A MSP-1 de Plasmodium vivax (PvMSP-1), o principal alvo para o desenvolvimento de uma vacina contra a malária, é constituída por seis domínios altamente polimórficos flanqueados por seqüências conservadas. Apesar de evidências de que a divergência na seqüência da PvMSP-1 é está sendo mantida por mais de cinco milhões de anos por seleção balanceada exercida pela imunidade adquirida pelo hospedeiro, a especificidade dos anticorpos adquiridos naturalmente contra a PvMSP-1 ainda é pouco estudada. Este trabalho mostra que 15 proteínas recombinantes que correspondem às variantes da PvMSP-1 comumente encontradas em parasitos locais foram pouco reconhecidas por 376 indivíduos não-infectados com idade entre 5 e 90 anos expostos à malária na Amazônia rural; menos de 30% dos indivíduos tiveram anticorpos IgG detectáveis contra no mínimo uma variante dos blocos 2, 6 e 10 que foram expressas, embora 54,3% reconheceram o domínio conservado C-terminal PvMSP-119. Apesar da proporção de respondedores às variantes da PvMSP-1 ter aumentado substancialmente durante infecções agudas subseqüentes por P. vivax, os anticorpos não foram necessariamente específicos para as variantes da PvMSP-1 encontradas nos parasitos infectantes. São discutidos a contribuição relativa do polimorfismo antigênico, a fraca imunogenicidade e o pecado antigênico original (a tendência de a exposição a uma nova variante antigênica induzir resposta de anticorpos com especificidade pré-existente) para os padrões observados de reconhecimento por anticorpos da PvMSP-1. É sugerido que a resposta de anticorpos ao repertório de domínios variáveis da PvMSP-1 em indivíduos continuamente expostos é induzida somente após algumas infecções repetidas e requerem re-estímulo freqüente, com claras implicações para o desenvolvimento de subunidades de vacinas baseadas na PvMSP-1. / The merozoite surface protein 1 of Plasmodium vivax (PvMSP-1), a major target for malaria vaccine development, contains six highly polymorphic domains interspersed with conserved sequences. Although there is evidence that the sequence divergence in PvMSP-1 has been maintained over five million years by balanced selection exerted by host?s acquired immunity, the variant-specificity of naturally acquired antibodies to PvMSP-1 remains little investigated. Here we show that 15 recombinant proteins corresponding to PvMSP-1 variants commonly found in local parasites were poorly recognized by 376 noninfected subjects aged 5-90 years exposed to malaria in rural Amazonia; less than onethird of them had detectable IgG antibodies to at least one variant of blocks 2, 6 and 10 that were expressed, although 54.3% recognized the invariant C-terminal domain PvMSP-119. Although the proportion of responders to PvMSP-1 variants increased substantially during subsequent acute P. vivax infections, the specificity of IgG antibodies did not necessarily match the PvMSP-1 variant(s) found in infecting parasites. We discuss the relative contribution of antigenic polymorphism, poor immunogenicity, and original antigenic sin (the skew in the specificity of antibodies elicited by exposure to new antigenic variants due to preexisting variant-specific responses) to the observed patterns of antibody recognition of PvMSP-1. We suggest that antibody responses to the repertoire of variable domains of PvMSP-1 to which subjects are continuously exposed are only elicited after several repeated infections and may require frequent boosting, with clear implications for the development of PvMSP-1-based subunit vaccines.

A MSP-1 de Plasmodium vivax (PvMSP-1), o principal alvo para o desenvolvimento de uma vacina contra a malária, é constituída por seis domínios altamente polimórficos flanqueados por seqüências conservadas. Apesar de evidências de que a divergência na seqüência da PvMSP-1 é está sendo mantida por mais de cinco milhões de anos por seleção balanceada exercida pela imunidade adquirida pelo hospedeiro, a especificidade dos anticorpos adquiridos naturalmente contra a PvMSP-1 ainda é pouco estudada. Este trabalho mostra que 15 proteínas recombinantes que correspondem às variantes da PvMSP-1 comumente encontradas em parasitos locais foram pouco reconhecidas por 376 indivíduos não-infectados com idade entre 5 e 90 anos expostos à malária na Amazônia rural; menos de 30% dos indivíduos tiveram anticorpos IgG detectáveis contra no mínimo uma variante dos blocos 2, 6 e 10 que foram expressas, embora 54,3% reconheceram o domínio conservado C-terminal PvMSP-119. Apesar da proporção de respondedores às variantes da PvMSP-1 ter aumentado substancialmente durante infecções agudas subseqüentes por P. vivax, os anticorpos não foram necessariamente específicos para as variantes da PvMSP-1 encontradas nos parasitos infectantes. São discutidos a contribuição relativa do polimorfismo antigênico, a fraca imunogenicidade e o pecado antigênico original (a tendência de a exposição a uma nova variante antigênica induzir resposta de anticorpos com especificidade pré-existente) para os padrões observados de reconhecimento por anticorpos da PvMSP-1. É sugerido que a resposta de anticorpos ao repertório de domínios variáveis da PvMSP-1 em indivíduos continuamente expostos é induzida somente após algumas infecções repetidas e requerem re-estímulo freqüente, com claras implicações para o desenvolvimento de subunidades de vacinas baseadas na PvMSP-1. / The merozoite surface protein 1 of Plasmodium vivax (PvMSP-1), a major target for malaria vaccine development, contains six highly polymorphic domains interspersed with conserved sequences. Although there is evidence that the sequence divergence in PvMSP-1 has been maintained over five million