Made available in DSpace on 2014-06-11T19:26:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-01-31Bitstream added on 2014-06-13T18:54:59Z : No. of bitstreams: 1 000753711.pdf: 3825617 bytes, checksum: d602dc7d0b7403a01a3c8c28de208a0f (MD5) / A malária persiste como uma das principais doenças negligenciadas em todo o mundo. Anualmente três milhões de pessoas a contraem e cerca de um milhão morrem por causa dela. A região do mundo mais afetada é a África Subsariana e, no Brasil, a região amazônica é a mais afetada. As populações locais aprenderam a retirar do meio ambiente os recursos necessários para sobreviver e são atualmente a principal esperança na descoberta de novos medicamentos antimaláricos frente ao parasita da malária que apresenta resistência aos fármacos existentes. Neste trabalho estudou-se o manejo das plantas antimaláricas utilizadas por populações locais de Barcelos, Amazonas. Durante o primeiro semestre de 2013 foram entrevistadas 52 pessoas de sete comunidades rurais e da zona urbana de Barcelos, reconhecidas localmente por seu conhecimento sobre o uso de plantas medicinais. Foram indicadas 118 plantas, seis animais e dois minerais para o tratamento da malária e para outros oito sintomas reconhecidos pelos entrevistados. Foram indicadas 58 espécies para o tratamento da malária, 70% dessas são nativas da região amazônica e 15 plantas não possuem nenhuma referência na literatura com esta indicação de uso. Também foram indicadas 27 plantas para febre, 51 plantas para o tratamento do fígado, 17 plantas para o tratamento da anemia e 15 plantas para dores de cabeça. Foram descritas 12 diferentes formas de preparo das partes utilizadas. 47% das plantas indicadas têm suas folhas utilizadas e 24% sua casca e entrecasca. Das 118 plantas indicadas 46% são arbóreas, 30% herbáceas, 15% arbustivas e 9% trepadeiras. 65% têm origem amazônica, 26% são exóticas do Brasil e as demais são nativas do Brasil, mas não ocorrem naturalmente na região amazônica. De todas estas plantas 45% são cultivadas, 8% podem ser cultivadas ou favorecidas, 17% são favorecidas e as demais não têm nenhum tipo de... / Malaria remains one of the major diseases around the world. Every year three million people contract it and about a million died because of it. The most affected region of the world is sub-Saharan Africa and in Brazil the Amazon region is the most affected. Local people have learned how to survive just with the enviroment and are currently the main hope in the discovery of new antimalarial drugs against the malaria. This work studied the management of antimalarial plants used by local populations of Barcelos, Amazonas. During the first half of 2013 52 people from 7 rural communities and the urban area of Barcelos, locally recognized for their knowledge on the use of medicinal plants were interviewed. 118 plants , six animals and two minerals are used to treat malaria and eight other symptoms. 57 species are used for the treatment of malaria, 70 % of these are native from the Amazon region and 11 of them don't have any reference in the literature. 27 plants are used for fever, 51 plants for the treatment of liver, 17 plants for the treatment of anemia and 15 plants for headaches are also indicated. 12 different preparation of the plants were described. 47 % of listed plants have their leaves used and 24 % used their bark. Of the 118 plants indicated 46 % are woody herbaceous 30 % , shrub 15 % and 9 % climbing plants. 65 % have Amazonian origin , 26 % are exotic in Brazil and the rest are native to Brazil , but do not occur naturally in the Amazon region. 45 % are grown, 8 % can be grown or favored, 17 % are favored and the other does not have any kind of conscious management. 4 % of the plants are only acquired in trade. 26 % of plants are propagated by seeds directly, 17 % by vegetative parts of plants and 12% of seedlings that are transplanted. The use of antimalarial plants is important in the study region even with the use of allelochemicals medicine, but preventive methods , and plants used ...

INTRODUÇÃO: 50-86% dos pacientes recidivam a hepatite autoimune (HAI) após a suspensão do tratamento imunossupressor. A manutenção da imunossupressão em longo prazo diminui o risco de recidiva, entretanto é necessário ajuste da dose/suspensão do tratamento em 10-30%, em razão do maior risco de neoplasias e infecções. O difosfato de cloroquina (CQ) é droga imunomoduladora que foi utilizada anteriormente em monoterapia para manutenção da remissão da HAI com diminuição da recidiva quando comparada com controle histórico. O objetivo desse estudo foi investigar a eficácia e segurança do CQ na manutenção da remissão em estudo duplo cego e randomizado e avaliar se há um subgrupo com maior benefício ao seu uso. METODOLOGIA: 61 pacientes com diagnóstico provável ou definitivo de HAI em remissão histológica, 90,1% HAI tipo 1; 23% com reatividade do anti-SLA/LP, 56,6% com fibrose avançada (F3/4) à inclusão no estudo, mas com doença hepática compensada, foram randomizados de forma duplo cego e aleatória para receber CQ 250 mg/d ou placebo, durante 36 meses ou até recidiva da doença. No primeiro mês a droga foi utilizada em combinação com a imunossupressão que induziu remissão; com posterior desmame semanal da prednisona, suspensão imediata da azatioprina e manutenção do CQ/placebo até 36 meses. As curvas de sobrevida livre de recidiva foram estimadas pelo método de Kaplan-Meyer e comparadas pelo teste de Log-Rank; as razões de risco e seus respectivos intervalos de confiança foram estimados por regressão simples de Cox. Na regressão múltipla foram avaliadas co-variáveis clinicamente relevantes para recidiva. Para investigar o subgrupo com maior benefício, as interações entre a droga e reatividade de autoanticorpos e perfil de HLA foram analisadas por regressão múltipla de Cox. As variáveis categóricas foram comparadas pelo teste exato de Fisher e as quantitativas pelo teste-t ou teste de Mann-Whitney. Foi considerado estatisticamente significante um valor de p < 0,05. RESULTADOS: 31 pacientes receberam CQ e 30 placebo. Não houve diferenças entre os grupos em relação aos achados clínicos, laboratoriais, histológicos e perfil de HLA. A sobrevida livre de recidiva foi significativamente maior no grupo CQ quando comparada ao placebo (59,3% X 19,9%, p=0,039). Após a suspensão da medicação ao término do estudo, houve 41,6% de recidiva no grupo CQ e 0% no placebo. Na regressão simples de Cox, os fatores associados com recidiva da HAI foram uso placebo, reatividade do anticorpo anti-SLA/LP, perfil de HLA DR3 e DR8. Na regressão múltipla, o uso de placebo (razão de risco de 2,4[IC 95%:1,05- 5,5], p=0,039) e reatividade do anticorpo anti-SLA/LP (razão de risco= 5.4 [IC 95%:1,91-15,3], p=0,002) associaram-se a maior risco de recidiva. Não foi possível definir subgrupo de maior benefício com uso de CQ no que se refere à reatividade do anti-SLA/LP ou perfil de HLA, embora a recidiva tenha ocorrido em 100% dos pacientes anti-SLA/LP(+) no grupo placebo e 50% no grupo CQ. No grupo CQ, 54,8% apresentaram efeitos colaterais, com suspensão da droga em 19,3%. Os