Thesis (Ph.D.)(Biochemistry)--University of Pretoria, 2002. / Includes bibliographical references.

Thesis (Ph.D.)(Biochemistry))--University of Pretoria, 2008. / Includes summary. Includes bibliographical references. Available on the Internet via the World Wide Web.

Made available in DSpace on 2015-05-14T16:53:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-04-15Bitstream added on 2015-05-14T16:59:11Z : No. of bitstreams: 1 000828911.pdf: 473053 bytes, checksum: 63407242b7f0b46a1ef661b3ea907e82 (MD5) / Introdução: O envolvimento do sistema cardiovascular em pacientes com malária por Plasmodium vivax tem sido pouco estudado. Neste trabalho, avaliamos as estruturas cardíacas, a função ventricular e marcadores sistêmicos de lesão cardiovascular em pacientes com a forma não-grave da malária por P. vivax, em Manaus, estado do Amazonas, Brasil. Métodos: Foram avaliados, prospectivamente, 26 pacientes adultos com malária por P. vivax em tratamento ambulatorial, no período de janeiro de 2012 a março de 2013. Os resultados foram comparados com grupo controle de 25 indivíduos saudáveis, pareados por gênero e idade. Avaliação clínica, exames laboratoriais e ecocardiografia transtorácica foram realizados na primeira avaliação após o diagnóstico de malária (dia zero, D0) e sete dias após (D7) início do tratamento. Resultados: Os Casos apresentaram maiores valores do diâmetro sistólico do ventrículo esquerdo (VE; 28,8±2,82 vs 30,9±4,03 mm; p=0,037) e do volume diastólico do VE (82,4±12,3 vs 93,8±25,9 ml; p=0,05) e menor fração de ejeção do VE (método de Teicholz: 73,2±6,59 vs 68,4±4,87; p=0,004) que os Controles. A fração de variação da área do ventrículo direito (VD) foi menor (54,7±5,11 vs 50,5±6,71 %; p=0,014) e o índice de performance miocárdica do VD (0,21±0,71 vs 0,33±0,19; p=0,007), a área diastólica do VD (13,0±3,19 vs 15,3±2,96 cm2; p=0,009 ), a área de sistólica do VD (6,41±1,27 vs 7,45±1,46 cm2; p=0,009) e a resistência vascular pulmonar (1,13±0,25 vs 1,32±0,26 unidades Woods; p=0,012) foram maiores nos Casos que nos Controles. A fração de variação da área do VD foi também menor e a resistência vascular pulmonar maior nos Casos no D0 que no D7. No D0, os Casos apresentaram maior concentração sérica de bilirrubina indireta, da molécula de adesão celular vascular solúvel tipo 1, do fragmento N-terminal do pró-peptídeo natriurético cerebral e da troponina T, e menor ... / Purpose: Malaria is an endemic disease in the Amazon Region. In Brazil it has been largely attributed to Plasmodium vivax infection since the 1990’s. Cardiovascular system involvement in patients with P. vivax malaria has been poorly addressed. The aim of this study was to evaluate cardiac structures and function and serum markers of cardiovascular injury in patients with the nonsevere form of P. vivax malaria in Manaus, Amazonas state, Brazil. Methods: In an observational study, we prospectively evaluated 26 patients with P. vivax malaria in an outpatient referral hospital from January 2012 to March 2013 and compared results with a control group of 25 gender- and age-matched healthy individuals. Patients underwent clinical evaluation, laboratory tests, and transthoracic echocardiography at first evaluation after malaria diagnosis (day zero, D0) and seven days after starting malaria treatment (day seven, D7). Results: Echocardiography showed higher left ventricular (LV) systolic diameter (28.8±2.82 vs 30.9±4.03 mm; p=0.037) and LV diastolic volume (82.4±12.3 vs 93.8±25.9 ml; p=0.05), and lower LV ejection fraction (Teicholz method: 73.2±6.59 vs 68.4±4.87; p=0.004) values in patients than controls. Right ventricle (RV) fractional area change (54.7±5.11 vs 50.5±6.71%; p=0.014) was lower, and RV myocardial performance index (0.21±0.71 vs 0.33±0.19; p=0.007), RV diastolic area (13.0±3.19 vs 15.3±2.96 cm2; p=0.009) and systolic area (6.41±1.27 vs 7.45±1.46 cm2; p=0.009), and pulmonary vascular resistance (1.13±0.25 vs 1.32±0.26 Woods unit; p=0.012) were higher in patients than controls. RV fractional area change was lower and pulmonary vascular resistance higher in patients in D0 than D7. In D0, patients presented higher serum levels of indirect bilirubin, soluble vascular cell adhesion molecule–1 (sVCAM-1), Nterminal prohormone brain natriuretic peptide, and troponin T, and lower levels of nitric oxide than D7 and controls