years by balanced selection exerted by host?s acquired immunity, the variant-specificity of naturally acquired antibodies to PvMSP-1 remains little investigated. Here we show that 15 recombinant proteins corresponding to PvMSP-1 variants commonly found in local parasites were poorly recognized by 376 noninfected subjects aged 5-90 years exposed to malaria in rural Amazonia; less than onethird of them had detectable IgG antibodies to at least one variant of blocks 2, 6 and 10 that were expressed, although 54.3% recognized the invariant C-terminal domain PvMSP-119. Although the proportion of responders to PvMSP-1 variants increased substantially during subsequent acute P. vivax infections, the specificity of IgG antibodies did not necessarily match the PvMSP-1 variant(s) found in infecting parasites. We discuss the relative contribution of antigenic polymorphism, poor immunogenicity, and original antigenic sin (the skew in the specificity of antibodies elicited by exposure to new antigenic variants due to preexisting variant-specific responses) to the observed patterns of antibody recognition of PvMSP-1. We suggest that antibody responses to the repertoire of variable domains of PvMSP-1 to which subjects are continuously exposed are only elicited after several repeated infections and may require frequent boosting, with clear implications for the development of PvMSP-1-based subunit vaccines.

Made available in DSpace on 2015-04-11T13:38:47Z (GMT). No. of bitstreams: 1 Janaina de Araujo Evangelista.pdf: 5258011 bytes, checksum: f25739b96a1b2d123d21c1753b3204e8 (MD5) Previous issue date: 2011-05-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / subtropical regions of the planet. In North America, Plasmodium vivax is responsible for the most part of the infections. In 2011, 250,498 cases of malaria fever were studied; 80% of these cases were caused by Plasmodium vivax. The purpose of this study was to investigate the diversity generation of the gene MSP1 from Plasmodium vivax through the analisys of a specific mutation in the region from the block 2 genetic precombination events. In order to identify the existing mutations in multiclonal infections and generation of diversity in PvMSP1 a series of experiments were done, respectively, the extraction of genomic DNA of the parasite, PCR (polymerase chain reaction) using specific primers for the block 2, ligation of the fragment to cloning vector (top), processing using Escherichia coli competent cells, selection of colonies belonging to the same sample, DNA sequencing and analysis of synonymous and nonsynonymous mutations as their location in the prediction of B and T cell epitopes (not synonymous). The calculation of genetic distance between recombinant clones of the same sample by the MEGA 4.0 program confirmed the multiclonality of samples. The alignment of amino acid sequences showed the presence of genetic recombination events using DNASP program. DNA sequences obtained showed another interesting result: several synonymous and non-synonymous mutations in a relatively small stretch of DNA. Genetic diversity showed most mutations are not synonymous, and that most of them were located in regions referred to as B and T cell epitopes by BcPred and ProPred. So, as expected, the genetic diversity based on synonymous mutations and not synonymous possible sustains the phenomenon of escape on the immunity of the host. The characterization of these polymorphisms may contribute to immunological studies aiming at the development of a vaccine against malaria on stages caused by p. vivax. / A malária é um problema da saúde pública amplamente distribuída nas regiões tropicais e subtropicais do globo. No continente americano, o Plasmodium vivax é responsável por maior parte das infecções. No ano de 2011, 250.498 casos de malária foram observados no estado do Amazonas; 80% destes casos foram causados por Plasmodium vivax. O objetivo desse trabalho foi Investigar a geração de diversidade do gene MSP1 de Plasmodium vivax através da análise de mutações pontuais na região do bloco 2, eventos de precombinação genética. Para identificar as mutações existentes nas infecções multiclonais e geração de diversidade em PvMSP1 realizou-se uma série de experimentos, respectivamente, a extração de DNA genômico do parasita, PCR (Reação da Polimerase em Cadeia) utilizando primers específicos para o bloco 2, ligação do fragmento ao vetor de clonagem ( TOPO), transformação utilizando células de E.coli competentes , seleção de colônias pertencentes a uma mesma amostra, seqüenciamento de DNA e análise das mutações não sinônimas e sinônimas quanto sua localização em regiões de predição de epítopos de células B e T (não sinônimas). O cálculo da distância genética entre clones recombinantes de uma mesma amostra pelo programa MEGA 4.0 confirmou a multiclonalidade das amostras. O alinhamento das sequências de aminoácidos mostrou a presenção de eventos de recombinação genética utilizando o programa DNASP. As sequências de DNA obtidas demonstrou outro resultado interessante: várias mutações sinônimas e não sinônimas num trecho relativamente pequeno de DNA. A diversidade genética mostrou mais mutações não sinônimas, sendo que maior parte delas estavam localizadas em regiões previstas como epítopos das células B e T pelo programa BcPred e ProPred. Assim, como esperado, a diversidade genética baseado nas mutações sinônimas e não sinônimas sustenta o fenômeno de escape sobre a imunidade do hospedeiro. A caracterização desses polimorfismos poderá contribuir para estudos imunológicos visando o desenvolvimento de uma vacina contra os estágios eritrocitários da malária causada por P.vivax.