efeitos colaterais mais comuns foram prurido e hiperpigmentação cutânea. CONCLUSÕES: O CQ reduziu com segurança o risco de recidiva de HAI, mas não foi possível definir subgrupo com maior benefício com essa medicação / INTRODUCTION: 50-86% of patients relapse autoimmune hepatitis (AIH) after immunosuppressive treatment withdrawal, with a higher risk of progression to liver cirrhosis, death due to liver disease and liver transplantation. The maintenance of long-term immunosuppression decreases the risk of relapse, however, treatment dose adjustment and/or interruption is required in 10-30%, with increased risk of neoplasias and infections. Chloroquine diphosphate (CQ) is an immunomodulatory drug used previously in monotherapy to maintain AIH remission with a decrease risk in relapse rates when compared to a historical control. The aims of this study were to investigate the efficacy and safety of CQ in the maintenance of remission in a double-blind and randomized study, and to evaluate if there is a subgroup with a greater benefit of its use. METHODS: 61 patients with probable or definitive diagnosis of AIH in histological remission, 90.1% type 1; 23% with anti-SLA / LP seropositivity, 56.6% with advanced fibrosis [F3 / 4] at inclusion in the study and with compensated liver disease were randomized double-blindly to receive either CQ 250 mg/day or placebo for 36 months or until relapse. In the first month, the drug was used in combination with the immunosuppressive regimen that induced the remission; with subsequent weekly weaning of prednisone, immediate withdrawal of azathioprine and maintenance of CQ/placebo for up to 36 months. Recurrence-free survival curves were estimated by the Kaplan-Meyer method and compared by the Log-Rank test; the hazard ratios and their respective confidence intervals were estimated by simple Cox regression. Clinically relevant covariables for relapse were re-evaluated bymultiple Cox regression. To investigate the existence of a subgroup with a greater benefit, interactions between the drug and autoantibody reactivity and HLA profile were analyzed by the Cox multiple regression. Categorical variables were compared by Fisher\'s exact test and the quantitative by the t-test or Mann- Whitney test. A p value of < 0.05 was considered statistically significant. RESULTS: 31 patients received CQ and 30 placebo. There were no differences between the two groups in relation to clinical, laboratory, histological and HLA profiles. Relapse-free survival was significantly higher in the CQ group when compared to placebo (59.3% X 19.9%, p=0.039). After antimalarial withdrawal at the end of the study, there was 41.6% relapse in the CQ group and 0% in the placebo. In the Cox simple regression, factors associated with AIH relapse were placebo use, anti-SLA/LP seropositivity, and HLA DR3 and DR8 profiles. In multiple regression, placebo use (Hazard Ratio = 2.4 [95% CI: 1.05-5.5], p = 0.039) and anti-SLA/LP seropositivity (Hazard Ratio = 5.4 [95% CI: 1.91-15.3], p = 0.002) were associated with a higher risk of relapse. It was not possible to define a subgroup with a greater benefit of CQ with respect to anti-SLA/LP positivity or HLA profile, although all anti-SLA/LP(+) patients in placebo group relapsed, compared to 50% in CQ group. In the CQ group, 54.8% had side effects, but 19.3% had drug withdrawal. The most common side effects were pruritus and cutaneous hyperpigmentation. CONCLUSIONS: Chloroquine safely reduced the risk of relapse of AIH, but it was not possible to define a subgroup with greater benefit with medication use

A maioria das cepas de Plasmodium falciparum mostra-se resistente à cloroquina (CQ), considerado o antimalárico ideal. A busca por novos agentes terapêuticos bem como a restauração do efeito antimalárico de fármacos disponíveis, através da associação a agentes moduladores da resistência (AMR), vem sendo enfatizada. Entretanto, ausência de efeito modulador da resistência e efeito antiplasmódico intrínseco foram observados quando AMR clássicos, como o fenotiazínico clorpromazina e o iminodibenzílico desipramina, foram ensaiados in vitro em isolados brasileiros de P. falciparum resistentes à CQ. Sabe-se que a ação antiparasitária de compostos de natureza tricíclica, como os fenotiazínicos, foi descrita há mais de um século e continua a ser de interesse. Em adição, vale notar a ocorrência de farmacóforo comum, formado por sistema heteroaromático, ligado a átomo de nitrogênio, secundário ou terciário, por cadeia lateral de três a quatro átomos de carbono, entre compostos quinolínicos antimaláricos, fármacos psicotrópicos e AMR. Este trabalho teve como objetivo estudar, por emprego da modelagem molecular, características estereo-eletrônicas e lipofílicas e a interação a nível molecular de compostos de natureza tricíclica (fenotiazínicos e iminodibenzílicos) com a hematina (provável sítio de ação da CQ) comparando ao antimalárico CQ. Semelhanças estéreo-eletrônicas e lipofílicas puderam ser visualizadas entre as moléculas da CQ e dos compostos tricíclicos. No entanto, algumas distinções ausência de planaridade e maior densidade eletrônica sobre os anéis tricíclicos dos anéis heterocíclicos quando comparadas à CQ. Tais características se fizeram refletir na interação com a hematina, como demonstrado nos estudos de ancoramento como também nos estudos de UV-VIS e de Raman Ressonante. / The most Plasmodium falciparum strains show resistance to chloroquine (CQ), yet considered the ideal antimalaric agent. The search for new therapeutic compounds and the restoration of the antimalarial effect of available drugs through the association with modulating agents has been emphasized. However, lack of modulating effect and intrinsic antiplasmodial activity were observed when classic modulating agents, such phenothiazine chlorpromazine and iminodibenzylic desipramine, were tested in vitro against Brazilian isolated resistant of P. falciparum to CQ. The antiparasitic action of tricyclic compounds as the phenotiazine class has been described for more than a century and continues to be of interest. In addition, it was noted the occurrence of common pharmacophore, formed by a heteroaromatic system, a secondary or tertiary nitrogen atom, linked by a side chain of three to four carbon atoms, present among the quinoline antimalarials, the psychotropic drugs and the modulating agents of chloroquine resistance. The goal of this work was by using molecular modeling to study stereo-electronic features and lipophilic characteristics and the interaction on molecular level of tricyclic compounds (phenothiazines and iminodibenzylics) with hematin (probable site of action of CQ) in comparison to antimalaric CQ. In results, similarities stereo-electronic and lipophilic could be viewed between the molecules of CQ and tricyclic compounds. However different features could be noticed such as absence of planarity and a higher electronic density on the tricyclic rings when compared to CQ. These features shown to be relevant to interaction with the &#181;-oxo dimer of hematin, as observed in docking studies and UV-VIS and Resonance Raman.

