Hemoglobin degradation in the human malaria pathogen Plasmodium falciparum: a catabolic pathway initiated by a specific aspartic protease.

Hemoglobin is an important nutrient source for intraerythrocytic malaria organisms. Its catabolism occurs in an acidic digestive vacuole. Our previous studies suggested that an aspartic protease plays a key role in the degradative process. We have now isolated this enzyme and defined its role in the hemoglobinolytic pathway. Laser desorption mass spectrometry was used to analyze the proteolytic action of the purified protease. The enzyme has a remarkably stringent specificity towards native hemoglobin, making a single cleavage between alpha 33Phe and 34Leu. This scission is in the hemoglobin hinge region, unraveling the molecule and exposing other sites for proteolysis. The protease is inhibited by pepstatin and has NH2-terminal homology to mammalian aspartic proteases. Isolated digestive vacuoles make a pepstatin-inhibitable cleavage identical to that of the purified enzyme. The pivotal role of this aspartic hemoglobinase in initiating hemoglobin degradation in the malaria parasite digestive vacuoles is demonstrated.

The role of intracellular oxidants in apoptosis.

Apoptotic cell death is a complex process whose biochemistry is poorly understood. Direct exposure of various cell types of oxidants such as hydrogen peroxide or lipid hydroperoxides can directly induce apoptosis, while in many experimental models pretreatment of cells with antioxidants has been shown to protect against this form of cell death. Recent experimental evidence suggests that multiple forms of thymocyte apoptosis can be inhibited by free radical spin traps, spin probes and thiol reductants, and that this inhibition correlates with a lower oxidative burden within the treated cells. Possible sites of production of these oxidants include mitochondrial electron transport and phospholipase A2-activated arachidonic acid metabolism, while intracellular targets may include redox sensitive transcription factors and inhibitory proteins that must be tagged for proteolysis before apoptosis can commence.

Intracellular redox changes during apoptosis.

In the current paradigm for apoptotic cell death, the activity of a family of proteases related to interleukin 1-beta converting enzyme (ICE) orchestrates the multiple downstream events (such as cell shrinkage and chromatin degradation) that comprise apoptosis. A variety of stimuli can induce this type of cell death. One of the most reproducible inducers is mild oxidative stress, although it is unclear how an oxidative stimulus activates ICE-like proteases. Oxidative modification of proteins and lipids have also been observed in cells undergoing apoptosis in response to non-oxidative stimuli, suggesting that intracellular oxidation may be a general feature of the effector phase of apoptosis. However, attempts to consistently detect a requirement for reactive oxygen species in apoptosis have been inconclusive. Recent experiments revealing that apoptosis is typically accompanied by a depletion of intracellular reduced glutathione (GSH) are also discussed. In JURKATT lymphocytes treated with antibodies to the Fas/APO-1 surface receptor, this depletion results from an accelerated efflux of the reduced thiol rather than any intracellular oxidation. As GSH is the most abundant cytosolic reductant, we propose that its efflux may provide a non-oxidative mechanism by which the reducing environment of apoptotic cells is lost. An increase in oxidative damage to proteins and lipids would then result even in the absence of an increase in the production of oxidants. This may explain the seemingly contradictory findings that increased oxidative stress is not required for apoptosis even though antioxidants often inhibit the process and peroxidised products accumulate in apoptotic cells.

Chloroquine: mechanism of drug action and resistance in Plasmodium falciparum.

