Delayed gametocyte clearance in Plasmodium vivax malaria is associated with polymorphisms in the cytochrome P450 reductase (CPR).

Primaquine (PQ) is the main drug used to eliminate dormant liver stages and prevent relapses in Plasmodium vivax malaria. It also has an effect on the gametocytes of Plasmodium falciparum; however, it is unclear to what extent PQ affects P. vivax gametocytes. PQ metabolism involves multiple enzymes, including the highly polymorphic CYP2D6 and the cytochrome P450 reductase (CPR). Since genetic variability can impact drug metabolism, we conducted an evaluation of the effect of CYP2D6 and CPR variants on PQ gametocytocidal activity in 100 subjects with P. vivax malaria. To determine gametocyte density, we measured the levels of pvs25 transcripts in samples taken before treatment (D0) and 72 hours after treatment (D3). Generalized estimating equations (GEEs) were used to examine the effects of enzyme variants on gametocyte densities, adjusting for potential confounding factors. Linear regression models were adjusted to explore the predictors of PQ blood levels measured on D3. Individuals with the CPR mutation showed a smaller decrease in gametocyte transcript levels on D3 compared to those without the mutation (P = 0.02, by GEE). Consistent with this, higher PQ blood levels on D3 were associated with a lower reduction in pvs25 transcripts. Based on our findings, the CPR variant plays a role in the persistence of gametocyte density in P. vivax malaria. Conceptually, our work points to pharmacogenetics as a non-negligible factor to define potential host reservoirs with the propensity to contribute to transmission in the first days of CQ-PQ treatment, particularly in settings and seasons of high Anopheles human-biting rates.

Prospective assessment of malaria infection in a semi-isolated Amazonian indigenous Yanomami community: Transmission heterogeneity and predominance of submicroscopic infection.

In the Amazon basin, indigenous forest-dwelling communities typically suffer from a high burden of infectious diseases, including malaria. Difficulties in accessing these isolated ethnic groups, such as the semi-nomadic Yanomami, make official malaria data largely underestimated. In the current study, we longitudinally surveyed microscopic and submicroscopic malaria infection in four Yanomami villages of the Marari community in the northern-most region of the Brazilian Amazon. Malaria parasite species-specific PCR-based detection of ribosomal and non-ribosomal targets showed that approximately 75% to 80% of all malaria infections were submicroscopic, with the ratio of submicroscopic to microscopic infection remaining stable over the 4-month follow-up period. Although the prevalence of malaria infection fluctuated over time, microscopically-detectable parasitemia was only found in children and adolescents, presumably reflecting their higher susceptibility to malaria infection. As well as temporal variation, the prevalence of malaria infection differed significantly between villages (from 1% to 19%), demonstrating a marked heterogeneity at micro-scales. Over the study period, Plasmodium vivax was the most commonly detected malaria parasite species, followed by P. malariae, and much less frequently P. falciparum. Consecutive blood samples from 859 out of the 981 studied Yanomami showed that malaria parasites were detected in only 8% of the previously malaria-positive individuals, with most of them young children (median age 3 yrs). Overall, our results show that molecular tools are more sensitive for the identification of malaria infection among the Yanomami, which is characterized by heterogeneous transmission, a predominance of low-density infections, circulation of multiple malaria parasite species, and a higher susceptibility in young children. Our findings are important for the design and implementation of the new strategic interventions that will be required for the elimination of malaria from isolated indigenous populations in Latin America.

A systematic scoping review of the genetic ancestry of the Brazilian population.

The genetic background of the Brazilian population is mainly characterized by three parental populations: European, African, and Native American. The aim of this study was to overview the genetic ancestry estimates for different Brazilian geographic regions and analyze factors involved in these estimates. In this systematic scoping review were included 51 studies, comprehending 81 populations of 19 states from five regions of Brazil. To reduce the potential of bias from studies with different sampling methods, we calculated the mean genetic ancestry weighted by the number of individuals. The weighted mean proportions of European, African, and Native American ancestries were 68.1%, 19.6%, and 11.6%, respectively. At the regional level, the highest European contribution occurred in the South, while the highest African and Native American contributions occurred in the Northeastern and Northern regions, respectively. Among states in the Northeast region, Bahia and Ceará showed significant differences, suggesting distinct demographic histories. This review contributes for a broader understanding of the Brazilian ancestry and indicates that the ancestry estimates are influenced by the type of molecular marker and the sampling method.

Detection of Plasmodium in faeces of the New World primate Alouatta clamitans.