A Malária continua sendo a mais difundida e devastadora doença infecciosa, com aproximadamente 300 milhões de casos anuais e mais de 2 milhões de pessoas vivendo em áreas de risco. Entre os parasitas do gênero plasmodium causadores da malária em humanos, o plasmodium falciparum é a espécie mais letal. Este projeto teve como objetivo a síntese de pró-fármaco recíproco de cloroquina e primaquina e de pró-fármacos duplicados de cloroquina e de primaquina utilizando, para tanto, espaçantes inespecíficos (carboxílicos). Espera-se que o pró-fármaco recíproco permita a cura radical em casos de malária vivax e que os derivados duplicados apresentem maior eficácia, com diminuição da toxicidade, especialmente no caso do derivado de primaquina. Além desses compostos, propôs-se a síntese de pró-fármacos duplicados de cloroquina mediante a ligação com grupo espaçante específico (peptídeos) à cisão pela falcipaína. Tais derivados são potencialmente ativos em malária causada pelo P. falciparum resistente à cloroquina. / Malaria remains the world\'s most widespread and devastating infectious disease, with approximately 300 million annual cases and more than 2 million casualties. Among the protozoan parasites of the genus Plasmodium causing malaria in humans, Plasmodium falciparum is the most lethal species. This project had as objective the synthesis of reciprocal prodrug of chloroqine and primaquine using, for in such a way, inespecífics agents (carboxylics). One expects that the mutual prodrug allows to the radical cure in cases of malaria vivax and that the derivatives duplicates present greater effectiveness, with reduction of the toxicity, especially in the case of the primaquine derivative. Beyond these composites, it was considered synthesis of mutual prodrugs of chloroquine by means of the linking with specific carrier group (peptides) to the split for falcipain. Such derivatives are potentially active in malaria caused for the resistant P. falciparum to the chloroquine.

Malaria, caused by Plasmodium, is one of the most devastating infectious diseases of the world in terms of mortality as well as morbidity (WHO, 2002). The development of resistance in the Plasmodium falciparum against the present antimalarials has made the situation very alarming (Trape et al., 2000). To combat this situation, new antimalarials as well as identification of new drug targets are urgently required. The discovery of the presence of type II fatty acid biosynthesis system in the malarial parasite has offered several promising new targets for this mission. This thesis describes the successful cloning of fabZ from Plasmodium falciparum, its expression in E. coli, single step affinity purification, kinetic characterization and most importantly discovery of two small molecule inhibitors (Sharma et al., 2003). The study was executed to gain insights into the structure and function of PfFabZ to get better understanding of the interactions with its substrate analogs, novel inhibitors and also acyl carrier protein (PfACP). The molecular details of the interactions of the two novel inhibitors were also determined. Lastly, the residues of PfFabZ important for the interaction with PfACP were successfully elucidated. Chapter 1 presents a brief review of the literature about the disease as well as the life cycle, biology and the metabolic pathways operational in malarial parasite, Plasmodium falciaparum. The discovery of type II FAS in P. falciparum and the aims and the scope of the thesis are also discussed. The quest of developing new antimalarials, study of the mechanism of actions of antimalarials such as quinine and its derivatives along with the major metabolic pathways (Purine, pyrimidine, phospholipids, carbohydrate metabolism, folate and heme biosynthesis pathways etc.) existing in P. falciparum are described in detail in this chapter. Origin and importance of apicoplast in P. falciaprum is also described in brief. For long, it was believed that Plasmodium spp. are incapable of de novo fatty acid synthesis but this view has undergone substantial revision due to the recent discovery of plant and bacterial type of fatty acid biosynthesis pathway in them (Surolia and Surolia, 2001). As this pathway is distinct from that of the human host it has accelerated the momentum for the discovery of new antimalarials (Surolia and Surolia, 2001). The Chapter also surveys the details of type II FAS in bacteria, particularly that of E. coli (Rock and Cronan, 1996). The dehydratase step which is the third step of fatty acid elongation cycle has been covered in considerable detail. Lastly, it focuses on the recent advancement in the understanding of fatty acid biosynthesis system in Plasmodium falciparum along with some inhibitors targeting the malarial FAS. As each enzyme of the Plasmodium FAS can serve as good antimalarial targets, my work focuses on the dehydratase step catalyzed by β-hydroxyacyl-ACP dehydratase (PfFabZ). Cloning, expression and kinetic characterization of PfFabZ forms the major content of Chapter 2. The PlasmoDB data base was searched for this gene and the mined out open reading frame contained sequence of the putative FabZ together with the bipartite leader polypeptide. Our aim was to clone the mature PfFabZ without the bipartite leader sequence. Amplification of the mature pffabZ using Plasmodium falciparum genomic DNA revealed the presence of an intron in the ORF and the gene was finally cloned by RT-PCR in pET-28a(+) vector. It was expressed with an N-terminal hexahistidine tag in BL-21(DE3) cells and purified to near homogeneity but the protein was insoluble and unstable. Truncation of 12 residues from the N-terminal end improved the stability and solubility of the protein by 3-5 fold. Truncated PfFabZ was used for all future experiments. FabZs from other sources are reported to be hexamer in solution but PfFabZ showed homodimeric arrangement in the conditions used for gel filtration as well as dynamic light scattering studies. Kinetics of PfFabZ was characterized using substrate analogs, β-hydroxybutryl-CoA (forward substrate) and Crotonoyl-CoA (reverse substrate). Both the forward and reverse reaction were thoroughly characterized by spectrophotometry and HPLC and the reverse reaction was found to be 7 times faster than the forward reaction. Km οf crotonoyl-CoA was calculated to be 86 µM and kcat/Km of 220 M-1s-1 whereas the Kmfor β-hydroxybutryl-CoA was found to be 199 µM and kcat/Kmof 80.2 M-1s-1. The kinetic data clearly indicates the higher affinity of PfFabZ for the reverse substrate. Chapter 3 describes the discovery of two small molecules inhibitors, NAS-21 and NAS-91 for PfFabZ, their detailed inhibition kinetics and their effect on the growth of Plasmodium falciparum in culture. These inhibitors were the first inhibitors to be reported for FabZ class of enzymes with an IC50 ranging below 15 