Quinoline-containing drugs such as chloroquine and quinine have had a long and successful history in antimalarial chemotherapy. Although these drugs are known to accumulate by a weak base mechanism in the acidic food vacuoles of intraerythrocytic trophozoites and thereby prevent hemoglobin degradation from occurring in that organelle, the mechanism by which their selective toxicity for lysosomes of malaria trophozoites is achieved has been subject to much discussion and argument. In this review the recent discovery that chloroquine and related quinolines inhibit the novel heme polymerase enzyme that is also present in the trophozoite food vacuole is introduced. The proposal that this inhibition of heme polymerase can explain the specific toxicity of these drugs for the intraerythrocytic malaria parasite is then developed by showing that it is consistent with much of the disparate information currently available. The clinical usefulness of chloroquine, and in some recent cases of quinine as well, has been much reduced by the evolution and spread of chloroquine resistant malaria parasites. The mechanism of resistance involves a reduced accumulation of the drug, although again the mechanism involved is controversial. Possible explanations include an energy-dependent efflux of preaccumulated drug via an unidentified transmembrane protein pump, or an increase in vacuolar pH such that the proton gradient responsible for drug concentration is reduced. New data are also presented which show that heme polymerase isolated from chloroquine resistant trophozoites retains full sensitivity to drug inhibition, consistent with the observation that resistance involves a reduced accumulation of the drug at the (still vulnerable) target site. The significance of this result is discussed in relation to developing new strategies to overcome the problem presented by chloroquine resistant malaria parasites.

Antioxidant inhibition of thymocyte apoptosis by dihydrolipoic acid.

Recent findings suggest that intracellular oxidants are involved in the induction of apoptosis, and that this type of cell death can be inhibited by various thiol-containing antioxidants such as N-acetyl cysteine. To study the effects of a physiologically important thiol reductant, rat thymocytes were preincubated with either lipoic acid, dihydrolipoic acid, or lipoamide and then exposed to methylprednisolone or etoposide, two stimuli known to induce apoptosis in these cells. Dihydrolipoic acid and lipoamide both exerted an inhibitory effect on apoptosis induced by the two stimuli, while lipoic acid was inactive. Inhibition of apoptosis was evident as (a) reduced formation of condensed, pyknotic nuclei; (b) a prevention of cell shrinkage; and (c) decreased chromatin degradation. Furthermore, the depletion of reduced glutathione that occurs as thymocytes undergo apoptosis was also prevented in the presence of DHLA. Investigation of the pattern of chromatin fragmentation revealed that DNA in the antioxidant-loaded thymocytes remained above 50 kb pairs in size, indicating that inhibition by DHLA was operative at an early step in the apoptotic pathway. These results suggest that intracellular oxidation is an obligate, early component of thymocyte apoptosis.

Effects of N-acetyl-L-cysteine on T-cell apoptosis are not mediated by increased cellular glutathione.

Thiol-containing antioxidants such as N-acetyl-L-cysteine (NAC) are known to inhibit apoptosis, although it is unclear whether this effect is direct or mediated through modulation of intracellular glutathione (GSH). In the present study, NAC treatment of the murine T-cell hybridoma DO-11.10 was found to inhibit apoptosis triggered by anti-CD3 antibody but enhance the process when induced by 6-alpha- methylprednisolone. HPLC measurements showed that these effects were not correlated with the levels of GSH or glutathione disulfide (GSSG) in the cells. Similar effects on DNA fragmentation were obtained when the experiments were repeated in the presence either of a specific inhibitor of GSH biosynthesis (buthionine sulfoximine) or the isomer N-acetyl-D-cysteine which cannot be enzymatically converted into GSH. We conclude that NAC can have divergent effects on apoptosis independent of changes in either the amount or redox state of intracellular GSH.

Malaria-specific metabolite hemozoin mediates the release of several potent endogenous pyrogens (TNF, MIP-1 alpha, and MIP-1 beta) in vitro, and altered thermoregulation in vivo.

