquine-treated children (35.5 ± 7.1 [standard error of mean] versus 49.8 ± 11.3 %·h, P = 0.02) indicating larger exposure to anemia in mefloquine-treated children. In artemether-lumefantrine- and amodiaquine-artesunate-treated children, both anemia resolution times (8.6 ± 5.3 [standard deviation] versus 8.6 ± 4.8 days, P = 0.98) and mean AUC (57.1 ± 12.9 [standard error of mean] versus 46.3 ± 8.7 %·h, P = 0.74) were similar. Estimation of AUC appears more robust than estimation of anemia resolution time in evaluating antimalarial drug effects and can be used in both observational studies and clinical trials assessing the effects of therapies on malaria-associated anemia.
Collapse
|
37
|
LaCrue AN, Scheel M, Kennedy K, Kumar N, Kyle DE. Effects of artesunate on parasite recrudescence and dormancy in the rodent malaria model Plasmodium vinckei. PLoS One 2011; 6:e26689. [PMID: 22039533 PMCID: PMC3200358 DOI: 10.1371/journal.pone.0026689] [Citation(s) in RCA: 50] [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: 04/26/2011] [Accepted: 10/02/2011] [Indexed: 11/25/2022] Open
Abstract
Artemisinin (ART) is the recommended first line therapy for treating uncomplicated and drug-resistant Plasmodium falciparum, the most pathogenic form of malaria. However, treatment failure following ART monotherapy is not uncommon and resistance to this rapidly acting drug has been reported in the Thai-Cambodian border. Recent in vitro studies have shown that following treatment with dihydroartemisinin (DHA), the development of ring-stage parasites is arrested for up to 20 days. These arrested (i.e. dormant) rings could be responsible for the recrudescence of infection that is observed following ART monotherapy. To develop a better understanding of the stage-specific effects of ART and determine if dormancy occurs in vivo, the ART derivative artesunate (AS) was used to treat mice infected with the synchronous rodent malaria parasites P. vinckei petteri (non-lethal) and P. v. vinckei (lethal). Results show that in both the non-lethal and lethal strains, ring-stage parasites are the least susceptible to treatment with AS and that the day of treatment has more of an impact on recrudescence than the total dose administered. Additionally, 24 hrs post-treatment with AS, dormant forms similar in morphology to those seen in vitro were observed. Finally, rate of recrudescence studies suggest that there is a positive correlation between the number of dormant parasites present and when recrudescence occurs in the vertebrate host. Collectively, these data suggest that dormancy occurs in vivo and contributes to recrudescence that is observed following AS treatment. It is possible that this may represent a novel mechanism of parasite survival following treatment with AS.
Collapse
Affiliation(s)
- Alexis N. LaCrue
- Department of Global Health, University of South Florida, Tampa, Florida, United States of America
- * E-mail: (DEK); (ANL)
| | - Misty Scheel
- Department of Global Health, University of South Florida, Tampa, Florida, United States of America
| | - Katherine Kennedy
- Department of Global Health, University of South Florida, Tampa, Florida, United States of America
| | - Nikesh Kumar
- Department of Global Health, University of South Florida, Tampa, Florida, United States of America
| | - Dennis E. Kyle
- Department of Global Health, University of South Florida, Tampa, Florida, United States of America
- * E-mail: (DEK); (ANL)
| |
Collapse
|
38
|
Gbotosho GO, Sowunmi A, Okuboyejo TM, Happi CT, Folarin OA, Michael OS, Adewoye EO. Therapeutic efficacy and effects of artemether-lumefantrine and artesunate-amodiaquine coformulated or copackaged on malaria-associated anemia in children with uncomplicated Plasmodium falciparum malaria in Southwest Nigeria. Am J Trop Med Hyg 2011; 84:813-9. [PMID: 21540395 PMCID: PMC3083753 DOI: 10.4269/ajtmh.2011.10-0582] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 01/15/2011] [Indexed: 11/07/2022] Open
Abstract
The therapeutic efficacy and effects of artemether-lumefantrine (AL) and artesunate-amodiaquine co-formulated (AAcf) or co-packaged (AAcp) on malaria-associated anemia (MAA) were evaluated in 285 children < 12 years of age with uncomplicated Plasmodium falciparum malaria randomized to receive one of the three drug combinations. Fever and parasite clearance times were similar in all treatment groups. Mean drug-attributable fall in hematocrit (DAFH), defined as difference between hematocrit values pre- and 3 d post-initiation of treatment, was low (< 4.5%) and rates of recovery from MAA were similar with all treatments. Mean areas under curve (AUCs) of the plot of deficit in hematocrit levels from 30% versus time in anemic children were similar in all groups. All regimens were well tolerated. AL, AAcf and AAcp cleared fever and parasitemia rapidly and had similar rates of resolution of MAA after treatment in malarious Nigerian children.
