Chloroquine resistant malaria: Association with enhanced plasmodial protease activity

Chloroquine resistant Plasmodium berghei has several unusual features including (i) lack of malaria “pigment”, (ii) more efficient host catabolism of heme from infected erythrocytes, and (iii) relatively inefficient uptake of external chloroquine by infected red cells. The malaria pigment produced by chloroquine sensitive P. berghei is probably incompletely catabolized hemoglobin, the heme group of which is unavailable for subsequent catabolism by the host's reticuloendothelial system. This pigment has been suggested by others as the site of high affinity chloroquine binding. We hypothesized that all three characteristics of chloroquine resistant infections might be explained by enhanced proteolytic digestion of host cell hemoglobin. In confirmation, we report that chloroquine resistant P. berghei has 700–800% greater protease activity than the chloroquine sensitive form. This greatly elevated protease activity may explain the aforementioned characteristics of chloroquine resistant P. berghei and may help elucidate the basis of chloroquine resistance in human P. falciparum.     

Plasmodium berghei: Development of resistance to clindamycin and minocycline in mice

Strains of Plasmodium berghei resistant to clindamycin or minocycline were selected by a procedure in which groups of infected mice were treated with increasing doses of drug during each of a series of subpassages. Groups of five mice, each infected by intravenous inoculation with 10 million parasitized erythrocytes, were treated orally with different doses of drug for four consecutive days beginning on the day of infection. Subpassages were routinely made by Day 7, using donor mice from the group that had been treated with the highest dose of drug that allowed for some development of parasitemia during the preceding passage. Drug doses were increased in each passage as dictated by the development of parasitemia during the previous treated passage.The rate of development of resistance to clindamycin or minocycline was much slower than to conventional antimalarials such as chloroquine, quinine, or pyrimethamine. P. berghei developed total resistance to the latter compounds in nine to 12 treated passages in mice over a period of 60 to 85 days. In contrast, development of total resistance to clindamycin required 42 treated passages over a period of 300 days. Total resistance to minocycline was not attained during 86 successive minocycline-treated passages in mice over a period of 600 days, but a sixfold increase in resistance to minocycline was observed.The clindamycin-resistant strain was normally sensitive to minocycline, chloroquine, quinine, and pyrimethamine. The strain partially resistant to minocycline was normally sensitive to clindamycin, chloroquine, quinine, and pyrimethamine. Resistance to clindamycin was stable during 51 drug-free passages in mice over a period of 1 year. Resistance to minocycline was unstable. During 16 drug-free passages in mice the strain reverted towards normal sensitivity to minocycline. Strains resistant to clindamycin or minocycline showed no difference in rate of development in mice as compared to the parent strain. Likewise, only minor morphological modifications were seen in Giemsa-stained blood smears between the two resistant strains and the parent strain.These results suggest that other species of malaria may develop resistance to clindamycin or minocycline. Should resistance to one of these compounds appear, however, it should not invalidate the use of the other in the treatment of malaria.     

Implications of Glutathione Levels in the Plasmodium berghei Response to Chloroquine and Artemisinin

Malaria is one of the most devastating parasitic diseases worldwide. Plasmodium drug resistance remains a major challenge to malaria control and has led to the re-emergence of the disease. Chloroquine (CQ) and artemisinin (ART) are thought to exert their anti-malarial activity inducing cytotoxicity in the parasite by blocking heme degradation (for CQ) and increasing oxidative stress. Besides the contribution of the CQ resistance transporter (PfCRT) and the multidrug resistant gene (pfmdr), CQ resistance has also been associated with increased parasite glutathione (GSH) levels. ART resistance was recently shown to be associated with mutations in the K13-propeller protein. To analyze the role of GSH levels in CQ and ART resistance, we generated transgenic Plasmodium berghei parasites either deficient in or overexpressing the gamma-glutamylcysteine synthetase gene (pbggcs) encoding the rate-limiting enzyme in GSH biosynthesis. These lines produce either lower (pbggcs-ko) or higher (pbggcs-oe) levels of GSH than wild type parasites. In addition, GSH levels were determined in P. berghei parasites resistant to CQ and mefloquine (MQ). Increased GSH levels were detected in both, CQ and MQ resistant parasites, when compared to the parental sensitive clone. Sensitivity to CQ and ART remained unaltered in both pgggcs-ko and pbggcs-oe parasites when tested in a 4 days drug suppressive assay. However, recrudescence assays after the parasites have been exposed to a sub-lethal dose of ART showed that parasites with low levels of GSH are more sensitive to ART treatment. These results suggest that GSH levels influence Plasmodium berghei response to ART treatment.     