Estudos relacionados à malária autóctone em regiões de baixa transmissão no Brasil ganham cada vez mais relevância científica e epidemiológica, pois revelam a manutenção desse cenário em regiões de Mata Atlântica remanescente. No sudeste do Estado de São Paulo, a ocorrência de surtos no município de Juquitiba tem sido foco de pesquisas sobre a prevalência de Plasmodium na população, com registros de casos assintomáticos. Relatos de ocorrência da doença ou da presença de anticorpos antiplasmodiais em gestantes nessa região não haviam sido descritos anteriormente. Embora infecções por P. falciparum em gestantes tenham sido amplamente abordadas na literatura, a interação entre P. vivax e P. malariae com esta coorte imunodeprimida foi pouco explorada até o momento. Nesse estudo nós monitoramos trimestralmente a circulação de Plasmodium em gestantes atendidas em cinco Unidades de Saúde de Juquitiba. Para isso foi empregado o diagnóstico por gota espessa e metodologias moleculares sensíveis para detecção do parasito, além de ensaios imunológicos para avaliação de parâmetros imunes humorais. Desse modo, foram detectadas infecções por P. vivax e P. malariae em gestantes, incluindo casos assintomáticos. A alta prevalência de anticorpos IgG nesta população mostrou importante exposição das gestantes ao Plasmodium. Em regiões com perfil semelhante ao apresentado neste estudo, o diagnóstico de malária poderia ser indicado no seguimento pré-natal / Studies related to autochthonous malaria in low transmission areas in Brazil have acquired scientific and epidemiological relevance, since they suggest continued transmission in remaining Atlantic Forest regions. In the Southeast of São Paulo State, outbreaks in the municipality of Juquitiba has been focus of studies on the prevalence of Plasmodium in the population, with reports of asymptomatic cases. Data on the occurrence of the disease or presence of antiplasmodial antibodies in pregnant women in this region were not described previously. Although P. falciparum infections in pregnant women have been widely addressed in the literature, the interaction of P. vivax and P. malariae with this immunocompromised cohort were poorly explored to date. In this study, we monitored quarterly the circulation of Plasmodium in pregnant women in five health facilities in Juquitiba. For this purpose, we performed diagnosis by thick blood film and sensitive molecular protocols for parasite DNA detection, as well immunological assays in order to evaluate humoral immune parameters. Through these tools, it was possible to detect infections due to P. vivax and P. malariae in pregnant women, including asymptomatic cases. The high prevalence of IgG antibodies showed a significant exposure of this population to Plasmodium. In regions with a similar profile presented in this study, the diagnosis of malaria might be indicated in prenatal care

Os diversos aspectos da cadeia de transmissão da malária autóctone são importantes para o estabelecimento de estratégias de intervenção. Entre abril de 2001 e março de 2004, 65 pacientes e 1.777 habitantes foram avaliados em nove municípios da região montanhosa do Espírito Santo. Foram realizados: gota espessa, esfregaço fino, PCR Multiplex, reação de imunofluorescência indireta (IFI) para detecção de anticorpos contra antígenos de estágios eritrocitários de Plasmodium e ELISA para detecção de anticorpos contra peptídeos sintetizados a partir da porção repetitiva da proteína circunsporozoíta (CSP) das variantes de P. vivax e do P. malariae. Foram capturados anofelíneos no peridomicílio, com pesquisa, por PCR Multiplex, de DNA de Plasmodium. O mesmo foi pesquisado também em alguns símios locais. Os pacientes tinham 35,11 + 16 anos, em média. A maioria era do gênero masculino (51 ou 78,5%), 42 (64,6%) residiam em área rural, 23 (35,4%) eram agricultores e oito (12,3%) estudantes. Não houve viagens relevantes. Sessenta e dois (95,4%) nunca haviam tido malária. Vinte e quatro (36,9%) declararam ter entrado na mata. Predominaram a febre, a cefaléia e os calafrios. A febre era episódica em 63 (96,9%), a cada 48 horas em 48 (73,8%) e a cada 24 horas em 15 pacientes (23,1%). O baço foi impalpável em 26 (42,6%). Foi evidenciado o P. vivax em 47 de 48 pacientes e o P. malariae naquele restante, por características morfológicas e pela PCR Multiplex. Esta foi positiva para P. vivax em 45 dos 48, para P. malariae em um e negativa em dois. A IFI foi positiva, para P. malariae, em seis de sete testados, para IgM, e em todos os sete para IgG. Para o P. vivax, entre 50, 47 (94%) foram positivos para IgM e 48 (96%) para IgG. Entre 50 pacientes, pelo ELISA, 25 (50%) tinham anticorpos contra variantes do P. vivax ou contra o P. malariae. As