Molecular screening of Plasmodium sp. asymptomatic carriers among transfusion centers from Brazilian Amazon region

The transmission of malaria in Brazil is heterogeneous throughout endemic areas and the presence of asymptomatic Plasmodium sp. carriers (APCs) in the Brazilian Amazon has already been demonstrated. Malaria screening in blood banks is based on the selection of donors in respect to possible risks associated with travel or residence, clinical evidence and/or inaccurate diagnostic methods thereby increasing the probability of transfusion-transmitted infection. We evaluated the frequency of APCs in four blood services in distinct areas of the Brazilian Amazon region. DNA was obtained from 400 human blood samples for testing using the phenol-chloroform method followed by a nested-PCR protocol with species-specific primers. The positivity rate varied from 1 to 3% of blood donors from the four areas with an average of 2.3%. All positive individuals had mixed infections for Plasmodium vivax and Plasmodium falciparum. No significant differences in the results were detected among these areas; the majority of cases originated from the transfusion centres of Porto Velho, Rondônia State and Macapá, Amapá State. Although it is still unclear whether APC individuals may act as reservoirs of the parasite, efficient screening of APCs and malaria patients in Brazilian blood services from endemic areas needs to be improved.

Targeting the plasmepsin 4 orthologs of Plasmodium sp with "Double Drug" inhibitors

Plasmepsin 4 (PM4) is a digestive vacuole enzyme found in all Plasmodium species examined to date. While P. falciparum has three additional aspartic proteinases in its digestive vacuole in addition to plasmepsin 4, other Plasmodium species have only PM4 in their digestive vacuole. Therefore, PM4 may be a good target for the development of an antimalarial drug. This study presents data obtained with PM4s from several Plasmodium species. Low nanomolar K-i values have been observed for all PM4s studied.

Molecular screening of Plasmodium sp. asymptomatic carriers among transfusion centers from Brazilian Amazon region

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Plasmodium vivax apical membrane antigen-1: comparative recognition of different domains by antibodies induced during natural human infection

The Apical Membrane Antigen-1 (AMA-1) of Plasmodium sp. has been suggested as a vaccine candidate against malaria. This protein seems to be involved in merozoite invasion and its extra-cellular portion contains three distinct domains: DI, DII, and DIII. Previously, we described that Plasmodium vivax AMA-1 (PvAMA-1) ectodomain is highly immunogenic in natural human infections. Here, we expressed each domain, separately or in combination (DI-II or DII-III), as bacterial recombinant proteins to map immunodominant epitopes within the PvAMA-1 ectodomain. IgG recognition was assessed by ELISA using sera of P. vivax-infected individuals collected from endemic regions of Brazil or antibodies raised in immunized mice. The frequencies of responders to recombinant proteins containing the DII were higher than the others and similar to the ones observed against the PvAMA-1 ectodomain. Moreover, ELISA inhibition assays using the PvAMA-1 ectodomain as substrate revealed the presence of many common epitopes within DI-II that are recognized by human immune antibodies. Finally, immunization of mice with the PvAMA-1 ectodomain induced high levels of antibodies predominantly to DI-II. Together, our results indicate that DII is particularly immunogenic during natural human infections, thus indicating that this region could be used as part of an experimental sub-unit vaccine to prevent vivax malaria. (C) 2008 Elsevier Masson SAS. All rights reserved.

Performance of OptiMAL® in the diagnosis of Plasmodium vivax and Plasmodium falciparum infections in a malaria referral center in Colombia

Alternative, non-microscopic methods for the diagnosis of malaria have recently become available. Among these, rapid dipstick methods stand out. One such test, OptiMAL®, is based on the immunochromatographic detection of Plasmodium lactate dehydrogenase (pLDH) and has the capacity to detect and distinguish infections caused by P. falciparum and Plasmodium sp. This capacity is particularly important in countries where different species of Plasmodium co-exist. In this study we evaluated the performance of OptiMAL® in an urban referral center for malaria diagnosis. Two sets of patients were included: one (n = 112) having predetermined infections with P. falciparum or P. vivax and individuals with negative blood smears; and another consisting of all eligible consecutive patients (n = 80) consulting for diagnosis at the referral center during one month. The overall diagnostic efficiency of OptiMAL® for both sets of patients was 96.9%. Efficiency was higher for P. vivax (98.1%) than for P. falciparum (94.9%). These results corroborate the diagnostic utility of OptiMAL® in settings where P. vivax and P. falciparum co-exist and support its implementation where microscopic diagnosis is unavailable and in circumstances that exceed the capacity of the local microscopic diagnosis facility.