A characteristic feature of malaria infection is the occurrence of periodic bouts of fever. Experimental and clinical studies have strongly implicated inflammatory cytokines, like tumour necrosis factor (TNF), in the induction of these intermittent fevers [Clark et al., Infect Immunol 32:1058-1066, 1981; Clark et al., Am J Pathol 129:192-199, 1987; Karunaweera et al., Proc Natl Acad Sci USA 89:3200-3203, 1992], but the malaria-specific metabolite(s) which induce the production of such endogenous pyrogens have not yet been fully characterized. It is well known that during the course of malaria infection, a unique schizont component, alternatively referred to as "malaria pigment" or hemozoin, is released along with merozoites as the host erythrocyte bursts [Urquhart, Clin Infect Dis 19:117-131, 1994]. We have recently determined that the core structure of hemozoin comprises a novel insoluble polymer of heme units linked by iron-carboxylate bonds [Slater et al., Proc Natl Acad Sci USA 88:325-329, 1991; Slater et al., Nature 355:167-169, 1992]. We now report that purified native, as well as chemically synthesized, hemozoin crystals potently induce the release of several pyrogenic cytokines, including TNF, MIP-1 alpha, and MIP-1 beta, from murine macrophages and human peripheral blood monocytes in vitro. Also, intravenous administration of chemically synthesized preparations of hemozoin to anaesthetized rats results in a marked drop in body temperature. A similar drop in body temperature is observed following the intravenous injection of other well-characterized pyrogenic cytokines (e.g., TNF) which are known to induce a fever response in awake animals, and is thought to reflect the inability of rats to appropriately regulate their body temperature while anaesthetized. As a consequence of its ability to induce pyrogenic cytokines in vitro, and thermal dysregulation in vivo, we propose that this unique parasite metabolite is an important pyrogen released by malaria parasites at schizogomy, which acts by eliciting the production of a group of potent endogenous pyrogens, which include MIP-1 alpha and MIP-1 beta, as well as TNF, in macrophages.

Antigenic cross-reactivity between Necator americanus and Ascaris lumbricoides in a community in Papua New Guinea infected predominantly with hookworm.

Sero-epidemiological data are presented in which antigenic cross-reactivity between Necator americanus and Ascaris lumbricoides has been investigated in a community in Papua New Guinea infected predominantly with N. americanus. It is our contention that the antigenic cross-reactivity which undoubtedly exists between these species accounted for (i) a peak in antibody levels against N. americanus in 10-13 years old children (driven by infection with A. lumbricoides), and (ii) the maintenance of apparent antibody levels against A. lumbricoides in older age groups (driven by infection with N. americanus in the absence of overt infection with A. lumbricoides). Cross-reactivity was analysed further, and apparently N. americanus-specific epitopes identified, by immunoblotting. These observations could have considerable bearing on the interpretation of data from sero-epidemiological studies which failed to take account of concurrent infection with these parasites.

Hookworm (Necator americanus) infection and storage iron depletion.

The relationship between iron status and the intensity of infection with hookworm was investigated in a rural population on Karkar Island, Mandang Province, Papua New Guinea. There was a significant negative correlation between plasma ferritin level and hookworm burden, which was strongest in males. In contrast, there was no correlation between plasma ferritin and hookworm egg count, and no consistent correlation between haemoglobin level or haematocrit and either measure of hookworm intensity. The results suggest that the role of hookworm in the aetiology of anaemia may be difficult to assess without the accurate measurement of hookworm burden.

Signalling mechanisms and oxidative stress in apoptosis.

A variety of stimuli can induce cells to undergo apoptotic death. One of the most reproducible inducers is mild oxidative stress, be it via exposure to hydrogen peroxide, redox-cycling quinones or thiol-alkylating agents. Oxidative modifications of proteins and lipids have also been observed in cells undergoing apoptosis in response to non-oxidative stimuli such as glucocorticoids or topoisomerase II inhibitors. This suggests that some unidentified oxidative changes occur during apoptosis in many, if not all, cases. However, recent experiments demonstrating apparently normal apoptosis even when cells are cultured at low oxygen tensions show that reactive oxygen species cannot be essential mediators of this type of cell death. Experiments revealing that apoptosis is typically accompanied by a depletion of intracellular reduced glutathione (GSH) are also discussed. As GSH depletion will lower a cell's capacity to buffer against endogenous oxidants, we propose that it contributes to the increased oxidative damage commonly observed to accompany apoptosis. In addition, it may set a time limit on continued mitochondrial function (and thus indirectly on total ATP levels and membrane integrity) in apoptotic cells, and thereby explain the often observed 'secondary necrosis' of cells undergoing apoptosis in vitro.