µM. Both of them inhibited PfFabZ following competitive kinetics with respect to the substrates utilized for both the forward and reverse reactions. The inhibition data were analyzed by Lineweaver-Burk and Dixon plots and both inhibitors showed competitive inhibition kinetics with dissociation constant in submicromolar range. Binding constants for both the inhibitors were also determined by fluorescence titration method and were calculated to be 1.6 (± 0.04) X 106 M-1 for NAS-91 and 1.2 (± 0.03) X 106 M-1 for NAS-21. These inhibitors were checked on Plasmodium falciparum culture and both inhibited parasite growth with IC50 values of 7 µM and 100 µM for NAS-21 and NAS-91, respectively. They also inhibited the incorporation of [1,2-14C]-acetate in the fatty acids of the P. falciparum conforming the inhibition of fatty acid biosynthesis. FabZ class of enzymes are thought to contain His-Glu as a catalytic dyad. Based on the disparity in the arrangement of residues at the active site of the dimeric (Swarnamukhi et al., 2006) and hexameric forms of PfFabZ in the crystal structures (Kosteriva et al., 2005), we set out to elucidate the active site residues in PfFabZ which is described in Chapter 4. The role of each of the presumed active site residues His-133 and Glu-147 along with Arg-99 and His-98 were analyzed by chemical modification studies and site directed mutagenesis. Single and double mutants were prepared and the activity of the mutants was monitored by spectrophotometry and isothermal titration calorimetry (ITC). It was concluded that in PfFabZ, His-133 and Glu-147 makes the catalytic dyad, His-98 might be important in directing the substrate in correct orientation while Arg-99 is involved in maintaining the active site loop in proper orientation rather than taking direct part in catalysis. Chapter 4 also concludes that dimeric form of PfFabZ is inactive species and turns into active hexameric form in the presence of substrate. Chapter 5 describes the molecular details of NAS-21 and NAS-91 interactions with PfFabZ. The fact that both these compounds inhibited PfFabZ in competitive manner, prompted me to examine their interaction with the residues in the active site tunnel. Apart from the His-133 and Glu-147 catalytic dyad the only polar residue is His-98 and chemical modification and site directed mutagenesis studies were done to elucidate the interactions of these residues with NAS-21 and NAS-91. Both the inhibitors were able to protect the modification of histidines by DEPC in wild type PfFabZ, His-98-Ala mutant and His-133-Ala mutant but with differential strength, indicating that they do interact with histidines. The interaction of these inhibitors was further confirmed by determining the dissociation constants of wPfFabZ, His-98-Ala, His-133-Ala, His-98-Ala/His-133-Ala double mutant, Glu-147-Ala mutant by fluorescence titration method. The results obtained from chemical modification and fluorescence titration studies confirmed that NAS-21 interacts strongly with histidines, His-98 and His-133 but not with Glu-147. On the other hand NAS-91 interacts loosely with His-98 and His-133 but strongly with Glu-147. Chapter 5 concludes with the observation that both the inhibitors (NAS-21 and NAS-91) interact with the active site residues of PfFabZ, preventing the substrate to enter the active site tunnel. Acyl carrier protein (ACP) is a small acidic protein to which the acyl chain intermediates are tethered and shuttled from one enzyme to another for the completion of fatty acid elongation cycle. Whenever acyl carrier proteins are expressed in E. coli, they are present in three forms apo, holo and acyl-ACPs. Chapter 6 describes a novel method for the expression of histidine tagged PfACP in pure holo form, protocol for the cleavage of his-tag from PfACP by thrombin preparation of homogenous singly enriched ie PfACP [15N]-labeled or [13C]-labeled PfACP as well as doubly enriched [15N]-[13C] PfACP samples for its structure elucidation by NMR (Sharma et al., 2005). These studies also constituted reporting of a holo-ACP structure from any of the sources for the first time (Sharma, et. al. 2006). The purified pure holo-PfACP was further used for the interaction studies with PfFabZ. Earlier studies have shown that ACP interacts with FAS enzymes via helix II with conserved set of residues but the molecular details of the interactions are poorly known (Zhang, et. al., 2003). We have recently solved the NMR structure (Sharma, et. al., 2006) of PfACP and crystal structure of PfFabZ (Swarnamukhi, et. al., 2006). So, both the structures were docked using Cluspro server. Chapter 7 elucidates the roles of important residues on PfFabZ surface near the active site entry which are responsible for interacting with PfACP. The residues lining the active site entry were identified and mutated. The residues lining the active site tunnel of PfFabZ are Arg102, Lys104, Lys105, Lys123, Leu94, Phe95, Ala96, Gly97, Ile128, Ile145, Phe150 and Ala151. Charged residues were mutated to alanine and also to oppositely charged residues while the neutral residues were changed to charged residues. The interaction of PfFabZ mutants with PfACP was studied by ACP independent enzymatic assay and surface plasmon resonance (SPR) spectroscopy. It was concluded that PfFabZ and PfACP interaction is mainly governed by electrostatic interaction made by the charged residues (Lys104 being the most important residue) and is fine tuned by hydrophobic interactions. Chapter 8 summarizes the findings of the thesis. FabZ from Plasmodium falciparum was cloned and biochemically characterized. Two inhibitors for this enzyme were discovered and their molecular details of binding to PfFabZ were elucidated. The presence of catalytic dyad was confirmed and finally the residues of PfFabZ important for interaction with PfACP were elucidated. Appendix I describes the inhibition of PfENR (enoyl ACP reductase), the rate limiting and the fourth enzyme of the fatty acid elongation pathway by green tea extracts. Three tea catechins (EGCG, EGC and ECG) and two plant polyphenols (quercetin and buteine) were selected for the inhibition study. All the catechins inhibited PfENR potently with Ki values in nanomolar range. Among the five compounds studied, EGCG was found to be the best inhibitor. All of them blocked the NADH binding site showing competitive kinetics with respect to NADH and uncompetitive kinetics with crotonoyl-CoA, the substrate analog. Most importantly, the catechins potentiated the inhibition of PfENR by triclosan, a well known PfENR inhibitor. We also report that in the presence of tea catechins triclosan behaves as a slow-tight binding inhibitor of PfENR. The overall inhibition constant of triclosan in the presence of EGCG was calculated to be 2pM which is 50 times better than the earlier reported values with NAD+ (Kapoor, et. al., 2004).

