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Strict pairing of var promoters and introns is required for var gene silencing in the malaria parasite Plasmodium falciparum.

The human malaria parasite, Plasmodium falciparum, maintains a persistent infection altering the proteins expressed on the surface of the infected red blood cells, thus avoiding the host immune response. The primary surface antigen, a protein called PfEMP1, is encoded by a multicopy gene family called var. Each individual parasite only expresses a single var gene at a time, maintaining all other members of the family in a transcriptionally silent state. Previous work using reporter genes in transiently transfected plasmid constructs implicated a conserved intron found in all var genes in the silencing process. Here we have utilized episomal recombination within stably transformed parasites to generate different var promoter and intron arrangements and show that loss of the intron results in var promoter activation. Further, in multicopy plasmid concatamers, each intron could only silence a single promoter, suggesting a one-to-one pairing requirement for silencing. Transcriptionally active, "unpaired" promoters remained active after integration into a chromosome; however, they were not recognized by the pathway that maintains mutually exclusive var gene expression. The data indicate that intron/promoter pairing is responsible for silencing each individual var gene and that disruption of silencing of one gene does not affect the transcriptional activity of neighboring var promoters. This suggests that silencing is regulated at the level of individual genes rather than by assembly of silent chromatin throughout a chromosomal region, thus providing a possible explanation of how a var gene can be maintained in a silent state while the immediately adjacent var gene is transcriptionally active.

Alleles↗

Alternative mutations at position 76 of the vacuolar transmembrane protein PfCRT are associated with chloroquine resistance and unique stereospecific quinine and quinidine responses in Plasmodium falciparum.

Chloroquine resistance (CQR) in Plasmodium falciparum is associated with multiple mutations in the digestive vacuole membrane protein PfCRT. The chloroquine-sensitive (CQS) 106/1 line of P. falciparum has six of seven PfCRT mutations consistently found in CQR parasites from Asia and Africa. The missing mutation at position 76 (K76T in reported population surveys) may therefore be critical to CQR. To test this hypothesis, we exposed 106/1 populations (10(9)-10(10) parasites) to a chloroquine (CQ) concentration lethal to CQS parasites. In multiple independent experiments, surviving CQR parasites were detected in the cultures after 28 to 42 days. These parasites showed novel K76N or K76I PfCRT mutations and corresponding CQ IC(50) values that were approximately 8- and 12-fold higher than that of the original 106/1 IC(50). A distinctive feature of the K76I line relative to 106/1 parasites was their greatly increased sensitivity to quinine (QN) but reduced sensitivity to its enantiomer quinidine (QD), indicative of a unique stereospecific response not observed in other CQR lines. Furthermore, verapamil had the remarkable effect of antagonizing the QN response while potentiating the QD response of K76I parasites. In our single-step drug selection protocol, the probability of the simultaneous selection of two specific mutations required for CQR is extremely small. We conclude that the K76N or K76I change added to the other pre-existing mutations in the 106/1 PfCRT protein was responsible for CQR. The various mutations that have now been documented at PfCRT position 76 (K76T, K76N, K76I) suggest that the loss of lysine is central to the CQR mechanism.

Acridine Orange↗

pfcrt polymorphism and chloroquine resistance in Plasmodium falciparum strains isolated in Cambodia.