freqüências individuais foram: 22 (44%) para a VK 210, 11 (22%) para a VK 247, 10 (20%) para o P. vivax-like e 10 (20%) para o P. malariae. Entre 253 amostras dos habitantes testadas na IFI para o P. malariae, o resultado foi positivo em 15,8% (40/253) para IgM e em 44,6% (113/253) para IgG. Para o P. vivax , em 1.701, foram 6,2% (105/1701) para IgM e 37,7% (641/1.701) para IgG. Foram detectados anticorpos contra a CSP em 615 de 1.702 amostras (36,1%). Foram 433 (25,4%) para a VK210, 258 (15,1%) para P. malariae, 108 (6,3%) para a VK 247 e 182 (10,7%) para P. vivax -like. A PCR Multiplex, em 1.527 amostras, detectou P. vivax em 23, P. malariae em 15, P. falciparum em nove e P. falciparum e P. malariae em um. Entre 785 espécimes de anofelíneos, com 10 espécies, foi encontrado DNA de P. vivax em um conjunto de exemplares de A. evansae. O P. malariae/brasilianum foi identificado pela PCR Multiplex em dois de cinco símios da região, em um também pelo esfregaço fino. Existem dois possíveis cenários para a transmissão. No primeiro, ela seria inter-humana, com vetores Nyssorhynchus secundários. Em um segundo, viria do reservatório símio, por indivíduos adentrando o ambiente florestal. / The several aspects of the transmission cycle of the indigenous malaria are important to base on the intervention strategies. From April 2001 to March 2004, 65 patients and 1,777 inhabitants were evaluated in nine Municipalities of the highlands of Espírito Santo State. Laboratory methods included: thick and thin smears, Multiplex PCR, imunnofluorescent assay to detect antibodies against crude blood-stages antigens of the Plasmodium genus (IFA) and ELISA to detect antibodies against synthetic peptides corresponding to the repetitive region of the Circumsporozoite protein of P. vivax variants and P. malariae. Anopheline mosquitoes were captured nearby the houses, being screened by Multiplex PCR in the search for Plasmodium DNA. The same test was also applied to some local wild monkeys. Patients had 35.11 + 16 years old in average. Most of them were males (51 or 78.5%), 42 (64,6%) lived in the rural environment, 23 (35.4%) were farmers and eight (12.3%) were students. There was no relevant history of travel. Sixty-two (95.4%) of them had never experienced malaria before. Twenty- four (36.9%) of them informed excursions inside the forest. The predominant symptoms were fever, headache and chills. Fever was periodic in 63 patients (96.9%), recurring each 48 hours in 48 of them (73.8%) and each 24 hours in 15 (23.1%). Spleen was not palpable in 26 patients (42.6%). Morphologic aspects and PCR results disclosed P. vivax as the agent involved in 47 of the 48 cases so screened. Multiplex PCR was positive for P. vivax in 45 of 48 tested, for P. malariae in another one and negative for the two remaining. IFA tested positive for IgM against P. malariae in six of seven evaluated samples, and for IgG against the same parasite in all of the seven. For P. vivax , the figures were 47 of 50 (94%) for IgM antibodies and 48 of 50 (96%) for IgG antibodies. From fifty patients whose samples were screened by ELISA, 25 (50%) were positive for P. vivax variants or P. malariae. The results considering each one of the tested peptides were: 22 (44%) for VK 210, 11 (22%) for VK 247, 10 (20%) for P. vivax -like e 10 (20%) for P. malariae. Among 253 population samples screened in search for P. malariae antibodies at IFA, 40 (15.8%) were positive for IgM antibodies and 113 (44,6%) for IgG antibodies. The search for P. vivax antibodies by the same technique in1,701 samples, resulted in 105 (6.2%) positive for IgM antibodies and in 641 positive for IgG antibodies. Anti-CSP antibodies were detected in 615 of 1,702 tested samples (36.1%). Among these 615, the positive results for each one of the tested peptides were: 433 (25,4%) for VK210, 258 (15,1%) for P. malariae, 108 (6,3%) for VK 247 e 182 (10,7%) for P. vivax-like. Multiplex PCR detected P. vivax DNA in 23 out of 1,527 tested samples, as it did for P. malariae in 15 of them, for P. falciparum in nine of them and both for P. malariae and P. falciparum in one of them. Among 785 mosquito specimens, representing 10 Anopheline species, P. vivax DNA was found in a set of some A. evansae specimens. P. malariae/brasilianum was identified by Multiplex PCR in two of five wild monkeys screened, in one of them also by thin smear. There are two possible scenarios to explain this transmission cycle. The first one bears malaria as a disease transmitted exclusively among human beings by secondary Nyssorhynchus vectors present nearby the houses. In a second scenario, the malaria is acquired after the simian reservoir when the human beings make excursions inside the forest.