Plasmodium falciparum and Plasmodium vivax have evolved with host switches between non-human primates (NHPs) and humans. Studies on the infection dynamics of Plasmodium species in NHPs will improve our understanding of the evolution of these parasites; however, such studies are hampered by the difficulty of handling animals in the field. The aim of this study was to detect genomic DNA of Plasmodium species from the faeces of New World monkeys. Faecal samples from 23 Alouatta clamitans from the Centre for Biological Research of Indaial (Santa Catarina, Brazil) were collected. Extracted DNA from faecal samples was used for molecular diagnosis of malaria by nested polymerase chain reaction. One natural infection with Plasmodium simium was identified by amplification of DNA extracted from the faeces of A. clamitans. Extracted DNA from a captive NHP was also used for parasite genotyping. The detection limit of the technique was evaluated in vitro using an artificial mixture of cultured P. falciparum in NHP faeces and determined to be 6.5 parasites/µL. Faecal samples of New World primates can be used to detect malaria infections in field surveys and also to monitor the genetic variability of parasites and dynamics of infection.

Detection of Plasmodium in faeces of the New World primate Alouatta clamitans

Abstract Plasmodium falciparum and Plasmodium vivax have evolved with host switches between non-human primates (NHPs) and humans. Studies on the infection dynamics of Plasmodium species in NHPs will improve our understanding of the evolution of these parasites; however, such studies are hampered by the difficulty of handling animals in the field. The aim of this study was to detect genomic DNA of Plasmodium species from the faeces of New World monkeys. Faecal samples from 23 Alouatta clamitans from the Centre for Biological Research of Indaial (Santa Catarina, Brazil) were collected. Extracted DNA from faecal samples was used for molecular diagnosis of malaria by nested polymerase chain reaction. One natural infection with Plasmodium simium was identified by amplification of DNA extracted from the faeces of A. clamitans. Extracted DNA from a captive NHP was also used for parasite genotyping. The detection limit of the technique was evaluated in vitro using an artificial mixture of cultured P. falciparum in NHP faeces and determined to be 6.5 parasites/µL. Faecal samples of New World primates can be used to detect malaria infections in field surveys and also to monitor the genetic variability of parasites and dynamics of infection.

Assessing the mitochondrial DNA diversity of the Chagas disease vector Triatoma sordida (Hemiptera: Reduviidae).

Triatoma sordida is a species that transmits Trypanosoma cruzi to humans. In Brazil, T. sordida currently deserves special attention because of its wide distribution, tendency to invade domestic environments and vectorial competence. For the planning and execution of control protocols to be effective against Triatominae, they must consider its population structure. In this context, this study aimed to characterise the genetic variability of T. sordida populations collected in areas with persistent infestations from Minas Gerais, Brazil. Levels of genetic variation and population structure were determined in peridomestic T. sordida by sequencing a polymorphic region of the mitochondrial cytochrome b gene. Low nucleotide and haplotype diversity were observed for all 14 sampled areas; π values ranged from 0.002-0.006. Most obtained haplotypes occurred at low frequencies, and some were exclusive to only one of the studied populations. Interpopulation genetic diversity analysis revealed strong genetic structuring. Furthermore, the genetic variability of Brazilian populations is small compared to that of Argentinean and Bolivian specimens. The possible factors related to the reduced genetic variability and strong genetic structuring obtained for studied populations are discussed in this paper.

Assessing the mitochondrial DNA diversity of the Chagas disease vector Triatoma sordida (Hemiptera: Reduviidae)

Triatoma sordida is a species that transmits Trypanosoma cruzi to humans. In Brazil, T. sordida currently deserves special attention because of its wide distribution, tendency to invade domestic environments and vectorial competence. For the planning and execution of control protocols to be effective against Triatominae, they must consider its population structure. In this context, this study aimed to characterise the genetic variability of T. sordida populations collected in areas with persistent infestations from Minas Gerais, Brazil. Levels of genetic variation and population structure were determined in peridomestic T. sordida by sequencing a polymorphic region of the mitochondrial cytochrome b gene. Low nucleotide and haplotype diversity were observed for all 14 sampled areas; π values ranged from 0.002-0.006. Most obtained haplotypes occurred at low frequencies, and some were exclusive to only one of the studied populations. Interpopulation genetic diversity analysis revealed strong genetic structuring. Furthermore, the genetic variability of Brazilian populations is small compared to that of Argentinean and Bolivian specimens. The possible factors related to the reduced genetic variability and strong genetic structuring obtained for studied populations are discussed in this paper.

The Duffy binding protein as a key target for a Plasmodium vivax vaccine: lessons from the Brazilian Amazon

Plasmodium vivax infects human erythrocytes through a major pathway that requires interaction between an apical parasite protein, the Duffy binding protein (PvDBP) and its receptor on reticulocytes, the Duffy antigen/receptor for chemokines (DARC). The importance of the interaction between PvDBP (region II, DBPII) and DARC to P. vivax infection has motivated our malaria research group at Oswaldo Cruz Foundation (state of Minas Gerais, Brazil) to conduct a number of immunoepidemiological studies to characterise the naturally acquired immunity to PvDBP in populations living in the Amazon rainforest. In this review, we provide an update on the immunology and molecular epidemiology of PvDBP in the Brazilian Amazon - an area of markedly unstable malaria transmission - and compare it with data from other parts of Latin America, as well as Asia and Oceania.