Collapse
Affiliation(s)
- Grace O Gbotosho
- Department of Pharmacology and Therapeutics, Institute for Medical Research Training, and Department of Physiology, University of Ibadan, Ibadan, Oyo State, Nigeria.
| | | | | | | | | | | | | |
Collapse
|
39
|
The pathogenesis of Plasmodium falciparum malaria in humans: insights from splenic physiology. Blood 2010; 117:381-92. [PMID: 20852127 DOI: 10.1182/blood-2010-04-202911] [Citation(s) in RCA: 221] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Clinical manifestations of Plasmodium falciparum infection are induced by the asexual stages of the parasite that develop inside red blood cells (RBCs). Because splenic microcirculatory beds filter out altered RBCs, the spleen can innately clear subpopulations of infected or uninfected RBC modified during falciparum malaria. The spleen appears more protective against severe manifestations of malaria in naïve than in immune subjects. The spleen-specific pitting function accounts for a large fraction of parasite clearance in artemisinin-treated patients. RBC loss contributes to malarial anemia, a clinical form associated with subacute progression, frequent splenomegaly, and relatively low parasitemia. Stringent splenic clearance of ring-infected RBCs and uninfected, but parasite-altered, RBCs, may altogether exacerbate anemia and reduce the risks of severe complications associated with high parasite loads, such as cerebral malaria. The age of the patient directly influences the risk of severe manifestations. We hypothesize that coevolution resulting in increased splenic clearance of P. falciparum-altered RBCs in children favors the survival of the host and, ultimately, sustained parasite transmission. This analysis of the RBC-spleen dynamic interactions during P falciparum infection reflects both data and hypotheses, and provides a framework on which a more complete immunologic understanding of malaria pathogenesis may be elaborated.
Collapse
|
40
|
Abstract
PURPOSE OF REVIEW Splenomegaly is frequent in acute or chronic forms of Plasmodium falciparum malaria, and splenectomy is associated with more frequent fever and parasitaemia. A novel role for the spleen in malaria is indicated by recent epidemiological and experimental data, bringing about a novel paradigm on severe malaria pathogenesis. RECENT FINDINGS In Sudanese children, severe malarial anaemia was associated with larger spleen, longer fever duration, and lower parasitaemia than cerebral malaria. These findings are consistent with evolution toward severe malarial anaemia being linked to the presence of a spleen-dependent mechanism that is absent or inefficient in cerebral malaria. An isolated-perfused human spleen model revealed unexpected retention of numerous erythrocytes harbouring young parasite stages (rings), probably through an innate mechanical process. SUMMARY A new paradigm is discussed, whereby the extent of erythrocyte retention in the spleen conditions not only haemoglobin concentration and spleen size but also the rate of parasite load increase. The prediction is that, in nonimmune children, stringent splenic retention of rings and uninfected erythrocytes reduces the risk of cerebral malaria (a complication associated with high parasite loads) but increases the risk of severe malarial anaemia. This hypothesis casts new light on epidemiological, genetic, and experimental studies in malaria pathogenesis.
