El objetivo de esta investigación retrospectiva, fue determinar la asociación existente entre mutaciones puntuales en los genes dihidrofolato reductasa (Pfdhfr) y dihidropteroato sintasa (Pfdhps) de Plasmodium falciparum y la respuesta clínica en pacientes con diagnóstico de malaria no complicada causada por P. falciparum, admitidos en un estudio de eficacia in vivo de sulfadoxina-pirimetamina (SP) llevado a cabo en dos áreas de la región Loreto en 1999. Se tomaron muestras de sangre de 86 pacientes antes de administrarles SP, las que se analizaron usando PCR-anclado específico de alelo para estudiar a los codones S108N/T, N51I, C59R, I164L y C50R del gen Pfdhf y los codones A436G, A437G, K540E, A581G y A613S/T del gen Pfdhps, encontrándose que las infecciones causadas por parásitos con 3 mutaciones en Pfdhfr (108Asn/51Ile/164Leu) y 2 (581Gli/437Gli) ó 3 mutaciones en Pfdhps (581Gli/437Gli/540Glu) denominados el quíntuple mutante y el séxtuple mutante, respectivamente, se encontraban asociadas con la falla del tratamiento con SP. Además, se estableció que cuanto más alto era el número de mutaciones tanto en Pfdhfr como en Pfdhps, más alto era el riesgo de fallar al tratamiento con SP, según resultado del análisis de regresión logística empleado para asociar a estas dos variables. Este estudio contribuye en brindar evidencias científicas de la asociación existente entre las variables en la región Loreto contribuyendo a su validación y su futuro uso para estudios de vigilancia de fármaco resistencia a SP no solo en el Perú sino en general para los países de América del Sur que comparten territorio de la selva Amazónica. / -- The objective of this retrospective study was to determine the asociation between point mutations in dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) Plasmodium falciparum genes, and clinical outcome of patients with non complicated P.falciparum malaria diagnosis, admitted to a in vivo sulphadoxine-pirymethamine (SP) drug efficacy study conducted in 1999, in two areas of Loreto region. We used allelic specific-nested PCR to analize 86 blood samples collected before SP treatment, and study mutations at codons S108N/T, N51I, C59R, I164L and C50R in Pfdhfr and codons A436G, A437G, K540E, A581G y A613S/T in Pfdhps genes, and found that Infections caused by parasites harbouring 3 mutations in Pfdhfr (108Asn/51Ile/164Leu) and either 2 or 3 mutations in Pfdhps (581Gly/437Gly and 540Glu) called the quintuple and sextuple mutants, respectively, were associated to failure with SP treatment. Logistic regression analysis was used to look for association between the variables, helping to establish the higher the number of mutations in both Pfdhfr and Pfdhps genes, the higher the risk of treatment failures when using SP.The contribution of this study is to provide scientific evidences of the association between both variables in Loreto region supporting its validation and future application in surveillance studies for SP drug resistance, that can be conducted not only in Peru but also in South American countries that share the Amazon basin territory.