Molecular chaperones have emerged in recent years as major players in many aspects of cell biology. Molecular chaperones are also known as heat shock proteins (HSPs) since many were originally discovered due to their increased synthesis in response to heat shock. They were initially identified when Drosophila salivary gland cells were exposed to a heat shock at 37°C for 30 min and then returned to their normal temperature of 25°C for recovery. A “puffing” of genes was found to have occurred in the chromosome of recovering cells, which was later shown to be accompanied by an increase in the synthesis of proteins with molecular masses of 70 and 26 kDa. These proteins were hence named “heat shock proteins”. The first identification of a function for HSPs was the discovery in Escherichia coli that five proteins synthesized in response to heat shock were involved in λ phage growth. The products of the groEL and groES genes were found to be essential for phage head assembly while the dnaK, dnaJ and grpE gene products were essential for λ phage replication. It was later shown that GroEL and GroES are part of a chaperonin system for protein folding in the prokaryotic cytosol while DnaK is a member of the Hsp70 family that works in conjunction with the DnaJ (Hsp40) co-chaperone and the nucleotide exchange factor GrpE to promote phage replication by dissociating the DnaB helicase from the phage-encoded P protein. Since then, a large number of other proteins collectively referred to as HSPs have been discovered. However, heat shock is not the only signal that induces synthesis of heat shock proteins. Stress of any kind, such as nutrient deprivation, chemical treatment and oxidative stress among others causes increased production of HSPs and therefore, they are also known as stress proteins. The term “molecular chaperone” was originally used to describe the function of nucleoplasmin, a Xenopus oocyte protein that promotes nucleosome assembly by binding tightly to histones and donating the bound histone to chromatin. However, since then, chaperones have been defined as “a family of unrelated classes of proteins that mediate the correct assembly of other proteins, but are not themselves components of the final functional structure”. This view of molecular chaperones, though undoubtedly correct, doesn’t capture the multifaceted roles they have since been discovered to play in cellular processes. In recent years, molecular chaperones have been shown to perform other functions in addition to the maintenance of protein homeostasis: translocation of proteins across organelle membranes, quality control in the endoplasmic reticulum, turnover of misfolded proteins as well as signal transduction. As a result, many chaperones are also essential under non-stress conditions and play crucial roles in cell growth and development, cell-cell communication and regulation of gene expression. Heat shock protein 90 (Hsp90) is one of the most abundant and highly conserved molecular chaperones in organisms ranging from bacteria to all branches of eukarya. It has been shown to be essential for cell viability in Saccharomyces cerevisiae, Schizosaccharomyces pombe and Drosophila melanogaster. Although the bacterial homolog HtpG is dispensable under normal conditions, it is important for cell survival during heat shock. In addition to its role as general chaperone in protein folding following stress, Hsp90 has a more specialized role as a chaperone for several protein kinases and transcription factors. Many Hsp90 client proteins are signaling proteins involved in regulation of cell growth and survival. These proteins are critically dependent on Hsp90 for their maturation and conformational maintenance resulting in a key role for Hsp90 in these processes. Recent reports have also highlighted a role for Hsp90 in linking the expression of genetic and epigenetic variation in response to environmental stress with morphological development in Drosophila melanogaster and Arabidopsis thaliana. In Candida albicans, Hsp90 augments the development of drug resistance, implicating a role for Hsp90 in the evolution of infectious diseases. The malarial parasite, Plasmodium falciparum, is the causative agent of the most lethal form of human malaria. The parasite life cycle involves two hosts: an invertebrate mosquito vector and a vertebrate human host. As the parasite moves from the mosquito to the human body, it experiences an increase in temperature resulting in a severe heat shock. The mechanisms by which the parasite adapts to changes in temperature have not been deciphered. Our laboratory has been interested in investigating the role of heat shock proteins during acclimatization of the parasite to such temperature fluctuations. Heat shock proteins of the Hsp40, Hsp60, Hsp70 and Hsp90 families have been characterized in the parasite and are being examined in our laboratory. This thesis pertains to understanding the functional role of Plasmodium falciparum Hsp90 (PfHsp90) during adaptation of the parasite to fluctuations in environmental temperature. The parasite expresses a single gene for cytosolic Hsp90 on chromosome 7 (PlasmoDB accession no.: PF07_0029) coding for a protein of 745 amino acids with a pI of 4.94 and Mw of 86 kDa. Eukaryotic Hsp90 regulates several protein kinases and transcription factors involved in cell growth and differentiation pathways resulting in a crucial role for Hsp90 in developmental processes. A role for PfHsp90 in parasite development, therefore, seems likely. Indeed, PfHsp90 has previously been implicated in parasite development from the ring stage to the trophozoite stage during the intra-erythrocytic cycle. Pharmacological inhibition of PfHsp90 function using geldanamycin (GA), a specific inhibitor of Hsp90 activity, abrogates stage progression. These experiments suggest that PfHsp90 may play a critical role in parasite development. This is further substantiated by the fact that several pathogenic protozoan parasites such as Leishmania donovani, Trypanosoma cruzi, Toxoplasma gondii and Eimeria tenella depend on Hsp90 function during different stages of their life cycles. It appears, therefore, that a principal role of Hsp90 in protozoan parasites may be the regulation of their developmental cycles. However, the precise functions of PfHsp90 during the intra-erythrocytic cycle of the malarial parasite are not clear. In this study we have carried out a functional analysis of PfHsp90 in the malarial parasite. We have examined the role of PfHsp90 in parasite development during repeated exposure to febrile temperatures. We have investigated its involvement in parasite development during a commonly used synchronization protocol involving cyclical changes in temperature. We have examined the interaction of GA with the Hsp90 multi-chaperone complex from P. falciparum as well as the human host. Finally, we have carried out a systems level analysis of chaperone networks in the malarial parasite as well as its human host using an in silico approach. We have analyzed the protein-protein interactions of PfHsp90 in the chaperone network and predicted putative cellular processes likely to be regulated by parasite chaperones, particularly PfHsp90.