Collapse
|
41
|
Brattig NW, Kowalsky K, Liu X, Burchard GD, Kamena F, Seeberger PH. Plasmodium falciparum glycosylphosphatidylinositol toxin interacts with the membrane of non-parasitized red blood cells: a putative mechanism contributing to malaria anemia. Microbes Infect 2008; 10:885-91. [DOI: 10.1016/j.micinf.2008.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 04/22/2008] [Accepted: 05/04/2008] [Indexed: 10/22/2022]
|
42
|
Borrmann S, Matsiegui PB, Missinou MA, Kremsner PG. Effects of Plasmodium falciparum parasite population size and patient age on early and late parasitological outcomes of antimalarial treatment in children. Antimicrob Agents Chemother 2008; 52:1799-805. [PMID: 18299407 PMCID: PMC2346661 DOI: 10.1128/aac.00755-07] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 08/22/2007] [Accepted: 02/16/2008] [Indexed: 11/20/2022] Open
Abstract
The design and interpretation of trials assessing the chemotherapeutic effects of antimalarial drugs depend on our understanding of how different selection criteria affect treatment outcomes. In this study, we analyzed the effects of baseline parameters on the initial parasite elimination rate and the risk of subsequent recrudescence as a marker for incompletely eliminated asexual blood-stage parasites in pediatric patients with uncomplicated Plasmodium falciparum infection treated with amodiaquine in a high-transmission area. We found that (i) parasite population size and patient age independently determine early and late parasitological treatment outcome measurements; (ii) the rate of recrudescence is higher in patients 1 to 3 years of age than in patients aged <1 or >3 years; (iii) patients aged >5 years with parasite densities between 2,000 and 10,000/microl have a lower recrudescence rate (13%; 95% confidence interval [CI], 8% to 21%) than patients aged <5 years with parasite densities of >10,000/microl (40%; 95% CI, 30% to 50%); and (iv) the sensitivity of detecting recrudescences outside this high-risk group, i.e., in patients of >5 years of age or with parasite densities of <10,000/microl, is as low as 27% or 22%, respectively. In conclusion, these findings highlight the need to use adequate selection criteria and to report parasitological outcome results adjusted for the readily available determinants of chemotherapeutic failure, i.e., patient age and baseline parasitemia. The thresholds may vary by transmission intensity and drug regimen. A better understanding of the limitations of antimalarial regimens in high-risk subgroups of patients has important implications for setting policy recommendations.
Collapse
Affiliation(s)
- Steffen Borrmann
- Institute of Hygiene, University of Heidelberg, School of Medicine, Heidelberg, Germany.
| | | | | | | |
Collapse
|
43
|
Ghosh K, Ghosh K. Pathogenesis of anemia in malaria: a concise review. Parasitol Res 2007; 101:1463-9. [PMID: 17874326 DOI: 10.1007/s00436-007-0742-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 08/21/2007] [Indexed: 10/22/2022]
Abstract
Anemia is a common complication in malarial infection, although the consequences are more pronounced with Plasmodium falciparum malaria (Ghosh, Indian J Hematol Blood Tranfus 21(53):128-130, 2003). Anemia in this infection is caused by a variety of pathophysiologic mechanisms, and in areas where malaria infection is endemic, co-morbidities like other parasitic infestations, iron, folate and Vitamin B12 deficiency, deficiency of other nutrients, and anemia, which is aggravated by anti-malarial drugs both through immune and non-immune mechanisms, are important considerations. In different endemic areas, beta-thalassemia, alpha-thalassemia, Hb S, Hb E, G6PD deficiency, or ovalocytosis in different proportions interact with this infection. Finally, aberrant immune response to repeated or chronic falciparum malarial infection may produce tropical splenomegaly syndrome, a proportion of which show clonal proliferation of B lymphocytes. Cooperation between chronic malarial infection and infection with E-B virus infection in producing Burkitt's lymphoma is well known. In this review, the fascinating and multifaceted pathophysiolgoy of malarial anemia has been discussed.
Collapse
Affiliation(s)
- Kanjaksha Ghosh
- Institute of Immunohaematology (ICMR), 13th Floor, KEM Hospital Campus, Parel, Mumbai 400 012, India.
| | | |
Collapse
|
44
|
Anyona SB, Schrier SL, Gichuki CW, Waitumbi JN. Pitting of malaria parasites and spherocyte formation. Malar J 2006; 5:64. [PMID: 16879740 PMCID: PMC1552078 DOI: 10.1186/1475-2875-5-64] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Accepted: 07/31/2006] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A high prevalence of spherocytes was detected in blood smears of children enrolled in a case control study conducted in the malaria holoendemic Lake Victoria basin. It was speculated that the spherocytes reflect intraerythrocytic removal of malarial parasites with a concurrent removal of RBC membrane through a process analogous to pitting of intraerythrocytic inclusion bodies. Pitting and re-circulation of RBCs devoid of malaria parasites could be a host mechanism for parasite clearance while minimizing the anaemia that would occur were the entire parasitized RBC removed. The prior demonstration of RBCs containing ring-infected erythrocyte surface antigen (pf 155 or RESA) but no intracellular parasites, support the idea of pitting. METHODS An in vitro model was developed to examine the phenomenon of pitting and spherocyte formation in Plasmodium falciparum infected RBCs (iRBC) co-incubated with human macrophages. In vivo application of this model was evaluated using blood specimens from patients attending Kisumu Ditrict Hospital. RBCs were probed with anti-RESA monoclonal antibody and a DNA stain (propidium iodide). Flow cytometry and fluorescent microscopy was used to compare RBCs containing both the antigen and the parasites to those that were only RESA positive. RESULTS Co-incubation of iRBC and tumor necrosis factor-alpha activated macrophages led to pitting (14% +/- 1.31% macrophages with engulfed trophozoites) as opposed to erythrophagocytosis (5.33% +/- 0.95%) (P < 0.01). Following the interaction, 26.9% +/- 8.1% of the RBCs were spherocytes as determined by flow cytometric reduction in eosin-5-maleimide binding which detects RBC membrane band 3. The median of patient RBCs with pitted parasites (RESA+, PI-) was more than 3 times (95,275/muL) that of RESA+, PI+ RBCs (28,365/muL) (P < 0.01). RBCs with pitted parasites showed other morphological abnormalities, including spherocyte formation. CONCLUSION It is proposed that in malaria holoendemic areas where prevalence of asexual stage parasites approaches 100% in children, RBCs with pitted parasites are re-circulated and pitting may produce spherocytes.
