Significant association between TIM1 promoter polymorphisms and protection against cerebral malaria in Thailand.

Although cerebral malaria is a major life-threatening complication of Plasmodium falciparum infection, its pathophysiology is not well understood. Prolonged activation of the T helper type 1 (Th1) response characterized by the production of pro-inflammatory cytokines such as IFN-gamma and TNF-alpha has been suggested to be responsible for immunopathological process leading to cerebral malaria unless they are downregulated by the anti-inflamatory cytokines produced by the Th2 response. The T cell immunoglobulin and mucin domain (TIM) family of proteins are cell surface proteins involved in regulating Th1 and Th2 immune responses. In this study, the possible association between the polymorphisms of TIM1, TIM3, and TIMD4 genes and the severity of malaria was examined in 478 adult Thai patients infected with P. falciparum malaria. The TIM1 promoter haplotype comprising three derived alleles, -1637A (rs7702919), -1549C (rs41297577) and -1454A (rs41297579), which were in complete linkage disequilibrium, was significantly associated with protection against cerebral malaria (OR = 0.41; 95% CI = 0.24-0.71; P= 0.0009). Allele-specific transcription quantification analysis revealed that the level of mRNA transcribed from TIM1 was higher for the protective promoter haplotype than for the other promoter haplotype (P= 0.004). Engagement with TIM1 in combination with T cell receptor stimulation induces anti-inflammatory Th2 cytokine production, which can protect the development of cerebral malaria caused by overproduction of pro-inflammatory Th1 cytokines. The present results suggest that the higher TIM1 expression associated with the protective TIM1 promoter haplotype confers protection against cerebral malaria.

Significant association between TNF-alpha (TNF) promoter allele (-1031C, -863C, and -857C) and cerebral malaria in Thailand.

We examined a possible association of three single nucleotide polymorphisms (SNPs) of the tumor necrosis factor alpha (TNF) promoter -1031T>C (rs1799964), -863C>A (rs1800630), and -857C>T (rs1799724) with severe malaria in 466 adult patients having Plasmodium falciparum malaria in northwest Thailand. Four TNF promoter alleles comprising these three SNPs were detected in the studied population. The frequency of the TNF U04 allele designated -1031C, -863C, and -857C was found to be significantly greater in patients with cerebral malaria than in patients with mild malaria (12.6%, cerebral malaria vs 5.6%, mild malaria; odds ratio =2.5; P=0.002). The association of U04 with susceptibility to cerebral malaria was not caused by linkage disequilibrium with any specific HLA-B and -DRB1 alleles.

A single-nucleotide substitution from C to T at position -1055 in the IL-13 promoter is associated with protection from severe malaria in Thailand.

We examined a possible association of single-nucleotide polymorphisms (SNPs) in the promoters of IL-3, IL-4, and IL-13 genes on the 5q31-33, IL-3 -16T>C, IL-4 -590T>C, and IL-13 -1055C>T, with severity of malaria in 361 adult malaria patients in Thailand. The IL-13 -1055T allele showed a significant association with protection from severe malaria (OR 0.51, 95% CI 0.32-0.80; P=0.0032 by the chi(2) test), while allele frequencies of IL-3 -16T>C and IL-4 -590T>C were not statistically different between mild and severe malaria patients. An IL-13 -1055C>T has been reported to alter the regulation of IL-13 production. Thus, IL-13 -1055T may show resistance to severe malaria through the alteration of IL-13 production.

Storage duration and polymerase chain reaction detection of Plasmodium falciparum from blood spots on filter paper.

To evaluate the effect of long-term storage of sample filters on the sensitivity of polymerase chain reaction (PCR) detection of malaria, 252 blood spots from patients with microscopically confirmed Plasmodium falciparum malaria were analyzed and stratified by storage duration. The spots were collected between 1996 and 2000 on filter paper and stored at room temperature. A Chelex-based method was used to extract the DNA. Unexpectedly, after the first purification, the sensitivity of the PCR from recently stored samples was low and showed progressively increased with time storage (P = 0.003, by chi-square test for linear trend). This suggested that PCR inhibitors were easier to dissolve from the more recent blood spots (< 4 years old) than from blood spots > or = 4 years old, thus leading to a time-dependent increase in PCR sensitivity. However, if DNA was purified again (when the first PCR result was negative), the cumulative sensitivity was not influenced by storage duration. This indicated that length of storage is not a critical issue providing purification is sufficient.

