Oxidative stress and rheology in severe malaria

There is mounting evidence that the release of haemozoin (beta-haematin), which is produced in large amounts during malaria infection and is released into the circulation during schizont rupture, is associated with damage to cell membranes through an oxidative mechanism. The red blood cell membrane is thus oxidised, causing rigidity of the cell. This can contribute to the pathophysiology of severe malaria, since red blood cells will have to deform considerably in order to squeeze through the microcirculation, the patency of which is disturbed by sequestered red blood cells containing the mature forms of the parasite. Rigidity of red blood cells forms a new target for intervention. Since this seems to be caused by oxidative damage to the red blood cell membrane, the anti-oxidant N-acetylcysteine is a promising candidate for adjunctive treatment in severe malaria, which still has a mortality rate as high as 20%.

Dysregulation of L-arginine metabolism and bioavailability associated to free plasma heme

Severe Plasmodium falciparum malaria is associated with hypoargininemia, which contributes to impaired systemic and pulmonary nitric oxide (NO) production and endothelial dysfunction. Since intravascular hemolysis is an intrinsic feature of severe malaria, we investigated whether and by which mechanisms free heme [Fe(III)-protoporphyrin IX (FP)] might contribute to the dysregulation of l-arginine (l-Arg) metabolism and bioavailability. Carrier systems “y+” [or cationic amino acid transporter (CAT)] and “y+L” transport l-Arg into red blood cells (RBC), where it is hydrolyzed to ornithine and urea by arginase (isoform I) or converted to NO^· and citrulline by endothelial nitric oxide synthase (eNOS). Our results show a significant and dose-dependent impairment of l-Arg transport into RBC pretreated with FP, with a strong inhibition of the system carrier y+L. Despite the impaired l-Arg influx, higher amounts of l-Arg-derived urea are produced by RBC preexposed to FP caused by activation of RBC arginase I. This activation appeared not to be mediated by oxidative modifications of the enzyme. We conclude that l-Arg transport across RBC membrane is impaired and arginase-mediated l-Arg consumption enhanced by free heme. This could contribute to reduced NO production in severe malaria.

Old and new targets for innovative antimalarial compounds: the different strategies of the Italian Malaria Network

Clinical treatment-failures to affordable drugs encouraged new investigation for discovery and development of new prophylactic and therapeutic interventions against malaria. The Drug Discovery Cluster (DDcl) of the Italian Malaria Network gathers several highly integrated and complementary laboratories from different Italian Institutions to identify, synthesise, screen in vitro and in vivo new antimalarial molecules directed against the intraerythrocytic stage of P. falciparum parasites and/or with transmission blocking activity to select lead compounds for further development. Complementary research activities, both in vitro and in the clinics, aim at investigating the pathogenetic mechanisms of severe malaria anaemia and the different manifestations of the disease in malaria-HIV co-infected patients to identify new therapies and improve survival.

Ultrastructural characteristics, biological activity and pharmacological relevance of synthetic malaria pigment (beta-haematin)

Malaria pigment (haemozoin, HZ) is the detoxification product of haemoglobin-derived haem of intraerythrocytic malaria parasites. At schizont rupture, haemozoin accumulates inside host phagocytic cells. The chemical structure and the spectroscopic characteristics of haemozoin are identical to those of beta-haematin (BH), a synthetic pigment obtained from Ferriprotoporphyrin IX (Fe (III) PPIX) in acidic conditions. The process of BH formation is the target of quinoline antimalarials. Here, we summarise the results of our studies on the ultrastructural characteristics, biological and pharmacological relevance of synthetic vs. native haemozoin. 1) By electron microscopy, native HZ and synthetic BH appear as dark brown crystals, morphologically indistinguishable and are internalised by phagocytes at the same extent. 2) Both HZ and BH modulate the production of cytokines (TNF and NO) and increase the susceptibility to lipid peroxidation of mouse or human phagocytes. The antioxidant status of the phagocytes regulates the susceptibility to BH/HZ-mediated effects. 3) The process of BH formation from Fe(III)PPIX, hence haem detoxification, can be inhibited by electrochemically-reduced, Fe(II)PPIX molecules. Maintaining iron in the reduced state can thus be considered a new pharmacological target. This was confirmed by the observation that thiol-reducing agents (NAC, cystein) were able to inhibit BH formation and were toxic to parasites in vitro.

