Submitted by Hellen Luz (hellencrisluz@gmail.com) on 2017-09-21T19:14:04Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AvaliacaoInVitro.pdf: 1439306 bytes, checksum: 7f71a06de5db3f1824c5314ed19c43b4 (MD5) / Rejected by Edisangela Bastos (edisangela@ufpa.br), reason: on 2017-10-10T17:00:49Z (GMT) / Submitted by Hellen Luz (hellencrisluz@gmail.com) on 2017-10-17T18:38:23Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AvaliacaoInVitro.pdf: 1439306 bytes, checksum: 7f71a06de5db3f1824c5314ed19c43b4 (MD5) / Approved for entry into archive by Edisangela Bastos (edisangela@ufpa.br) on 2017-11-24T15:00:16Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AvaliacaoInVitro.pdf: 1439306 bytes, checksum: 7f71a06de5db3f1824c5314ed19c43b4 (MD5) / Made available in DSpace on 2017-11-24T15:00:16Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AvaliacaoInVitro.pdf: 1439306 bytes, checksum: 7f71a06de5db3f1824c5314ed19c43b4 (MD5) Previous issue date: 2011-08-12 / CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico / O artesunato representa uma das principais drogas utilizadas como antimaláricos em diversos países. É um composto semi-sintético derivado de artemisinina, substancia extraída da planta chinesa Artemisia annua L. Apesar da ampla utilização do artesunato na terapêutica antimalárica, estudos demonstrando seus efeitos genotóxicos e citotóxicos em cultura de linfócitos humanos são ainda hoje quase inexistentes. Portanto, no presente trabalho, avaliamos os efeitos genotóxicos e citotóxicos do artesunato em cultura de linfócitos humanos. Nossos resultados demonstraram aumento significativo (p<0,05) no número de células apoptóticas dos linfócitos, tanto em 24 quanto em 48 h de tratamento. Desta forma, demonstrou-se em nosso trabalho, que o artesunato é uma droga genotóxica e citotóxica em cultura de linfócitos humanos, nas condições avaliadas. / Artesunate is one of the main drugs used as antimalarials in various countries. It is a semi-synthetic compound from artemisinin, a substance extracted from the Chinese plant Artemisia annua L. Despite the widespread use of antimalarial artesunato in malaria treatment, studies demonstrating its cytotoxic and genotoxic effects in human lymphocyte cultures are almost nonexistent. Therefore, in this study, we evaluated possible cytotoxic and genotoxic effects of artesunate on cultured human lymphocytes. A significant increase (p <0.05) in the rate of DNA damage and micronucleus frequency was observed after artesunato treatment. We also observed that artesunato induces a statically significant increase (p <0,05) in the number of apoptotic cells in both 24 and 48 h of treatment. Thus, we conclude in our work that artesunate is a highly cytotoxic and genotoxic drug in cultured human lymphocytes.

Submitted by Cássio da Cruz Nogueira (cassionogueirakk@gmail.com) on 2017-03-22T12:53:35Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_CaracterizacaoInVitro.pdf: 4204396 bytes, checksum: a66ea9273f20dfc9a3cd37f2eab74163 (MD5) / Approved for entry into archive by Edisangela Bastos (edisangela@ufpa.br) on 2017-03-27T12:50:35Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_CaracterizacaoInVitro.pdf: 4204396 bytes, checksum: a66ea9273f20dfc9a3cd37f2eab74163 (MD5) / Made available in DSpace on 2017-03-27T12:50:35Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_CaracterizacaoInVitro.pdf: 4204396 bytes, checksum: a66ea9273f20dfc9a3cd37f2eab74163 (MD5) Previous issue date: 2015-10-23 / FAPESPA - Fundação Amazônia de Amparo a Estudos e Pesquisas / A malária é uma das patologias infecto-contagiosas mais graves no mundo, apresentando distribuição geográfica bastante extensa em zonas tropicais. Seu tratamento é baseado na administração de drogas específicas, como, a artemisinina e seus derivados: artesunato, o qual será objeto deste estudo, e artemeter. O artesunato, é um composto semi-sintético derivado da artemisinina, substância extraída da planta chinesa Artemisia annua L. Apesar da ampla utilização do artesunato na terapia antimalárica, e de haver fortes evidências de que outros antimaláricos como, a partenina e a cloroquina, apresentem efeitos genotóxicos in vitro; ainda hoje são escassos os trabalhos que demonstrem seus efeitos genotóxicos em linfócitos humanos. Em estudos prévios realizados no laboratório de citogenética humana, foi demonstrado