A new challenge for malaria control in Brazil: asymptomatic Plasmodium infection - a review

The evolution of malaria in Brazil, its morbidity, the malaria control programs, and the new challenges for these programs in the light of the emergence of asymptomatic infection in the Amazon region of Brazil were reviewed. At least six Brazilian research groups have demonstrated that asymptomatic infection by Plasmodium is an important impediment to malaria control, among mineral prospectors in Mato Grosso and riverside communities in Rondônia and, in our group, in the middle and upper reaches of the Negro river, in the state of Amazonas. Likewise, other researchers have studied the problem among indigenous communities in the Colombian, Peruvian, and Venezuelan parts of the Amazon basin, adjacent to Brazil. The frequency of positive results from the polymerase chain reaction (PCR) among asymptomatic individuals has ranged from 20.4 to 49.5%, and the presence of Plasmodium in the thick blood smears, from 4.2 to 38.5%. Infection with Anopheles darlingi has also been demonstrated by xenodiagnosis among asymptomatic patients with positive PCR results. If a mean of 25% is taken for the asymptomatic infection caused by Plasmodium sp. in the Amazon region of Brazil, malaria control will be difficult to achieve in that region with the measures currently utilized for such control.

Incrimination of Anopheles (Anopheles) intermedius Peryassú, An. (Nyssorhynchus) nuneztovari Gabaldón, An. (Nys.) oswaldoi Peryassú as natural vectors of Plasmodium falciparum in French Guiana

Anopheles darlingi Root is the major vector of human malaria in the Neotropics and has been considered to be the sole malaria vector in French Guiana. The presence of other potential vectors suggests that malaria may be transmitted by other species under certain conditions. From 2006-2011, all anopheline specimens collected from 11 localities were assayed to determine if the Plasmodium circumsporozoite protein was present. In addition to An. darlingi, we found Anopheles oswaldoi, Anopheles intermedius and Anopheles nuneztovari specimens that were infected with Plasmodium sp. Further investigations on the behaviour and ecology of An. oswaldoi, An. intermedius and An. nuneztovari are necessary to determine their role in malaria transmission in French Guiana.

Natural Plasmodium infections in Brazilian wild monkeys: Reservoirs for human infections?

Four hundred and forty-eight samples of total blood from wild monkeys living in areas where human autochthonous malaria cases have been reported were screened for the presence of Plasmodium using microscopy and PCR analysis. Samples came from the following distinct ecological areas of Brazil: Atlantic forest (N = 140), semideciduous Atlantic forest (N = 257) and Cerrado (a savannah-like habitat) (N = 51). Thick and thin blood smears of each specimen were examined and Plasmodium infection was screened by multiplex polymerase chain reaction (multiplex PCR). The frequency of Plasmodium infections detected by PCR in Alouatta guariba clamitans in the Sao Paulo Atlantic forest was 11.3% or 8/71 (5.6% for Plasmodium malariae and 5.6% for Plasmodium vivax) and one specimen was positive for Plasmodium falciparum (1.4%); Callithrix sp. (N = 30) and Cebus apella (N = 39) specimens were negative by PCR tests. Microscopy analysis was negative for all specimens from the Atlantic forest. The positivity rate for Alouatta caraya from semideciduous Atlantic forest was 6.8% (16/235) in the PCR tests (5.5, 0.8 and 0.4% for P. malariae, P. falciparum and P. vivax, respectively), while C apella specimens were negative. Parasitological examination of I he samples using thick smears revealed Plasmodium sp. infections in only seven specimens, which had few parasites (3.0%). Monkeys from the Cerrado (a savannah-like habitat) (42 specimens of A. caraya, 5 of Callithrix jacchus and 4 of C. apella) were negative in both tests. The parasitological prevalence of P. vivax and P. malariae in wild monkeys from Atlantic forest and semideciduous Atlantic forest and the finding of a positive result for P.falciparum in Alouatta from both types of forest support the hypothesis that monkeys belonging to this genus could be a potential reservoir. Furthermore, these findings raise the question of the relationship between simian and autochthonous human malaria in extra-Amazonian regions. (C) 2008 Elsevier B.V. All rights reserved.