Le paludisme reste une des principales causes de mortalité infantile dans le monde tropical. L'émergence continue des résistances du parasite aux anti-paludiques constitue un sérieux problème de santé publique. La recherche de nouvelles cibles thérapeutiques, basée sur une connaissance plus approfondie des mécanismes moléculaires de la vie du parasite, est une nécessité permanente dans un paradigme de « reine rouge » qui s'applique parfaitement à la capacité d'adaptation du parasite. La découverte récente d'une métacaspase de Plasmodium falciparum (PfMCA1) et la mise en évidence de son rôle potentiel dans l'apoptose du parasite, fait qu'elle est une cible thérapeutique contre le paludisme. Dans le but de mieux approfondir les connaissances sur cette protéine cible, nous avons voulu, dans un premier temps, déterminer la structure tridimensionnelle de PfMCA1, afin de confirmer les différentes structures prédites in silico, et chercher de nouvelles molécules candidates par le docking moléculaire. Cependant cet objectif n'a pas pu être atteint, à cause d'un phénomène d'autoclivage de la protéine suite à son expression, ce qui fait que nous n'avons pas réussi à récupérer la protéine. Dans un second temps, nous avons étudié la métacaspase de Plasmodium vivax (PvMCA1) en comparaison avec PfMCA1, et nous avons montré que les résidus histidine et cystéine dans la dyade catalytique sont bien conservés. Nous avons identifié un deuxième site potentiel dans le domaine catalytique de PvMCA1. A partir d'échantillons collectés en Mauritanie, au Soudan et à Oman, nous avons montré que les résidus histidine et cystéine, ainsi, que les résidus du second site du domaine catalytique de PvMCA1 sont très variables. Les mutations de ces résidus doivent faire l'objet d'étude approfondie de leurs effets sur la fonction de la protéine PvMCA1. Ce polymorphisme trouvé dans les résidus catalytiques de PvMCA1, doit-être évalué comme marqueurs moléculaires de résistance / Malaria remains one of the main causes of infant mortality in the tropical world.The continuous emergence of parasite resistant to drug treatment is a serious threat to public health. Exploring new therapeutics targets based on depth knowledge on molecular mechanism of the parasite’s life is utmost needed in a paradigm of « red queen», which applies perfectly on the ability of the parasitic adaptation. The recent discovery of metacaspase of Plasmodium falciparum (PfMCA1) and the demonstration of its potential role in apoptosis, make it a therapeutic target against malaria. In order to increase knowledge about this protein, we planned, to determine the three-dimensional structure of PfMCA1, to confirm the different structures predicted in silico, and to look for new drug using molecular docking. However, this goal was not reached, since autoprocessing occurred during expression, and we failed to obtain the full-length protein. Then we studied the metacaspase of Plasmodium vivax (PvMCA1) in comparison with PfMCA1 and, we shown that histidine and cysteine residues in the dyad catalytic are well conserved. We have identified a second potential site in the catalytic domain of PvMCA1. We shown that residues in both putative sites are highly polymorphic in samples from Mauritania, Sudan and Oman. Mutations on these residues need to be deeply studied for their effects on the PvMCA1 function. This polymorphism found in catalytic residues of PvMCA1should be evaluated as new molecular marker of resistance

Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2018-06-04T14:38:05Z No. of bitstreams: 1 DISS_2013_ Dione Viero Viana.pdf: 1878209 bytes, checksum: 5cdd9b9453f4b473ba5370390bb90b4b (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2018-06-15T15:09:13Z (GMT) No. of bitstreams: 1 DISS_2013_ Dione Viero Viana.pdf: 1878209 bytes, checksum: 5cdd9b9453f4b473ba5370390bb90b4b (MD5) / Made available in DSpace on 2018-06-15T15:09:13Z (GMT). No. of bitstreams: 1 DISS_2013_ Dione Viero Viana.pdf: 1878209 bytes, checksum: 5cdd9b9453f4b473ba5370390bb90b4b (MD5) Previous issue date: 2013-05-03 / CNPq / No Brasil, 99% do total de ocorrências de malária concentram-se na região da Amazônia brasileira. Na região Extra-amazônica são escassos os estudos referenciando os casos de malária, visto que o maior número de episódios de malária ocorrerem na região Amazônica. A malária é um agravo infeccioso febril produzido por protozoários do gênero Plasmodium. Nas Américas e no Brasil, predominam duas espécies parasitárias: P. vivax e P. falciparum, com predomínio deste evento nas zonas tropicais e sub-tropicais e está associado a fatores climáticos e ambientais, sejam elas antrópicas ou não, a fatores sócio-culturais e econômicos, e fatores biológicos do hospedeiro intermediário (homem) e definitivo (vetor) e do agente etiológico. Objetivo: Analisar a situação epidemiológica e a distribuição espaçotemporal da malária por Plasmodium vivax no Brasil. Método: Estudo ecológico da distribuição geográfica dos casos confirmados de malária, internações, óbitos e letalidade por malária em indivíduos residentes na região da Amazônia brasileira e Extra-amazônica, a partir dos bancos de dados do Sistema de Informação de Vigilância Epidemiológica – (SIVEP-Malária), Sistema de Informação de Agravos de Notificação – (SINAN), Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) e Sistema de Informação de Mortalidade (SIM), compreendendo as ocorrências por Unidades da Federação da região Amazônica e Extra-amazônica e segundo a espécie parasitária infectante. Resultados: Na região Amazônica, no período de 2003 a 2011, foram notificados 3.736.894 casos, destes 2.955.618 por P. vivax e 734.483 por P. falciparum, correspondendo à razão P. vivax/P. falciparum (V/F) de 4,0 casos por malária vivax para cada ocorrência por malária falciparum. Na distribuição mensal dos casos de malária, observaram-se valores mais elevados nos meses de julho a outubro, picos principalmente nos meses de julho e agosto. Na região Extra-amazônica entre 2001 a 2011, das 11.874 lâminas positivas para malária, 48,3% foram por P. vivax, 20% por P. falciparum e 8,6% por infecções mistas (P. vivax + P. falciparum). As infecções por Plasmodium vivax foram mais frequentes entre os anos de 2001 e 2007 (c 2 = 1987,041; p = < 0,0001). Verificaram-se 15,2% casos autóctones 70,3% casos importados (c 2 = 4226,806; p = < 0,0001). As duas regiões em estudo totalizaram 41.465 internações por malária vivax e 32.182 por malária falciparum entre 2000 e 2011. Destaca-se o acréscimo anual das internações por malária vivax, espécie considerada como benigna. Dos 1.229 óbitos por malária, 1.044 (85%) ocorreram no âmbito hospitalar, no qual 924 (88,5%) óbitos ocorreram na região Amazônica e 120 (11,5%) na área Extraamazônica do país. Conclusões: No que se refere à sazonalidade, as proporções de ocorrência de malária foram maiores no período seco, quando comparado ao período intermediário e chuvoso, apresentando importante variação sazonal. Na região Extraamazônica, o monitoramento contínuo da epidemiologia da malária autóctone e importada, em especial a cada alteração do Plasmodium persistente constitui-se como uma importante ferramenta para o controle e elaboração das atividades de vigilância em saúde em áreas não endêmicas. A Amazônia brasileira apresentou percentual maior de internações e óbitos, verificou-se tendência da taxa de letalidade crescente em ambas as regiões, a partir de 2005, apesar da taxa de letalidade da região extraamazônica, durante todo o período ser superior (taxa média de 3,2%), enquanto que a da Amazônia foi de 0,9%. Os estados da região Amazônica apresentaram tendência decrescente das taxas de internação ao longo do período, com importante predominância das internações por malaria vivax. / In Brazil 99% of the total incidence of malaria are concentrated in the Brazilian Amazon region. Extra-Amazonian region is scarce studies referencing malaria cases, since the greater number of episodes of malaria occur in the Amazon region. Malaria is an infectious febrile injury caused by protozoa of the genus Plasmodium. In the Americas and Brazil, two parasitic species predominate: P. vivax and P. falciparum. Predominance of this event in the tropics and sub-tropics and is associated with environmental and climatic factors, whether or not antropúrgicas, the socio-cultural and economic factors and biological intermediate host (man) and final (vector) and etiologic agent. Objective: To analyze the epidemiological situation and the spatial-temporal distribution of Plasmodium vivax malaria in Brazil. Methods: An ecological study of the geographical distribution of confirmed cases of malaria, hospitalizations, deaths and mortality from malaria in individuals living in the Brazilian Amazon region and Extra-Amazonian. From the databases of the Sistema de Informação de Vigilância Epidemiológica – (SIVEP-Malária), Sistema de Informação de Agravos de Notificação – (SINAN), Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) and Sistema de Informação de Mortalidade (SIM). Understanding occurrences by Federative Units of the Amazon region and Extra-Amazonian and according to the parasite species infecting. Results: In the Amazon region in the period 2003-2011 were reported 3,736,894 cases positive, 2,955,618 of these cases by P. vivax and 734 483 P. falciparum corresponding to the ratio P. vivax/P. falciparum (V/F) of 4.0 vivax malaria positive cases for each occurrence falciparum malaria. Distribution of malaria cases per month, it was observed higher values in the months from July to October, peaks mainly in the months of July and August each year. Extra-Amazonian region between 2001 to 2011 of 11,874 slides positive for malaria, 48.3% were due to P. vivax, 20% for P. falciparum and 8.6% for mixed infections (P. vivax + P. falciparum). Plasmodium vivax were more frequent between the years 2001 and 2007 (c 2 = 1987.041, p = <0.0001), in subsequent years there was an increase in infections by P. falciparum and mixed infections. It was found 15.2% 70.3% native cases imported cases (c 2 = 4226.806, p = <0.0001). The two