Absence of association between the allele coding methionine at position 29 in the N-terminal domain of ICAM-1 (ICAM-1(Kilifi)) and severe malaria in the northwest of Thailand.

Intercellular adhesion molecule 1 (ICAM-1) is known to be the endothelial receptor for Plasmodium falciparum-infected erythrocytes. Associations of the variant allele coding methionine at position 29 in the N-terminal domain of ICAM-1, ICAM-1(Kilifi), with severe malaria have been investigated in African populations, and the results of these investigations have varied widely. In this study, we investigated a possible association between the ICAM-1(Kilifi) and severe malaria in adult malaria patients living in northwest Thailand. The frequencies of the ICAM-1(Kilifi) among patients with mild malaria, with non-cerebral severe malaria, and with cerebral malaria were 1.7%, 2.7%, and 2.3%, respectively. This variant showed neither positive nor negative association with severe malaria in Thailand.

A primary malarial infection is composed of a very wide range of genetically diverse but related parasites.

To address the question of how many distinct parasites are injected when a mosquito bites, we have characterized isolates resulting most probably from a single sporozoite inoculum. We describe the direct and immediate cloning on hepatocyte feeder layers of a Thai and an African Plasmodium falciparum primary isolate and the characterization of 67 independent clones by four techniques totaling nine different markers. This led to three main conclusions: (a) both the phenotypic and genotypic markers revealed an unexpectedly large degree of diversity within the clones from a single isolate; (b) the clones are nonetheless genetically related; and (c) a single mosquito inoculum would most likely be sufficient to generate considerable isolate complexity in the absence of repeated exposure. This diversity, which has been greatly underestimated in previous studies, does not bode well for the development of successful malaria control means.

Antibody-enhanced binding of dengue-2 virus to human platelets.

The mechanisms underlying severe thrombocytopenia in dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) are not completely understood. We present here the first evidence that dengue type 2 virus binds to human platelets only in the presence of virus-specific antibody, supporting a role for immune-mediated clearance of platelets in the pathogenesis of thrombocytopenia in DHF/DSS. Antibody-enhanced binding of virus of platelets was also demonstrated with a panel of eight murine monoclonal antibodies specific for the dengue E protein. The degree of binding was dependent on the antibody used but not on the antibody IgG subclass, indicating that factors other than the platelet Fc receptor are involved in binding of virus-antibody complexes to the platelet surface. Confirmation that antibody-dependent virus binding to platelets is not primarily mediated by the platelet Fc receptor was obtained by demonstrating good binding even when platelets were pretreated with the Fc gamma RII-specific antibody IV.3.

Comparison between microscopic examination, ELISA and quantitative buffy coat analysis in the diagnosis of falciparum malaria in an endemic population.

Monoclonal antibody-based ELISA and QBC (quantitative buffy coat analysis) were tested in two endemic areas with low and high incidence of malaria in Kanchanaburi Province, West Thailand with annual parasite incidence in 1992 of 119 and 5 per 1,000 population, respectively. The numbers of individuals positive by thick blood film examination (TBF) for P. falciparum with or without P. vivax, and P. vivax only were 82 and 69, respectively. The detection limit of ELISA was 10 parasites/10(6) red blood cells (RBC) (0.001% parasitemia). Of 1,095 individuals involved in the study at the beginning of the study, ELISA showed sensitivity, specificity, positive predictive value and negative predictive value of 78.1%, 94.9%, 72% and 98.1%, respectively. Nine of 18 (50%) TBF-positive but ELISA-positive individuals had parasitemia of less than 10 parasites/10(6) RBC. High and low incidence areas did not affect the validity of our result. Regression analysis showed good correlation between log parasitemia and ELISA percent OD increase (Y = 0 + 64.9*logX, r = 0.65), and agreement between TBF and ELISA results was 95.9%. In a fortnightly follow-up, in 82 TBF-positive individuals, both ELISA and TBF positive rates correlatively declined with agreement of 96.3%. With samples taken on the first day of the study, the TBF and QBC results were also correlated with agreement of 95.8% for P. falciparum, 95.6% for P. vivax. During 8 week follow-up involving altogether 191 samples, agreement between TBF and QBC results were 87.4% for P. falciparum. QBC detected more cases with P. falciparum infections but detected smaller number of cases with P. vivax infections.