Duffy Binding Protein: análise da diversidade genética em isolados do plasmodium vivax da Amazônia Brasileira / Duffy Binding Protein: analysis of genetic diversity in plasmodium vivax isolates from the Brazilian Amazon

A invasão dos eritrócitos pelos merozoítos de Plasmodium vivax requer a interação da Duffy binding protein (PvDBP) com o receptor DARC na superfície dos eritrócitos humanos. Esta interação parece ser essencial na formação de uma junção irreversível entre as membranas do merozoíto e da célula do hospedeiro, uma etapa chave no processo de invasão dos eritrócitos. Diante disso, a PvDBP é considerada uma das mais importantes candidatas para compor uma vacina anti-P. vivax. O domínio de ligação da PvDBP (região II, PvDBPII) ao seu receptor é rico em resíduos de cisteína e constitui a região mais polimórfica da proteína. Embora a maioria dos aminoácidos envolvidos na interação PvDBPII-DARC seja invariável, a resposta imune que parece ser direcionada principalmente contra regiões polimórficas da PvDBPII é capaz de bloquear a interação proteína-receptor. Como esta diversidade genética pode comprometer a eficácia de uma vacina que inclua este antígeno, o objetivo principal deste trabalho foi caracterizar o padrão de diversidade do domínio de ligação da Duffy binding protein de isolados de P. vivax de várias regiões da Amazônia Legal brasileira. Utilizando ferramentas estatísticas adequadas, evidenciou-se o papel da recombinação e da seleção natural na geração e manutenção da diversidade genética na PvDBPII.

Em adição, a seleção positiva parece agir em codons individuais da proteína, preferencialmente nos epitopos de células T e B da PvDBPII. Em geral, estas regiões apresentam uma diversidade genética maior do que toda a região II da proteína. Em conjunto, os resultados obtidos sugerem que o sistema imune do hospedeiro é um importante fator de seleção de mutações relacionadas ao escape do parasito. Adicionalmente, avaliou-se a associação entre prevalência dos alelos DARC e suscetibilidade à infecção por P. vivax na Amazônia Legal brasileira. Com este objetivo foi desenvolvida uma nova metodologia de genotipagem de DARC baseada no PCR em tempo real. Este foi um dos primeiros estudos a evidenciar uma associação significativa entre indivíduos que expressam dois alelos DARC funcionais e maior suscetibilidade à infecção por P. vivax e o primeiro a caracterizar o padrão de variabilidade genética da DBPII em isolados de P. vivax do Brasil.

Duffy Binding Protein: Análise da diversidade genética em isolados do Plasmodium vivax da Amazônia Brasileira

A invasão dos eritrócitos pelos merozoítos de Plasmodium vivax requer a interação da Duffy binding protein (PvDBP) com o receptor DARC na superfície dos eritrócitos humanos. Esta interação parece ser essencial na formação de uma junção irreversível entre as membranas do merozoíto e da célula do hospedeiro, uma etapa chave no processo de invasão dos eritrócitos. Diante disso, a PvDBP é considerada uma das mais importantes candidatas para compor uma vacina anti-P. vivax. O domínio de ligação da PvDBP (região II, PvDBPII) ao seu receptor é rico em resíduos de cisteína e constitui a região mais polimórfica da proteína. Embora a maioria dos aminoácidos envolvidos na interação PvDBPII-DARC seja invariável, a resposta imune que parece ser direcionada principalmente contra regiões polimórficas da PvDBPII é capaz de bloquear a interação proteína-receptor. Como esta diversidade genética pode comprometer a eficácia de uma vacina que inclua este antígeno, o objetivo principal deste trabalho foi caracterizar o padrão de diversidade do domínio de ligação da Duffy binding protein de isolados de P. vivax de várias regiões da Amazônia Legal brasileira. Utilizando ferramentas estatísticas adequadas, evidenciou-se o papel da recombinação e da seleção natural na geração e manutenção da diversidade genética na PvDBPII.

Em adição, a seleção positiva parece agir em codons individuais da proteína, preferencialmente nos epitopos de células T e B da PvDBPII. Em geral, estas regiões apresentam uma diversidade genética maior do que toda a região II da proteína. Em conjunto, os resultados obtidos sugerem que o sistema imune do hospedeiro é um importante fator de seleção de mutações relacionadas ao escape do parasito. Adicionalmente, avaliou-se a associação entre prevalência dos alelos DARC e suscetibilidade à infecção por P. vivax na Amazônia Legal brasileira. Com este objetivo foi desenvolvida uma nova metodologia de genotipagem de DARC baseada no PCR em tempo real. Este foi um dos primeiros estudos a evidenciar uma associação significativa entre indivíduos que expressam dois alelos DARC funcionais e maior suscetibilidade à infecção por P. vivax e o primeiro a caracterizar o padrão de variabilidade genética da DBPII em isolados de P. vivax do Brasil.