Orientador: Marina Politi Okoshi / Coorientador: Marcus Vinícius Guimarães de Lacerda / Coorientador: Katashi Okoshi / Banca: Roberto Jorge da Silva Franco / Banca: José Francisco Kerr Saraiva / Banca: Eros Antonio de Almeida / Banca: Alexandre Rodrigues / Resumo: Introdução: O envolvimento do sistema cardiovascular em pacientes com malária por Plasmodium vivax tem sido pouco estudado. Neste trabalho, avaliamos as estruturas cardíacas, a função ventricular e marcadores sistêmicos de lesão cardiovascular em pacientes com a forma não-grave da malária por P. vivax, em Manaus, estado do Amazonas, Brasil. Métodos: Foram avaliados, prospectivamente, 26 pacientes adultos com malária por P. vivax em tratamento ambulatorial, no período de janeiro de 2012 a março de 2013. Os resultados foram comparados com grupo controle de 25 indivíduos saudáveis, pareados por gênero e idade. Avaliação clínica, exames laboratoriais e ecocardiografia transtorácica foram realizados na primeira avaliação após o diagnóstico de malária (dia zero, D0) e sete dias após (D7) início do tratamento. Resultados: Os Casos apresentaram maiores valores do diâmetro sistólico do ventrículo esquerdo (VE; 28,8±2,82 vs 30,9±4,03 mm; p=0,037) e do volume diastólico do VE (82,4±12,3 vs 93,8±25,9 ml; p=0,05) e menor fração de ejeção do VE (método de Teicholz: 73,2±6,59 vs 68,4±4,87; p=0,004) que os Controles. A fração de variação da área do ventrículo direito (VD) foi menor (54,7±5,11 vs 50,5±6,71 %; p=0,014) e o índice de performance miocárdica do VD (0,21±0,71 vs 0,33±0,19; p=0,007), a área diastólica do VD (13,0±3,19 vs 15,3±2,96 cm2; p=0,009 ), a área de sistólica do VD (6,41±1,27 vs 7,45±1,46 cm2; p=0,009) e a resistência vascular pulmonar (1,13±0,25 vs 1,32±0,26 unidades Woods; p=0,012) foram maiores nos Casos que nos Controles. A fração de variação da área do VD foi também menor e a resistência vascular pulmonar maior nos Casos no D0 que no D7. No D0, os Casos apresentaram maior concentração sérica de bilirrubina indireta, da molécula de adesão celular vascular solúvel tipo 1, do fragmento N-terminal do pró-peptídeo natriurético cerebral e da troponina T, e menor ... / Abstract: Purpose: Malaria is an endemic disease in the Amazon Region. In Brazil it has been largely attributed to Plasmodium vivax infection since the 1990's. Cardiovascular system involvement in patients with P. vivax malaria has been poorly addressed. The aim of this study was to evaluate cardiac structures and function and serum markers of cardiovascular injury in patients with the nonsevere form of P. vivax malaria in Manaus, Amazonas state, Brazil. Methods: In an observational study, we prospectively evaluated 26 patients with P. vivax malaria in an outpatient referral hospital from January 2012 to March 2013 and compared results with a control group of 25 gender- and age-matched healthy individuals. Patients underwent clinical evaluation, laboratory tests, and transthoracic echocardiography at first evaluation after malaria diagnosis (day zero, D0) and seven days after starting malaria treatment (day seven, D7). Results: Echocardiography showed higher left ventricular (LV) systolic diameter (28.8±2.82 vs 30.9±4.03 mm; p=0.037) and LV diastolic volume (82.4±12.3 vs 93.8±25.9 ml; p=0.05), and lower LV ejection fraction (Teicholz method: 73.2±6.59 vs 68.4±4.87; p=0.004) values in patients than controls. Right ventricle (RV) fractional area change (54.7±5.11 vs 50.5±6.71%; p=0.014) was lower, and RV myocardial performance index (0.21±0.71 vs 0.33±0.19; p=0.007), RV diastolic area (13.0±3.19 vs 15.3±2.96 cm2; p=0.009) and systolic area (6.41±1.27 vs 7.45±1.46 cm2; p=0.009), and pulmonary vascular resistance (1.13±0.25 vs 1.32±0.26 Woods unit; p=0.012) were higher in patients than controls. RV fractional area change was lower and pulmonary vascular resistance higher in patients in D0 than D7. In D0, patients presented higher serum levels of indirect bilirubin, soluble vascular cell adhesion molecule-1 (sVCAM-1), Nterminal prohormone brain natriuretic peptide, and troponin T, and lower levels of nitric oxide than D7 and controls / Doutor