Plasmodium falciparum chloroquine resistance was first detected in Cambodia in the early sixties. Treatment with chloroquine was abandoned 20 years ago. In vitro chloroquine sensitivity monitoring indicates that all eastern Cambodian isolates were sensitive to chloroquine, whereas most isolates collected from western provinces displayed reduced susceptibility to chloroquine. This indicates that the rate of chloroquine resistance remains high and stable in this region in the absence of chloroquine pressure. Characterization of codons 72 to 78 and 218 to 220 of pfcrt revealed six distinct haplotypes, four of which had never been described. The frequency of each haplotype depended on the geographical origin of the samples. The CVIETIF//ISS haplotype was detected in 92% of western Cambodian isolates and in 11% of isolates collected from the eastern province, where CVMNKIF//ISA and CVIDTIF//ISS predominate. The detection of an intermediate haplotype from a susceptible area with 76T/220A, suggests that acquisition of chloroquine resistance might be a stepwise process, during which accumulation of point mutations modulates the response to chloroquine. The association of the K76T mutation with chloroquine resistance was not clear. The mutation was detected in resistant and susceptible samples, suggesting that additional factors are involved in chloroquine resistance. By contrast, the pfcrt D/N75E mutation was strongly associated with the in vitro chloroquine resistance in Cambodian isolates. The N86 allelic form of pfmdr1 was detected in all isolates, consistent with a poor association with resistance to chloroquine. This indicates that in vitro resistance to chloroquine was associated with accumulation of point mutations in pfcrt.

Animals↗

Covalent modification of the permeability pathways induced in the human erythrocyte membrane by the malarial parasite Plasmodium falciparum.

The intraerythrocytic malarial parasite Plasmodium falciparum induces permeation pathways in the plasma membrane of its host, the red blood cell. The pathways display porelike properties with selectivity toward anions and neutral molecules. They are shown here to be susceptible to chemical modification by 4,4'-diisothiocyano-2,2'-dihydrostilbene disulfonic acid (H2DIDS), an amino-reactive reagent which is impermeant to uninfected cells. At pH 7.4 the reagent affected transport only marginally while freely entering into infected cells and reacting with intracellular hemoglobin. On the other hand, at pH above 8.5, the compound blocked the pathways efficiently (IC 50 approximately equal to 50 microM, at 37 degrees C for 10 min) as judged by four criteria: (1) selective lysis of infected erythrocytes in the presence of isotonic polyols; (2) uptake of [14C] sorbitol into infected cells; (3) uptake of the fluorescent anion Nbd-taurine into infected cells under conditions in which the native anion transport systems was inhibited; and (4) labeling of intracellular hemoglobin by the permeating reagent [3H]H2DIDS. The inhibitory effect was observed only with mature forms of parasitized cells, i.e., from the trophozoite stage and onward, while the pathways of immature ring forms were refractive. However, when the probe was incorporated into the interior of hemoglobin-depleted resealed ghosts prepared from ring forms, it was found to inhibit the pore-mediated transport. On the basis of these and other studies we postulate that the H2DIDS-sensitive sites on the pathways are endofacial, thus requiring penetration of the probe (probably through the same pathway) for their inactivation. Labeling studies with the radiolabeled modifier implicate 120-Kd, 63-Kd, and/or 51-Kd polypeptides as candidates for the pore components.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗

Chloroquine resistance of Plasmodium falciparum: a biological advantage?

The response in vitro of Plasmodium falciparum to chloroquine, mefloquine and quinine was studied in a hyperendemic peri-urban area of Accra, Ghana, during the fourth quarter of 1991, yielding a total of 159 valid tests. Schizont maturation in drug-free controls and effective chloroquine concentrations were strongly correlated. This was not seen with mefloquine or quinine. Higher mean parasitaemia in untreated oligo-symptomatic carriers of overtly chloroquine-resistant P. falciparum than in carriers of more sensitive parasites was another indication of higher viability and biological advantage of chloroquine-resistant P. falciparum that may conceivably have clinical implications.

Adolescent↗

Cerebral malaria is associated with IgG2 and IgG4 antibody responses to recombinant Plasmodium falciparum RIFIN antigen.