Plasmodium yoelii and Plasmodium berghei: Isolation of infected erythrocytes from blood by colloidal silica gradient centrifugation

Percoll (colloidal silica coated with polyvinylpyrrolidone) and Ficoll (MW 400,000) were used to separate erythrocytes infected with Plasmodium yoelii and Plasmodium berghei from uninfected red blood cells. Samples of blood collected from mice in different phases of malarial infection were overlaid on cushions of 55% Percoll, 20% Ficoll, or 28% Ficoll, respectively, centrifuged, and the interphase layers compared. The best yield of parasitized erythrocytes (PE) was achieved using Percoll when about 95% of the erythrocytes infected by the late developmental forms of the parasites (late trophozoites, schizonts, and gametocytes) were recovered from the gradient interphase, irrespective of the phase of the infection and the number of young erythrocytes in the sample. No alteration of antigenicity (assessed by immunofluorescence) or of osmotic fragility (over the range of 160–460 mOsm) could be detected in PE separated by Percoll or by Ficoll. In addition, parasites separated on Percoll gradients showed no significant ultrastructural changes and retained their normal infectivity to mice. Although both gradient media could be used for the separation of Plasmodium-infected erythrocytes, Percoll presented some advantages over Ficoll. Apart from the better reproducibility of the separation of high yields of very pure PE obtained with Percoll, its lower viscosity allowed easier handling, and lower centrifugal forces were needed to enable the cells to reach their isopycnic positions. Thus, Percoll fulfilled many of the criteria for an ideal density gradient medium. Parasitized erythrocytes were isolated by an easy, reproducible, and inexpensive procedure, and separated cells retained their normal structure, antigenicity, and infectivity.     

NMR studies of malaria 31P nuclear magnetic resonance of blood from mice infected with Plasmodium berghei

High resolution ³¹P-NMR has been used for the non-invasive observation of metabolites and metabolic rates in blood of normal mice and of mice infected with Plasmodium berghei, the causative agent of malaria. ³¹P-NMR was used to quantitate levels of 2,3-diphosphoglycerate in whole cells as a function of the degree of parasitemia and yielded good agreement with the results of enzymatic assays. The time-dependence of ³¹P metabolites was monitored in both normal and infected erythrocytes, greater rates of decay of 2,3-diphosphoglycerate being observed in malarial blood which correlate with the level of parasitemia. Very high metabolic rates of infected cells render measurement of intracellular pH unreliable on freshly drawn whole blood. When appropriate measures are taken to avoid this complication, no difference is observed in the intracellular pH of parasitized and non-parasitized erythrocytes from infected animals. In both normal and parasitized mice the intraerythrocytic pH is more acidic than that of the suspending medium by 0.15 pH unit at 25°C. Unlike free-living protozoa, the parasitic protozoan Plasmodium does not contain detectable levels of phosphonates or polyphosphates, in either whole cells or perchloric acid extracts thereof.     