Malaria, caused by the parasite Plasmodium, continues to exact high global morbidity and mortality rate next only to tuberculosis. It causes 300-500 million clinical infections out of which more than a million people succumb to death annually. Worst affected are the children below 5 years of age in sub-Saharan Africa. Plasmodium is a protozoan parasite classified under the phylum Apicomplexa that also includes parasites such as Toxoplasma, Lankestrella, Eimeria and Cryptosporidium. Of the four species of Plasmodium affecting man viz., P. falciparum, P. vivax, P. ovale and P. malariae, Plasmodium falciparum is the deadliest as it causes cerebral malaria. The situation has worsened recently with the emergence of drug resistance in the parasite. Therefore, deciphering new pathways in the parasite for developing lead antimalarial compounds is the need of the hour. The discovery of the type II fatty acid biosynthesis pathway in Plasmodium falciparum has opened up new avenues for the design of new antimalarials as this pathway is different from the one in human hosts. Although many biochemical pathways such as the purine, pyrimidine and carbohydrate metabolic pathways, and the phospholipid, folate and heme biosynthetic pathways operate in the malaria parasite and are being investigated for their amenability as antimalarial therapeutic targets, no antimalarial of commercial use based on the direct intervention of these biochemical pathways has emerged so far. This is due to the fact that the structure and function of the targets of these drugs overlaps with that of the human host. A description of the parasite, its metabolic pathways, efforts to use these pathways for antimalarial drug discovery, inhibitors targeting these pathways, introduction to fatty acid biosynthesis pathway, discovery of type II fatty acid biosynthesis pathway in Plasmodium falciparum and prospects of developing lead compounds towards antimalarial drug discovery is given in Chapter 1 of the thesis. In the exploration of newly discovered type II fatty acid biosynthesis pathway of P. falciparum as a drug target for antimalarial drug discovery, one of the enzymes; β-hydroxyacyl- acyl carrier protein dehydratase (PfFabZ) was cloned and being characterized in the lab. The atomic structure of PfFabZ was not known till that point of time. Chapter 2 describes the homology modeled structure of PfFabZ and docking of the discovered inhibitors with this structure to provide a rationale for their inhibitory activity. Despite low sequence identity of ~ 21% with the closest available atomic structure then, E. coli FabA, a good model of PfFabZ could be built. A comparison of the modeled structure with recently determined crystal structure of PfFabZ is provided and design of new potential inhibitors is described. This study provides insights to further improve the inhibition of this enzyme. Enoyl acyl carrier protein reductase (ENR) is the most important enzyme in the type II fatty acid biosynthesis pathway. It has been proved as an important target for antibacterial as well as antimalarial drug discovery. The most effective drug against tuberculosis – Isoniazid targets this enzyme in M. tuberculosis. The well known antibacterial compound – Triclosan, a diphenyl ether, also targets this enzyme in P. falciparum. I designed a number of novel diphenyl ether compounds. Some of these compounds could be synthesized in the laboratory. Chapter 3 describes the design, docking studies and inhibitory activity of these novel diphenyl ether compounds against PfENR and E. coli ENR. Some of these compounds inhibit PfENR in nanomolar concentrations and EcENR in low micromolar concentrations, and many of them inhibit the growth of parasites in culture also. The structure activity relationship of these compounds is discussed that provides important insights into the activity of this class of compounds which is a step towards developing this class of compounds into an antimalarial and antibacterial candidate drugs. Components of the green tea extract and polyphenols are well known for their medicinal properties since ages. Recently they have been shown to inhibit components of the bacterial fatty acid biosynthesis pathway. Some selected tea catechins and polyphenols were tested in the laboratory for their inhibitory activity against PfENR. I conducted docking studies to find their probable binding sites in PfENR. On kinetic analysis of their inhibition, these compounds were found to be competitive with respect to the cofactor NADH. This has an implication that they could potentiate inhibition of PfENR by Triclosan in a fashion similar to that of NADH. As a model case, one of the tea catechins; EGCG ((-) Epigalocatechin gallate) was tested for this property. Indeed, in the presence of EGCG, the inhibition of PfENR improved from nanomolar to picomolar concentration of Triclosan.conducted molecular modeling studies and propose a model for the formation of a ternary complex consisting of EGCG, Triclosan and PfENR. Docking studies of these inhibitors and a model for the ternary complex is described in Chapter 4. Docking simulations show that these compounds indeed occupy NADH binding site. This study provides insights for further improvements in the usage of diphenyl ethers in conjugation or combination with tea catechins as possible antimalarial therapeutics. In search for new lead compounds against deadly diseases, in silico virtual screening and high throughput screening strategies are being adopted worldwide. While virtual screening needs a large amount of computation time and hardware, high throughput screening proves to be quite expensive. I adopted an intermediate approach, a combination of both these strategies and discovered compounds with a 2-thioxothiazolidin-4-one core moiety, commonly known as rhodanines as a novel class of inhibitors of PfENR with antimalarial properties. Chapter 5 describes the discovery of this class of compounds as inhibitors of PfENR. A small but diverse set of 382 compounds from a library of ~2,00,000 compounds was chosen for high throughput screening. The best compound gave an IC50 of 6.0 µM with many more in the higher micromolar range. The compound library was searched again for the compounds similar in structure with this best compound, virtual screening was conducted and 32 new compounds with better binding energies compared to the first lead and reasonable binding modes were tested. As a result, a new compound with an IC50 of 240 nM was discovered. Many more compounds gave IC50 values in 3-15 µM range. The best inhibitor was tested in red blood cell cultures of Plasmodium, it was found to inhibit the growth of the malaria parasite at an IC50 value of 0.75 µM. This study provides a new scaffold and lead compounds for further exploration towards antimalarial drug discovery. The summary of the results and conclusions of studies described in various chapters is given in Chapter 6. This chapter concludes the work described in the thesis. Cloning, over-expression and purification of PanD from M. tuberculosis, FabA and FabZ from E. coli are described in the Appendix.