RIFIN proteins belong to the largest Plasmodium falciparum multicopy family of variant surface antigens (VSA) expressed by infected erythrocytes. VSA antibodies have been shown to be associated with protection against malaria. Here, antibody subclass responses to a recombinant RIFIN protein (RIF-29) in 116 Ghanaian children were determined by ELISA to investigate the relationship between severe malaria and anti-RIF-29 antibodies. The study group was composed of 23 children diagnosed exclusively for cerebral malaria and 35 children who had non-cerebral severe malaria. The remaining 58 individuals were age-, gender- and area-matched asymptomatic controls. The finding that IgG1 and IgG3 responses predominated in severe malaria patients compared to matched controls suggests that these antibodies are not protective, but are most probably induced by a current infection, an observation substantiated by the equally high reactivity to both recombinant RIF-29 protein and to P. falciparum crude lysate proteins. The exclusive detection of IgG2 and IgG4 antibodies to RIF-29 protein only in cerebral malaria children brings to mind the possibility that these antibodies are pathogenic. This is a new finding that may go some way towards explaining why these children are at risk of developing the life-threatening form of cerebral malaria.

Animals↗

Rational use of drugs against Plasmodium falciparum.

Recent studies on resistance to blood schizontocides in Plasmodium falciparum give a rational basis for the use of artemisinins combined with arylaminoalcohols for the treatment of uncomplicated chloroquine-resistant malaria in Africa. In areas where such combinations are introduced, there is reason to believe that the continued use of chloroquine in the community will help protect the new drugs from resistance. In view of several laboratory studies, combinations of artemisinins with antifolates or chloroquine pose a risk of antagonistic interaction. This can be avoided by use of the artemisinin and the companion drug sequentially.

Animals↗

Pre-erythrocytic antigens of Plasmodium falciparum: from rags to riches?

A growing number of Plasmodium genomes have joined the sequencing treadmill, and the genome of Plasmodium falciparum has recently been published. Most malaria vaccinologists will soon be confronted by a bewildering array of new potential antigens from the recently completed genome of this parasite. However, for those aiming to target the pre-erythrocytic stages of the hepatic parasite, the wait might be long. In the absence of readily available materials and specific reagents, the selection of pre-erythrocytic antigens from raw sequence data is likely to prove difficult. Here, current knowledge of pre-erythrocytic antigens is updated in the light of recent results, and the post-genomic prospects of completing the antigenic repertoire of these immunologically important and intriguing stages is discussed.

Animals↗

Artemisinin antimalarials in pregnancy: a prospective treatment study of 539 episodes of multidrug-resistant Plasmodium falciparum.

The emergence and spread of multidrug-resistant Plasmodium falciparum compromises the treatment of malaria, especially during pregnancy, where the choice of antimalarials is already limited. Artesunate (n=528) or artemether (n=11) was used to treat 539 episodes of acute P. falciparum malaria in 461 pregnant women, including 44 first-trimester episodes. Most patients (310 [57.5%]) received re-treatments after earlier treatment with quinine or mefloquine. By use of survival analysis, the cumulative artemisinin failure rate for primary infections was 6.6% (95% confidence interval, 1.0-12.3), compared with the re-treatment failure rate of 21.7% (95% confidence interval, 15.4-28.0; P=.004). The artemisinins were well tolerated with no evidence of adverse effects. Birth outcomes did not differ significantly to community rates for abortion, stillbirth, congenital abnormality, and mean gestation at delivery. These results are reassuring, but further information about the safety of these valuable antimalarials in pregnancy is needed.

Animals↗

Mechanisms that reduce transmission of Plasmodium falciparum malaria in semiimmune and nonimmune persons.

Transmission of Plasmodium falciparum can be reduced by immune factors present in the mosquito blood meal. Specific antibodies and white blood cells (WBCs) can interact with the sexual stages of the parasite inside the mosquito midgut. The relative contribution of serum factors and WBCs on transmission reduction in gametocyte carriers from an endemic area in Cameroon and in travelers with a first malaria experience was studied. Blood from these gametocyte carriers was fed to mosquitoes through membrane feeders after serum replacement, WBC depletion, or both. In most imported malaria cases, serum factors, WBCs, or both showed a significant effect on transmission reduction, while infectiousness of gametocyte carriers from Cameroon was reduced by humoral plasma factors only. In addition, the infectivity of gametocytes from semiimmune carriers was significantly lower compared with that of nonimmune carriers, and infectivity was independent of gametocyte density and the presence of WBCs or plasma factors (or both) in the blood meal.

