Apoptosis of non-parasitized red blood cells in malaria: a putative mechanism involved in the pathogenesis of anaemia

<p>Abstract</p> <p>Background</p> <p>Severe anaemia is a common complication of <it>Plasmodium falciparum </it>malaria in hyperendemic regions. Premature elimination of non-parasitized red blood cells (nRBC) has been considered as one mechanism involved in the genesis of severe malaria anaemia. It has been reported that apoptosis can occur in RBC and, consequently, this cell death process could contribute to anaemia. This study was performed to evaluate the susceptibility of nRBC to apoptosis in a malaria anaemia murine model.</p> <p>Methods</p> <p>Balb/c mice were intraperitonially inoculated with 1 × 10⁶<it>P. yoelii </it>17XL parasitized RBC (pRBC) and, then, parasitaemia and anaemia were monitored. Apoptosis in both pRBC and nRBC was assessed during early and late phases of infection by flow cytometry using Syto 16 and annexin V-PE double staining and forward scatter measurement.</p> <p>Results</p> <p>As expected, experimental infection of Balb/c mice with <it>Plasmodium yoelii </it>17XL parasites was characterized by progressive increase of parasitaemia and acute anaemia, leading to death. Flow cytometry analysis showed that a number of pRBC was in the apoptotic process. It was noteworthy that the increase of nRBC apoptosis levels occurred in the late phase of infection, when anaemia degree was notably accentuated, while no significant alteration was observed in the early phase.</p> <p>Conclusion</p> <p>The increased levels of nRBC apoptosis herein firstly reported, in malaria infection could represent a putative mechanism worsening the severity of malarial anaemia.</p

Plasmodium falciparum isolates from Angola show the StctVMNT haplotype in the pfcrt gene

<p>Abstract</p> <p>Background</p> <p>Effective treatment remains a mainstay of malaria control, but it is unfortunately strongly compromised by drug resistance, particularly in <it>Plasmodium falciparum</it>, the most important human malaria parasite. Although <it>P. falciparum </it>chemoresistance is well recognized all over the world, limited data are available on the distribution and prevalence of <it>pfcrt </it>and <it>pfmdr1 </it>haplotypes that mediate resistance to commonly used drugs and that show distinct geographic differences.</p> <p>Methods</p> <p><it>Plasmodium falciparum</it>-infected blood samples collected in 2007 at four municipalities of Luanda, Angola, were genotyped using PCR and direct DNA sequencing. Single nucleotide polymorphisms in the <it>P. falciparum pfcrt </it>and <it>pfmdr1 </it>genes were assessed and haplotype prevalences were determined.</p> <p>Results and Discussion</p> <p>The most prevalent <it>pfcrt </it>haplotype was <b>S</b>_tctVMN<b>T </b>(representing amino acids at codons 72-76). This result was unexpected, since the <b>S</b>_tctVMN<b>T </b>haplotype has previously been seen mainly in parasites from South America and India. The CV<b>IET</b>, CVMN<b>T </b>and CV<b>I</b>N<b>T </b>drug-resistance haplotypes were also found, and one previously undescribed haplotype (CVM<b>DT</b>) was detected. Regarding <it>pfmdr1</it>, the most prevalent haplotype was <b>Y</b>EYSNVD (representing amino acids at codons 86, 130, 184, 1034, 1042, 1109 and 1246). Wild haplotypes for <it>pfcrt </it>and <it>pfmdr1 </it>were uncommon; 3% of field isolates harbored wild type <it>pfcrt </it>(CVMNK), whereas 21% had wild type <it>pfmdr1 </it>(NEYSNVD). The observed predominance of the <b>S</b>_tctVMN<b>T </b>haplotype in Angola could be a result of frequent travel between Brazil and Angola citizens in the context of selective pressure of heavy CQ use.</p> <p>Conclusions</p> <p>The high prevalence of the <it>pfcrt </it><b>S</b>VMN<b>T </b>haplotype and the <it>pfmdr1 </it>86<b>Y </b>mutation confirm high-level chloroquine resistance and might suggest reduced efficacy of amodiaquine in Angola. Further studies must be encouraged to examine the <it>in vitro </it>sensitivity of <it>pfcrt </it><b>S</b>VMN<b>T </b>parasites to artesunate and amodiaquine for better conclusive data.</p

Brazilian Plasmodium falciparum isolates: investigation of candidate polymorphisms for artemisinin resistance before introduction of artemisinin-based combination therapy