Malaria causes nearly 3 million deaths annually. The parasite species responsible for the most lethal forms of malaria is P. falciparum (Miller et.al., 2002). Its destructive effect is most evident in the developing African countries, which lack the infrastructure and financial support to effectively control the disease. The only viable means of control at this stage is the use of antimalarial chemotherapy and –prophylaxis, but these drugs are losing their effectivity due to parasite resistance. This underlines the need for new, safe, efficient and cheap drugs as a solution to the African malaria problem. Within the validated folate metabolic pathway of P. falciparum, the identification of three new genes has provided new options for drug inhibition (Lee et.al., 2001). One of these genes encodes the bifunctional dihydrofolate synthase-folylpolyglutamate synthase (DHFS-FPGS), which is unique to P. falciparum (Salcedo et.al., 2001). When compared to human folylpolyglutamate synthase (FPGS), the parasite enzyme is an attractive drug target for selective inhibition due to the additional DHFS activity and low sequence similarity. However, to assess the value of DHFS-FPGS as a drug target and rationally design new drugs against the enzyme, large amounts of enzyme are needed for activity studies and structural determination. The heterologous expression of malaria genes often result in low expression levels, due to its high A+T content and codon bias. To circumvent this problem, a modified P. falciparum dhfs-fpgs, adapted to E.coli codon preferences and with a lower A+T content was synthesised in this study for increased expression. A two-step overlap-extension PCR method was optimised for the synthesis of the 1586bp dhfs-fpgs from only 1 pmol each of partially overlapping oligonucleotides. The use of partially overlapping oligonucleotides, lower amounts of starting material and fewer PCR cycles cut the costs of gene synthesis and the optimisation increased PCR efficiency, when compared to other gene synthesis reports (Carpenter et al., 1999; Zhang et al., 2002). The correct sequences could be obtained from the sequencing of as little as three clones. The successfully constructed dhfs-fpgs gene was expressed in a variety of E. coli expression hosts and vector systems. In all the systems, expression levels of the synthetic gene were much higher than for the native P. falciparum gene. Functional complementation of a DHFS-FPGS deficient E. coli strain verified that the DHFS and FPGS activities were encoded by the synthetic gene, that complementation was achieved to a greater extent than for native P. falciparum dhfs-fpgs and that a synthetic tagless and C-terminal Histidine-tagged DHFS-FPGS had the highest levels of DHFS and FPGS activity. Preliminary purification studies for these two constructs were performed for optimised enzyme isolation, to be followed by activity assays. These optimisations will also serve as basis for future large-scale isolation strategies to obtain sufficient amounts of protein for the structural determination of the enzyme, which would be vital to drug target verification, drug development and –design, thus paving the way for a new generation of antifolate malaria therapy. / Dissertation (MSc(Biochemistry))--University of Pretoria, 2006. / Biochemistry / unrestricted

Malaria remains one of the most serious tropical infectious diseases affecting mankind. The prevention of the disease is hampered by the increasing resistance of the parasite to existing chemotherapies. The need for novel therapeutic targets and drugs is therefore of the utmost importance and detailed knowledge of the biochemistry of the parasite is imperative. This study was directed at the biochemical characterisation of the polyamine metabolic pathway of P. falciparum in order to elucidate differences between the parasite and its human host that can be exploited in the design of novel antimalarials. The thesis focussed on the two rate-limiting enzymes in polyamine biosynthesis, S¬adenosylmethionine decarboxylase (AdoMetDC) and ornithine decarboxylase (ODC), which occur as a unique bifunctional complex in P. falciparum. The genomic structure of the bifunctional gene indicated a single, monocistronic transcript with large untranslated regions that were predicted to be involved in unique translational regulatory mechanisms. This gives rise to a bifunctional protein containing both decarboxylase activities on a single polypeptide forming