Folate Cofactor Biosynthesis by Plasmodium berghei. Comparison of Folate and Dihydrofolate as Substrates*

SYNOPSIS. The ability of Plasmodium berghei to convert folate and dihydrofolate to folinate in vitro was investigated. Neither parasitized mouse erythrocytes nor free parasites synthesized more than trace amounts of folinate from folate under a wide variety of experimental conditions. Since disrupted cell preparations were no more efficient than whole cells, permeability barriers did not seem to be involved. However, dihydrofolate was a good substrate for the synthesis of folinate by uninfected and parasitized erythrocytes, and by free parasites. The reaction by parasitized erythrocytes required NADPH and dihydrofolate, and was inhibited by pyrimethamine, indicating the presence of dihydrofolate reductase in P. bergkei. It was postulated that P. berghei cannot utilize folate directly, since these experiments indicate that the cells lack a folate reductase. This finding is consistent with the hypothesis that plasmodia synthesize folate cofactors de novo, and do not utilize exogenous folates.     

Plasmodium berghei: Glycolytic enzymes of the infected mouse erythrocyte

This paper documents the maximal activities of the glycolytic enzymes in the red blood cells of normal mice and mice infected with Plasmodium berghei. There appears to be sufficient parasite-related activity of each glycolytic enzyme to support the increased glycolytic rate, i.e., increased glucose consumption, of the parasite-infected red blood cell. The relative proportions of glycolytic enzyme activities in parasite-infected red cells are different from the proportions in either normal or reticulocyte-rich blood, indicating that the increased enzyme activities associated with infected cells are not due to contaminating host red cells or reticulocytes. A comparison of maximal enzyme activities to the rate of whole cell glucose consumption indicates that different glycolytic control mechanisms are operating in the infected RBC from those in the uninfected cells.     

Chemotherapy of rodent malaria: transfer of resistance vs mutation

Pyrimethamine-resistant strains of Plasmodium berghei and P. vinckei were produced by exposing populations of erythrocytic parasites to the selection pressure of increasing doses of drug as well as by single-step mutations. Pyrimethamine-sensitive parasites of both rodent plasmodia were found to mutate at a rate of 1–2 × 10^?11 when exposed to a single course of drug therapy, consisting of 15 mg/kg/day for 4 consecutive days, given subcutaneously. Resistance obtained by either method, was found to be stabile for at least 40 passages in the absence of drug pressure, the longest number of passages tested. Parasites exposed to 15 mg/ kg/day were also found to be resistant to 160 mg/kg/day, the maximum dose of pyrimethamine tolerated by the rodent host.Plasmodium berghei chloroquine-sensitive parasites were found to have a mutation rate of 1.5 × 10^?10, when exposed to a single course of chloroquine therapy, consisting of 30 mg/kg/day chloroquine base given for 4 consecutive days, subcutaneously. These parasites were also found to be resistant to 60 mg/kg/day the highest dose of chloroquine tolerated by the rodent host. Chloroquine-resistant strains of P. vinckei could not be developed by a single-step mutation nor by selection by slow increases in drug pressure.Pyrimethamine-resistant strains of P. berghei, whether, the resistance was developed by single-step mutation, or by slowly increasing the pyrimethamine doses over extended periods of time, demonstrated dihydrofolate reductases which were similar in activity, Michaelis constants, and inability to be stimulated by increased concentrations of KCl. The same was found to be true for the dihydrofolate reductases (EC 1.5.1.3) isolated from pyrimethamine-resistant P. vinckei strains. The enzymes isolated from the resistant strains differed in all respects from their sensitive counterparts.Attempts at drug resistance-transfer, using both a biological filter system, and a dual drug resistant system, were both unsuccessful. The origin of all drug resistant strains studied and reported in this paper, can best be explained by the occurrence of mutation, most probably involving the change of a single nucleotide base in the DNA.     