que o artesunato induz danos genotóxicos e citotóxicos ao DNA de linfócitos humanos em cultura. Apesar destes achados, os mecanismos indutores de tais efeitos não foram devidamente caracterizados devido a limitações das técnicas utilizadas. Assim, o presente estudo teve como objetivo caracterizar in vitro os efeitos genotóxicos e citotóxicos do artesunato em linfócitos de sangue periférico humano utilizando técnicas como FISHMN, ensaios de estresse oxidativo e imunocitoquímica por imunofluorescência. Pretendeu-se através do uso de tais técnicas, elucidar os mecanismos responsáveis pelos efeitos do artesunato no DNA de linfócitos humanos. A partir dos resultados encontrados no presente estudo foi possível inferir que o artesunato induz a formação de ROS e outros radicais livres e que estas substâncias estão causando danos no DNA dos linfócitos humanos em cultura. Assim, as células com o DNA danificado, não sendo capazes de reverter tal condição, ativam a apoptose pelas vias extrínseca e intrínseca. / Malaria is one of the most serious infectious disease in the world, with quite extensive geographic distribution in tropical areas. Its treatment is based on administration of specific drugs, as artemisinin and its derivatives: artesunate, which will be the subject of this study, and artemether. The artesunate is a semi-synthetic compound derived from artemisinin, a substance extracted from the Chinese plant Artemisia annua L. Despite the widespread use of artesunate in antimalarial therapy and the strong evidences that other antimalarials such as partenin and chloroquine present genotoxic effects in vitro; there are few studies that demonstrate artesunate genotoxic effects in human lymphocytes. In previous studies carried out in laboratory human cytogenetics, it was shown that artesunate induces cytotoxic and genotoxic effects in human lymphocytes in vitro. Despite these findings, the mechanisms of these effects have not been adequately characterized due to limitations of the techniques used. This study aimed to assess in vitro the cytotoxic and genotoxic effects of artesunate on human peripheral blood lymphocytes using assays such as FISHMN, oxidative stress and immunocytochemistry by immunofluorescence. We aimed through these tools elucidate the mechanisms responsible for the effects of artesunate in DNA of human lymphocytes. The results found in this study suggest that the artesunate induces the formation of ROS and other free radicals and that these substances are causing DNA damage in human lymphocytes in culture. Thus cells with damaged DNA, not being able to reverse this condition, activate apoptosis through the extrinsic and intrinsic pathways.

Abstract not available

Le développement érythrocytaire du parasite Plasmodium falciparum est composé de deux phases successives : une prolifération intense responsable de la maladie et une différenciation en gamétocytes responsable de la dissémination du parasite. Ce changement de statut de la cellule serait en partie dû à une expression différentielle des gènes, notamment à une régulation transcriptionnelle. Cette régulation nécessite l'interaction de deux acteurs dont la caractérisation devrait aboutir à une meilleure connaissance du développement du parasite et permettre de trouver de nouvelles voies pour combattre la maladie.<br />Après identification des promoteurs de gènes, des éléments connus chez les autres eucaryotes ainsi que des éléments dits spécifiques de Plasmodium ont été recherchés à l'aide de différents programmes bioinformatiques, puis regroupés en modules. Les différentes familles de gènes dont l'expression est cordonnée ou altérée par l'expression diminuée d'un facteur de transcription, devraient partager dans leurs promoteurs des éléments de régulation leur permettant d'être exprimées à un moment précis du développement.<br />Des facteurs se liant à l'ADN et impliqués dans la régulation transcriptionnelle ont été recherchés dans le génome du parasite. Des phases ouvertes de lecture codant des facteurs appartenant aux familles de protéines à domaine Myb, à doigt de zinc ou encore avec une architecture beta ont été identifiées et les protéines correspondantes modélisées. Le clonage et la caractérisation biochimique de trois de ces facteurs ont confirmé la pertinence de la mise en évidence informatique de ces protéines.