Identificação de Plasmodium spp. em primatas neotropicais e em anofelinos em municípios da região de São Luís, estado do Maranhão, Brasil

Pós-graduação em Medicina Veterinária - FCAV

Evaluation of an immunochromatography test for malaria diagnosis under different storage conditions

This study aimed to evaluate the second-generation OptiMal test for malaria diagnosis under various storage conditions. It detected all the positive samples, except for two Plasmodium malariae samples. Further research evaluating diverse environmental conditions are important for ICT test applicability in Brazilian malaria areas.

Malária em mulheres de idade de 10 a 49 anos, segundo o SIVEP- Malária, Manaus, Amazonas, 2003-2006

INTRODUÇÃO: O Sistema de Informação de Vigilância Epidemiológica SIVEP-Malária é um sistema de informação onde são notificados os casos de malária diagnosticados no Brasil, desde 2003. Este estudo analisou os casos de malária notificados em mulheres de 10 a 49 anos de idade, segundo a presença ou ausência de gestação no período de 2003-2006. MÉTODOS: Foi solicitado à Fundação de Vigilância em Saúde, a autorização para avaliação dos dados. RESULTADOS: Foram analisados 13.308 casos notificados no período, sendo 815 (6,1%) registrados em gestantes. Houve diminuição gradativa do número absoluto de casos entre gestantes e não gestantes. Em relação à esp��cie, 14,3% dos casos notificados foram causadas pelo Plasmodium falciparum; 85% pelo Plasmodium vivax e 0,6% pela associação dos dois. A frequência da infecção por Plasmodium falciparum foi maior entre gestantes que não gestantes (p>0,05). Embora a maior parte dos casos residam na zona leste da cidade, a zona oeste apareceu como o local de provável infecção em 39% dos casos. Observou-se picos endêmicos de malária entre as não gestantes nos meses de julho e agosto dos quatro anos analisados. CONCLUSÕES: Os dados mostram que o SIVEP-Malária é importante ferramenta para o conhecimento da distribuição da malária que deve ser usado para controle da endemia. Entretanto, os dados dos primeiros anos de funcionamento tiveram sua qualidade comprometida por falhas no preenchimento, usando o campo de notificação gravidez como exemplo.

Altitudinal variation in haemosporidian parasite distribution in great tit populations.

BACKGROUND: One of the major issues concerning disease ecology and conservation is knowledge of the factors that influence the distribution of parasites and consequently disease outbreaks. This study aimed to investigate avian haemosporidian composition and the distribution of these parasites in three altitudinally separated great tit (Parus major) populations in western Switzerland over a three-year period. The objectives were to determine the lineage diversity of parasites occuring across the study populations and to investigate whether altitudinal gradients govern the distribution of haemosporidian parasites by lineage. METHODS: In this study molecular approaches (PCR and sequencing) were used to detect avian blood parasites (Plasmodium sp., Haemoproteus sp. and Leucocytozoon sp.) in populations of adult great tits caught on their nests during three consecutive breeding seasons. RESULTS: High levels of parasite prevalence (88-96%) were found across all of the study populations with no significant altitude effect. Altitude did, however, govern the distribution of parasites belonging to different genera, with Plasmodium parasites being more prevalent at lower altitudes, Leucocytozoon parasites more at high altitude and Haemoproteus parasite prevalence increasing with altitude. A total of 27 haemosporidian parasite lineages were recorded across all study sites, with diversity showing a positive correlation to altitude. Parasites belonging to lineage SGS1 (P. relictum) and PARUS4 and PARUS19 (Leucocytozoon sp.) dominated lower altitudes. SW2 (P. polare) was the second most prevalent lineage of parasite detected overall and these parasites were responsible for 68% of infections at intermediate altitude, but were only documented at this one study site. CONCLUSIONS: Avian haemosporidian parasites are not homogeneously distributed across host populations, but differ by altitude. This difference is most probably brought about by environmental factors influencing vector prevalence and distribution. The high occurrence of co-infection by different genera of parasites might have pronounced effects on host fitness and should consequently be investigated more rigorously.

