Trotz weltweiter Bemühungen, die Tropenkrankheit Malaria zurückzudrängen, erkranken jährlich bis zu einer halben Milliarde Menschen an Malaria mit der Folge von über einer Million Todesopfern. Da zur Zeit eine wirksame Impfung nicht in Sicht ist und sich Resistenzen gegen gängige Medikamente ausbreiten, werden dringend neue Antimalariamittel benötigt. Um die Suche nach neuen Angriffsorten für Medikamente zu unterstützen, untersucht die vorliegende Arbeit mit einem rechnergestützten Ansatz den Stoffwechsel von Plasmodium falciparum, dem tödlichsten Malaria-Erreger. Basierend auf einem aus dem aktuellen Forschungsstand rekonstruierten metabolischen Netzwerk des Parasiten werden metabolische Flüsse für die einzelnen Stadien des Lebenszyklus von P. falciparum berechnet. Dabei wird ein im Rahmen dieser Arbeit entwickelter Fluss-Bilanz-Analyse-Ansatz verwendet, der ausgehend von in den jeweiligen Entwicklungsstadien gemessenen Genexpressionsprofilen entsprechende Flussverteilungen ableitet. Für das so ermittelte stadienspezifische Flussgeschehen ergibt sich eine gute Übereinstimmung mit bekannten Austauschprozessen von Stoffen zwischen Parasit und infiziertem Erythrozyt. Knockout Simulationen, die mit Hilfe einer ähnlichen Vorhersagemethode durchgeführte werden, decken essentielle metabolische Reaktionen im Netzwerk auf. Fast 90% eines Sets von experimentell bestimmten essentiellen Enzymen wird wiedergefunden, wenn die Annahme getroffen wird, dass Nährstoffe nur begrenzt aus der Wirtszelle aufgenommen werden können. Die als essentiell vorhergesagten Enzyme stellen mögliche Angriffsorte für Medikamente dar. Anhand der Flussverteilungen, die für die einzelnen Entwicklungsstadien berechnet wurden, können diese potenziellen Targets nach Relevanz für Malaria Prophylaxe und Therapie sortiert werden, je nachdem, in welchem Stadium die Enzyme als aktiv vorhergesagt wurden. Dies bietet einen vielversprechenden Startpunkt für die Entwicklung von neuen Antimalariamitteln. / Despite enormous efforts to combat malaria, the disease still afflicts up to half a billion people each year, of which more than one million die. Currently no effective vaccine is within sight, and resistances to antimalarial drugs are wide-spread. Thus, new medicines against malaria are urgently needed. In order to aid the process of drug target detection, the present work carries out a computational analysis of the metabolism of Plasmodium falciparum, the deadliest malaria pathogen. A comprehensive compartmentalized metabolic network is assembled, which is able to reproduce metabolic processes known from the literature to occur in the parasite. On the basis of this network metabolic fluxes are predicted for the individual life cycle stages of P. falciparum. In this context, a flux balance approach is developed to obtain metabolic flux distributions that are consistent with gene expression profiles observed during the respective stages. The predictions are found to be in good accordance with experimentally determined metabolite exchanges between parasite and infected erythrocyte. Knockout simulations, which are conducted with a similar approach, reveal indispensable metabolic reactions within the parasite. These putative drug targets cover almost 90% of a set of experimentally confirmed essential enzymes if the assumption is made that nutrient uptake from the host cell is limited. A comparison demonstrates that the applied flux balance approach yields target predictions with higher specificity than the topology based choke-point analysis. The previously predicted stage-specific flux distributions allow to filter the obtained set of drug target candidates with respect to malaria prophylaxis, therapy or both, providing a promising starting point for further drug development.