In der vorliegenden Arbeit haben wir unter Nutzung bioinformatischer Methoden eine innovative Strategie zur Eindämmung der Malaria entwickelt. Die genetische Modifikationsstrategie beinhaltet sowohl Manipulationen aufseiten des gefährlichsten Erregers, Plasmodium falciparum, als auch des Hauptvektors, Anopheles gambiae. In den Genomen beider Spezies wurden eine Reihe neuer konkreter targets identifiziert. Auch bereits beschriebene targets und Ansätze wurden in die Strategie einbezogen bzw. weiter ausgestaltet. Bezüglich der Vektormoskitos wird die Verbreitung eines gegenüber Plasmodien resistenten Genotyps angestrebt. Es werden einerseits effiziente natürliche und künstliche Resistenzgene diskutiert und andererseits eine bekannte Strategie zur Fixierung natürlicher Resistenzallele in natürlichen Populationen verbessert. Auf der Seite der Plasmodien erweiterten wir einen bereits von A. Burt (2003) beschriebenen Eradikationsansatz um weitere targets. Aus ethischen und evolutionsbiologischen Erwägungen bevorzugen wir jedoch eine alternative Strategie, welche die Etablierung von in ihrer Virulenz gemilderten Parasiten zum Ziel hat. Der attenuierte Genotyp wird unter anderem durch komplexe Pathway-Remodellierungen beschrieben (Löwe, Sauerborn, Schirmer, Dandekar, A refined genome engineering strategy against parasites and vectors, Manuskript beim Journal „Genome Biology“ eingereicht). Da sich Mutanten in der Natur gegen Wildtyp-Organismen kaum durchsetzen können, werden zwei drive-Systeme beschrieben, welche für die Implementierung der genetischen Manipulationsstrategie entwickelt wurden. Beide Konstrukte wurden zur Patentierung angemeldet (Patentanmeldung U30010 DPMA bzw. Aktenzeichen 102006029354.1). Zusätzlich zur deutschen wurde für eines der beiden Konstrukte eine PCT-Anmeldung eingereicht, welche in Zukunft einen internationalen Patentschutz ermöglichen soll. Es werden Kalkulationen vorgelegt, welche die Verbreitungstendenzen der Konstrukte in natürlichen Populationen vorhersagen. Die Beschreibung der entwickelten Konstrukte beschränkt sich nicht auf das primäre Anwendungsgebiet der Arbeit (Malaria), sondern beinhaltet auch andere Anwendungsgebiete, vor allem im Bereich der Medizin und Molekularbiologie. / Background: Gene drive strategies are an important alternative to control tropical diseases such as malaria. Results: Here we introduce a new gene drive strategy based on gene conversion constructs. We identify a gene drive strategy both for plasmodia and for anopheles including design of an inducible modification vector. Our constructs are based on group II introns or homing endonuclease genes. They include besides the intron to modify vector or parasite genome sites inducible promoters for gene activation. We thus separate gene modification from activation of the modified gene. Moreover, we provide a detailed list of suitable targets in vector and plasmodia for the modification strategy. Finally, we discuss the control effect of an eradication strategy versus a mild strategy of the gene construct for vector and parasite populations. Conclusions: A new eukaryotic vector and parasite control strategy using gene drive systems is presented and discussed.

In Säugetieren existieren im wesentlichen zwei Abwehrsysteme gegen oxidativen Streß, in welchen die Glutathionreduktase (GR) und Thioredoxinreduktase (TrxR) Schlüsselenzyme sind. Ein einzelnes Gen der Taufliege, genannt dmtrxr-1, kodiert sowohl für die durch alternatives Splicing entstehende cytoplasmatische und mitochondriale Form der DmTrxR-1. Zum Teil innerhalb des dmtrxr-1-Gens findet sich auf dem Komplementärstrang ein weiteres Gen, welches sniffer genannt wurde. In Kooperation wurde nachgewiesen, daß dieses Gen essentiell zur Verhinderung alterungsbedingter Neurodegeneration ist. Durch biochemische Charakterisierung konnte das rekombinant hergestellte Produkt dieses Gens in der vorliegenden Arbeit als Carbonylreduktase, ein zu den Kurzketten-Dehydrogenasen (short-chain dehydrogenases) gehörendes Enzym, identifiziert werden. Sniffer weist das für Carbonylreduktasen typische Substratspektrum mit