<p>This study investigated the associations between IL-4 -590 C/T and IL-10 -1087 A/G polymorphisms and malariometric indexes in the Fulani and the Dogon ethnic groups living in sympatry in Mali and differing in susceptibility to malaria. The correlations between antibodies level and parasitological data as well as splenomegaly were assessed. The impact of IL-4 -590 variants on the levels of the studied antibodies was also studied. </p><p>The allele and genotype frequencies of both studied SNPs differed significantly between the two groups. The Fulani IL-4 T allele carriers had a significantly higher infection prevalence compared with those carrying the CC genotype. No correlation between anti-malarial antibody levels and parasite prevalence was seen in any of the communities. In the Fulani, the increase in total IgE levels was related to the presence of infection. Malaria-specific IgG4 levels were negatively correlated to the number of clones within the Fulani. The Fulani IL-4 T allele carriers had higher total and malaria-specific IgE levels, compared to the CC genotype carriers. These results suggest that the amount of antibodies may not be the key element in the protection against malaria. IgG4 might be involved in protection against malaria. The impact of IL-4 -590 variants on the antibody levels may be affected by other genetic/epigenetic/epistatic or environmental factors. </p><p>In the study in Senegal, multiplicity of infection (MOI) increased after the transmission season in all subjects, except in α-thalassaemic and in G6PD-mutated children, suggesting that α-thalassaemia may protect against infection by certain parasite strains. G6PD-mutated individuals may resist against increase in MOI after the transmission season due to rapid clearance of infection at an early stage. HbAs and the ABO system do not affect MOI in asymptomatic individuals. MOI was positively correlated to parasitemia, and did not vary over age (in the range of 2 to 10 years). No relation between MOI and clinical attack was noted. </p>

This study investigated the associations between IL-4 -590 C/T and IL-10 -1087 A/G polymorphisms and malariometric indexes in the Fulani and the Dogon ethnic groups living in sympatry in Mali and differing in susceptibility to malaria. The correlations between antibodies level and parasitological data as well as splenomegaly were assessed. The impact of IL-4 -590 variants on the levels of the studied antibodies was also studied. The allele and genotype frequencies of both studied SNPs differed significantly between the two groups. The Fulani IL-4 T allele carriers had a significantly higher infection prevalence compared with those carrying the CC genotype. No correlation between anti-malarial antibody levels and parasite prevalence was seen in any of the communities. In the Fulani, the increase in total IgE levels was related to the presence of infection. Malaria-specific IgG4 levels were negatively correlated to the number of clones within the Fulani. The Fulani IL-4 T allele carriers had higher total and malaria-specific IgE levels, compared to the CC genotype carriers. These results suggest that the amount of antibodies may not be the key element in the protection against malaria. IgG4 might be involved in protection against malaria. The impact of IL-4 -590 variants on the antibody levels may be affected by other genetic/epigenetic/epistatic or environmental factors. In the study in Senegal, multiplicity of infection (MOI) increased after the transmission season in all subjects, except in α-thalassaemic and in G6PD-mutated children, suggesting that α-thalassaemia may protect against infection by certain parasite strains. G6PD-mutated individuals may resist against increase in MOI after the transmission season due to rapid clearance of infection at an early stage. HbAs and the ABO system do not affect MOI in asymptomatic individuals. MOI was positively correlated to parasitemia, and did not vary over age (in the range of 2 to 10 years). No relation between MOI and clinical attack was noted.