Le paludisme est une infection parasitaire de répartition mondiale notamment en zones intertropicales où l’infection par Plasmodium falciparum est responsable de centaines de milliers de morts par an principalement chez les enfants de moins de cinq ans. Le paludisme constitue également un problème en France par l’importation de cas de paludisme chez le voyageur de retour de zone d’endémie. L’infection à Plasmodium falciparum dans cette population, considérée comme à risque de développer les formes graves de la maladie, peut se présenter sous différentes formes cliniques plus ou moins associées au risque de mortalité. Même si certains facteurs de risque de gravité tels que l’âge et l’immunité ont été identifiés, cette interaction complexe hôte-parasite n’a été largement étudiée que chez l’enfant en zone d’endémie et peu de données sont disponibles pour le paludisme d’importation. L’objectif de ces travaux de thèse repose sur l’analyse des facteurs d’hôte et des facteurs parasitaires intervenant dans le paludisme d’importation. A travers le réseau de surveillance du centre national de référence du paludisme en France métropolitaine, l’ensemble des données démographiques, épidémiologiques, cliniques et biologiques des cas de paludisme d’importation, notifiés entre 2011 et 2015, ont été collectées ainsi que les échantillons ayant servis au diagnostic. Après expertise diagnostique, le plasma obtenu après centrifugation a été utilisé pour les dosages des antipaludéens, pour la quantification d’HRP2 ainsi que pour la sérologie anti-palustre. L’ARN extrait par le TRIZOL® à partir du culot globulaire a été utilisé pour l’étude de l’expression des gènes var et des domaines cassettes par qRT-PCR. Le culot de globules rouges parasités a été mis en culture pour la maturation des formes parasitaires en vue de l’étude du phénotype de cytoadhérence sur les récepteurs solubles CD36, ICAM-1, EPCR et du phénomène de rosetting . L’ensemble de ces études a été réalisé sur une population de patients dans le cadre du paludisme d’importation groupée en migrants de première génération, migrants de deuxième génération et voyageurs/expatriés et dont la présentation clinique du paludisme d’importation a été classée en paludisme « très grave », paludisme « grave » et paludisme « simple ». L’ensemble des données épidémiologiques, cliniques et biologiques recueillies au cours de l’étude a permis d’identifier l’âge élevé, l’origine ethnique, la profondeur de la thrombopénie et l’absence d’antécédents de paludisme comme des facteurs de risque associés à la survenue d’un accès palustre « très grave », entité clinique caractérisée pour une biomasse parasitaire séquestrée élevée. L’effet de la pré-exposition au parasite, reflété par le statut sérologique des patients, semble être à l’origine de la présentation clinique de la maladie en limitant notamment la biomasse parasitaire séquestrée au cours de l’accès palustre. L’étude de l’expression des gènes var et des domaines cassettes réalisée dans cette population, en fonction de la présentation clinique, de l’origine ethnique et du statut sérologique des patients, a révélé une surexpression du groupe de gènes var A et B et des motifs protéiques composant les domaines cassettes DC4, DC8 et DC13 dans le paludisme « grave » et « très grave » d’importation au sein de cette population hétérogène de patients. L’étude du phénotype de cytoadhérence et du rosetting, réalisée dans un autre groupe de patients rencontré dans le cadre du paludisme d’importation, a identifié le rosetting comme le phénotype d’adhérence à l’origine de l’accès palustre « très grave ». Le profil d’expression des gènes var et domaines cassettes correspondants à cette population a confirmé les observations antérieures et corrèle le phénotype de rosetting à l’expression des motifs protéiques DBLß3 et DBLa2 de DC4 et DC8 (...) / Malaria is a worldwide parasitic infection especially in tropical area where Plasmodium falciparum infection is responsible for hundreds of thousands annually mainly among children under five years old. Malaria is also a problem in France by the importation of malaria cases in travelers coming from endemic area. The Plasmodium falciparum infection in this population, considered at risk of developping severe malaria, can present different clinical forms more or less associated with mortality.While some risk factors for severity like age and immunity have been identified, this complex host-parasite interactions have been widely studied in children in endemic areas and few data are available for imported malaria. The aim of the thesis work is based on analysis of host factors and parasite factors in imported malaria.Through the monitoring network of the French National reference center of malaria, all the demographic, epidemiological, clinical and laboratory of imported malaria cases, notified between 2011 and 2015, were collected and also samples of the parasitological diagnosis. After diagnostic expertise, the plasma obtained after centrifugation was used for determinations of antimalarial drugs, for quantification of plasmatic HRP2 and for serological tests. RNA extracted by the Trizol® from red cells pellets was used to study the expression of var genes and domain cassettes by qRT-PCR. The pellet of parasitized red blood cells were cultured for maturation of parasitic forms for the study of phenotype cytoadherence on soluble receptor CD36, ICAM-1 and EPCR and for the study of the rosetting phenomenon. All of these studies was conducted in an imported malaria context,in a population of patients composed by first-generation migrants, second-generation migrants and travelers / expatriates and whose clinical presentation of imported malaria was classified into very severe (VSM), mild severe (MSM) and uncomplicated malaria (UM).All the epidemiological, clinical and biological data collected during the study identified the high age, ethnicity, depth of thrombocytopenia and no history of malaria as factors risk associated with the occurrence of very severe malaria, clinical entity characterized by high sequestered parasite biomass. The effect of pre-exposure to the parasite, reflected by the serological status of patients, seems to be the cause of the clinical presentation of the disease in particular by limiting parasite biomass sequestered during malaria. The study of the expression of var genes and domain cassettes performed in this population, according to clinical presentation, ethnicity and the serological status of patients, revealed an overexpression of the group of var genes A and B and protein patterns of the domain cassette DC4, DC8 and DC13 in mild severe and very severe malaria within this heterogeneous patient population. The study of cytoadherence phenotype and rosetting, made in another group of patients in imported malaria context, identified the rosetting as adhesion phenotype causing very severe malaria. The expression profile of var genes and domain cassettes corresponding to this population confirmed earlier observations and correlates rosetting phenotype to the expression of DBLß3 and DBLa2 of DC4 and DC8 (...)