a heterotetrameric complex. Activity of the decarboxylases decreases dramatically if these proteins are expressed in their monofunctional forms as homodimeric ODC and heterotetrameric AdoMetDC. The deduced amino acid sequence indicated that all the essential residues for catalysis are conserved and highlighted the presence of three parasite-specific insertions. The parasite-specific inserts were shown to be essential for the catalytic activity of the respective domains and also to influence the activity of the neighbouring domain, indicating that intramolecular communication exists in the heterotetrameric complex. The most structured and smallest insert was also shown to mediate protein-protein interactions between the two domains and to stabilise the complex. Further structure- functional characterisations of specifically the ODC domain were deduced from a comparative homology model. The model predicted an overall structure corresponding to those of other homologous proteins. The validity of the model is supported by mutagenesis results. However, certain parasite-specific properties were identified in the active site pocket and dimerisation interface. The former was exploited in the rational design of novel putative ODC inhibitors directed only against the P. falciparumprotein by in silico screening of chemical structure libraries. This study therefore describes the identification of certain parasite-specific properties in a unique bifunctional protein involved in regulation of polyamine metabolism of P. falciparum. Such discoveries are invaluable in strategies aimed at elucidating biochemical and metabolic differences between the parasite and its human host that could be exploited in the design of alternative, parasite-specific chemotherapies. Moreover, the thesis also contributed new knowledge on certain less well-understood biological phenomena characteristic of P. falciparum, the nature and origin of bifunctional proteins and the functional properties of parasite-specific inserts found in some proteins of the parasite. / Thesis (PhD (Biochemistry))--University of Pretoria, 2002. / Biochemistry / unrestricted

Department of Chemistry / MSc (Chemistry) / Due to the increasing incidence of Plasmodium strains that are resistant to current frontline antimalarial drugs, malaria remains a global public health challenge. In recent years, the emergence of resistance to frontline antimalarial drugs including the more recently discovered artemisinin class drugs has become one of the greatest challenges of controlling malaria incidence and mortality. There is, therefore, an urgent need to develop novel targets and antimalarial drugs that are effective against drug-resistant malarial parasites. Recent studies have demonstrated that calcium dependent protein kinases (CDPKs) regulate a variety of biological processes in the malaria parasite Plasmodium falciparum and that CDPK4 is important for parasite development. The gene disruption of CDPK4 in Plasmodium berghei, which results in major defects in sexual differentiation of the parasite has highlighted the importance of CDPK4 in Plasmodium biology and suggests that it may be used as a target for therapeutic drugs. PfCDPK4 is expressed in the gamete/gametocyte stage, and this could make PfCDPK4 an essential target for malaria drug discovery. The structure of PfCDPK4 was used as a template in the discovery of malaria drug leads and in designing chemical compounds or inhibitors that will show anti-parasitic activity against the target molecule. The model structure of PfCDPK4 was generated through homology modelling, and model structure validation confirmed that the model structure of PfCDPK4 is of stereochemical quality. The molecular modelling approach of in silico screening was utilized in this research, wherein a large library of chemical compounds, some natural chemical compounds, and clinically approved kinase inhibitors were screened against the target molecule PfCDPK4. In silico screening of the Bio-Focus library against PfCDPK4 resulted in twenty-six compounds being identified; in vitro single screening at a concentration of 5 μM confirmed that three compounds exhibit moderate antimalarial activity against the NF54 strain of Plasmodium falciparum, with the percentage inhibition ranging between 42% and 47%.