In-depth validation of acridine orange staining for flow cytometric parasite and reticulocyte enumeration in an experimental model using Plasmodium berghei

Flow cytometry is potentially an effective method for counting malaria parasites, but inconsistent results have hampered its routine use in rodent models. A published two-channel method using acridine orange offers clear discrimination between the infected and uninfected erythrocytes. However, preliminary studies showed concerns when dealing with Plasmodium berghei-infected blood samples with high numbers of reticulocytes.In hyperparasitemic or chronic P. berghei infection, enhanced erythropoietic activity results in high numbers of circulating immature reticulocytes. We show that even though the protocol offered good discrimination in newly infected animals, discrimination between infected erythrocytes and uninfected reticulocytes became difficult in animals with hyperparasitemia or chronic infections maintained with subcurative treatment. Discrimination was especially hampered by increased nucleic acid content in immature uninfected reticulocytes. Our data confirms that though flow cytometry is a promising analytical tool in malaria research, care should still be taken when analysing samples from anemic or chronically infected animals.     

Plasmodium berghei: biological variation in immune serum-treated mice.

Antiserum was obtained from mice which had been immunized with irradiated Plasmodium berghei parasitized erythrocytes and which survived subsequent challenge. This antiserum suppressed P. berghei infections in mice; parasitemia and mortality were delayed 7–8 days as compared to those of control animals. Parasites surviving in antiserum-treated animals were isolated by inoculation of blood into normal recipients. When antiserum was tested against this derived parasite population, there was no observable effect on parasitemia or mortality. The derived parasites also exhibited a decreased virulence for mice. This work confirms the previous observation that antiserum treatment can result in a biologically variant population of P. berghei.     

Plasmodium berghei ANKA: Selection of resistance to piperaquine and lumefantrine in a mouse model

We have selected piperaquine (PQ) and lumefantrine (LM) resistant Plasmodium berghei ANKA parasite lines in mice by drug pressure. Effective doses that reduce parasitaemia by 90% (ED₉₀) of PQ and LM against the parent line were 3.52 and 3.93 mg/kg, respectively. After drug pressure (more than 27 passages), the selected parasite lines had PQ and LM resistance indexes (I₉₀) [ED₉₀ of resistant line/ED₉₀ of parent line] of 68.86 and 63.55, respectively. After growing them in the absence of drug for 10 passages and cryo-preserving them at −80 °C for at least 2 months, the resistance phenotypes remained stable. Cross-resistance studies showed that the PQ-resistant line was highly resistant to LM, while the LM-resistant line remained sensitive to PQ. Thus, if the mechanism of resistance is similar in P. berghei and Plasmodium falciparum, the use of LM (as part of Coartem^®) should not select for PQ resistance.     

Babesia rodhaini: effects of the immune system in mice

Possible functions of antibody in controlling multiplication of B. rodhaini in mice have been investigated. The infectivity of parasites which have been circulating in the blood of immune hosts for 4 hr is not impaired. Clearance of parasitized red cells from the blood of immune hosts is not impaired if the parasites are prevented from leaving the red cells by the effects of radiation damage. The rate of clearance of parasitized red cells by immune hosts is very slow compared with the clearance of foreign red cells by normal hosts.     

NMR studies of malaria P nuclear magnetic resonance of blood from mice infected with Plasmodium berghei

High resolution ³¹P-NMR has been used for the non-invasive observation of metabolites and metabolic rates in blood of normal mice and of mice infected with Plasmodium berghei, the causative agent of malaria. ³¹P-NMR was used to quantitate levels of 2,3-diphosphoglycerate in whole cells as a function of the degree of parasitemia and yielded good agreement with the results of enzymatic assays. The time-dependence of ³¹P metabolites was monitored in both normal and infected erythrocytes, greater rates of decay of 2,3-diphosphoglycerate being observed in malarial blood which correlate with the level of parasitemia. Very high metabolic rates of infected cells render measurement of intracellular pH unreliable on freshly drawn whole blood. When appropriate measures are taken to avoid this complication, no difference is observed in the intracellular pH of parasitized and non-parasitized erythrocytes from infected animals. In both normal and parasitized mice the intraerythrocytic pH is more acidic than that of the suspending medium by 0.15 pH unit at 25°C. Unlike free-living protozoa, the parasitic protozoan Plasmodium does not contain detectable levels of phosphonates or polyphosphates, in either whole cells or perchloric acid extracts thereof.     