Malaria wird durch den einzelligen Parasiten Plasmodium verursacht. Hierbei handelt es sich um einen obligat intrazellulären, eukaryotischen Erreger, der zum Phylum der Apicomplexa gehört. Apicomplexa zeichnen sich durch das einzigartige Vorhandensein eines ungewöhnlichen Plastids, genannt Apicoplast, aus. Die Exklusivität dieser Organelle und ihre metabolische Notwendigkeit für das Parasitenwachstum haben sie als attraktives pharmakologisches Ziel bestätigt. In dieser Arbeit wurden, unter Anwendung des Nagetier-Malariaerregers Plasmodium berghei, zwei verschiedene Aspekte von Apicoplast Proteinfunktionen untersucht. Zum Ersten wurde ein bislang unbeschriebenes Plasmodium Apicoplast Protein, Plasmodium-specific Apicoplast protein important for Liver Merozoite formation (PALM), charakterisiert. Drei voneinander unabhängige palm— Parasitenlinien, wurden durch zielgerichtete Gendeletion generiert. Die PALM Knockout-Mutanten entwickelten sich während eines Großteils des Lebenszyklus normal, jedoch war die Abgabe von Merozoiten in den Blutstrom und die Fähigkeit eine Blutstadien-Infektion zu etablieren signifikant beeinträchtigt. Experimentelle Immunisierung von Mäusen mit palm— Sporozoiten bewirkte einen starken und langanhaltenden Schutz gegen Reinfektion mit Malaria. Diese Ergebnisse lassen darauf schließen, dass Parasiten mit einem Arrest in den finalen Schritten der Bildung von Leberstadien-Merozoiten einen Vorteil gegenüber genetisch attenuierten Parasiten der ersten Generation haben, die in der frühen Leberstadienentwicklung arretiert sind. Zum Zweiten wurden die sechs Nucleus-kodierten Komponenten der [Fe-S] Cluster Biosynthese im Apicoplast systematisch durch experimentelle Genetik analysiert. Insgesamt zeigen meine Studien, dass bisher unbekannte Ziele im Plasmodium Apicoplast für Interventionsstrategien gegen Malaria geeignet sind. / Malaria is caused by Plasmodium, an obligate intracellular eukaryotic pathogen that belongs to the phylum Apicomplexa. Apicomplexan parasites harbor an unusual plastid organelle, termed apicoplast. Because this unique organelle is indispensable for parasite growth it is a validated and attractive drug target. Using the rodent malaria parasite Plasmodium berghei, two different aspects of apicoplast protein functions were analyzed in this study. Firstly, a previously uncharacterized Plasmodium apicoplast protein, Plasmodium-specific Apicoplast protein important for Liver Merozoite formation (PALM), was investigated. Three independent palm— knockout parasite lines were generated by targeted gene deletion. While the resulting knockout mutants developed normally for most of the life cycle, merozoite release into the blood stream and the ability to establish an infection was severely impaired. Experimental immunization of mice with palm— sporozoites elicited unprecedented potent and long-lasting protection against malaria re-infection. The results indicate that a tailor-made arrest in the final steps of hepatic merozoite formation could be an improvement over first-generation early liver-stage genetically arrested parasites (GAPs). Secondly, the six nuclear-encoded components of the apicoplast [Fe-S] cluster biosynthesis pathway were systematically targeted by experimental genetics. Together, my studies show that the Plasmodium apicoplast harbors previously unrecognized targets for anti-malaria intervention strategies.

Submitted by JACIARA CRISTINA ALMEIDA DO AMARAL (jaciaramaral@ufpa.br) on 2018-06-25T17:31:15Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇÃO- MARJORIE FINALSEC.pdf: 2385529 bytes, checksum: a737205933ed5944c458d304889604a7 (MD5) / Approved for entry into archive by JACIARA CRISTINA ALMEIDA DO AMARAL (jaciaramaral@ufpa.br) on 2018-06-25T17:31:41Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇÃO- MARJORIE FINALSEC.pdf: 2385529 bytes, checksum: a737205933ed5944c458d304889604a7 (MD5) / Made available in DSpace on 2018-06-25T17:31:41Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇÃO- MARJORIE FINALSEC.pdf: 2385529 bytes, checksum: a737205933ed5944c458d304889604a7 (MD5) Previous issue date: 2018-05-17 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico / FAPESPA - Fundação Amazônia de Amparo a Estudos e Pesquisas / A malária cerebral (MC) é uma das complicações mais severas atribuídas à infecção pelo protozoário Plasmodium falciparum, ganhando destaque nas taxas de mortalidade infantil em áreas endêmicas. Esta enfermidade apresenta uma patogênese complexa e ainda pouco elucidada, estando associada a alterações cognitivas, comportamentais e motoras. Visando ampliar os conhecimentos a respeito desta patologia e procurando os benefícios atribuídos ao consumo diário de antioxidantes, o principal objetivo deste trabalho é avaliar o possível efeito protetor do fruto da Euterpe oleracea (açaí) durante a evolução do quadro de malária cerebral experimental (MCE) induzida em modelo murino por meio da inoculação da cepa ANKA de Plasmodium berghei (PbA). Para tal, utilizaram-se camungondos da linhagem albino suíço, os quais foram inoculados intraperitonealmente (i.p.) com 10⁶ de eritrócitos parasitados. Os animais (fêmeas e machos entre 4 a 6 semanas) foram divididos em quatro grupos, dentre os quais os grupos Açaí e PbA+Açaí foram mantidos com uma dieta exclusiva com ração enriquecida com açaí, e aos grupos Controle e PbA foram proporcionadas somente ração padrão durante os 22 dias de experimento. Para caracterização do quadro de MCE foram avaliados diversos parâmetros como o surgimento dos sinais clínicos, curva de sobrevivência, parasitemia (%), ganho de massa corpórea e permeabilidade vascular. Para avaliação das alterações comportamentais e locomotoras dos animais foi utilizado o protocolo SHIRPA. Observamos prolongamento de sobrevida dos animais infectados e tratados com dieta enriquecida com açaí, além