La malària és encara avui en dia una malaltia que causa aproximadament un milió de morts a l'any a tot el món. La seva eradicació suposa un gran repte per a la humanitat i per a la comunitat científica, en particular. El cultiu in vitro del paràsit és essencial per al desenvolupament de nous medicaments. Els mètodes de cultiu actuals es basen en l'heurística i requereixen millores.En aquesta tesi es presenta una aproximació teòrica al procés d'infecció a eritròcits en cultius in vitro amb Plasmodium falciparum, un dels protozous paràsits causants de la malària. El treball està centrat en la construcció i avaluació de models d'una complexitat adequada per tractar els problemes específics detectats pels experts en l'àmbit, i inclou també la formulació d'algorismes de simulació i el disseny de protocols experimentals.Aquest tipus de treball requereix de la col·laboració multidisciplinària. La visió dels experts en malària es complementa amb la modelització i simulació, que permet la comprovació dels supòsits preestablerts, la comprensió de fenòmens observats i la millora dels mètodes de cultiu actuals. Així doncs, cal establir i desenvolupar eines que permetin crear, analitzar i compartir models amb grups que estudien la malària des d'altres perspectives. En aquesta tesi, s'ha optat per la modelització basada en l'individu (IbM) i orientada a la reproducció de múltiples patrons (PoM). El model s'ha formulat seguint l'ODD, un protocol estàndard en el camp de l'ecologia teòrica, que s'ha adaptat a la representació de comunitats microbianes.Els models basats en l'individu (IbMs) defineixen un conjunt de normes que regeixen el comportament de cada cèl·lula i les seves interaccions amb les altres cèl·lules i amb el seu entorn immediat. A partir d'aquestes regles, i tenint en compte una certa diversitat dins de la població i un cert grau d'aleatorietat en els processos individuals, els IbMs mostren explícitament el comportament emergent del sistema en conjunt. Complementàriament, s'han aplicat conceptes propis de la termodinàmica per tal d'entendrel'aparició de patrons macroscòpics a partir de l'estructura de la població (per exemple de la distribució de les fases d'infecció entre els glòbuls vermells infectats).Aquesta recerca ha comportat la la creació i aplicació del model i simulador INDISIM-RBC, que ha demostrat ser una bona eina per millorar la comprensió dels cultius estudiats. Es tracta d'un model mecanicista, basat en l'individu, que reprodueix quantitativament els patrons observats en cultius reals a diferents nivells de descripció, i que en prediu el comportament sota determinades condicions.Hem demostrat que INDISIM-RBC pot ser emprat per a estudiar en detall alguns aspectes del cultiu del paràsit causant de la malària que calia aclarir. Permet realitzar experiments virtuals i així impulsar noves línies de recerca i explorar noves tècniques de cultiu. En particular, INDISIM-RBC s'ha utilitzat per millorar els protocols experimentals actuals del cultius estàtics, definint la geometria òptima de l'hematòcrit i els protocols de subcultiu més adequats per als cultius continus.El treball realitzat en malària s'ha comparat amb la investigació duta a terme pel grup de recerca em relació amb d'altres comunitats microbianes. D'aquesta manera, podem estudiar les propietats emergents dels sistemes microbians en general en relació als efectes de la individualitat de la cèl·lula, la diversitat de les poblacions, l'heterogeneïtat en el medi, o el caràcter local de les interaccions, entre d'altres. Aquesta visió general proporciona eines conceptuals que poden ser emprades per refinar l'anàlisi dels processos d'infecció sota estudi. / Malaria is still a major burden that causes approximately one million deaths annually worldwide. Its eradication supposes a great challenge to the humanity and to the scientific community, in particular. In vitro cultivation of the parasite is essential for the development of new drugs. Current culture methods are based on heuristics and demand for specific improvements.The present thesis is a theoretical approach to in vitro cultivation of the protozoan parasite Plasmodium falciparum infecting human red blood cells. It mainly focuses on the process of building a model of appropriate complexity to deal with the specific demands above mentioned, but it also includes the formulation and implementation of algorithms, and the design and execution of experimental trials.This kind of work requires multidisciplinary collaboration: the insight of the experts in malaria research is complemented with modeling and simulation, which allows for checking settled assumptions, increasing the understanding on the system and improving the current culturing methods.The use of tools for building, analyzing and sharing models is an imperative to this end. In this thesis, Pattern-oriented Modeling (PoM) has been adopted as the most appropriate way for raising of models and the ODD protocol (Objectives, Design Concepts and Details) has been proposed as the standard tool for communicating them.Individual-based Modeling (IbM) has been used to tackle malaria culture systems. IbMs define a set of rules governing each cell, its interactions with others and with its immediate surroundings. From this set of rules, and taking into account diversity within the population and a certain degree of randomness in the individual processes, IbMs explicitly show the emerging behavior of the system as a whole. Methods from statistical thermodynamics have been applied to understand the emergence of macroscopic patterns from the population structure (e.g. distribution of infection stages among infected red blood cells).The research resulted in the development of the model and simulator INDISIM-RBC, which has proved to be a good tool to improve understanding of the cultures under study. It is a mechanistically rich individual-based model and it quantitatively reproduces and predicts several patterns observed in real cultures at different levels of description.We demonstrated that INDISIM-RBC can be used to study in detail several aspects of malaria cultivation that remained unclear, as well as to perform virtual experiments. Consequently, it can be used to open novel lines of research and to examine potential experimental techniques. INDISIM-RBC has also been used to improve the current experimental culturing protocols in static cultivation by obtaining the optimal geometry of the hematocrit layer and subcultivation periods in the continuous cultures.This study on malaria has been compared to the research carried out by the group regarding other microbial communities. Thereby studying general emerging properties of microbial systems in general, with regard to the effect of cell individuality, heterogeneity and diversity, the local nature of interactions; and biological and spatial complexity. In doing so, the acquired holistic view has been used to develop tools that allow for a better characterization and study of the infection process, in particular.