As international travel is rapidly increasing, more people are being exposed to potentially more antibiotic resistant bacteria, a changed infectious disease epidemiology, and an increased risk of accidents and crime. Research-based advice is needed to adequately inform travellers about these risks. We studied travellers who sought advice from the Travel Medicine Clinic at the Department of Infectious Diseases, Umeå University Hospital, as well as university students from Umeå, Stockholm, and Gothenburg travelling abroad for study, research, and clinical exchange programs. From retrospective data at the Travel Medicine Clinic, we found that pre-existing health problems were rare among travellers from Umeå seeking pre- travel health advice and vaccinations. In addition, we found that the travel destination and the sex of the traveller affected vaccination levels. Although hepatitis A is endemic to both Thailand and Turkey, compared to travellers to Thailand few travellers to Turkey visited the clinic for hepatitis A vaccination. The data also revealed that more women than men were vaccinated against Japanese encephalitis despite comparable trips. A prospective survey study showed that travellers felt that the pre-travel health advice they received was helpful. Two-thirds of the travellers followed the advice given although they still fell ill to the same extent as those who were not compliant with the advice. Factors outside the control of travellers likely affect the travel-related morbidity. Compared to older travellers, younger travellers were less compliant with advice, fell ill to a greater extent, and took greater risks during travel. In a prospective survey study, we found that healthcare students had higher illness rates and risk exposure when abroad compared to students from other disciplines. This difference was mainly due to the fact that healthcare students more often travelled to developing regions during their study period abroad. When abroad, half of all students increased their alcohol consumption and this was linked to an increased risk of theft and higher likelihood of meeting a new sex partner. The healthcare students participating in the survey study also submitted stool samples before and after travel. These samples were tested for the presence of antibiotic resistance, both by selective culturing for ESBL-PE (Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae) as well as by metagenomic sequencing. About one-third (35%) of the students became colonised by ESBL-PE following their study abroad. The strongest risk factor for colonisation was travel destination; for example, 70% of students who had travelled to India became colonised. Antibiotic treatment during travel was also a significant risk factor for colonisation. The stool samples from a subset of study subjects were analysed using metagenomic sequencing. From this we learned that although the majority of resistance genes in the gut microbiome remained unchanged following travel, several clinically important resistance genes increased, most prominently genes encoding resistance to sulphonamide, trimethoprim, and beta-lactams. Overall, taxonomic changes associated with travel were small but the proportion of Proteobacteria, which includes several clinically important bacteria (e.g., Enterobacteriaceae), increased in a majority of the study subjects. Clearly, there are risks associated with international travel and these risks include outside factors as well as the personal behaviour of travellers. We believe our results can be used to develop better pre-travel advice for tourists as well as university students studying abroad resulting in safer travel.

A Malária continua sendo a mais difundida e devastadora doença infecciosa, com aproximadamente 300 milhões de casos anuais e mais de 2 milhões de pessoas vivendo em áreas de risco. Entre os parasitas do gênero plasmodium causadores da malária em humanos, o plasmodium falciparum é a espécie mais letal. Este projeto teve como objetivo a síntese de pró-fármaco recíproco de cloroquina e primaquina e de pró-fármacos duplicados de cloroquina e de primaquina utilizando, para tanto, espaçantes inespecíficos (carboxílicos). Espera-se que o pró-fármaco recíproco permita a cura radical em casos de malária vivax e que os derivados duplicados apresentem maior eficácia, com diminuição da toxicidade, especialmente no caso do derivado de primaquina. Além desses compostos, propôs-se a síntese de pró-fármacos duplicados de cloroquina mediante a ligação com grupo espaçante específico (peptídeos) à cisão pela falcipaína. Tais derivados são potencialmente ativos em malária causada pelo P. falciparum resistente à cloroquina. / Malaria remains the world\'s most widespread and devastating infectious disease, with approximately 300 million annual cases and more than 2 million casualties. Among the protozoan parasites of the genus Plasmodium causing malaria in humans, Plasmodium falciparum is the most lethal species. This project had as objective the synthesis of reciprocal prodrug of chloroqine and primaquine using, for in such a way, inespecífics agents (carboxylics). One expects that the mutual prodrug allows to the radical cure in cases of malaria vivax and that the derivatives duplicates present greater effectiveness, with reduction of the toxicity, especially in the case of the primaquine derivative. Beyond these composites, it was considered synthesis of mutual prodrugs of chloroquine by means of the linking with specific carrier group (peptides) to the split for falcipain. Such derivatives are potentially active in malaria caused for the resistant P. falciparum to the chloroquine.