de diminuição das alterações neurológicas decorrentes da exposição do parênquima cerebral. Este trabalho nos permitiu validar o desenvovimento do quadro de malária cerebral experimental (MCE) em modelo murino e avaliar o efeito neuroprotetor do açaí (Euterpe oleracea) no decorrer da doença. / Cerebral malaria (CM) is one of the most severe complications attributed to protozoal infection by Plasmodium falciparum, gaining prominence in infant mortality rates in endemic areas. It´s a complex pathogenesis and still little elucidated, being associated with cognitive, behavioral and motor changes. Aiming to broaden the knowledge about this pathology and looking for the benefits attributed to the daily consumption of antioxidants, the objective of this work is to evaluate the possible protective effect of Euterpe oleracea fruit (açaí) during evolution of experimental cerebral malaria (ECM) induced in murine model by means of inoculation of Plasmodium berghei (PbA), ANKA stain. For this, we used the Swiss line, which were inoculated intraperitoneally (i.p.) with 10⁶ of parasited erythrocytes. The animals (females and males between 4 and 6 weeks) were divided into four groups, among which Açaí and PbA+Açaí groups were maintained on a ration-exclusive diet enriched with açaí and the Control and PbA groups were given only standard ration during 22 days of experiment. To characterize the ECM framework, several parameters were evaluated such as the appearence of clinical signs, survival curve, parasitemia, body mass gain and vascular permeability. The SHIRPA protocol was used to evaluate the behavioral and locomotor changes in animals. We observed an extension of survival of the infected animals and treated with a diet enriched with acai berry, and decreased the neurological changes arising from the exposure of the cerebral parenchyma. This work allowed us to validate the development of the experimental brain malaria framework in murine model and evaluate the neuroprotective effect of Acai (Euterpe oleracea) in the course of the disease.

En Afrique, la valorisation des pharmacopées traditionnelles constitue bien souvent un moyen d'orienter la recherche vers de nouveaux antipaludéens. Les plantes médicinales antipaludiques peuvent servir de base à la formulation de Médicaments Traditionnels Améliorés (MTA) ou être source de nouvelles molécules antiplasmodiales. Sur la base d'une recherche bibliographique exhaustive, 10 plantes médicinales largement utilisées au Mali dans le traitement du paludisme et des affections hépatiques (ictères) ont été sélectionnées par une approche d'ethnopharmacologie quantitative et évaluées in vitro sur Plasmodium falciparum FcB1, conduisant à la sélection de Terminalia macroptera (Feuilles et Racines). Terminalia macroptera est une espèce largement utilisée au Mali contre le paludisme, la fièvre, les affections hépatiques (ictères) et la plaie. Dans le contexte de mise sur le marché d'un MTA, une monographie botanique a été réalisée sur ces organes de plante afin de définir les normes pharmacopées de la poudre de feuilles et de racines permettant d'éviter les falsifications. Une étude toxicologique in vivo et une étude pharmacologique in vivo (activités antiplasmodiales, antipyrétiques, antalgiques, antiinflammatoires et hépatoprotectrice) ont été réalisées. L'extrait éthanolique des feuilles et des racines ont démontré des propriétés antiplasmodiales in vivo sur des modèles murins de paludisme simple et paludisme sévère des propriétés antipyrétiques, antalgiques, antiinflammatoires et hépatoprotectrices sur modèles murins d'hyperthermie, d'algie, d'inflammation et d'hépatotoxicité, respectivement. Un fractionnement bio-guidé, et une méthode de déréplication ont été réalisés sur les extraits actifs afin d'établir leur profil chimique. Ces résultats vont dans le sens de la validation de l'utilisation traditionnelle de Terminalia macroptera dans le traitement du paludisme et des affections hépatiques, et peuvent servir de base pour l'élaboration d'un médicament traditionnel amélioré au Mali. / In Africa, the promotion of traditional pharmacopoeias is often a means of directing research towards new antimalarial drugs. Anti-malarial medicinal plants can be used as a basis for the formulation of improved traditional medicine (médicament traditionnel amélioré, MTA) or as a source of new antiplasmodial molecules. Based on a comprehensive literature search, 10 medicinal plants widely used in Mali for the treatment of malaria and liver disease (jaundice) were selected by a quantitative ethnopharmacology approach and evaluated in vitro on Plasmodium falciparum FcB1, leading to the selection of Terminalia macroptera (leaves and roots). Terminalia macroptera is a species widely used in Mali against malaria, fever, liver diseases (jaundice) and wound. In the context of the marketing of a Terminalia macroptera based MTA, a botanical monography has been carried out on previously cited plant organs in order to define pharmacopoeia standards for leaf and root powder in order to avoid falsification. An in vivo toxicological study and a pharmacological study in vivo (antiplasmodial, antipyretic, analgesic, anti-inflammatory and hepatoprotective activities) were carried out. Ethanolic extract from leaves and roots demonstrated antiplasmodial properties in vivo on mouse models of simple malaria and severe malaria, antipyretic, analgesic, anti-inflammatory and hepatoprotective properties on mouse models. A bioguided fractionation and a dereplication method were carried out on the active extracts in order to establish their chemical profile. These results support the validation of the traditional use of Terminalia macroptera in the treatment of malaria and liver disease, and may serve as a basis for the development of an improved traditional medicine in Mali.