Chloroquine resistance is not associated with drug metabolism in Plasmodium falciparum.

Chloroquine-sensitive and -resistant clones of Plasmodium falciparum were incubated in vitro with [3H]chloroquine for 16 hr, and the resulting culture supernatants and cell pellets were analyzed by high-performance liquid chromatography for evidence of chloroquine metabolism. After separation by normal- or reverse-phase chromatography, there was no evidence of drug metabolism by the chloroquine-resistant P. falciparum. However, a single, unidentified, radiolabeled metabolite, which did not coelute with desethylchloroquine, was produced by 1 of the chloroquine-sensitive clones. Thus, chloroquine resistance does not appear to be due to drug metabolism by the resistant parasites.

The influence of dietary protein on the experimental epidemiology of Heligmosomoides polygyrus (Nematoda) in the laboratory mouse.

The influence of dietary protein on the epidemiology of an intestinal helminth infection was investigated with an experimental system that allowed transmission of the nematode Heligmosomoides polygyrus to occur naturally between laboratory mice. Mortality of mice was greatly increased in infected populations that were fed ad libitum on synthetic diets containing 2% compared with 16% protein. Larger numbers of larval and adult H. polygyrus were found to infect mice in the low-protein cage compared with the high-protein cage. No evidence for density dependence in the fecundity of female worms was detected; on average the daily egg output per female worm was greater for parasites infecting mice in the low-protein cage. The rate at which naïve mice acquired infection was also higher in the low-protein cage. Pinworm (Aspiculuris tetraptera) became established in each cage, and average worm burdens were again greater in the low-protein cage. The acquisition of resistance to reinfection was not found to be an important factor influencing the survival of parasites infecting mice in either cage. The epidemiology of H. polygyrus and A. tetraptera was therefore characterized by low average worm burdens and high host survival in a well-nourished population of mice, and by a high intensity of infection and severe parasite-induced host mortality in a malnourished colony of mice. This reflects differences in the survival and fecundity of adult parasites between mice in the two cages, and suggests that malnourished mice are predisposed to acquire large numbers of several species of intestinal worm.

The influence of protein deficiency on immunity to Heligmosomoides polygyrus (Nematoda) in mice.

The influence of dietary protein on the efficiency with which mice could be immunized against infection with the nematode Heligomosomoides polygyrus was investigated. Immunization with irradiated larvae did not protect outbred mice fed synthetic diets containing 2% or 4% protein against a challenge infection, while animals fed a diet containing 8% protein were significantly resistant. In further experiments with high-responder NIH mice, protein malnutrition was again found to cause a significant depression in immunity. Immunization primed all mice for an intense production of antibody against larval worms in a challenge infection, and although a slightly higher titre of antibody was detected in the plasma of mice fed a 16% compared with a 2% protein diet it seemed unlikely that this was sufficient to account for the reduced resistance of the malnourished mice. The development of eosinophilia in the blood of immunized mice was significantly delayed in malnourished animals following challenge, and it is suggested that a reduction in the number of granulocytes attacking larval worms contributed to the low level of resistance observed in these animals. Protein malnutrition thus markedly suppresses the effectiveness of immunization of mice against an intestinal nematode, and it is suggested that this result may be of general significance with regard to the potential for widespread immunization of people against infections of this type.

Heligmosomoides polygyrus (Nematoda): the influence of dietary protein on the dynamics of repeated infection.