Animals↗

Rheological properties of rosettes formed by red blood cells parasitized by Plasmodium falciparum.

A proportion of red blood cells parasitized by Plasmodium falciparum form rosettes with non-parasitized red cells. Although these rosettes are thought to impair microcirculatory flow, their rheological characteristics have not been fully described. Using dual-micropipette manipulation to pull apart individual rosettes, we found that the forces binding rosettes together were strong (average force for removal of a cell was 4.4 x 10(-10) N, approximately 5 times that required to detach a parasitized cell adhered to cultured endothelium). If disrupted rosettes were re-formed, cells rosetted immediately on contact, but the strength of attachment increased over minutes, and did not apparently reach its maximal level for hours. All non-parasitized cells tested could adhere to rosette-forming parasitized cells. Rosettes could withstand arterial flow stresses (1.4-1.6 Pa) for minutes without disintegration. To test the effects of rosetting on flow resistance, the time required for entry into a 4.3 microns pipette was measured. Entry times depended strongly on the number of cells in the rosette, and averaged 35 times longer than for non-parasitized cells. Our studies show that the cell-cell attachments within rosettes are strong, and suggest that rosettes might survive both the arterial circulation and passage through microvessels and could contribute to the ischaemic complications of falciparum malaria.

Animals↗

Trial with ParaSight-F in the detection of Plasmodium falciparum infection in Chennai (Tamil Nadu), India.

Efficacy of Plasmodium falciparum histidine-rich protein (HRP-II) based diagnostic test ParaSight-F, was evaluated for diagnosis of P. falciparum malaria at the Malaria Clinic in Malaria Research Centre (Field Station), Chennai, Tamil Nadu. A total of 93 febrile patients were screened in parallel by microscopy and by ParaSight-F. The sensitivity and specificity of the test were 100% for the detection of P. falciparum infection.

Animals↗

Monoclonal antibody against the Plasmodium falciparum chitinase, PfCHT1, recognizes a malaria transmission-blocking epitope in Plasmodium gallinaceum ookinetes unrelated to the chitinase PgCHT1.

To initiate invasion of the mosquito midgut, Plasmodium ookinetes secrete chitinases that are necessary to cross the chitin-containing peritrophic matrix en route to invading the epithelial cell surface. To investigate chitinases as potential immunological targets of blocking malaria parasite transmission to mosquitoes, a monoclonal antibody (MAb) was identified that neutralized the enzymatic activity of the sole chitinase of Plasmodium falciparum, PfCHT1, identified to date. This MAb, designated 1C3, previously shown to react with an apical structure of P. falciparum ookinetes, also reacts with a discrete apical structure of P. gallinaceum ookinetes. In membrane feeding assays, MAb 1C3 markedly inhibited P. gallinaceum oocyst development in mosquito midguts. MAb 1C3 affinity isolated an approximately 210-kDa antigen which, under reducing conditions, became a 35-kDa antigen. This isolated 35-kDa protein cross-reacted with an antiserum raised against a synthetic peptide derived from the P. gallinaceum chitinase active site, PgCHT1, even though MAb 1C3 did not recognize native or recombinant PgCHT1 on Western blot. Therefore, this affinity-purified 35-kDa antigen appears similar to a previously identified protein, PgCHT2, a putative second chitinase of P. gallinaceum. Epitope mapping indicated MAb 1C3 recognized a region of PfCHT1 that diverges from a homologous amino acid sequence conserved within sequenced chitinases of P. berghei, P. yoelii, and P. gallinaceum (PgCHT1). A synthetic peptide derived from the mapped 1C3 epitope may be useful as a component of a subunit transmission-blocking vaccine.

Aedes↗

Declining chloroquine resistance of Plasmodium falciparum in Lambaréné, Gabon from 1992 to 1998.