regions under study totaled 41,465 admissions for malaria vivax and falciparum malaria by 32,182 between 2000 and 2011. Noteworthy is the annual increase of admissions for malaria vivax, a species considered benign and self-limited. Of the 1,229 deaths from malaria, 1,044 (85%) occurred in the hospital, in which 924 (88.5%) deaths occurred in the Amazon region and 120 (11.5%) on the Extra-Amazonian country. Conclusions: With regard to the seasonality of malaria occurrence ratios were higher in the dry compared to the period intermediate and rainy, presenting substantial seasonal variation in prevalence of this event during the dry period. Extra- Amazonian region in the continuous monitoring of the epidemiology of imported and autochthonous malaria, especially every change of Plasmodium persistent constitutes an important tool for the control and development of health surveillance activities in non-endemic areas. The Brazilian Amazon presented a higher rate of hospitalizations and deaths, there was a trend of increasing mortality in both regions since 2005, despite the lethality of extra-Amazonian region throughout the period is higher (average rate of 3.2 %), whereas the Amazon was 0.9%. The states of the Amazon region showed a downward trend in rates of hospitalization over the period, with significant predominance of admissions for malaria vivax.

Le paludisme, maladie parasitaire et vectorielle, sévissant principalement dans les zones intertropicales où vit près de 40% de la population mondiale, reste un problème majeur en santé publique. Les cinq espèces de Plasmodium connues infectées le paludisme chez l'homme sont présentes au Cambodge, qui est reconnu comme l'épicentre de l'émergence de souches de P. falciparum multi-résistantes (chloroquine, sulfadoxine- pyriméthamine, méfloquine, artémisinine), pouvant entraver les progrès accomplis depuis plus d'une décennie. Le travail de thèse intitulé « Approche génomique et bio-informatique de l'émergence et de la diffusion des résistances chez Plasmodium au Cambodge » avait pour objectif de développer de nouveaux outils moléculaires et biologiques pour 1) une meilleure compréhension de l'impact des stratégies mises en place pour lutter contre le paludisme à P. falciparum sur les autres espèces de Plasmodium, 2) la mise en place d'outils biologique et moléculaire, permettant de mieux définir l'épidémiologie des parasites résistants, en particulier la résistance à la quinine et aux dérivés de l'artémisinine, 3) l'étude et la définition des sous-populations parasitaires circulant au Cambodge afin d'estimer les risques associés à la diffusion de la résistance à l'artémisinine. Cette thèse a été réalisée dans l'Unité d'Epidémiologie Moléculaire du Paludisme à l'Institut Pasteur du Cambodge (IPC) sous la codirection du Dr. Didier Ménard (Chef de laboratoire à l'IP) et du Pr. Emmanuel Cornillot (Professeur à l'Université Montpellier I). Le premier objectif visait à étudier l'impact de la pression médicamenteuse sur la dynamique d'évolution des populations parasitaires. Nous avons d'abord évalué le polymorphisme des gènes associés à la résistance à la pyriméthamine (gène dhfr, dihydrofolate reductase) chez Plasmodium malariae et Plasmodium ovale (article 1 et manuscrit en préparation1), et le polymorphisme du gène mdr-1 (multidrug resistance 1) associé à la résistance à la mefloquine chez P. vivax (article 2). De plus, en collaboration avec l'Institut Pasteur de Madagascar, nous avons étudié le lien pouvant exister entre le polymorphisme du gène candidat Plasmodium falciparum Na+/H+ exchanger (Pfnhe-1) et la résistance (clinique et in vitro) de P. falciparum à la quinine (articles 3 et 4).Le deuxième objectif s'est interessé au développement d'outils biologiques et moléculaires permettant d'évaluer la résistance des souches de P. falciparum aux dérivés de l'artémisinine. Les 3 articles présentés (articles 5, 6 et 7) decrivent la méthodologie d'approche originale utilisée associant la génomique, la biologie, la clinique et l'épidémiologie, qui a permis d'aboutir à la découverte d'un marqueur moléculaire (mutations au sein du gène Kelch 13) fiable pour identifier les souches résistantes aux dérivés de l'artémisinine.Le dernier objectif était consacré au développement de la technique PCR-LDR-FMA appliqué à la détection d'un panel de 24 SNPs permettant de caractériser par un « barcode » chaque isolat de P. falciparum. Cette technique couplée avec une analyse bio-informatique et statistique des données nous a permis d'étudier et de définir la structuration des populations parasitaires circulant au Cambodge afin d'estimer les zones à risque de diffusion de la résistance à l'artémisinine (manuscrit en préparation 2).A travers ce travail de thèse, nous nous sommes efforcés de montrer la puissance des techniques de biologie moléculaire disponibles couplées avec des approches génomique et bio-informatique pour améliorer notre compréhension de la dynamique d'évolution des populations parasitaires. Ce travail s'est essentiellement concentré sur les phénomènes