Avaliação do nível de concordância do teste imunocromatográfico OptiMAL-IT® e a gota espessa no diagnóstico da malária, no município de Mazagão-AP, Brasil

O diagnóstico precoce e o tratamento adequado dos casos de malária é a principal estratégia para o controle da doença. Várias alternativas para o diagnóstico microscópico tradicional foram propostas nos últimos anos, os testes imunocromatográficos que capturam antígenos alvos dos parasitos da malária estão sendo propostos, como o teste OptiMAL-IT® que detecta a desidrogenase lática do Plasmodium sp.. O estudo teve como objetivo a avaliação do nível de concordância entre o teste imunocromatográfico (OptiMAL-IT®) e a gota espessa para o diagnóstico da malária no Município de Mazagão – Amapá. Foram analisados 413 indivíduos com sintomatologia de malária, que procuraram o serviço da Unidade Mista de Saúde de Mazagão, com idade entre 01-68 anos. Os resultados do teste OptiMAL-IT® foram comparados com os resultados obtidos (das amostras) através da gota espessa corada pelo Giemsa. Dos 413 pacientes suspeitos de apresentarem malária, 317(76.8%) eram positivos através da GE e 311 (75.3%) eram positivos pelo TDR. Das lâminas de GE positivas, foram encontrados 27.4% de P. falciparum e 72.6% de P. vivax. O teste OptiMAL-IT® detectou 27.7% de P. falciparum e 72.3% de P. vivax. A sensibilidade obtida com o TDR para o P. falciparum foi de 97.7% e para o P. vivax foi de 98.2%, a sensibilidade global do TDR foi de 98.1% e a especificidade global e para ambas as esp��cies foi de 100%. Foram encontrados valores preditivos positivos e negativos de 100% e 94.1%, respectivamente. O teste OptiMAL-IT®, teve uma alta concordância com a GE, foi específico e eficiente, podendo ser usado no diagnóstico de malária nas situações onde a microscopia não está disponível.

Biochemische Charakterisierung der Zyklin-abhängigen Kinase 2,Aktivator-Komplexe des Parasiten Eimeria tenella sowie deren Nutzung in der Wirkstoffforschung