Phenanthrenequinone als bestem Substrat auf und wird von Flavonoiden wie Quercetin und Rutin sowie Hydroxymercuribenzoat gehemmt. In verschiedenen Ansätzen konnten Kristalle des rekombinanten Proteins gewonnen werden, die inzwischen in Kooperation vermessen wurden und so zu einer Kristallstruktur mit einer Auflösung von 1,7 Angström führten. Durch diese Arbeiten konnte zum ersten Mal eine Verbindung zwischen einem charakterisierten Gen (snifffer), oxidativem Streß und neurodegenerativen Effekten auf molekularer Ebene nachgewiesen werden. Parasiten haben während ihres Lebenszyklus einen hohen Bedarf an Energie und sind abhängig von einer starken Syntheseleistung. Zur Bewältigung dieses Stresses benötigen sie hohe Aktivitäten an Adenylatkinase (AK; ATP + AMP  2 ADP) und GTP-AMP-Phosphotransferase (GAK; GTP + AMP  GDP + ADP). Beide Enzyme wurden in Blutstadien des Malariaparasiten Plasmodium falciparum identifiziert und die entsprechenden Gene der PfAK und PfGAK auf den Chromosomen 10 und 4 respektive lokalisiert. Klonierung und heterologe Expression in E. coli ergab enzymatisch aktive Proteine mit einer Größe von 28,9 (PfAK), bzw. 28,0 kDa (PfGAK). Das rekombinante Protein der PfAK entspricht in seinen biochemischen Charakteristika denen der authentischen PfAK. Dies gilt auch für eine mögliche Assoziation mit einem stabilisierenden Protein mit einem Molekulargewicht von ca. 70 kDa und der hohen Substratspezifität für das Monophosphat-Nukleotid AMP. Die Spezifität für das Triphosphat-Substrat ist weniger stringent. Das beste Triphosphat-Substrat ist ATP mit einem Vmax-Wert von 75 U/mg und einem kcat von 2800 min-1. Die Sequenz der PfAK enthält eine amphiphatische Helix, welche als notwendig für die Translokation zytosolischer Adenylatkinasen in den Intermembranraum der Mitochondrien beschrieben wurde. Die PfGAK bevorzugt GTP und AMP als Substrat (100 U/mg; kcat = 2800 min-1 bei 25°C) und zeigt als Besonderheit keine messbare Aktivität mit ATP. Im Gegensatz zu ihrem Ortholog im Menschen (AK3) enthält die Sequenz der PfGAK ein Zinkfinger-Motiv und bindet Eisenionen. Erste Immunfluoreszenz-Analysen lokalisieren die PfGAK in den Mitochondrien. PfAK und PfGAK werden von den Dinukleosid-Pentaphosphat-Verbindungen AP5A beziehungsweise GP5A gehemmt. Die Ki-Werte liegen mit ca. 0.2 µM ungefähr 250-fach niedriger als die KM-Werte der entsprechenden Nukleotidsubstrate. Zur Lösung der vor allem im Rahmen einer rationalen Medikamentenentwicklung notwendigen Kristallstruktur des Zielmoleküls konnten bereits Kristalle der PfGAK erhalten werden. / In mammalia, two major systems with glutathione reductase (GR) and thioredoxin reductase (TrxR) as key enzymes defend the organism against oxidative stress. The single copy gene dmtrxr-1 codes for both the cytoplasmic and mitochondrial form of DmTrxR-1, generated by alternative splicing. Another gene, located on the complementary strand partially within the dmtrxr-1 gene, could be identified and was named sniffer. This gene is essential for prevention of age-related neuro-degeneration, as could be shown in a cooperation with the group of Prof. Schneuwly. In this thesis, biochemical characterization of the recombinant protein identified sniffer as a carbonyl reductase, an enzyme belonging to the short-chain-dehydrogenases. Sniffer shows the typical substrate spectrum of carbonyl reductases with phenthrenequinone as best substrate and is inhibited by the flavonoids quercetin and rutin and also by hydroxymercurybenzoate (HMB). Protein crystals could be obtained under different conditions. In a cooperation with the group of Prof. Klebe, these already lead to a crystal structure with a resolution of 1.7 angstrom. The work on sniffer is the first that directly links a characterized gene (sniffer), oxidative stress and neurodegeneration on the molecular level. For coping with energetic and synthetic challenges, parasites require high activities of adenylate kinase (AK; ATP + AMP  2 ADP) and GTP:AMP phosphotransferase (GAK; GTP + AMP  2 ADP). These enzymes were identified in bloodstream stages of Plasmodium falciparum. The genes encoding PfAK