Malaria is a devastating parasitic disease in humans caused by species in the genus Plasmodium. With over 100 million cases and at least 1.5 million fatalities each year, the disease accounts for 4-5% of all fatalities in the world. A recent increase in the number of malaria cases in South Africa has imposed severe costs on the economy and public health. Immunity to malaria is a multi-component system involving both B and T celllymphocytes. Pc96 is a 96 kDa antigen identified in the mouse malaria model Plasmodium chabaudi adami. It is known to be associated with the outer membrane of mouse erythrocytes infected with the parasite and has shown protective roles in mice challenged with P. chabaudi adami. A specific T cell clone has been identified that adoptively provides protection to athymic mice infected with P. chabaudi adami. Antibodies raised against Pc96 identified proteins that induced the proliferation of the protective T cell clones. At least four other antigens of different species of. malaria share at least one cross-reactive epitope. In an attempt to identify a Plasmodiumfalciparum homologue ofPc96, the amino-acid sequence was used in a BLAST search of the P. falciparum genome database, identifying a 403 kDa protein with a high degree of homology to Pc96. Sequence alignments indicated a region spanning 90 amino acids in Pf403 that overlaps the Pc96 amino acid sequence. A 178 kDa protein in P. yoelii yoelii (Pyy178) was shown to be highly similar to Pc96. Tvcell epitope prediction programs identified putative T cell epitopes in Pc96 which appear to be conserved in Pf403 and Pyy178. A casein kinase IT phosphorylation site was also identified in this region and is conserved in both sequences. PCR primers were designed to amplify regions of the MAL3P6.11 gene coding for Pf403 from P.falciparum genomic DNA. An 817 bp region in the MAL3P6.11 gene was amplified. This codes for the region ofPf403 that shows high homology to Pc96 and contains the conserved T cell epitopes and casein kinase phophorylation site. A BamHI site was incorporated into the forward primer to facilitate in-frame ligation with cloning vectors. The PCRproduct obtained was verified by restriction analysis using HindIII and EcoRI sites within the fragment. The 817 bp peR product was cloned into the pMOSBlue vector using a blunt-endedPCR cloning kit, and transformed into MOSBlue competent cells. Recombinants were identified using the uIV complementation system, and verified by PCR, plasmid DNA isolation, and restriction digestion analysis. The insertDNA in pMOSBlue was cut out with BamHI and sub-cloned into the BamHI site in the pMAL-C2x expression vector. Sequencing ofthe construct confirmed the identity of the cloned insert and showed the sequence to be in frame with the malE gene coding for maltose binding protein (MBP). The fusion protein, MBP-Pf32 .5, was induced and expressed as a 75 kDa protein comprising ofthe 32.5 kDa region ofPf403, and MBP (42.5 kDa) and was detected by anti-MBP antibodies, by western blotting. This recombinant protein has many applications for further studies involving the characterisation of the Pf403 protein, and the determination of possible roles that the protein may have in stimulating an immune response during human malaria infections. / Thesis (M.Sc.) - University of Natal, Pietermaritzburg, 2003.

