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Ramos S, Jeney V, Figueiredo A, Paixão T, Sambo MR, Quinhentos V, Martins R, Gouveia Z, Carlos AR, Ferreira A, Pais TF, Lainé H, Faísca P, Rebelo S, Cardoso S, Tolosano E, Penha-Gonçalves C, Soares MP. Targeting circulating labile heme as a defense strategy against malaria. Life Sci Alliance 2024; 7:e202302276. [PMID: 38307624 PMCID: PMC10837040 DOI: 10.26508/lsa.202302276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024] Open
Abstract
Severe presentations of malaria emerge as Plasmodium (P.) spp. parasites invade and lyse red blood cells (RBC), producing extracellular hemoglobin (HB), from which labile heme is released. Here, we tested whether scavenging of extracellular HB and/or labile heme, by haptoglobin (HP) and/or hemopexin (HPX), respectively, counter the pathogenesis of severe presentations of malaria. We found that circulating labile heme is an independent risk factor for cerebral and non-cerebral presentations of severe P. falciparum malaria in children. Labile heme was negatively correlated with circulating HP and HPX, which were, however, not risk factors for severe P. falciparum malaria. Genetic Hp and/or Hpx deletion in mice led to labile heme accumulation in plasma and kidneys, upon Plasmodium infection This was associated with higher incidence of mortality and acute kidney injury (AKI) in ageing but not adult Plasmodium-infected mice, and was corroborated by an inverse correlation between heme and HPX with serological markers of AKI in P. falciparum malaria. In conclusion, HP and HPX act in an age-dependent manner to prevent the pathogenesis of severe presentation of malaria in mice and presumably in humans.
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Affiliation(s)
- Susana Ramos
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Viktoria Jeney
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Ana Figueiredo
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Tiago Paixão
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Maria Rosário Sambo
- Hospital Pediátrico David Bernardino, Luanda, Angola
- Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
| | - Vatúsia Quinhentos
- Hospital Pediátrico David Bernardino, Luanda, Angola
- Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
| | - Rui Martins
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Zélia Gouveia
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Ana Rita Carlos
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Ana Ferreira
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Teresa F Pais
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Hugo Lainé
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Pedro Faísca
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Sofia Rebelo
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Silvia Cardoso
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Emanuela Tolosano
- Department Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | | | - Miguel P Soares
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
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Sambo MR, Trovoada MJ, Benchimol C, Quinhentos V, Gonçalves L, Velosa R, Marques MI, Sepúlveda N, Clark TG, Mustafa S, Wagner O, Coutinho A, Penha-Gonçalves C. Transforming growth factor beta 2 and heme oxygenase 1 genes are risk factors for the cerebral malaria syndrome in Angolan children. PLoS One 2010; 5:e11141. [PMID: 20585394 PMCID: PMC2886838 DOI: 10.1371/journal.pone.0011141] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 05/21/2010] [Indexed: 11/30/2022] Open
Abstract
Background Cerebral malaria (CM) represents a severe outcome of the Plasmodium falciparum infection. Recent genetic studies have correlated human genes with severe malaria susceptibility, but there is little data on genetic variants that increase the risk of developing specific malaria clinical complications. Nevertheless, susceptibility to experimental CM in the mouse has been linked to host genes including Transforming Growth Factor Beta 2 (TGFB2) and Heme oxygenase-1 (HMOX1). Here, we tested whether those genes were governing the risk of progressing to CM in patients with severe malaria syndromes. Methodology/Principal Findings We report that the clinical outcome of P. falciparum infection in a cohort of Angolan children (n = 430) correlated with nine TGFB2 SNPs that modify the risk of progression to CM as compared to other severe forms of malaria. This genetic effect was explained by two haplotypes harboring the CM-associated SNPs (Pcorrec. = 0.035 and 0.036). In addition, one HMOX1 haplotype composed of five CM-associated SNPs increased the risk of developing the CM syndrome (Pcorrec. = 0.002) and was under-transmitted to children with uncomplicated malaria (P = 0.036). Notably, the HMOX1-associated haplotype conferred increased HMOX1 mRNA expression in peripheral blood cells of CM patients (P = 0.012). Conclusions/Significance These results represent the first report on CM genetic risk factors in Angolan children and suggest the novel hypothesis that genetic variants of the TGFB2 and HMOX1 genes may contribute to confer a specific risk of developing the CM syndrome in patients with severe P. falciparum malaria. This work may provide motivation for future studies aiming to replicate our findings in larger populations and to confirm a role for these genes in determining the clinical course of malaria.
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Affiliation(s)
- Maria Rosário Sambo
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
- Hospital Pediátrico David Bernardino, Luanda, Angola
- Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
| | | | | | | | | | - Rute Velosa
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | | | | | - Taane G. Clark
- Departments of Epidemiology and Public Health and Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stefan Mustafa
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Oswald Wagner
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
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Pimentel S, Nogueira F, Benchimol C, Quinhentos V, Bom J, Varandas L, do Rosário V, Bernardino L. Detection of atovaquone-proguanil resistance conferring mutations in Plasmodium falciparum cytochrome b gene in Luanda, Angola. Malar J 2006; 5:30. [PMID: 16597338 PMCID: PMC1513587 DOI: 10.1186/1475-2875-5-30] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 04/05/2006] [Indexed: 11/10/2022] Open
Abstract
Background The fixed dose combination atovaquone-proguanil is a recently introduced antimalarial for treatment and prophylaxis of Plasmodium falciparum malaria. It is highly effective with a good tolerability profile and a convenient prophylactic regimen. Nevertheless, cases of treatment failure have already been reported, which have been associated to mutations in the cytochrome b gene of the Plasmodium (pfcytb). The presence of atovaquone-proguanil in vivo resistance conferring mutations in pfcytb gene in Luanda, Angola, was investigated, in order to make recommendations on prescribing this antimalarial as prophylaxis for travellers. Methods Two hundred and forty nine blood samples from children hospitalized at Luanda Pediatric Hospital for malaria were studied. The PCR-RFLP methodology was used in order to identify pfcytb wild type codon 268 and two point mutations: T802A and A803C. Results All samples were identified as wild type for pfcytb gene at codon 268. In the studied population, no mutations associated to atovaquone-proguanil treatment failure were found. Prevalence of the studied mutations in the region was estimated to be less than 0.77% (99% significance level). Conclusion Atovaquone-proguanil can be recommended for use by travellers to Luanda with expected high efficacy. This represents an improvement compared to other currently used prophylatic antimalarials in this region. However, it is imperative to continue surveillance.
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Affiliation(s)
- Sónia Pimentel
- Centro de Malária e Outras Doenças Tropicais / IHMT / UNL, Lisbon, Portugal
| | - Fátima Nogueira
- Centro de Malária e Outras Doenças Tropicais / IHMT / UNL, Lisbon, Portugal
| | | | | | - Joana Bom
- Centro de Malária e Outras Doenças Tropicais / IHMT / UNL, Lisbon, Portugal
| | - Luís Varandas
- Centro de Malária e Outras Doenças Tropicais / IHMT / UNL, Lisbon, Portugal
- Unidade de Clínica das Doenças Tropicais / IHMT / UNL, Lisbon, Portugal
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