PhD (Biochemistry) / Department of Biochemistry / The main malaria agent, Plasmodium falciparum expresses an Hsp70 (PfHsp70-1) which plays a significant role in parasite survival. PfHsp70-1 is distinct in that it possesses glycine-glycine-methionine-proline (GGMP) tetrapeptide repeats in its C-terminal domain. To date, the GGMP motif of PfHsp70-1 has not been studied. The motif is positioned within the C-terminal lid segment of PfHsp70-1. The motif is also about seven residues upstream the terminal EEVD residues that are responsible for the interaction of PfHsp70-1 with its functional regulators (co-chaperones). P. falciparum Hsp70/Hsp90 organizing protein (PfHop) constitutes one of the functional regulators of PfHsp70-1. PfHop allows PfHsp70-1 and its chaperone partner, PfHsp90 to form a functional partnership. Given the proximity of the GGMP repeats to the C-terminus of PfHsp70-1, it was postulated in this study that the GGMP repeat residues may regulate attachment of PfHop to PfHsp70-1. Hence, this study hypothesized that the GGMP repeat motif is important for the interaction between PfHop and PfHsp70-1 as well as the chaperone activity of PfHsp70-1. Two variants in which the N-terminal and the C-terminal GGMP repeats were conservatively substituted were generated. E. coli Hsp70 (DnaK) lacks a GGMP motif. Thus, the GGMP motif of PfHsp70-1 was introduced into E. coli DnaK in order to generate a third GGMP variant. Recombinant forms of PfHsp70-1, DnaK, and their GGMP variants were heterologously expressed in E. coli XL1 Blue cells. The proteins were purified to homogeneity by using a combination of Ni-NTA affinity chromatography, ion exchange, and size exclusion chromatography. Purified proteins were then biophysically characterized using CD spectroscopy and tryptophan fluorescence. Findings from this study revealed that there were minimal secondary structural differences between PfHsp70-1, DnaK and their GGMP variants. In order to investigate the chaperone function of PfHsp70-1, DnaK and the GGMP variants, a complementation assay in E. coli dnak756 cells whose Hsp70 is functionally compromised was conducted. The PfHsp70-1 GGMP variants were able to suppress the thermosensitivity of the E. coli cells. However, the Investigation of the role of GGMP motif of Plasmodium falciparum Hsp70-1 on the chaperone function of the protein and its interaction with a co-chaperone, PfHop ii DnaK-G variant failed to confer cytoprotection to the E. coli dnak756 cells. To further validate the findings from the complementation assay, the ability of the recombinant proteins to suppress aggregation of heat stressed Malate dehydrogenase (MDH) was elucidated. PfHsp70-1 had better MDH aggregation suppression capabilities than its GGMP variants. Overall, findings from the MDH aggregation suppression assay suggest that the GGMP repeats may contribute towards substrate binding. Substrate binding might be dependent on the specific positioning of a particular repeat in the GGMP motif of PfHsp70-1. Furthermore, the ATPase activity of PfHsp70-G632 and PfHsp70-G648 was significantly reduced compared to PfHsp70-1 (wild type). However, PfHsp70-G632 had the lowest ATPase activity. Interestingly, the ATPase activity of PfHsp70-G632 was enhanced in the presence of synthetic Hsp70 model peptide substrates. Slot blot and ELISA approaches confirmed that the GGMP mutations partially abrogated the interaction of PfHsp70-1 with PfHop. Altogether, the findings suggest that the GGMP motif of PfHsp70-1 has marginal effects on the structure of PfHsp70-1. In conclusion, this study provides the first direct evidence that the GGMP motif is important for the chaperone function of PfHsp70-1 as well as its interaction with PfHop. / NRF