Mapping of functional epitopes of Japanese encephalitis virus using monoclonal antibodies.

Epitopes involved in the important functions, hemagglutination (HA) and neutralization (NT), were mapped on Japanese encephalitis (JE) virus proteins by using monoclonal antibodies (MAbs). Fourteen MAbs raised against Nakayama-Yoken strain of JE virus characterized by hemagglutination inhibition (HI) and plaque reduction neutralization test (PRNT) were used to map the epitopes on the JE proteins by Western blot analysis in which non-reducing conditions were used for sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). With these MAbs, at least 8 functional epitopes were demonstrated comprising (i) epitopes recognized by 5 MAbs which gave strong HI but weak NT activities and were mapped on the envelope (E) 53 kDa protein; (ii) epitopes recognized by 2 MAbs which showed weak HI but strong NT activities and were mapped also on the E protein; (iii) epitopes recognized by 2 MAbs which possessed weak HI but no NT activities and were mapped on the E protein; (iv) an epitope recognized by 1 MAb which gave weak NT and no HI activities and was mapped on the nonstructural protein 5 (NS5); (v) an epitope recognized by 1 MAb which showed activities similar to (i) but was mapped on both E and NS5; (vi) an epitope recognized by 1 MAb which had high activities to both HI and NT and was mapped on E and NS5; (vii and viii) epitopes recognized by 1 MAb which also gave low HI but high NT, and strong HI as well as strong NT activities respectively, but their location could not be demonstrated by SDS-PAGE under non-reducing condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Western blot analysis of antigens specifically recognized by natural immune responses of patients with Japanese encephalitis infections.

Specific recognition of antigenic proteins of Japanese encephalitis virus (JEV) by JE patients was investigated by using non-reducing and reducing Western immunoblot analysis. Under non-reducing conditions, the profile of JEV proteins recognized comprised E (52 kDa), NS1 (45 and 41 kDa), NS3 (66.2 kDa) and NS5 (103 and 97.4 kDa). When recognition patterns of sera from JE and dengue patients were compared, only slight differences between JE and dengue sera were found (under non-reducing conditions), involving only the 66.2 kDa protein: to this protein, JE sera exhibited greater reactivity, but not in greater frequency, than did dengue sera. In contrast, cerebrospinal fluid (CSF) from JE patients showed more differences from JE sera: CSF antibody lacked recognition of the 41 kDa protein and had lower frequencies, as well as less reactivities to several other proteins. These results suggested that restricted populations of lymphocytes were localized in the central nervous system of JE patients. The effect of reducing agent (2 beta-mercaptoethanol) on the recognition patterns of those groups of sera was also analysed: the reducing agent affected all the proteins mentioned above, however, the effects were not uniform. It is proposed that JE and dengue sera may recognize different epitopes on some or all of these proteins. Such differences cannot be detected by Western immunoblot analysis, but it would be feasible to test this hypothesis using epitope mapping with synthetic peptides in a multi-pin ELISA. Analysis in this fine detail is essential for designing improved JE vaccines.

Plasmodium vivax: karyotype polymorphism of field isolates.

Pulse-field gradient electrophoresis (PFG) has been applied to the karyotype analysis of Plasmodium vivax isolates obtained directly from infected patients in Sri Lanka. Detection of separated chromosomes was performed either by ethidium bromide staining of gels or by hybridization with a telomer specific probe. Each of the 15 different isolates examined exhibited a different chromosome migration pattern, indicating that a high level of polymorphism prevailed in wild populations of P. vivax. Chromosome size variation was further confirmed using a P. vivax chromosome-specific probe which also demonstrated that, in each isolate, the parasite population appeared to be homogeneous. These observations were made directly on parasites from infected blood, without the necessity for culture amplification, indicating that PFG can be used on a large scale for the epidemiological analysis of wild parasite populations.

Chromosome size polymorphism in Plasmodium falciparum can involve deletions of the subtelomeric pPFrep20 sequence.

The P. falciparum pPFrep20 repetitive element from the Palo Alto Uganda strain has been isolated and sequenced. The Palo Alto pPFrep20 repeat (pPFPArep20) has a clustered subtelomeric location and on chromosome 1 has been deleted from one end. Analysis of chromosome 1 from 5 other strains has revealed that pPFrep20 sequences have been deleted from one end in 3 of them. Thus, deletion of pPFrep20 appears to be a frequent event that could significantly contribute to chromosome size polymorphism in P. falciparum.