Malaria accounts for 198 million cases worldwide; with a high mortality rate. 584000 deaths were reported in 2013. Malaria is a re-emerging disease globally due to drug resistance, parasite recrudescence and non-availability of a vaccine. Chloroquine, quinine and antifolates served as frontline antimalarial drugs for decades. Development of resistance to chloroquine and antifolates, and the decreased efficacy of mefloquine, and even quinine, in malaria-endemic regions, has led to artemisinin derivatives evolving as frontline drugs. Artemisinin is a potent antimalarial compound and clears around 104 parasites per cycle. Despite being a potent antimalarial, artemisinin derivatives suffer from poor pharmacokinetic properties and short half lives. This has led to the development of artemisinin-based combination therapies (ACTs) using a partner drug with a longer half-life. However, resistance to ACTs has been reported in the last few years, perhaps due to lack of adherence to prescribed regimens or suboptimal treatment and the use of counterfeit drugs. Therefore there is an urgent need to develop an alternative ACT which overcomes these limitations. This thesis entitled “Adjunct therapy with curcumin for the treatment of malaria: studies in a murine model” describes the antimalarial activity of curcumin and artemisinin and the adjunct role of curcumin in the prevention of parasite recrudescence and cerebral malaria. The thesis is divided into three chapters: The first chapter entitled “Introduction: Malaria and anti-malarial drugs” consists of a brief introduction of malaria, the parasite life cycle and currently known antimalarial drugs. During the course of infection, the Plasmodium undergoes sporogony in the mosquito, and merogony and schizogony in the human host. All these life cycle stages are briefly described with depictions. A major part of this chapter is dedicated to describe antimalarial compounds under the following headings 1. Quinoline derivatives 2. 4-aminoquinolines 3. Antifolates 4. Artemisinin derivatives 5. Antibiotics and 6. Curcumin. The second chapter is aimed at examining the ability of curcumin-arteether (a synthetic derivative of artemisinin) combination therapy in preventing parasite recrudescence in a murine model through immunomodulation employing various immunological, molecular biological, and biochemical techniques. The use of suboptimal doses of antimalarial drugs leads to recrudescence or relapse of malaria (reappearance of the parasite in blood after antimalarial regimen). In the present study we have addressed this issue by the use of curcumin as an adjunct molecule with α,β arteether (a synthetic derivative of artemisinin). We have studied recrudescence in a Swiss mice model. A suboptimal dose was standardized by the use of different doses of α,β arteether (AE) ranging from 250µg to 1500 µg. We found 750 µg to be a suboptimal dose and studied the adjunct nature of curcumin when animals were treated with AE suboptimal dose or AE+curcumin (AC) combination treatment and monitored the survival of animals. Our results clearly demonstrate that ~95% of animals treated with the suboptimal AE dose died of recrudescent malaria but there was almost 100% survival of AC-treated animals; these animals were under observation for at least 3 months. We have studied the effect of curcumin in a recrudescence model at the molecular level. Curcumin by itself has antimalarial activity, but only in combination with α,β arteether prevented recrudescence. Our results indicate that curcumin has immunomodulatory activity. Serum cytokine analysis and spleen mRNA analysis for proinflammatory and anti-inflammatory mediators indicate that AC treatment effectively reduced both mRNA and serum cytokine levels of IFNγ, TNFα, IL-12 and effectively increased both mRNA and serum levels IL-10 and antibodies of the IgG subclass. Using TLR2 and IL-10 knockout animals, we have conclusively demonstrated that TLR2 is involved in the production of IL-10, and IL-10 is required for the AC-mediated protection of animals during the recrudescence period. We conclude that curcumin is able to prevent parasite recrudescence essentially by switching the Th1 response to a Th2 response. The third chapter deals with the study the effect of areether-curcumin (AC) combination therapy in the prevention of Experimental Cerebral Malaria. Although malaria mortality rates have decreased by an impressive 47% between 2000 and 2013, it is still a major affliction of mankind (WHO 2014). Plasmodium falciparum infection causes human cerebral malaria (HCM). The mortality rate in HCM is unacceptably high (15–20%), despite the availability of artemisinin-based therapy. HCM is characterized by a rapid progression from headache, general malaise, and prostration to hemiparesis, ataxia, unrousable coma, and death. Paediatric HCM deaths are mostly due to respiratory arrest. Alternatively, death may be due to parasite-mediated injury to a sensitive location; a small lesion due to parasite in brain stem can cause sudden respiratory arrest. In HCM, cytoadherence of pRBCs in brain microvasculature has been implicated as a major contributing factor for CM pathology. The failure of a large number of adjunct therapies in HCM demands the development of new intervention strategies. An effective adjunct therapy is urgently needed. Experimental Cerebral Malaria (ECM) in mice manifests many of the neurological features of HCM. In this study, we have demonstrated the efficacy of curcumin and PLGA nanocurcumin in the treatment of Experimental Cerebral Malaria (ECM), using the Plasmodium berghei ANKA-infected mouse model (C57BL/6). Curcumin/PLGA nanocurcumin alone can prevent the onset of ECM. We have shown that curcumin/PLGA nanocurcumin can prevent CD8+ T cell, CXCR3+ CD8 T cell and parasite-infected RBC (pRBC) sequestration in the brain. These are also the essential parameters underlying HCM. We have also demonstrated that curcumin effectively inhibits T cell proliferation in spleen. We have explained the anti-inflammatory effects of curcumin by showing the inhibition of NF-B in both brain and spleen, which is a plausible explanation. But, curcumin/PLGA nanocurcumin treated animals died later due to build up of parasitemia in blood and subsequent anemia. Moreover, a combination therapy with arteether and curcumin given even after the onset of neurological symptoms can completely cure and protect the animals against mortality. We have tested AC-combination after the onset of symptoms to mimic patient conditions in HCM, since the murine regimens reported were not successful in the treatment of HCM. Our results clearly demonstrate that AC treatment even after the onset of symptoms ensures 100% survival. Since the bioavailability of curcumin is reported to be poor, we have also tested the efficacy of PLGA nanocurcumin and find that it is superior to native curcumin in terms of therapeutic effects. It is concluded that curcumin would be an ideal adjunct drug to be used with the artemisinin derivatives to treat malaria, including cerebral malaria.