Prooxidant activity of beta-hematin (synthetic malaria pigment) in arachidonic acid micelles and phospholipid large unilamellar vesicles

Intraerythrocytic malaria parasite has evolved a unique pathway to detoxify hemoglobin-derived heme by forming a crystal of Ferri-protoporphyrin IX dimers, known as hemozoin or "malaria pigment." The prooxidant activity of beta-hematin (BH), the synthetic malaria pigment obtained from hematin at acidic pH, was studied in arachidonic acid micelles and phospholipid Large Unilamellar Vesicles (LUVs) and compared to that of alpha-hematin (AH, Ferri-protoporphyrin IX-hydroxide) and hemin (HE, Ferri-protoporphyrin-chloride). Lipid peroxidation was measured as production of thiobarbituric acid reactive substances (TBARS). The extent of peroxidation induced by either AH or BH was strongly dependent upon the content of pre-existing hydroperoxides and efficiently inhibited by triphenylphosphine, a deoxygenating agent able to reduce hydroperoxides to hydroxides and by lipophilic scavengers. BH prooxidant activity was linearly related to the material, whereas that of AH seemed dependent on the aggregation state of the porphyrin. Maximal activity was observed when AH was present in concentration lower than 2 microM. In this case a shift of spectra in the Soret region, leading to the increase of the O.D. 400/385 nm ratio, suggested a transition toward a less aggregated state. BH prooxidant activity was significantly lower than that of monomeric AH, yet higher than that of AH aggregates. Differently from AH aggregates, BH-induced peroxidation was unaffected by GSH and inhibited rather than enhanced by acidic pH (5.7) and chloroquine. UV/Vis spectroscopy of AH aggregates at acidic pH, low GSH concentrations and chloroquine suggests a shift of AH aggregates toward the less aggregated state, more active as peroxidation catalyst.

Macrophage populations of different origins have distinct susceptibilities to lipid peroxidation induced by beta-haematin (malaria pigment)

We investigated the susceptibility of peritoneal mouse macrophages and macrophage and microglia cell lines to the peroxidative activity of beta-haematin, the synthetic polymer identical to native malaria pigment. The extent of lipid peroxidation, measured as production of thiobarbituric acid reactive substances (TBARS), was greater for peritoneal macrophages than for cell lines and microglia cells. TBARS production apparently was not attributable to the release of free iron from the protoporphyrin moiety, but related to lower glutathione content and different lipid composition of the cell membrane. These findings offer a new interpretation for the contentious immunomodulatory effects of beta-haematin reported for phagocytes of different origins.

Age-related effects of chronic ethanol intake on physical properties, lipid composition and galactosyltransferase activity of rat small intestine microsomes

The effect of a 4-week ethanol administration on: (1) glycoprotein content of brush border membrane (BBM): (2) galactosyltransferase activity; (3) lipid composition and fluidity of intestinal microsomes prepared from young and adult rats was investigated. In spite of a lower alcohol consumption, the more dramatic effects of treatment have been observed in the older rats, where BBM protein-bound hexoses and microsomal galactosyltransferase activity were significantly decreased. On the contrary, these parameters were unaffected in young rats. However, both rat groups were similarly affected in having their microsomal cholesterol contents significantly increased. Microsomal membranes from ethanol-fed adult rats were less fluid compared to control rats: the high fluorescence anisotropy value could be related to the high cholesterol/phospholipid ratio and to the decrease of the unsaturated fatty acids C22:4 and C22:6.

Phospholipid content and composition of human meningiomas

The content and distribution of phospholipids, as well as their fatty acid composition, were studied in 16 human meningiomas in comparison with normal leptomeninges. The total phospholipid content of tumors (expressed as organic phosphorus/mg DNA) was similar to that of the tissue from which they originated. The same phospholipid classes were present in both tissues, but with a different pattern: an increase of phosphatidylinositol and phosphatidylcholine and a decrease of sphingomyelin and alkenyl-acyl phosphatidylethanolamine were detected in meningiomas. Stearic, palmitic, and oleic acids were the major phospholipid fatty acids in both leptomeninges and meningiomas. However, remarkable differences between the fatty acid composition of the two tissues were shown. The most striking difference is a marked increase of unsaturated fatty acids in tumors associated with a decrease of saturated forms. This feature is common to all major phospholipid classes. The possible significance and role of phospholipid modifications in the functional properties of meningioma plasma membrane is discussed.

Effect of maternal diet on ganglioside distribution in fetal rat brain

Female rats were fed a diet with low protein content or with low and high amount of essential fatty acids (EFA). Ganglioside content and distribution were analyzed in the brain of animals at two different periods of fetal life (15th or 20th day). In the fetuses from mothers fed the diet with low amount of EFA the content of ganglioside is significantly lower than in the control group. The three diets resulted in the modification of ganglioside pattern, mainly for the animals on the 15th day of gestation.