Chromosome size variation in the malaria parasite of rodents, Plasmodium chabaudi.

Pulsed field gradient gel electrophoresis has been used to identify at least 10 large DNA fragments in the genome of the rodent malaria species Plasmodium chabaudi. The fragments range in size from approximately 650 to 5000 kb. All the fragments contain sequences homologous to a P. berghei telomere probe, suggesting that they represent intact chromosomes. Ribosomal RNA genes and P. chabaudi cDNA sequences have been mapped to specific fragments. The fragments vary in size in different cloned isolates of the parasite. In a cross between two cloned parasites differing in the sizes of chromosomes 4 and 5, independent segregation of each chromosome occurred during meiosis.

A liver-stage-specific antigen of Plasmodium falciparum characterized by gene cloning.

The liver phase of development of malaria parasites has been studied only recently and remains poorly understood compared to the other stages such as sporozoïtes, merozoïtes and gametes. Access to liver forms of Plasmodium falciparum has been improved by the development of in vivo and in vitro propagation methods, but the yield of mature schizonts remains limited and does not allow a detailed antigenic analysis. To date, only immunofluorescence assays (IFA) have permitted a description of a species and liver-stage-specific antigen(s) (LSA; ref. 3). Monospecific antibodies to these antigens have not been obtained due either to difficulty in immunizing mice (against LSA), or to poor stability of human monoclonal antibodies. Therefore, as a means of characterizing the LSA, we used an alternative immunological approach to identify clones of the corresponding LSA genes. We describe here the isolation of a DNA sequence coding for a P. falciparum liver-stage-specific antigen composed of repeats of 17 amino-acids, which is immunogenic in man.

Immunoprecipitating antibodies against blood stage antigens of Plasmodium falciparum in cerebral and non-cerebral malaria patients.

Immunoprecipitating antibodies were determined in paired sera of 31 patients with cerebral malaria (CM), of whom 14 had complicated cerebral malaria (CCM) and 17 had uncomplicated cerebral malaria (UCCM), 15 single specimens of patients with acute uncomplicated (AM) malaria taken on the day of admission and 8 healthy controls. All but one patient were admitted within the first three days of the onset of fever. More than 20 precipitating bands were observed, of which the predominating molecules were the Mr greater than 200, 180, 157, 135, 130, 115, 103, 96, 91, 73, 71, 61, 49, 45, 43, 41 and 14.3 Kd. In general, there were no significant differences in the positive rates among the AM, CCM and UCCM patients except for the pf135 Kd molecule which was more frequently reactive in UCCM patients than the AM and CCM patients. If immunological naiveness in term of protective immunity is the feature in CM patients, the immunoprecipitation test used is inadequate to demonstrate the fundamental differences in immune responses between CM and AM patients.

Cross-sectional seroepidemiological survey of malaria in endemic areas with different activities of malaria control.

A single cross-sectional seroepidemiological survey of malaria antibody was conducted in 1982 in Klang District, Rayong Province in three villages under different phases of malaria control activity to determine whether a single survey could be used to delineate malaria endemicity in Thailand and to compare the usefulness of ELISA and the indirect haemagglutination test (IHA) in the assessment of malaria endemicity. Village 11 was a control area with high infection rate with an annual slide positive rate of 16.3% in 1981. Village 6 was also a control area but was in the late attack phase in which residual insecticide spraying has been ceased since 1976. Village 7 was a consolidation area. Finger-tipped blood was collected from 189, 191 and 132 individuals from villages 11, 6 and 7 respectively, and the plasma tested for anti-P. falciparum antibody with ELISA and IHA. With ELISA, it was shown that the seropositive rate in population of village 11 (84.6%) was significantly higher than those of other two villages (48.9% in village 6 and 28.8% in village 7). After age stratification, it was shown that the differences were observed in every age group except in the greater than or equal to 45 year age group of village 6. With IHA, a significantly higher seropositive rates in population of village 11 was evident when they were compared with the corresponding age groups of 6-14, 15-29 and 30-44 years in village 7, and the age group of less than or equal to 5 year in village 6.(ABSTRACT TRUNCATED AT 250 WORDS)