MSc (Biochemistry) / Department of Biochemistry / Malaria is a disease that claims about half a million lives annually, mainly children. There are 5 Plasmodium species that cause malaria; namely, P. falciparum, P. ovale, P. malariae, P. knowlesi and P. vivax. P. falciparum is the most virulent of them all. The parasite upregulates some heat shock proteins (Hsps) in response to stress it encounters during its life cycle. These Hsps play a major role in proteostasis. The drug resistance of P. falciparum to traditionally used remedies has led to a need for the development of novel drugs. Hsps have been implicated as antimalarial drug targets. Hsps act as molecular chaperones and some make complexes, which are important in facilitating protein folding. As an example, heat shock protein 70 (Hsp70) and heat shock protein 90 (Hsp90) form a functional complex through an adaptor protein, Hsp70-Hsp90 organizing protein (Hop). P. falciparum expresses six Hsp70s that are localized in different subcellular compartments. Amongst them, P. falciparum Hsp70-x (PfHsp70-x), is exported to the erythrocyte where it is implicated in host cell remodeling. PfHsp70-x possesses an ATPase domain, substrate binding domain and a C-terminal subdomain. PfHsp70-x possesses an EEVN motif on its C-terminus which is implicated in interactions with co-chaperones amongst them, Hop. Although some of the chaperone functions of PfHsp70-x have been reported, its interaction with human chaperones has not been investigated. The availability of PfHsp70-x in the infected erythrocyte cytosol presents a possibility that this protein may functionally cooperate with human Hsp90 via human Hop (human Hop). This hypothesis that PfHsp70-x interacts with human chaperones is strengthened by the absence of Hsp90 and Hop of parasite origin in the infected erythrocytes. The main aim of this study was to explore the chaperone activity of PfHsp70-x and its functional co-operation with human Hop. Recombinant PfHsp70-x (full length and EEVN deletion mutant) proteins were expressed in E. coli XL1 Blue cells and purified using nickel affinity chromatography. PfHsp70-x was found to be structurally comprised of mostly alpha helices and demonstrated heat stability based on circular dichroism (CD) spectrometry studies. It was established that the EEVN motif may be important for the ATPase activity of PfHsp70-x. However, it was established that the EEVN motif was not important in regulating the holdase chaperone (protein aggregation suppression) function of PfHsp70-x. Furthermore, PfHsp70-x and its mutant preferentially bound to asparagine-rich peptides. Parasite proteins have high asparagine repeat regions as compared to human proteins. In addition, preference for asparagine-rich proteins iii could signify that PfHsp70-x is biased towards binding proteins of parasitic origin. Surface plasmon resonance (SPR) analysis suggested that PfHsp70-x interacts with human Hop with relatively higher affinity compared to its EEVN minus derivative. In conclusion, the removal of the EEVN motif of PfHsp70-x does not affect the chaperone function of PfHsp70-x. However, the EEVN motif is essential for the interaction of PfHsp70-x with human Hop.

Introduction: Le paludisme est une maladie parasitaire curable. Il sévit sous une forme endémique depuis des temps immémoriaux. Malgré le recul de l’endémie observé au cours de la dernière décennie à la suite des efforts menés à un niveau international, l’Afrique essentiellement tropicale continue encore à supporter une importante charge de morbidité et de mortalité liée au paludisme. L’Organisation Mondiale de la Santé (OMS) estime que sur les 216 millions malades et 655 000 décès survenus dans le monde en 2010, respectivement 80,6% et 91,6% l’étaient en Afrique tropicale. Au cours de cette année 2010, dans cette partie du monde, à chaque minute, un enfant de moins 5 ans est décédé des suites du paludisme. A elle seule, la République Démocratique du Congo (RDC) a supporté 13,3% de la charge mondiale de morbidité estimée en 2010. <p>La malnutrition est un autre fléau qui frappe le monde depuis la nuit des temps. Les pays les plus touchés sont ceux-là mêmes qui sont concernés par l’endémie palustre. En 2010, 38% d’enfants africains âgés de moins de 5 ans souffraient d’un retard de croissance et 9% étaient émaciés. Ces formes de malnutrition concernaient respectivement 43% et 9% d’enfants de la RDC. <p>Le paludisme et la malnutrition coexistent. Néanmoins, leur relation demeure un sujet de controverse malgré