Malaria is both a preventable and curable disease if treated early and appropriately. However, it is estimated that every 30 seconds a child dies of malaria in sub-Saharan Africa. The use of innovative eHealth/mHealth tools for malaria that seamlessly integrate into the workflow of healthcare workers could potentially ameliorate this problem. Successful design and development of these tools require an overarching understanding of the socio-technical context for the problems and opportunities in the application domain. A series of studies involving malaria management in the Millennium Village Project (MVP) cluster in rural Ghana were performed. A new method introduced by the author was applied to prioritize health information needs of stakeholders that have the potential to have a higher impact in solving health related problems. The result of applying this method was a group of impactful interventions for the MVP malaria program in Ghana. Findings from this study were validated with the MVP Ghana eHealth team, and after mutual agreement, an eHealth/mHealth intervention around malaria supply chain management was selected for further study. User-Centered Design (UCD) methods were adapted for use in a resource poor setting. Functional and non-functional requirements were identified. A low fidelity prototype was created and early usability inputs were collected. A high fidelity prototype was created to provide decision support to health workers through visualizations of stock levels and recommendations of quantities to order. Results from evaluation studies of the high fidelity prototype with end users suggest that they perceive the prototype as both easy to use and useful, with a potential for adoption and with a low risk of implementation. Usability problems found during the course of the study should be addressed to increase the potential of adoption. To obtain a more complete list of usability issues, both users’ and experts’ evaluations are recommended as well as the use of native and foreign test facilitators.

There is a growing interest in the dynamics of the co-infection of these two diseases. In this thesis, firstly we focus on studying the effect of a distributed delay representing the incubation period for the malaria parasite in the mosquito vector to possibly reduce the initial transmission and prevalence of malaria. This model can be regarded as a generalization of SEI models (with a class for the latently infected mosquitoes) and SI models with a discrete delay for the incubation period in mosquitoes. We study the possibility of occurrence of backward bifurcation. We then extend these ideas to study a full model of HIV and malaria co-infection. To get further inside into the dynamics of the model, we use the geometric singular perturbation theory to couple the fast and slow models from the full model. Finally, since the governing models are very complex, they cannot be solved analytically and hence we develop and analyze a special class of numerical methods to solve them.