and PfGAK are located on chromosomes 10 and 4, respectively. Molecular cloning and heterologous expression in E. coli yielded enzymatically active proteins of 28.9 (PfAK) and 28.0 kDa (PfGAK). Recombinant PfAK resembles authentic PfAK in its biochemical characteristics including the possible association with a stabilizing protein and the high specificity for AMP as the mononucleotide substrate. Specificity is less stringent for the triphosphate, with ATP as the best substrate (75 U/mg; kcat = 2160 min-1). PfAK contains the sequence of the amphiphatic helix that is known to mediate translocation of the cytosolic protein into the mitochondrial intermembrane space. PfGAK exhibits substrate preference for GTP and AMP (100 U/mg; kcat = 2800 min-1); notably, there is no detectable activity with ATP. In contrast to its human orthologue (AK3), PfGAK contains a zinc finger motif and binds ionic iron. The dinucleoside pentaphosphate compounds AP5A and GP5A inhibited PfAK and PfGAK, respectively, with Ki values of appr. 0.2 µM which is more than 250-fold lower than the KM values determined for the nucleotide substrates. The disubstrate inhibitors are useful for studying the enzymatic mechanism of PfAK and PfGAK as well as their function in adenine nucleotide homeostasis; in addition, the chimeric inhibitors represent interesting lead compounds for developing nucleosides to be used as antiparasitic agents. To elucidate the structure which is necessary for the use as a drug target, crystallization studies have been performed and the first crystals could be obtained.

Diese Arbeit untersucht zelluläre Netzwerke mit dem Ziel, die so gewonnenen Einsichten medizinisch beziehungsweise biotechnologisch zu nutzen. Hierzu müssen zunächst Proteindomänen und wichtige regulatorische RNA Elemente erkannt werden. Dies geschieht für regulatorische Elemente in Nukleinsäuren am Beispiel von Iron Responsive Elements (IREs) in Staphylococcus aureus, wobei sich solche Elemente in viel versprechender Nähe zu exprimierten Sequenzen finden lassen (T. Dandekar, F. Du, H. Bertram (2001) Nonlinear Analysis 47(1): 225-34). Noch bedeutsamer als Ziele zur Medikamentenentwicklung gegen Parasiten sind Domänenunterschiede in Struktur und Sequenz bei Proteinen (T. Dandekar, F. Du, H. Bertram (2001) Nonlinear Analysis 47(1): 225-34). Ihre Identifikation wird am Beispiel eines potentiellen Transportproteins in Plasmodium falciparum exemplarisch dargestellt. Anschließend wird das Zusammenwirken von regulatorischen Elementen und Domänen in Netzwerken betrachtet (einschließlich experimenteller Daten). Dies kann einerseits zu allgemeineren Schlussfolgerungen über das Netzwerkverhalten führen, andererseits für konkrete Anwendungen genutzt werden. Als Beispiel wählten wir hier Redoxnetzwerke und die Bekämpfung von Plasmodien als Verursacher der Malaria. Da das gesamte Redoxnetzwerk einer lebenden Zelle mit Methoden der pH Wert Messung nur unzureichend zu erfassen ist, werden als alternative Messmethode für dieses Netzwerk Mikrokristalle der Glutathionreduktase als Indikatorsystem nach digitaler Verstärkung experimentell genutzt (H. Bertram, M. A. Keese, C. Boulin, R. H. Schirmer, R. Pepperkok, T. Dandekar (2002) Chemical Nanotechnology Talks III - Nano for Life Sciences). Um komplexe Redoxnetzwerke auch bioinformatisch zu modulieren, werden Verfahren der metabolischen Fluxanalyse vorgestellt und verbessert, um insbesondere ihrer Verzahnung besser gerecht zu werden und solche Netzwerke mit möglichst wenig elementaren Flussmoden zutreffend beschreiben zu können. Die Reduktion der Anzahl von Elementarmoden bei sehr großen metabolischen Netzwerken einer Zelle gelingt hier mit Hilfe unterschiedlicher Methoden und führt zu einer vereinfachten Darstellungsmöglichkeit komplexer Stoffwechselwege von Metaboliten. Dabei dient bei jeder dieser Methoden die biochemisch sinnvolle Definition von externen Metaboliten als Grundlage (T. Dandekar, F. Moldenhauer, S. Bulik, H. Bertram, S. Schuster (2003) Biosystems 70(3): 255-70). Allgemeiner werden Verfahren der Proteindomänenklassifikation sowie neue Strategien gegen mikrobielle Erreger betrachtet. In Bezug auf automatisierte Einteilung von Proteinen in Domänen wird ein neues System von Taylor (2002b) mit bekannten Systemen verglichen, die in unterschiedlichem Umfang menschlichen Eingriffs bedürfen (H. Bertram, T. Dandekar (2002) Chemtracts 15: 735-9). Außerdem wurde neben einer Arbeit über die verschiedenen Methoden aus den Daten eines Genoms Informationen über das metabolische Netzwerk der Zelle zu erlangen (H. Bertram, T. Dandekar (2004) it 46(1): 5-11) auch eine Übersicht über die Schwerpunkte der Bioinformatik in Würzburg zusammengestellt (H. Bertram, S. Balthasar, T. Dandekar (2003) Bioforum 1-2: 26-7). Schließlich wird beschrieben, wie die Pathogenomik und Virulenz von Bakterien der bioinformatischen Analyse zugänglich gemacht werden können (H. Bertram, S. Balthasar, T. Dandekar (2003) Bioforum Eur. 3: 157-9). Im letzten Teil wird die metabolische Fluxanalyse zur Identifikation neuer Strategien zur Bekämpfung von Plasmodien dargestellt: Beim Vergleich der Stoffwechselwege mit Glutathion und Thioredoxin in Plasmodium falciparum, Anopheles und Mensch geht es darum, gezielte Störungen im Stoffwechsel des Malariaerregers auszulösen und dabei den Wirt zu schonen. Es ergeben sich einige interessante Ansatzpunkte, deren medizinische Nutzung experimentell angestrebt werden kann. / The objective of this thesis is to obtain information, which may be advantageous for biotechnical and medical purposes. In order to achieve this aim it is first necessary to identify protein domains and essential regulatory RNA elements. In case of regulatory RNA elements this is accomplished by investigating Iron Responsive Elements (IREs) in Staphylocuccus aureus as a model. In this case these elements are found in much promising vicinity to open reading frames coding for proteins (T. Dandekar, F. Du, H. Bertram (2001) Nonlinear Analysis 47(1): 225-34). Even more significant for the purpose of developing pharmaceuticals against parasites are differences of structure and sequence in protein domains (T. Dandekar, F. Du, H. Bertram (2001) Nonlinear Analysis 47(1): 225-34). Their identification is shown in a potential transport protein in Plasmodium falciparum. Subsequently the interaction of regulatory elements and domains in networks is considered (including experimental data). The resulting observations may lead to general conclusions concerning network reaction, as well as specific applications. Our example and field of interest are redox networks and Plasmodia causing malaria. It is not possible to cover the redox network state of a living cell using only pH measurements. Therefore small crystals of glutathione reductase are employed as a more suitable indicator, whose signal is digitally amplified (H. Bertram, M. A. Keese, C. Boulin, R. H. Schirmer, R. Pepperkok, T. Dandekar (2002) Chemical Nanotechnology Talks III - Nano for Life Sciences). In order to bioinformatically modulate complex redox networks techniques of metabolic flux analysis are presented. They are also improved particularly to advance the understanding of interdependences and to facilitate the correct comprehension of such networks with as few elementary flux modes as possible. In this thesis the reduction of the number of elementary modes of large and intertwined metabolic networks succeeds with various methods. This leads to a simpler model of complex metabolic functions. For each of the methods used in this process the biochemically justified definition of external and internal metabolites constitutes the basis (T. Dandekar, F. Moldenhauer, S. Bulik, H. Bertram, S. Schuster (2003) Biosystems 70(3): 255-70). In a more general sense methods of protein domain classification and new strategies for the control of microbial pathogens are considered. In reference to automated classification of protein domains a new system by Taylor (2002b) is compared with traditional systems, which require a varying degree of human intervention (H. Bertram, T. Dandekar (2002) Chemtracts 15: 735-9). In addition different methods of acquiring information on the cellular metabolic network from genomic data is discussed (H. Bertram, T. Dandekar (2004) it 46(1): 5-11). Furthermore a survey of the main fields of bioinformatic research in Würzburg is given (H. Bertram, S. Balthasar, T. Dandekar (2003) Bioforum 1-2: 26-7). Finally it is outlined how pathogenicity and virulence of bacteria may be made accessible to bioinformatic analysis (H. Bertram, S. Balthasar, T. Dandekar (2003) Bioforum Eur. 3: 157-9). In the conclusion metabolic flux analysis is used for the identification of new strategies in the battle against Plasmodia: The comparison of metabolic pathways with glutathione and thioredoxin in Plasmodium falciparum, Anopheles and man aims at raising planned dysfunctions in the metabolism of Plasmodium or Anopheles without harming the human host. Valuable suggestions for medical applications and pharmacological targets are obtained.

A research report submitted to the faculty of Medicine, University of the Witwatersrand, Johannesburg, in part fulfillment of the requirements for the degree of Master of Medicine (in the branch of Haematology) Johannesburg 1992. / The observation by Haldane in 1949 that the distribution of malaria and certain thalassaemias were similar and that the former disease must be a selective force tor the continued existence of the latter by preservation of the heterozygotes. This theory which later became known as lithe malaria hypothesis" has been applied to other inherited conditions such as G6PD deficiency, membranopathies, certain blood group polymorphisms, other heamoglobinopathies such as sickle cell disease, blood group polymorphisms and more recently HLA phenotypes. It has been shown that the Duffy blood group antigens are the receptors for. Plasmodium vivax and since these antigens are lacking in most black Africans this species of malaria is virtually absent in Africa. It has also been shown that the glycophorins are at least in part the receptors for Pfalciparum. Several variants of the glycophorins exist and the biochemistry and, where known, the molecular mechanisms by which these arise is reviewed. Experimental work is carried out to establish the growth characteristics of Pfalciparum in an in vitro culture system using cells with glycophorin variants on their membranes. Three such variants were compared to normal cells and two (S~s-U-and Dantu) were found to be partially resistant to invasion by Pfalciparum merozoites whereas the third (Henshaw) was found to be no different to controls. / MT2018

A DISSERTATION SUBMITTED TO THE FACULTY OF MEDICINE, UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG, FR THE DEGREE OF MASTER OF SCIENCE IN MEDICINE. / The influence of iron on the outcome of various infections have been extensively reviewed. Clinical observations suggests that iron deficiency may be protective against malaria. Various researchers have shown that certain iron chelators blocked the proliferation of plasmodium falciparum in vitro and in vivo. (Abbreviation abstract) / Andrew Chakane 2018

A dissertation submitted to the Faculty of Medicine University of the Witwatersrand, Johannesburg For the degree of Master of Science in Medicine / Chloroquine-resistant Plasmodium falciparum accumulate significantly less chloroquine than susceptical parasites, and this is thought to be the basis of their resistance ( Fitch, 1970 ). Martin et. al ( 1987 ), recently demonstrated that in the presence of verapamil, a calcium channel blocker, chloroquine-resistant P falciparum becomes chloroquine-sensitive, with an increase in the chloroquine accumulation.The mechanism of such reversal has yet to be elucidated / IT2018

Submitted by Cássio da Cruz Nogueira (cassionogueirakk@gmail.com) on 2017-10-18T16:10:43Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_MalariaMulheresIdade.pdf: 4024160 bytes, checksum: 025c0bc2483afa0356362d19ecf10361 (MD5) / Approved for entry into archive by Edisangela Bastos (edisangela@ufpa.br) on 2017-12-01T14:07:06Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_MalariaMulheresIdade.pdf: 4024160 bytes, checksum: 025c0bc2483afa0356362d19ecf10361 (MD5) / Made available in DSpace on 2017-12-01T14:07:06Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_MalariaMulheresIdade.pdf: 4024160 bytes, checksum: 025c0bc2483afa0356362d19ecf10361 (MD5) Previous issue date: 2010 / A malária na gestação representa uma ameaça à vida da mãe e do concepto além de influenciar na evolução da gravidez. Visando esclarecer aspectos da malária que acomete gestantes de áreas hiperendêmicas na Amazônia, este estudo se propõe avaliar aspectos clínico-epidemiológicos da doença em mulheres na idade reprodutiva, com ênfase em gestantes internadas em hospital público de referencia para a região de Itaituba. O estudo foi conduzido no HMI de Itaituba no período de 2005 a 2007, através do levantamento de prontuários de mulheres hospitalizadas e com diagnóstico de malária confirmado pela gota espessa, e da análise documental baseada nos dados do SIVEP-Malária. Os resultados evidenciaram que no Pará, em 2007, mais de 51% dos casos notificados foram oriundos de apenas nove municípios, dois deles (Itaituba e Jacareacanga), pertencentes à microrregião de Itaituba, área onde foi registrada maior Incidência Parasitária Anual (IPA). Os dados dos prontuários de 30 pacientes (sete, gestantes) revelaram, em sua maioria, que eram procedentes da área rural do município de Itaituba e haviam sido infectadas por P. falciparum; que as gestantes eram as mais jovens (p<0,05); e que o tempo de internação foi similar entre gestantes e não-gestantes. As intercorrências sobre o curso gestacional foram um óbito fetal (malária por P. vivax, segundo trimestre) e um parto prematuro (malária por P. falciparum, terceiro trimestre). Concluiu-se, a partir dessas observações, que casos graves de malária podem ocorrer tanto associados à espécie vivax como falciparum fazendo-se necessário constante vigilância epidemiológica, especialmente no município de Itaituba, onde está concentrado o maior número de casos da doença. As medidas de vigilância epidemiológica a serem adotadas devem privilegiar o diagnóstico precoce e tratamento imediato das pacientes, sobretudo das gestantes, já que estão sujeitas a maior risco de complicações com sérias conseqüências para o concepto. / A malária na gestação representa uma ameaça à vida da mãe e do concepto além de influenciar na evolução da gravidez. Visando esclarecer aspectos da malária que acomete gestantes de áreas hiperendêmicas na Amazônia, este estudo se propõe avaliar aspectos clínico-epidemiológicos da doença em mulheres na idade reprodutiva, com ênfase em gestantes internadas em hospital público de referencia para a região de Itaituba. O estudo foi conduzido no HMI de Itaituba no período de 2005 a 2007, através do levantamento de prontuários de mulheres hospitalizadas e com diagnóstico de malária confirmado pela gota espessa, e da análise documental baseada nos dados do SIVEP-Malária. Os resultados evidenciaram que no Pará, em 2007, mais de 51% dos casos notificados foram oriundos de apenas nove municípios, dois deles (Itaituba e Jacareacanga), pertencentes à microrregião de Itaituba, área onde foi registrada maior Incidência Parasitária Anual (IPA). Os dados dos prontuários de 30 pacientes (sete, gestantes) revelaram, em sua maioria, que eram procedentes da área rural do município de Itaituba e haviam sido infectadas por P. falciparum; que as gestantes eram as mais jovens (p<0,05); e que o tempo de internação foi similar entre gestantes e não-gestantes. As intercorrências sobre o curso gestacional foram um óbito fetal (malária por P. vivax, segundo trimestre) e um parto prematuro (malária por P. falciparum, terceiro trimestre). Concluiu-se, a partir dessas observações, que casos graves de malária podem ocorrer tanto associados à espécie vivax como falciparum fazendo-se necessário constante vigilância epidemiológica, especialmente no município de Itaituba, onde está concentrado o maior número de casos da doença. As medidas de vigilância epidemiológica a serem adotadas devem privilegiar o diagnóstico precoce e tratamento imediato das pacientes, sobretudo das gestantes, já que estão sujeitas a maior risco de complicações com sérias conseqüências para o concepto.