de nombreuses études menées sur le sujet. Certains auteurs affirment que la malnutrition protégerait contre le paludisme alors que d’autres soutiennent le contraire. Une troisième catégorie d’auteurs atteste qu’il n’existe aucune relation. <p>Ces divergences de points de vues font que, sur le terrain, dans une même localité, certains préconisent le traitement systématique du paludisme au cours de la réhabilitation nutritionnelle alors que d’autres n’administrent les médicaments que pour les cas avérés de paludisme. <p>Dans le but de contribuer non seulement à l’amélioration des connaissances sur cette relation entre la malnutrition et le paludisme, mais aussi à la rationalisation de la prise en charge du paludisme dans les zones de coexistence des deux entités, des études ont été menées au Kivu, dans la partie Est de la RDC. <p>Méthodologie:En vue d’atteindre ce but, les résultats de six analyses de données, portant sur cinq études épidémiologiques menées au Kivu en RDC, sont présentés dans cette monographie. <p>La monographie est composée de quatre parties. La première partie est consacrée à des généralités sur le paludisme et la malnutrition et la quatrième partie est une synthèse générale. <p>Les résultats des six analyses évoquées ci-haut font, chacun l’objet d’un chapitre et sont regroupés au sein de deux parties portant respectivement sur la description de la relation entre la malnutrition et le paludisme (deuxième partie) et sur le traitement antipaludéen chez l’enfant sévèrement malnutri (troisième partie). <p>La description de la relation entre le paludisme et la malnutrition est le résultat des analyses de données de trois études. Les deux premières études font l’objet d’analyses rétrospectives des données de routine récoltées au sein de l’hôpital pédiatrique de Lwiro. La troisième étude est prospective et réalisée en communauté. <p>Le traitement antipaludéen chez l’enfant sévèrement malnutri est abordé à travers deux études menées en milieu hospitalier. <p>La première étude de cette partie a été menée à l’hôpital pédiatrique de Lwiro. Cette étude portait sur l’efficacité de la combinaison Artésunate-Amodiaquine (AS+AQ) dans le traitement du paludisme non compliqué à Plasmodium falciparum. Elle a été réalisée suivant le protocole standard de l’OMS portant sur l’évaluation et la surveillance de l’efficacité des antipaludiques pour le traitement du paludisme à Plasmodium falciparum non compliqué. Cependant, en plus des enfants habituellement inclus dans ces études d’efficacité selon le protocole de l’OMS, cette étude a intégré les enfants souffrant de la malnutrition sévère. Cette étude a conduit à deux analyses distinctes ayant fait chacune l’objet d’un chapitre. La première analyse s’est focalisée sur l’efficacité proprement dite du traitement antipaludéen. La seconde analyse a utilisé les données individuelles des enfants inclus dans cette étude sur l’efficacité du traitement antipaludéen pour explorer la production des gamétocytes de Plasmodium falciparum chez l’enfant souffrant de Malnutrition Aigue Sévère (MAS). <p>La deuxième étude de cette partie consacrée au traitement antipaludéen chez l’enfant malnutri sévère porte sur l’efficacité d’une stratégie de traitement antipaludéen systématique chez l’enfant malnutri au cours de la réhabilitation nutritionnelle. Il s’est agi d’un essai clinique randomisé en double aveugle, réalisé au centre thérapeutique nutritionnel de l’hôpital général de référence de Kirotshe. Les enfants malnutris admis dans le programme de réhabilitation nutritionnelle étaient assignés dans l’un des deux groupes d’étude selon une procédure aléatoire. Le groupe d’intervention recevait systématiquement la combinaison AS+AQ à la posologie habituelle et le groupe témoin recevait un placebo composé d’avicel 97,1%, stéarate de magnésium 1,9%, aérosil 1% et de colorant.<p>Les quatre premières études ont eu lieu dans la zone de santé de Miti Murhesa dans la province du Sud Kivu et la dernière a été menée dans la zone de santé de Kirotshe dans la province du Nord Kivu en RDC. <p>Résultats: [1] \ / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished