Azathioprine favourably influences the course of malaria

Abstract

<p>Abstract</p> <p>Background</p> <p>Azathioprine triggers suicidal erythrocyte death or eryptosis, characterized by cell shrinkage and exposure of phosphatidylserine at the erythrocyte surface. Eryptosis may accelerate the clearance of <it>Plasmodium</it>-infected erythrocytes. The present study thus explored whether azathioprine influences eryptosis of <it>Plasmodium</it>-infected erythrocytes, development of parasitaemia and thus the course of malaria.</p> <p>Methods</p> <p>Human erythrocytes were infected <it>in vitro </it>with <it>Plasmodium falciparum (P. falciparum) </it>(strain BinH) in the absence and presence of azathioprine (0.001 – 10 μM), parasitaemia determined utilizing Syto16, phosphatidylserine exposure estimated from annexin V-binding and cell volume from forward scatter in FACS analysis. Mice were infected with <it>Plasmodium berghei (P. berghei) </it>ANKA by injecting parasitized murine erythrocytes (1 × 10⁶) intraperitoneally. Where indicated azathioprine (5 mg/kg b.w.) was administered subcutaneously from the eighth day of infection.</p> <p>Results</p> <p><it>In vitro </it>infection of human erythrocytes with <it>P. falciparum </it>increased annexin V-binding and initially decreased forward scatter, effects significantly augmented by azathioprine. At higher concentrations azathioprine significantly decreased intraerythrocytic DNA/RNA content (≥ 1 μM) and <it>in vitro </it>parasitaemia (≥ 1 μM). Administration of azathioprine significantly decreased the parasitaemia of circulating erythrocytes and increased the survival of <it>P. berghei</it>-infected mice (from 0% to 77% 22 days after infection).</p> <p>Conclusion</p> <p>Azathioprine inhibits intraerythrocytic growth of <it>P. falciparum</it>, enhances suicidal death of infected erythrocytes, decreases parasitaemia and fosters host survival during malaria.</p