This thesis entitled “Mechanism of Anticancer and Antimalarial Action of a Modulator of Heat Shock Proteins” describes the successful elucidation of the mechanism of anticancer and antimalarial action of 15-Deoxyspergualin (DSG). DSG, a relatively well known immunosuppressant and antitumor molecule has been demonstrated to kill the malaria parasite in vitro and in vivo (Midorikawa et al., 1997; Midorikawa et al., 1998). A highly polar molecule, DSG binds the carboxy terminal “EEVD” motif of heat shock proteins, Hsp70 and Hsp90, enhances the ATPase activity of Hsp70 (Nadler et al., 1992; Nadler et al., 1998), and modulates several seemingly unrelated cellular processes. DSG has also been demonstrated to inhibit protein synthesis and polyamine synthesis in cells (Kawada et al., 2002; Hibasami et al., 1991), and previously speculated to inhibit malaria parasite growth by inhibiting polyamine synthesis. The grim situation with regard to malaria infection and mortality, principally an offshoot of the emergence of chloroquine resistant strains of the causative agent of malaria - Plasmodium falciparum, calls for intense efforts towards developing efficacious antimalarial agents with few side effects. DSG, having been used already in graft rejection cases in man and demonstrated to potently inhibit malaria in mice (Midorikawa et al., 1997), offers promise in this regard. It was, therefore, of interest to solve the mystery of its mechanism of antimalarial action. Chapter 1 surveys literature related to DSG mechanism of action and presents the thesis objective. Chapter 1 also gives an overview of heat shock proteins and their role in cancer, and the biology of the malaria parasite (Plasmodium falciparum), the working of the principal metabolic pathways existing in it, and a description of processes related to the intriguing, relict plastid present in apicomplexans. The metabolic processes previously speculated to be targeted by DSG, and those later found to be involved in DSG mechanism of action – polyamine synthesis and transport, protein synthesis and apicoplast processes are dealt with in more detail. Though DSG has been speculated to kill the malaria parasite by inhibiting polyamine synthesis, that DSG could clear malaria infection in Plasmodium berghei infected mice did not corroborate with the observation that inhibitors of polyamine biosynthesis are incapable of inhibiting the malaria parasite in vivo probably because the parasites make do with polyamines salvaged from the host (Assaraf et al., 1984; Bitonti et al., 1987). On the other hand, DSG is known to bind heat shock proteins, and inhibit protein synthesis, and heat shock proteins are speculated to be involved in the activation of HRI (heme regulated inhibitor), a type of eIF2á kinase that phosphorylates the eukaryotic initiation factor, eIF2á in conditions of heme deficiency or other cellular stress. eIF2á phosphorylation leads to stalling of protein synthesis. It seemed likely that if HRI is activated upon sequestration of heat shock proteins by DSG, it would culminate in protein synthesis inhibition and ultimately, cell death. With the intention to investigate this line of thought, the PlasmodB database was mined for proteins essential to the existence of heme dependent protein synthesis in Plasmodium falciparum. Two Hsp70 proteins from Plasmodium falciparum, one with the carboxy terminal “EEVD” motif implicated in DSG binding, and one without, and an Hsp70 interacting protein were cloned and expressed in their recombinant form in Escherichia coli. The preliminary characterization of these heat shock proteins described in Chapter 2 revealed that they were functionally active. DSG did not inhibit either the chaperone activity of the Hsp70s or the interaction of Hsp70 with Hip, but stimulated their ATPase activity as anticipated. Chapter 3 gives a complete picture of the mechanism of protein synthesis inhibition by DSG in the standard protein synthesis system – reticulocyte lysate. The experiments carried out revealed that DSG inhibits protein synthesis precisely through the mechanism envisaged, i.e. through phosphorylation of HRI following sequestration of Hsp70. Experiments involving exogenous addition of heat shock protein to in vitro translation reactions confirmed this hypothesis. Moreover, DSG inhibited protein synthesis in cancer cells in vivo, too, and HRI knockdown cells were not affected by DSG. Interestingly, the Hsp70 levels in various cancer cell lines inversely correlated with the inhibitory activity of DSG, and modulation of Hsp70 levels through standard methods altered DSG inhibition of protein synthesis in these cells. It was thus confirmed that DSG did indeed inhibit mammalian cells through the pathway envisaged. Its previously reported antitumor property is probably through this outlined mechanism of interference with protein regulation. In the malaria parasite, too, DSG inhibited protein synthesis through eIF2 alpha phosphorylation following Hsp70 sequestration as outlined in Chapter 4. However, while the concentration of DSG required for inhibition of malaria parasite growth was in the nanomolar range, high micromolar concentrations of DSG were required to effect protein synthesis inhibition in the malaria parasite, indicating that yet another target for DSG existed in the malaria parasite. With protein synthesis no longer a candidate target of DSG, I looked into the previously implicated polyamine synthesis pathway. In the event of DSG inhibiting polyamine transport in addition to polyamine biosynthesis, it would be expected to clear malaria infection in vivo contrary to other inhibitors of polyamine biosynthesis. In Chapter 5, evidence for the polyamine synthesis pathway in the malaria parasite is provided. Experiments involving incorporation of radiolabeled precursors in the malaria parasite and in mammalian cells, however, revealed that only high micromolar concentrations of DSG inhibit polyamine synthesis. Polyamine transport was also studied in considerable detail in malaria parasite infected red blood cells. Though infected red blood cells demonstrated different kinetic parameters, implying that new polyamine transporters were employed by the parasite on the red blood cell upon infection, DSG did not potently inhibit polyamine transport, either. The mystery of the target of DSG in the malaria parasite was, however, close to solution, when the growth inhibition of the malaria parasite by DSG was studied carefully. DSG invoked “delayed death” – a phenomenon wherein death is invoked only one cycle after incubation with the inhibitor. “Delayed death” is typical of inhibitors that target apicoplast processes (Fichera and Roos, 1997). DSG did not inhibit either fatty acid synthesis or prokaryotic protein synthesis – processes that occur in the apicoplast, but effected a decrease in the amount of nucleus encoded proteins that are targeted to the apicoplast, suggesting that it inhibited the trafficking of nucleus encoded proteins to the apicoplast. Confocal microscopy of parasites transfected with GFP fusion protein confirmed these findings, and is described in Chapter 6. The thesis ends with a summary of the findings in Chapter 7. Apicoplast processes have always been considered to harbor immense potential in the development of antimalarial agents, thanks to the absence of an equivalent organelle and hence pathways, in the human host. Trafficking of nucleus encoded proteins to the apicoplast has remained unexplored however. The work done in this thesis not only serves to demystify DSG with regard to its mechanism of action, but also paves the way for further studies in this area of intracellular trafficking, which could help in the development of more efficacious antimalarial agents. It also adds a new dimension to previous work conducted with regard to the anticancer action of DSG. Appendix 1 revolves around inhibitors which target various apicoplast processes. Apicoplast processes have been conventionally linked to the intriguing but unfortunate (with respect to clinical application) “delayed death”. Results presented in this section demonstrate that not all apicoplast processes invoke “delayed death”. Inhibition of apicoplast processes such as fatty acid biosynthesis and heme synthesis evoke rapid death. Inhibitors designed to target these processes could, therefore, be highly efficacious.

Malaria afflicts 300-500 million people in the world and the mortality ranges from 1-2 million, children in Africa being the most susceptible. With a vaccine not being available against malaria and the front line drugs such as chloroquine and antifolates registering widespread parasite resistance, the challenge of malaria treatment is a formidable task. While, research to discover new drugs has become essential, it has also become necessary to identify therapeutic strategies in the short-term. One approach is to examine whether known drugs used for other applications can be used to treat malaria. A second strategy is to look for natural compounds for antimalarial activity either singly or in combination. Combination therapy has assumed considerable importance in the context of artemisinin derivatives being the sole, tested, efficacious antimalarials left in the basket. A combination therapy with artemisinin derivative may prevent recrudescence due to monotherapy, extend the life of the drug and perhaps bring down the cost of therapy as well. A primary requirement to embark on such studies is to assess the status of drug resistance to the front line drugs in use. In India, chloroquine is still used as the front line drug for malaria therapy. Although, there have been indications and sporadic reports on the development of chloroquine resistance in the country, there has not been a detailed molecular or clinical evaluation for resistance. Keeping all these considerations in mind, the objectives of the present study are as follows: 1. Evaluation of chloroquine resistance inP.falciparum isolates from patients using Pfcrt-mutation as marker. 2. Evaluation of the anti-tubercular drugs, rifampicin and isonicotinic acid hydrazide (INH) for antimalarial activity. 3. Evaluation of curcumin from turmeric singly and in combination with α,β- arteether for antimalarial acitivity. Chapter I deals with the review of literature pertaining to scenario of available antimalarials, efforts to discover new antimalarials based on new drug targets, mechanisms of drug resistance and strategies for combination therapies. Chapter II deals with an evaluation of Pfcrt mutation in clinical samples of P.falciparum malaria in India. After several false starts to find molecular markers to identify chloroquine resistance, mutations in the Pfcrt gene of P.falciparum, K76T mutation in particular, has been shown to correlate very well with chloroquine resistance in culture. A study of 109 P.falciparum – infected blood samples from different parts of India has revealed that close to 95% of the isolates carry the K76T mutation. This was shown on the basis of susceptibility to ApoI restriction digestion of the PCR product covering this region (264 nt) and DNA sequencing of the PCR product. Interestingly, the resistant haplotype in this region of 72-76 amino acids was found to be mostly SVMNT, except for 4 samples with CVIET haplotype. SVMNT has all along been considered to be of South American origin, where as CVIET is of South East Asian/African origin. Subsequent studies by another group in the country has also shown that the Pfcrt - K76T mutation is seen at least in 85% of the cases and in addition to the dominant SVMNT haplotype, newer haplotypes are also seen. The present study has also included an analysis of N86Y mutation in the Pfmdr1 gene based on susceptibility to Afl III restriction enzyme digestion and DNA sequencing of the PCR product (603 nt). Pfmdr1 mutations have been extensively studied in literature for possible correlation to CQR. The net conclusion is that it does not contribute directly to CQR but may have an indirect correlation. It has been shown in Mali that there is very good correlation between Pfcrt - K76T mutation and Pfmdr1 - N86Y mutation in the P.falciparum isolates. However, in the present study with Indian isolates only around 30% of the samples were found to carry the Pfmdr1 - N86Y mutation. While, further studies on the clinical relevance of the extensive Pfcrt mutation seen in the Indian isolates are needed, it is clear that the genetic change towards chloroquine resistance has already taken place in the Indian context. Chapter III is devoted to a study of the antimalarial effects of the anti-tubercular drugs, rifampicin and INH. This is on the basis that rifampicin is an inhibitor of prokaryotic and mitochondrial/chloroplast RNA polymerase. P.falciparum harbors the apicoplast, a remnant of chloroplast with a 35kb DNA. It is known that the β, β’- subunits of the apicoplast RNA polymerase are coded by the apicoplast DNA. There is a report that rifampicin is a slow acting antimalarial in cases of P.vivax -nfection. INH is known to act by inhibiting the enoyl-ACP reductase and β - hydroxy ACP synthase in M.tuberculosis. While, M.tuberculosis is known to manifest Fab I and Fab II pathways of fatty acid biosynthesis, it has recently been shown that P.falciparum manifests the FabII (discrete enzymes) pathway. Thus, it was considered possible that INH may also inhibit the fatty acid biosynthetic pathway of P.falciparum leading to inhibition of phospohlipid and membrane biosynthesis. Studies were, therefore, carried out with rifampicin, INH and the combination on the survival of P.falciparum in culture and P.berghei in mice. With P.falciparum, growth was followed by measuring3[H]-Hypoxanthine incorporation