Collapse
Affiliation(s)
- Samuel B Anyona
- School of Pure and Applied Science, Department of Biochemistry and Biotechnology, Kenyatta University, Nairobi, Kenya.
| | | | | | | |
Collapse
|
45
|
Buffet PA, Milon G, Brousse V, Correas JM, Dousset B, Couvelard A, Kianmanesh R, Farges O, Sauvanet A, Paye F, Ungeheuer MN, Ottone C, Khun H, Fiette L, Guigon G, Huerre M, Mercereau-Puijalon O, David PH. Ex vivo perfusion of human spleens maintains clearing and processing functions. Blood 2005; 107:3745-52. [PMID: 16384927 DOI: 10.1182/blood-2005-10-4094] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The spleen plays a central role in the pathophysiology of several potentially severe diseases such as inherited red cell membrane disorders, hemolytic anemias, and malaria. Research on these diseases is hampered by ethical constraints that limit human spleen tissue explorations. We identified a surgical situation--left splenopancreatectomy for benign pancreas tumors--allowing spleen retrieval at no risk for patients. Ex vivo perfusion of retrieved intact spleens for 4 to 6 hours maintained a preserved parenchymal structure, vascular flow, and metabolic activity. Function preservation was assessed by testing the ability of isolated-perfused spleens to retain Plasmodium falciparum-infected erythrocytes preexposed to the antimalarial drug artesunate (Art-iRBCs). More than 95% of Art-iRBCs were cleared from the perfusate in 2 hours. At each transit through isolated-perfused spleens, parasite remnants were removed from 0.2% to 0.23% of Art-iRBCs, a proportion consistent with the 0.02% to 1% pitting rate previously established in artesunate-treated patients. Histologic analysis showed that more than 90% of Art-iRBCs were retained and processed in the red pulp, providing the first direct evidence of a zone-dependent parasite clearance by the human spleen. Human-specific physiologic or pathophysiologic mechanisms involving clearing or processing functions of the spleen can now be experimentally explored in a human tissue context.
Collapse
Affiliation(s)
- Pierre A Buffet
- Biomedical Research Team, 25-28 rue du Dr Roux, 75724 Paris Cedex 15, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Postma MJ, van Hulst M, De Wolf JTM, Botteman M, Staginnus U. Cost-effectiveness of pathogen inactivation for platelet transfusions in the Netherlands. Transfus Med 2005; 15:379-87. [PMID: 16202052 DOI: 10.1111/j.1365-3148.2005.00609.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study is to estimate cost-effectiveness of pathogen inactivation for platelet transfusions in the Netherlands. We used decision tree analysis to evaluate the cost-effectiveness of the addition of pathogen inactivation of pooled platelets to standard procedures for platelet transfusion safety (such as, donor recruitment and screening). Data on transfusions were derived from the University Medical Centre Groningen (the Netherlands) for 1997. Characteristics of platelet recipients (patient group, age, gender and survival) and data/assumptions on viral and bacterial risks were linked to direct and indirect costs/benefits of pathogen inactivation. Post-transfusion survival was simulated with a Markov model. Standard methods for cost-effectiveness were used. Cost-effectiveness was expressed in net costs per life-year gained (LYG) and estimated in baseline- and sensitivity analysis. Sensitivity was analysed with respect to various assumptions including sepsis risk, reduction of the discard rate and discounting. Stochastic analysis to derive 90% simulation intervals (SIs) was performed on sepsis risk. Net costs per LYG for pathogen inactivation were estimated 554,000 euro in the baseline-weighted average over the three patient groups (90% SI: 354,000-1092,500 euro). Sensitivity analysis revealed that cost-effectiveness was insensitive to viral risks and indirect costing, but highly sensitive to the assumed excess transfusions required and discounting of LYG. Given relatively high net costs per LYG that are internationally accepted for blood transfusion safety interventions, our estimated cost-effectiveness figures for pathogen inactivation may reflect acceptable cost-effectiveness in this specific area. Two main assumptions of our model were that the pathogen inactivation was 100% effective in preventing transmission of the pathogens considered and was not associated with major and/or costly adverse reactions. Validation of several crucial parameters is required, in particular the Dutch risk for acquiring and dying of transfusion-related sepsis.