Der Stamm der Apicomplexa ist eine artenreiche Gruppe, der einzellige, meist obligat intrazelluläre Parasiten angehören, darunter auch erstzunehmende Krankheitserreger wie Plasmodium sp. sowie tierpathogene Vertreter wie Eimeria sp. und Theileria sp. Eimeria sp. verursacht die Kokzidiose beim Huhn. Diese Krankheit bedingt weltweite Verluste in der Geflügelindustrie von etwa 3 Milliarden US$ pro Jahr [DALLOUL & LILLEHOJ, 2006; SHIRLEY et al., 2007; LUCIUS & LOOS-FRANK, 2008]. Die Parasiten weisen eine hohe Resistenzbildungsrate gegen vorhandene Wirkstoffe auf. Zudem ist der Einsatz von Vakzinen mit Nebenwirkungen verbunden und für hohe Produktionskosten verantwortlich. Daher ist die Entwicklung von neuen, kostengünstigen und effektiven Kokzidiostatika eine dringend notwendige Herausforderung [KINNAIRD et al., 2004]. rnAuf Grund ihrer essentiellen, regulatorischen Funktion im eukaryotischen Zellzyklus sind Zyklin-abhängige Kinasen (CDKs) validierte Zielproteine [LEHNINGER et al., 2005]. Auch Eimeria tenella CDC2-related kinase 2 (EtCRK2) wurde bereits mittels des bekannten CDK-Inhibitors Flavopiridol als Zielprotein chemisch validiert [ENGELS et al., 2010]. Wie bei allen CDKs ist die Aktivität von EtCRK2 abhängig von der Bindung eines Aktivators, der zur Zyklin-Proteinfamilie gehört. Dieser natürliche EtCRK2-Aktivator war jedoch bislang nicht bekannt. Deshalb war ein Teil dieser Arbeit die Identifizierung des natürlichen EtCRK2-Aktivators. Bioinformatische Analysen identifizierten vier E. tenella Zyklin-ähnliche Proteine (EtCYC1, EtCYC3a, EtCYC3b und EtCYC4), die nah verwandt zu den Plasmodium falciparum-Zyklinen sind [ENGELS et al., 2010; SUÁREZ FERNÁNDEZ et al., bislang unveröffentlichte Daten]. Im Rahmen dieser Arbeit konnten zwei neue Aktivatoren identifiziert und biochemisch charakterisiert werden: der bekannte CDK-Aktivator XlRINGO und das neue E. tenella-Zyklin EtCYC3a. Nachdem der nicht-radioaktive TR-FRET-Assay für die EtCRK2 etabliert und optimiert wurde, konnte die EtCRK2-Aktivität im Komplex mit beiden Aktivatoren und weitere wichtige kinetische Parameter bestimmt werden.rnZusätzlich wurde dieser Assay zum in vitro Screening einer kommerziellen Chemikalienbibliothek auf die EtCRK2 eingesetzt, um potentielle Inhibitoren für EtCRK2 zu identifizieren. Dieses in vitro Screening gefolgt von einer in silico Hit-Anreicherung identifizierte 19 aktive Verbindungen für die durch EtCYC3a und XlRINGO aktivierte EtCRK2. Zudem wurden drei Struktur-Cluster definiert: Naphthoquinone, 8-Hydroxyquinoline und 2-Pyrimidinyl-aminopiperidin-propan-2-ole. rnDie aktivsten Vertreter von jedem Cluster wurden als Leitstrukturen ausgewählt und auf EtCRK2 und HsCDK2 getestet. Aufgrund ihrer inhibierenden Wirkung auf EtCRK2 stellen diese Verbindungen viel versprechende Leitstrukturen für die Entwicklung eines neuen Antikokzidiums dar. Hiermit konnte auch gezeigt werden, dass BES124764, der Vertreter des 2-Pyrimidinyl-aminopiperidin-propan-2-ol-Clusters, in der Lage ist, die EtCRK2 selektiv zu inhibieren. rnDaher wird BES124764 sowie einige Derivate in den Leitstruktur-Optimierungsprozess für die Auffindung eines neuen Arzneimittelkandidaten gegen Kokzidiose eingehen.rn

Immunoregulation in human malaria: the challenge of understanding asymptomatic infection

Asymptomatic Plasmodium infection carriers represent a major threat to malaria control worldwide as they are silent natural reservoirs and do not seek medical care. There are no standard criteria for asymptomatic Plasmodium infection; therefore, its diagnosis relies on the presence of the parasite during a specific period of symptomless infection. The antiparasitic immune response can result in reduced Plasmodium sp. load with control of disease manifestations, which leads to asymptomatic infection. Both the innate and adaptive immune responses seem to play major roles in asymptomatic Plasmodium infection; T regulatory cell activity (through the production of interleukin- 10 and transforming growth factor-β) and B-cells (with a broad antibody response) both play prominent roles. Furthermore, molecules involved in the haem detoxification pathway (such as haptoglobin and haeme oxygenase-1) and iron metabolism (ferritin and activated c-Jun N-terminal kinase) have emerged in recent years as potential biomarkers and thus are helping to unravel the immune response underlying asymptomatic Plasmodium infection. The acquisition of large data sets and the use of robust statistical tools, including network analysis, associated with welldesigned malaria studies will likely help elucidate the immune mechanisms responsible for asymptomatic infection.