and slide detection of parasites using Giemsa stain. The results indicate that while, rifampicin inhibits P.falciparum growth with an IC50 around 25nM, and INH fails to show any effect even at 200µM concentration. The combination of rifampicin (25nM) and INH (100µM) shows enhanced killing effect. In view of these results, studies were undertaken in mice infected with P.berghei. After 72 hr infection, the mice were orally fed with rifampicin (500 µg/40 g body weight) or INH (1 mg/40 g body weight) or a combination of the two orally for 5 days, starting on day 3. Apart from parasite clearance in blood, protection against mortality is a good index, since all the infected mice die in about 7-8 days. The results indicate that rifampicin leads to around 50% protection and INH treatment gives around 10% protection. However, the combination gives around 83% protection with complete clearance of the parasite in blood. Short- term treatment of infected mice with drugs and an assay of rpoB/C transcription in the parasite using appropriate PCR primers reveal a striking inhibition in combination treatment. Again, when such parasites were put into short-term culture and32P- incorporation into phospholipids was measured, there was striking inhibition with combination treatment. Thus, the results indicate that a combination of rifampicin and INH has potent antimalarial activity in P.berghei-infected mice. The results are dramatic in this case when compared to the results obtained with P.falciparum culture. It is not clear whether the differences are due to differences in action in vitro vs in vivo or due to differences in susceptibility between P.falciparum and P. berghei to the treatment provided. Chapter IV deals with the antimalarial activity of curcumin (diferuloyl methane) from turmeric singly or in combination with artemesinin or its derivative. Curcumin is reported to have a wide variety of biochemical effects and its anti-cancer activity is under serious investigation. There is an earlier report that curcumin shows antimalarial activity against chloroquine-sensitive P.falciparum. In the present study, curcumin was tested against a chloroquine-resistant culture of P.facliparum and it inhibits growth with an IC50 of 5-8 µM. When P.berghei-infected mice were orally fed with curcumin for 5 days, there was delay in the development of parasitemia, with about 30% of the animals protected against mortality by day 28. For reasons mentioned earlier curcumin was tested in combination with artemisinin/derivative in P.falciparum culture and P.berghei in mice. The results indicate that artemisinin and curcumin have an additive inhibitory effect on P.falciparum growth, based on a detailed analysis of the isobolograms. In terms of the mechanism of action, curcumin treatment leads to accumulation of45Ca in the parasite cytoplasm. It also has a striking inhibitory effect on32P-incorporation into parasite proteins and phospholipids, suggesting an interference with phosphorylation mechanisms. None of these effects are seen under artemisinin treatment, which has been reported to specifically inhibit PfATP6 (Ca ATPase) in P.falciparum. In view of the possible different modes of action of artemisinin and curcumin, the combination was tested in P.berghei-infected mice. The infected mice received a single injection of α,β-arteether and 3 oral doses of curcumin (5mg/30g body weight). Curcumin treatment was found to dramatically delay the onset of parasitemia seen in animals treated with α,β-arteether alone due to recrudescence. In particular, a combination with a single injection of α,β-arteether (750µg or 1.5mg/30g body weight) followed by 3 oral doses of curcumin leads to complete prevention of recrudescence and 100% protection against mortality. Several combinations with artemisinin derivative are under investigation and they all suffer from toxic side effects, pharmacokinetic mismatch, known resistance to the combining partner and high cost. It is felt that this artemisinin derivative curcumin combination could prove superior in view of the fact that no resistance is known to curcumin and is safe even at very high doses used in the human. Both the drugs are eliminated fast and curcumin is a cheap chemical and available in plenty from natural source (turmeric). In view of these positive attributes, a clinical trial with this combination is recommended. 121

There is a growing interest in the dynamics of the co-infection of these two diseases. In this thesis, firstly we focus on studying the effect of a distributed delay representing the incubation period for the malaria parasite in the mosquito vector to possibly reduce the initial transmission and prevalence of malaria. This model can be regarded as a generalization of SEI models (with a class for the latently infected mosquitoes) and SI models with a discrete delay for the incubation period in mosquitoes. We study the possibility of occurrence of backward bifurcation. We then extend these ideas to study a full model of HIV and malaria co-infection. To get further inside into the dynamics of the model, we use the geometric singular perturbation theory to couple the fast and slow models from the full model. Finally, since the governing models are very complex, they cannot be solved analytically and hence we develop and analyze a special class of numerical methods to solve them.