Plasmodium falciparum malaria continues to threaten human populations in the tropics and travellers in endemic areas. Drug resistance of the parasite is a major problem in treating this devastating disease. In a prospective trial we investigated the in vitro sensitivity of Plasmodium falciparum to chloroquine, quinine and mefloquine in the Albert Schweitzer Hospital in Lambaréné, Gabon every second year from 1992 to 1998. We used the standard WHO in vitro sensitivity assay. Parasite sensitivity to quinine and mefloquine remained stable over the years. However, parasite resistance to chloroquine decreased highly significantly with the change in local malaria treatment policy. In 1992, 100% of parasite isolates showed resistance to chloroquine, whereas in 1998 only 45% were found resistant.

Animals↗

Amino acid sequence constraint and gene expression pattern across the life history in the malaria parasite Plasmodium falciparum.

The relationship between gene expression across the life cycle and protein conservation in Plasmodium falciparum was examined by comparing gene expression data for six life-history stages with the number of nonsynonymous substitutions per site dN between 901 orthologous gene pairs of P. falciparum and Plasmodium yoelii. A high level of expression across the life history was associated with decreased dN and thus with protein conservation. By contrast, differential expression in the sporozoite and merozoite stages was associated with increased dN. At least some sporozoite- and merozoite-expressed genes with high dN have probably been subject to positive selection arising from parasite-host coevolution. A high level of expression across the life history was associated with higher than average G+C content at the first and second codon positions, whereas a high level of expression in the sporozoite and merozoite was associated with reduced G+C content at the first and second codon positions, the latter pattern evidently reflecting the relaxation of constraint on the amino acid sequence.

Amino Acid Sequence↗

Resistance patterns of Plasmodium falciparum malaria to chloroquine in Kampala, Uganda.

BACKGROUND: Chloroquine is a first line drug for the treatment of uncomplicated Plasmodium falciparum malaria in Uganda. Recently, there have been increasing reports of resistance of Plasmodium falciparum malaria to chloroquine, as well as an increase in malaria morbidity and mortality among adults and children. OBJECTIVES: To assess the current effectiveness (clinical and parasitological response) of chloroquine in the treatment of uncomplicated Plasmodium falciparum malaria, and to define the magnitude of chloroquine resistant Plasmodium falciparum malaria in Kampala. DESIGN: A descriptive cross-sectional study among adults and children. SETTING: Mulago hospital complex (the national referral and teaching hospital in Kampala, Uganda) between September 1998 and March 1999. RESULTS: Ninety six patients with Plasmodiumfalciparum parasitaemia of 1000 to 100,000/microl of blood were treated with oral chloroquine phosphate, and followed up for 14 days. Sixty three (65.6%) patients showed clinical improvement, 29 (30.2%) deteriorated and four (4.2%) had no change. Adequate parasitological response was seen in 71(74 %), moderate in four (4.2%) and poor in 21(21.8%) patients. Treatment failures were highest among children below five years, with eleven (57.9%) children not responding to chloroquine. CONCLUSION: Although chloroquine was found to be effective in two thirds of all patients, the high treatment failure, especially seen in children below five years is of concern. This necessitates further countrywide studies, and possibly a need to review the use of chloroquine as single first line drug for the treatment of uncomplicated malaria in Uganda, especially in children below five years of age.

Adolescent↗

In vitro potentiation of antimalarial activities by daphnetin derivatives against Plasmodium falciparum.

OBJECTIVE: To screen the antimalarial compounds of daphnetin derivatives against Plasmodium falciparum in vitro. METHOD: Plasmodium faciparum (FCC1) was cultured in vitro by a modified method of Trager and Jensen. Antimalarial compounds were screened by microscopy-based assay and microfluorimetric method. RESULTS: DA79 and DA78 showed potent antimalarial activity against Plasmodium falciparum cultured in vitro. CONCLUSION: Though the relationship between the structures of daphnetin derivatives and their antimalarial activities has not been clarified yet, this study may provide a new direction for discovery of more potential antimalarial compounds.

Animals↗