L'artémisinine (ART) est un composé antipaludique majeur très actif sur les souches multi-résistantes de Plasmodium falciparum. Cependant, son application clinique est limitée par sa faible solubilité en milieu aqueux et sa faible biodisponibilité par voie orale. La mise en œuvre de cyclodextrines (CDs) bioestérifiées et de dérivés amphiphiles polyoxyéthylénés permet de viser deux objectifs : i) d'une part d'améliorer la concentration aqueuse d'ART à travers son association aux vecteurs colloïdaux de CDs modifiées et ii) d'autre part d'améliorer sa biodisponibilité et son efficacité thérapeutique à travers la décoration de la surface des vecteurs. La décoration surfacique est sensée augmenter le temps de circulation sanguine des nanovecteurs de manière à maintenir des doses plasmatiques efficaces d'ART sur une longue période, suite à une administration intraveineuse. Des suspensions colloïdales stables suffisamment chargées d'ART ont été mises au point permettant de palier le problème d'insolubilité en milieu aqueux de la molécule active et donc d'envisager son administration par voie parentérale. Les essais de lyodisponibilité indiquent que l'ART est libérée des nanosystèmes pendant une période de 4 jours pour les nanoréservoirs et de 11 jours pour les nanosphères. En plus des caractérisations physico-chimiques et pharmacotechniques, les potentialités des nanoparticules décorées en surface ont été évaluées et comparées au cours de tests biologiques. In vitro, l'ART mise en forme a montré une bonne efficacité sur des souches plasmodiales choloroquino-sensibles (3D7) et chloroquino-résistantes (K1) avec des CI50 très faibles de l'ordre de 3 à 6 ng/mL. Le concept de co-nano-assemblage de dérivés amphiphiles de γ-CD-C10 bioestérifiée et de polyéthylène glycol (PEG) dans les conditions de nanoprécipitation semble être une approche intéressante pour conférer des propriétés de furtivité aux nano-systèmes de γ-CD-C10. En effet, les études in vitro mettent en évidence une diminution significativement de la phagocytose par les cellules macrophagiques et/ou de l'adsorption des protéines du complément sérique à la surface des nanoparticules de γ-CD-C10 décorées par le polysorbate 80, le stéarate de PEG1500, et le DMPE-mPEG2000. In vivo, nous observons une augmentation du temps de circulation sanguine des nanoréservoirs γ-CD-C10/polysorbate 80 et des nanosphères γ-CD-C10/DMPE-mPEG2000. Enfin, les études de pharmacocinétique réalisées chez le rat montrent que les paramètres pharmacocinétiques de l'ART sont améliorés lorsqu'elle est associée aux deux systèmes nanoparticulaires précédents. En effet, des valeurs de clairance plasmatique très faibles et de temps de demi-vie plasmatique longs (3 et 5 heures, respectivement) de l'ART ont été enregistrées avec ces deux formulations. Ces formes vectorisées d'ART mises au point ouvrent de perspectives intéressantes pour la prise en charge thérapeutiques des crises de paludisme sévère.

Despite a renewed impetus on bringing together efforts to wipe malaria from the globe, the truth is that this ancient disease remains one of the principal threats to child survival in vast areas of the world. The existing control measures are largely insufficient to reduce globally the malaria burden, and as of today, malaria remains endemic in more than 100 countries, where at least half of the world's population live exposed to the risk of being infected. Indeed, the burden of malaria morbidity and mortality continues to be unacceptably high, with more than 250 million clinical episodes and at least one million deaths per year. While morbidity due to malaria affects all age groups and is scattered throughout the world, Sub-Saharan Africa concentrates the brunt of the malaria deaths, which overwhelmingly occur in children under five years of age infected with P. falciparum. The exciting and almost palpable perspective of an effective malaria vaccine, added to the promotion of innovative control strategies such as intermittent preventive treatment for infants or pregnant women, have in the recent years centred the scientific discussions regarding the approach to malaria control. However, in contrast to these innovative perspectives, malaria control has remained in the last two decades essentially dependent on the early identification and prompt treatment of clinical malaria cases and the reduction of man-vector contact. Unless there is a major renewal, optimisation and scale-up of the antimalarial arsenal and strategies, malaria will continue to dictate the health status of the world, and eradication will not be achievable in a realistic timeframe. As malaria is a life-threatening infection, a fundamental requirement for its adequate control is the availability of effective antimalarial drugs. The first paper in this thesis describes a large randomised clinical trial (around 1500 children) performed in five different African countries to assess the non-inferiority of a novel combination, dihydroartemisinin-piperaquine, produced under strict good manufacturing practices, when compared to the standard combination therapy AL, for the treatment of uncomplicated malaria in African children under the age of five years. In the second paper, we describe the results of another large (around 900 