Collapse
Affiliation(s)
- M J Postma
- Groningen University Institute for Drug Exploration/University of Groningen Research Institute of Pharmacy (GUIDE/GRIP), Groningen, the Netherlands.
| | | | | | | | | |
Collapse
|
47
|
Affiliation(s)
- J P AuBuchon
- E. Elizabeth French Professor and Chair, Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
| |
Collapse
|
48
|
Suresh S, Spatz J, Mills JP, Micoulet A, Dao M, Lim CT, Beil M, Seufferlein T. Connections between single-cell biomechanics and human disease states: gastrointestinal cancer and malaria. Acta Biomater 2005; 1:15-30. [PMID: 16701777 DOI: 10.1016/j.actbio.2004.09.001] [Citation(s) in RCA: 458] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Revised: 09/02/2004] [Accepted: 09/02/2004] [Indexed: 10/26/2022]
Abstract
We investigate connections between single-cell mechanical properties and subcellular structural reorganization from biochemical factors in the context of two distinctly different human diseases: gastrointestinal tumor and malaria. Although the cell lineages and the biochemical links to pathogenesis are vastly different in these two cases, we compare and contrast chemomechanical pathways whereby intracellular structural rearrangements lead to global changes in mechanical deformability of the cell. This single-cell biomechanical response, in turn, seems to mediate cell mobility and thereby facilitates disease progression in situations where the elastic modulus increases or decreases due to membrane or cytoskeleton reorganization. We first present new experiments on elastic response and energy dissipation under repeated tensile loading of epithelial pancreatic cancer cells in force- or displacement-control. Energy dissipation from repeated stretching significantly increases and the cell's elastic modulus decreases after treatment of Panc-1 pancreatic cancer cells with sphingosylphosphorylcholine (SPC), a bioactive lipid that influences cancer metastasis. When the cell is treated instead with lysophosphatidic acid, which facilitates actin stress fiber formation, neither energy dissipation nor modulus is noticeably affected. Integrating recent studies with our new observations, we ascribe these trends to possible SPC-induced reorganization primarily of keratin network to perinuclear region of cell; the intermediate filament fraction of the cytoskeleton thus appears to dominate deformability of the epithelial cell. Possible consequences of these results to cell mobility and cancer metastasis are postulated. We then turn attention to progressive changes in mechanical properties of the human red blood cell (RBC) infected with the malaria parasite Plasmodium falciparum. We present, for the first time, continuous force-displacement curves obtained from in-vitro deformation of RBC with optical tweezers for different intracellular developmental stages of parasite. The shear modulus of RBC is found to increase up to 10-fold during parasite development, which is a noticeably greater effect than that from prior estimates. By integrating our new experimental results with published literature on deformability of Plasmodium-harbouring RBC, we examine the biochemical conditions mediating increases or decreases in modulus, and their implications for disease progression. Some general perspectives on connections among structure, single-cell mechanical properties and biological responses associated with pathogenic processes are also provided in the context of the two diseases considered in this work.
Collapse
Affiliation(s)
- S Suresh
- Department of Materials Science and Engineering, and Division of Bioengineering, Massachusetts Institute of Technology, Cambridge, MA 02139-4307, USA.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Affiliation(s)
- S J Slichter
- Executive Vice President of Research, Puget Sound Blood Center; Professor of Medicine, University of Washington School of Medicine, Seattle, Washington 98104-1256, USA.
| |
Collapse
|
50
|
Affiliation(s)
- M A Blajchman
- McMaster University, Department of Pathology, Hamilton, Ontario, Canada.
| |
Collapse
|