<p>Abstract</p> <p>Background</p> <p>This study was performed to better understand the genetic diversity of known polymorphisms in <it>pfatpase6 </it>and <it>pfmdr1 </it>genes before the introduction of ACT in Brazil, in order to get a genotypic snapshot of <it>Plasmodium falciparum </it>parasites that may be used as baseline reference for future studies.</p> <p>Methods</p> <p>Parasites from <it>P. falciparum </it>samples collected in 2002, 2004 and 2006-2007 were genotyped using PCR and DNA sequencing at codons 86, 130, 184, 1034, 1042, 1109 and 1246 for <it>pfmdr1 </it>gene, and 243, 263, 402, 431, 623, 630, 639, 683, 716, 776, 769 and 771 for <it>pfatpase6 </it>gene.</p> <p>Results</p> <p>A <it>pfmdr1 </it>haplotype NEF/CDVY was found in 97% of the samples. In the case of <it>pfatpase6</it>, four haplotypes, wild-type (37%), 630 S (35%), 402 V (5%) and double-mutant 630 S + 402 V (23%), were detected.</p> <p>Conclusion</p> <p>Although some polymorphism in <it>pfmdr1 </it>and <it>pfatpase6 </it>were verified, no reported haplotypes in both genes that may mediate altered response to ACT was detected before the introduction of this therapy in Brazil. Thus, the haplotypes herein described can be very useful as a baseline reference of <it>P. falciparum </it>populations without ACT drug pressure.</p

Evaluation of the genetic polymorphism of Plasmodium falciparum P126 protein (SERA or SERP) and its influence on naturally acquired specific antibody responses in malaria-infected individuals living in the Brazilian Amazon

<p>Abstract</p> <p>Background</p> <p>The <it>Plasmodium falciparum </it>P126 protein is an asexual blood-stage malaria vaccine candidate antigen. Antibodies against P126 are able to inhibit parasite growth <it>in vitro</it>, and a major parasite-inhibitory epitope has been recently mapped to its 47 kDa N-terminal extremity (octamer repeat domain – OR domain). The OR domain basically consists of six octamer units, but variation in the sequence and number of repeat units may appear in different alleles. The aim of the present study was to investigate the polymorphism of P126 N-terminal region OR domain in <it>P. falciparum </it>isolates from two Brazilian malaria endemic areas and its impact on anti-OR naturally acquired antibodies.</p> <p>Methods</p> <p>The study was carried out in two villages, Candeias do Jamari (Rondonia state) and Peixoto de Azevedo (Mato Grosso state), both located in the south-western part of the Amazon region. The repetitive region of the gene encoding the P126 antigen was PCR amplified and sequenced with the di-deoxy chain termination procedure. The antibody response was evaluated by ELISA with the Nt47 synthetic peptide corresponding to the P126 OR-II domain.</p> <p>Results</p> <p>Only two types of OR fragments were identified in the studied areas, one of 175 bp (OR-I) and other of 199 bp (OR-II). A predominance of the OR-II fragment was observed in Candeias do Jamari whereas in Peixoto de Azevedo both fragments OR-I and OR-II were frequent as well as mixed infection (both fragments simultaneously) reported here for the first time. Comparing the DNA sequencing of OR-I and OR-II fragments, there was a high conservation among predicted amino acid sequences of the P126 N-terminal extremity. Data of immune response demonstrated that the OR domain is highly immunogenic in natural conditions of exposure and that the polymorphism of the OR domain does not apparently influence the specific immune response.</p> <p>Conclusion</p> <p>These findings confirm a limited genetic polymorphism of the P126 OR domain in <it>P. falciparum </it>isolates and that this limited genetic polymorphism does not seem to influence the development of a specific humoral immune response to P126 and its immunogenicity in the studied population.</p

The Genome of the Zoonotic Malaria Parasite Plasmodium simium Reveals Adaptions to Host-switching

Oral Session

Unexpectedly long incubation period of Plasmodium vivax malaria, in the absence of chemoprophylaxis, in patients diagnosed outside the transmission area in Brazil