Plasmodium berghei: correlation of in vitro erythrophagocytosis with the dynamics of early-onset anemia and reticulocytosis in mice.

Infection of BALB/c mice with Plasmodium berghei results in an anemia which is excessive to that which can be accounted for solely by direct destruction of infected erythrocytes by the mature schizonts at the time of merozoite release. Mice infected with 10⁴ infected erythrocytes exhibited a progressive anemia beginning on Day 7. Significant reticulocytosis was first observed on Day 9 and parasitemia tended to parallel reticulocytosis with a lag of about 1 day. In studies of erythrophagocytosis, washed erythrocytes from randomly selected mice infected with 10⁵ infected red blood cells were phagocytized by peritoneal macrophages in vitro to a significantly greater extent on Days 3–5 postinfection than were erythrocytes taken from normal controls. The degree of erythrophagocytosis reached a peak on Day 4 and returned to control levels on Days 6 and 7. Erythrocytes taken from infected animals on Day 7 and incubated in normal plasma were phagocytized to a significantly greater extent than were normal erythrocytes incubated in normal plasma or erythrocytes from infected mice incubated in plasma from infected animals. The enhanced in vitro erythrophagocytosis observed on Days 3–5, which preceded and coincided with the beginning of the early-onset anemia on Day 5, may correlate with in vivo phenomena which may contribute to the developing anemia. Furthermore, the restoration of enhanced erythrophagocytosis by normal plasma seems to indicate that some component(s) of normal plasma may be depleted during the early stages of P. berghei infection.     

Glutathione Reductase and Thioredoxin Reductase: Novel Antioxidant Enzymes from Plasmodium berghei

Malaria parasites adapt to the oxidative stress during their erythrocytic stages with the help of vital thioredoxin redox system and glutathione redox system. Glutathione reductase and thioredoxin reductase are important enzymes of these redox systems that help parasites to maintain an adequate intracellular redox environment. In the present study, activities of glutathione reductase and thioredoxin reductase were investigated in normal and Plasmodium berghei-infected mice red blood cells and their fractions. Activities of glutathione reductase and thioredoxin reductase in P. berghei-infected host erythrocytes were found to be higher than those in normal host cells. These enzymes were mainly confined to the cytosolic part of cell-free P. berghei. Full characterization and understanding of these enzymes may promise advances in chemotherapy of malaria.     

CD8+ T cells and IFN-γ mediate the time-dependent accumulation of infected red blood cells in deep organs during experimental cerebral malaria

Background

Infection with Plasmodium berghei ANKA (PbA) in susceptible mice induces a syndrome called experimental cerebral malaria (ECM) with severe pathologies occurring in various mouse organs. Immune mediators such as T cells or cytokines have been implicated in the pathogenesis of ECM. Red blood cells infected with PbA parasites have been shown to accumulate in the brain and other tissues during infection. This accumulation is thought to be involved in PbA–induced pathologies, which mechanisms are poorly understood.

Methods and Findings

Using transgenic PbA parasites expressing the luciferase protein, we have assessed by real-time in vivo imaging the dynamic and temporal contribution of different immune factors in infected red blood cell (IRBC) accumulation and distribution in different organs during PbA infection. Using deficient mice or depleting antibodies, we observed that CD8⁺ T cells and IFN-γ drive the rapid increase in total parasite biomass and accumulation of IRBC in the brain and in different organs 6–12 days post-infection, at a time when mice develop ECM. Other cells types like CD4⁺ T cells, monocytes or neutrophils or cytokines such as IL-12 and TNF-α did not influence the early increase of total parasite biomass and IRBC accumulation in different organs.