patients) randomised clinical trial in which we assessed in 5 different African countries the non-inferiority of a new, paediatric-suited cherry-flavoured, dispersible formulation of AL, when compared to standard crushed AL tablets, for the treatment of uncomplicated malaria in children younger than 12 years of age. The results of these two trials, reflected in paper 1 and paper 2 of this thesis, bring to the malaria community public-health relevant data on alternatives to the currently limited antimalarial drug arsenal. The third paper in this thesis describes the clinical presentation of severe malaria in a rural Mozambican Hospital, and the associated risk factors for a negative outcome. It also presents minimum community based incidence rates, a useful indicator of the malaria burden in the area. Finally, the fourth paper addresses the relationship between severe malaria and bacterial invasive disease in children younger than 5 years admitted to a Manhiça's rural hospital, Mozambique. Malaria is an ancient disease of terrible consequences for mankind. All efforts devised to diminish the burden that malaria imposes in endemic areas need to be embraced and brought together on a coordinated manner to fight this infection from all possible fronts. Understanding the clinical determinants of the infection and its relation with other coexistent infectious diseases will give an insight to the basic pathophysiology of malaria, and thus guide appropriate management strategies. New highly effective drugs, and their paediatric-orientated formulations, need to be developed and made available to those most at need. / A pesar del renovado afán por eliminar la malaria de la faz de la tierra, esta histórica enfermedad se mantiene como uno de los principales peligros para la salud infantil en amplias zonas del mundo. Las medidas de control existentes son claramente insuficientes a la hora de reducir globalmente el impacto de esta enfermedad, y a día de hoy la malaria es endémica en más de 100 países en dónde más de la mitad de la población mundial está expuesta al riesgo de infectarse. De hecho, la carga de esta enfermedad en términos de morbilidad y mortalidad persiste inaceptablemente alta con, anualmente, más de 250 millones de episodios clínicos y cerca de un millón de muertes. Mientras que la enfermedad clínica puede afectar a cualquier grupo de edad, la mortalidad por malaria se ve esencialmente circunscrita a los niños menores de cinco años infectados por P. falciparum.La apasionante y casi palpable perspectiva de una vacuna efectiva contra la malaria, sumada a la promoción de innovadoras estrategias de control como el tratamiento intermitente en lactantes o mujeres embarazadas han centrado, en los últimos años, el debate científico relacionado con las estrategias de control. En contraste con estas innovadoras estrategias, el control de la malaria se ha visto sin embargo limitado en las últimas décadas a la identificación y tratamiento precoz de los episodios clínicos y a la reducción del contacto entre el reservorio humano y el vector. A menos que se produzca una importante renovación y optimización del arsenal terapéutico y de las estrategias frente a esta infección, acompañado por un despliegue masivo de las intervenciones en aquellas áreas dónde son más necesarias, la malaria continuará dictando el estado de salud global, y su erradicación no dejará de ser una utopía irrealizable a corto plazo.La malaria es una enfermedad potencialmente mortal, y por lo tanto, un requerimiento fundamental para su control es la disponibilidad de fármacos antimaláricos efectivos para su tratamiento. El desarrollo de la farmacopea antimalárica, estrechamente relacionada a los diferentes conflictos bélicos del último siglo, ha representado un constante desafío y debido a los repetidos problemas de financiación ha resultado claramente inadecuado, especialmente en comparación con el desarrollo de fármacos para otras enfermedades. Como ejemplo cabe destacar que, entre los años 1975-1999, apenas 4 de los cerca de 1400 fármacos registrados en el mundo, eran antimaláricos. Además, la aparición de resistencias por parte del parásito a los fármacos, un problema creciente y global, resulta un grave peligro para el control de esta infección, y representa una presión añadida para los pocos fármacos efectivos todavía disponibles. Con todo, en los últimos años, la malaria se está desprendiendo del status de enfermedad olvidada que arrastraba, e importantes esfuerzos han surgido para el desarrollo e investigación de nuevos fármacos con actividad antimalárica. Basado en el conocimiento adquirido con otras enfermedades infecciosas como la tuberculosis, la organización mundial de la salud promulga actualmente que el tratamiento frente a P. falciparum, la especie responsable de la mayoría de casos graves y la práctica totalidad de las muertes, debe basarse en la terapia combinada, incluyendo a ser posible un derivado de las artemisininas. La elección de los fármacos a combinar debe basarse en la potencial sinergia entre los perfiles farmacocinéticos y terapéuticos de los diferentes componentes, con el objetivo de conseguir una eliminación de la parasitemia rápida, protegiendo al mismo tiempo a los diferentes componentes frente al desarrollo de resistencias.