The influence of the protein component in the diet of the host on the population dynamics of gastrointestinal helminth infection was studied by using a mouse-H. polygyrus experimental model. Mice fed a 2% (by mass) protein diet ad libitum maintained body weight during the experiment, but gained weight steadily when fed a diet containing 8% (by mass) protein. When repeatedly infected with 5, 10, 20 or 40 larvae every 2 weeks, the mice fed the 2% (by mass) protein diet accumulated adult worms in direct proportion to exposure to the infective stages. Under similar infection régimes, mice fed an 8% (by mass) protein diet acquired a partly effective immunity to reinfection by the nematode. Acquired immunity was principally manifest as a reduction in the survival of adult worms, although a slight increase in the mortality rate and/or the development time of the tissue-dwelling larval phase was observed. Worm fecundity per head was significantly depressed in hosts fed the 8% protein diet. In conclusion, in these experiments it is demonstrated that the nutritional status of the host can influence the population dynamics of helminth infection.

Epidemiology of Heligmosomoides polygyrus in mice: experiments on natural transmission.

An experimental system is described for the study of the community dynamics of helminth-host populations, using Heligmosomoides polygyrus in the laboratory mouse. The results of a preliminary experiment using closed populations of 50 mice revealed that coexistence of host and parasite occurs for at least 4 months in the absence of immigration, with the generation of epidemiological patterns similar to those observed in the real world. In well-nourished mice the prevalence and intensity of infection initially increased with time and then declined, probably as a result of acquired immunity. The prevalence and intensity of infection increased less rapidly among hosts fed on a low protein diet, but continued to rise over the entire duration of the experiment. This continued rise is interpreted as evidence of a negative effect of protein malnutrition on host immunocompetence. The frequency distributions of parasite numbers/host were over-dispersed in each mouse population. No density dependence in parasite fecundity was detected. Aspiculuris tetraptera was also found to be present in the mouse populations. This parasite was not transmitted between mice fed on a high protein diet, but rose to a prevalence of 80% in protein malnourished animals. No association between the intensity of A. tetraptera and H. polygyrus could be detected in individual hosts. The results are discussed in terms of the future potential of the system for the investigation of the role of acquired immunity (and its genetic control) in the generation of epidemiological patterns.

Helminth fecundity: density dependence or statistical illusion?

Density-dependent constraints on fecundity or survival are critical for the regulation and stability o f all populations. Helminth parasites are no exception to this rule. In medical helminthology, it has been widely assumed that the most effective density-dependent constraints act upon parasite fecundity and are the result of intra-specific parasite competition or acquired immunity to infection. In this article, Anne Keymer and Andrew Slater advocate a more detailed examination of the evidence on which this assumption rests.

Inhibition by chloroquine of a novel haem polymerase enzyme activity in malaria trophozoites.

The incidence of human malaria has increased during the past 20 years; 270 million people are now estimated to be infected with the parasite. An important contribution to this increase has been the appearance of malaria organisms resistant to quinoline-containing antimalarials such as chloroquine and quinine. These drugs accumulate in the acid food vacuoles of the intraerythrocytic-stage malaria parasite, although the mechanism of their specific toxicity in this organelle is uncertain. The primary function of the food vacuole is the proteolysis of ingested red cell haemoglobin to provide the growing parasite with essential amino acids. Haemoglobin breakdown in the food vacuole releases haem, which if soluble can damage biological membranes and inhibit a variety of enzymes. Rather than degrading or excreting the haem, the parasite has evolved a novel pathway for its detoxification by incorporating it into an insoluble crystalline material called haemozoin or malaria pigment. These crystals form in the food vacuole of the parasite concomitant with haemoglobin degradation, where they remain until the infected red cell bursts. The structure of haemozoin comprises a polymer of haems linked between the central ferric ion of one haem and a carboxylate side-group oxygen of another. This structure does not form spontaneously from either free haem or haemoglobin under physiological conditions, and the biochemistry of its formation is unclear. Here we report the identification and characterization of a haem polymerase enzyme activity from extracts of Plasmodium falciparum trophozoites, and show that this enzyme is inhibited by quinoline-containing drugs such as chloroquine and quinine. This provides a possible explanation for the highly stage-specific antimalarial properties of these drugs.