The repeated emergence of drug resistance in Plasmodium falciparum underscores the importance of understanding the genetic architecture of current resistance pathways, as well as any associated fitness costs. Why resistance emerges in particular regions of the world has been linked to particular genetic backgrounds that better tolerate resistance-associated polymorphisms; this is likely to play a key role in driving the epidemiology of drug resistance, however is infrequently studied at a large scale in a laboratory setting. The first results chapter establishes a barcoding approach for P. falciparum with the aim of tracking parasite growth in vitro. The strategy used was adapted for P. falciparum by using a pseudogene (PfRh3) as a safe harbour to insert unique molecular barcodes. These libraries of barcoded P. falciparum vectors were also used as a readout of transfection efficiency. The second chapter establishes a proof of principle for phenotyping by barcode sequencing, using a panel of barcoded parasites generated in different genetic backgrounds that comprise sufficient genetic diversity to pilot the method. These were grown in the presence and absence of antimalarial compounds, and growth phenotypes were measured in parallel using BarSeq. The third results chapter studies the contribution of mutations in Pfkelch13, a molecular marker of artemisinin resistance, to parasite fitness. Combining CRISPR/Cas9-based genome editing and high throughput sequencing, the impact of Pfkelch13 alleles on fitness in the context of particular strain backgrounds is revealed. In particular, the impact of genetic background in the emergence and spread of drug-resistant lineages (referred to as KEL1) in Southeast Asia carrying a Y580 Pfkelch13 allele. Overall, given the current pace of genome sequencing of pathogenic organisms such as P. falciparum, it will be important to increase the scale of experimental genetics, in order to tackle in real-time natural variation that might be under constant selection from drugs, thus anticipating the emergence of drug resistance in changing parasite populations. Through this work, tools were developed to facilitate parallel phenotyping by measuring in vitro growth using high-throughput sequencing. The work also develops novel approaches to address the importance of genetic background and a potential role for positive epistasis in a lineage responsible for the recent outbreak of drug-resistant malaria in Southeast Asia.

The most virulent malaria parasite, Plasmodium falciparum, makes use of extensive antigenic diversity to maximise its transmission potential. Parasite genomes contain several highly polymorphic gene families, whose products are the target of protective immune responses. The best studied of these are the PfEMP1 surface proteins, which are encoded by the var multi-gene family and are important virulence factors. During infection, the parasite switches expression between PfEMP1 variants in order to evade adaptive immune responses and prolong infection. On the population level, parasites appear to be structured with respect to their var genes into non-overlapping repertoires, which can lead to high reinfection rates. This non-random structuring of antigenic diversity can also be found at the level of individual var gene repertoires and var genes themselves. However, not much is known about the evolutionary determinants which select for and maintain this structure at different ecological scales. In this thesis I investigate the mechanisms by which multi-scale immune selection and other ecological factors influence the evolution of structured diversity. Using a suite of theoretical frameworks I show that treating diversity as a dynamic property, which emerges from the underlying infection and transmission processes, has a major effect on the relationship between the parasite’s transmis- sion potential and disease prevalence, with important implications for monitoring control efforts. Furthermore, I show that an evolutionary trade-off between within-host and between-host fitness together with functional constraints on diversification can explain the structured diversity found at both the repertoire and parasite population level and might also account for empirically observed exposure-dependent acquisition of immunity. Together, this work highlights the need to consider evolutionary factors acting at different ecological scales to gain a more comprehensive understanding of the complex immune-epidemiology of P. falciparum malaria.