Conclusions

CD8⁺ T cells and IFN-γ are the major immune mediators controlling the time-dependent accumulation of P. berghei-infected red blood cells in tissues.     

Scanning electron microscope observations of Plasmodium berghei ookinetes in primary mosquito cell cultures

Plasmodium berghei-infected blood from mice was inoculated into primary cell cultures (PCC) obtained from the mosquito Anopheles stephensi. Immature and mature ookinetes of Plasmodium berghei, which developed in these cultures were studied with the scanning electron microscope. Immature ookinetes had a bulbous-like structure at the posterior end and a slightly wrinkled surface. Mature ookinetes were smoother in appearance and somewhat longer than immature forms. Shallow spiraling waves were observed on the surface of some ookinetes, especially in the anterior half of the body. Such waves may be involved in ookinete locomotion. Penetration of cultured cells by ookinetes was not observed. Infected red cells, which were present in the inoculum, had small depressions on the red cell surface, whereas some uninfected red cells had accentuated concavities. Mouse blood cells adhered closely to PCC cells; some attached red cells were irregular in shape.     

Plasmodium knowlesi: glycolytic intermediate levels of enzyme activities of infected rhesus monkey erythrocytes

In vitro glycolytic enzyme activities and in vivo glycolytic intermediate concentrations were assayed in Plasmodium knowlesi-infected rhesus monkey erythrocytes and control erythrocytes. The enzyme activities of infected erythrocytes were greater than controls indicating that P. knowlesi had its own glycolytic system and that parasite glycolysis was the source of the increased rate of glucose consumption by infected erythrocytes. The P. knowlesi glycolytic enzymes phosphofructokinase and hexokinase were less sensitive to acid inhibition than uninfected red cells.P. knowlesi-infected monkey erythrocytes and Plasmodium berghei-infected mouse erythrocytes had similar in vivo glycolytic profiles and in vitro enzyme activity increases.     

Distribution of chloroquine in normal,pronase-treated and malaria-infected red cells

Pronase treatment of mouse red cells in the presence of chloroquine leads to greatly enhanced accumulation of the drug, which after freeze-thaw or hypotonic lysis is found to be located mainly in the membrane fraction. Much lower proportions of the drug are found in the membrane fraction prepared from Plasmodium berghei-infected red cells, which also have a high capacity for chloroquine accumulation. Pronase treatment of infected cells result only in a slight enhancement of total accumulation. The membrane-bound fraction of the drug is, however, increased while the fraction in the lysate is decreased. Membranes prepared from hypotonic lysis of normal or P. berghei-infected cells have similar capacities for chloroquine binding. These results show that the distribution of chloroquine in pronase-treated and malaria-infected cells are different and that pronase treatment of both normal and infected cells followed by lysis leads to availability of potential membrane binding sites.     

Babesia rodhaini, Babesia bovis, and Babesia bigemina: analysis and sorting of red cells from infected mouse or calf blood by flow fluorimetry using 33258 Hoechst.

The DNA of Babesia spp. parasites within host intact red blood cells was labeled using the fluorescent bisbenzimidazole dye 33258 Hoechst. The labeled cells were sorted on a fluorescence activated cell sorter on the basis of cell fluorescence (proportional to DNA content) and the intensity of light scattered from the cells at low angles (related to cell size). The optimal conditions for dye uptake were established for the murine parasite Babesia rodhaini and the bovine parasites B. bovis and B. bigemina. Uninfected cells were nonfluorescent after incubation with the dye and could be completely separated from infected fluorescent cells. The fluorescence of cells infected with B. rodhaini was proportional to the number of parasite nuclei per cell. With saturation levels of dye, samples infected with B. bovis or B. bigemina in which erythrocytes contained one or two parasites, both exhibited only one fluorescent cell peak. Cell sorting did not eliminate the infectivity of B. rodhaini. The method may be used to separate populations of uninfected blood cells and cells infected with Babesia spp. for biochemical and immunochemical experiments.