<p>Abstract</p> <p>Background</p> <p>In 2010, Brazil recorded 3343,599 cases of malaria, with 99.6% of them concentrated in the Amazon region. <it>Plasmodium vivax </it>accounts for 86% of the cases circulating in the country. The extra-Amazonian region, where transmission does not occur, recorded about 566 cases imported from the Amazonian area in Brazil and South America, from Central America, Asia and African countries. Prolonged incubation periods have been described for <it>P. vivax </it>malaria in temperate climates. The diversity in essential biological characteristics is traditionally considered as one possible explanation to the emergence of relapse in malaria and to the differences in the duration of the incubation period, which can also be explained by the use of chemoprophylaxis. Studying the reported cases of <it>P. vivax </it>malaria in Rio de Janeiro, where there is no vector transmission, has made it possible to evaluate the extension of the incubation period and to notice that it may be extended in some cases.</p> <p>Methods</p> <p>Descriptive study of every malaria patients who visited the clinic in the last five years. The mean, standard deviation, median, minimum and maximum of all incubation periods were analysed.</p> <p>Results</p> <p>From the total of 80 patients seen in the clinic during the study time, with confirmed diagnosis of malaria, 49 (63%) were infected with <it>P. vivax</it>. Between those, seven had an estimated incubation period varying from three to 12 months and were returned travellers from Brazilian Amazonian states (6) and Indonesia (1). None of them had taken malarial chemoprophylaxis.</p> <p>Conclusions</p> <p>The authors emphasize that considering malaria as a possible cause of febrile syndrome should be a post-travel routine, independent of the time elapsed after exposure in the transmission area, even in the absence of malaria chemoprophylaxis. They speculate that, since there is no current and detailed information about the biological cycle of human malaria plasmodia's in Brazil, it is possible that new strains are circulating in endemic regions or a change in cycle of preexisting strains is occurring. Considering that a prolonged incubation period may confer advantages on the survival of the parasite, difficulties in malaria control might arise.</p

Evaluation of allelic forms of the erythrocyte binding antigen 175 (EBA-175) in Plasmodium falciparum field isolates from Brazilian endemic area

<p>Abstract</p> <p>Background</p> <p>The <it>Plasmodium falciparum </it>Erythrocyte Binding Antigen-175 (EBA-175) is an antigen considered to be one of the leading malaria vaccine candidates. EBA-175 mediates sialic acid-dependent binding to glycophorin A on the erythrocytes playing a crucial role during invasion of the <it>P. falciparum </it>in the host cell. Dimorphic allele segments, termed C-fragment and F-fragment, have been found in high endemicity malaria areas and associations between the dimorphism and severe malaria have been described. In this study, the genetic dimorphism of EBA-175 was evaluated in <it>P. falciparum </it>field isolates from Brazilian malaria endemic area.</p> <p>Methods</p> <p>The study was carried out in rural villages situated near Porto Velho, Rondonia State in the Brazilian Amazon in three time points between 1993 and 2008. The allelic dimorphism of the EBA-175 was analysed by Nested PCR.</p> <p>Results</p> <p>The classical allelic dimorphism of the EBA-175 was identified in the studied area. Overall, C-fragment was amplified in a higher frequency than F-fragment. The same was observed in the three time points where C-fragment was observed in a higher frequency than F-fragment. Single infections (one fragment amplified) were more frequent than mixed infection (two fragments amplified).</p> <p>Conclusions</p> <p>These findings confirm the dimorphism of EBA175, since only the two types of fragments were amplified, C-fragment and F-fragment. Also, the results show the remarkable predominance of CAMP allele in the studied area. The comparative analysis in three time points indicates that the allelic dimorphism of the EBA-175 is stable over time.</p

Algorithms to predict cerebral malaria in murine models using the SHIRPA protocol

<p>Abstract</p> <p>Background</p> <p><it>Plasmodium berghei </it>ANKA infection in C57Bl/6 mice induces cerebral malaria (CM), which reproduces, to a large extent, the pathological features of human CM. However, experimental CM incidence is variable (50-100%) and the period of incidence may present a range as wide as 6-12 days post-infection. The poor predictability of which and when infected mice will develop CM can make it difficult to determine the causal relationship of early pathological changes and outcome. With the purpose of contributing to solving these problems, algorithms for CM prediction were built.</p> <p>Methods</p> <p>Seventy-eight <it>P. berghei</it>-infected mice were daily evaluated using the primary SHIRPA protocol. Mice were classified as CM+ or CM- according to development of neurological signs on days 6-12 post-infection. Logistic regression was used to build predictive models for CM based on the results of SHIRPA tests and parasitaemia.</p> <p>Results</p> <p>The overall CM incidence was 54% occurring on days 6-10. Some algorithms had a very good performance in predicting CM, with the area under the receiver operator characteristic (_auROC) curve ≥ 80% and positive predictive values (PV+) ≥ 95, and correctly predicted time of death due to CM between 24 and 72 hours before development of the neurological syndrome (_auROC = 77-93%; PV+ = 100% using high cut off values). Inclusion of parasitaemia data slightly improved algorithm performance.</p> <p>Conclusion</p> <p>These algorithms work with data from a simple, inexpensive, reproducible and fast protocol. Most importantly, they can predict CM development very early, estimate time of death, and might be a valuable tool for research using CM murine models.</p