liés à l'émergence et de la diffusion des parasites résistants aux antipaludiques, le but final de ce travail étant d'améliorer les stratégies de lutte mises en place pour atteindre l'ambitieux objectif d'élimination du paludisme. / Malaria, a protozoan vector-borne disease, is mainly prevalent in tropical areas, where nearly 40% of the world population is residing and remains one of the most concerns for public health worldwide. In Cambodia, the five Plasmodium species known to cause malaria in humans are present. The main feature of this country is that it is recognized as the epicenter of the emergence of multi-resistant P. falciparum parasites (to chloroquine, sulfadoxine-pyrimethamine, mefloquine, and artemisinin), a very significant menace to public health in the Mekong region that could impact the worldwide strategy to fight malaria. The thesis presented here, entitled “Genomics and Bioinformatics in the emergence and spread of resistant Plasmodium in Cambodia” aimed to develop new molecular and biological tools for:1) improving our understanding of the collateral impact of the strategies implemented to fight against falciparum malaria on the other Plasmodium species; 2) defining the molecular epidemiology of antimalarial resistant parasites, especially resistance to quinine and artemisinin derivatives;3) studying and defining the structure of P. falciparum parasite populations circulating in Cambodia to estimate areas at risk of spread of artemisinin resistance, using genomic approaches and bioinformatics. This thesis was carried out in the Malaria Molecular Epidemiology Unit at Pasteur Institute in Cambodia (IPC) under the co-direction of Dr. Didier Ménard (Head of the Unit, IP) and Pr. Emmanuel Cornillot (Professor, University of Montpellier I). The first objective of this work was to study the impact of drug used to treat falciparum malaria on the dynamics of other Plasmodium species. In a first step, we evaluated the polymorphism in gene associated to pyrimethamine resistance (dhfr gene, dihydrofolate reductase) in Plasmodium malariae and in Plasmodium ovale (article 1 and manuscript in preparation 1) and the polymorphism in mdr-1 gene (multidrug resistance 1 gene) associated to mefloquine resistance in P. vivax (article 2). Secondly, in collaboration with Pasteur Institute in Madagascar, we investigated the association between the polymorphism in Plasmodium falciparum Na + / H + exchanger gene (Pfnhe-1) and quinine resistance defined either by clinical or in vitro phenotypes (articles 3 and 4). The second objective was focused on the development of novel biological and molecular tools to assess the resistance of P. falciparum to artemisinin derivatives. The three papers presented (articles 5, 6 and 7) describe an original approach combining genomics, biological, clinical and epidemiological studies, which lead to the discovery of a molecular marker (mutations Kelch 13 gene) associated to artemisinin resistance.The third and final objective was devoted to the development of the PCR-LDR-FMA technology applied to the detection of a panel of 24 SNPs to characterize a "barcode" of P. falciparum isolates. This technic coupled with bioinformatics and statistical analysis allowed us to study and define the structure of the parasite populations circulating in Cambodia for estimating areas at risk of spread of artemisinin resistance (manuscript in preparation 2). Through this work, we have tried to show the usefulness of available molecular biology methods coupled with genomic and bioinformatics approaches to improve our understanding of the dynamics of the malaria parasite populations. This work has been mainly focused on the emergence and spread of antimalarial resistant parasites, keeping in mind that the ultimate goal of this work was to improve strategies implemented to achieve the ambitious goal of malaria elimination.

Le paludisme demeure un problème de santé majeur en Afrique subsaharienne. Le nombre limité d'antipaludiques, l’apparition de résistances et l’absence d’un vaccin efficace, font de la lutte anti-vectorielle (LAV) la principale stratégie préventive de cette maladie. Les méthodes actuelles de LAV visant à limiter ou à interrompre le développement du parasite chez le moustique vecteur, il est donc nécessaire d’améliorer notre compréhension des interactions entre le vecteur Anopheles, son environnement et le parasite Plasmodium. A Madagascar, Anopheles gambiae s.l. et Anopheles funestus sont les vecteurs majeurs de Plasmodium falciparum et de Plasmodium vivax. Anopheles mascarensis, espèce endémique, peut également être un vecteur important. Dans ce contexte, l’objectif premier de ma thèse a été d’approfondir les connaissances sur An. mascarensis à travers une revue. Les données collectées plaident davantage qu’An. mascarensis est un complexe d'espèces et permettent de poser les bases pour une analyse moléculaire ciblée. En parallèle, j’ai contribué à la mise en place de la première plateforme expérimentale de Madagascar pour infecter des anophèles par P. falciparum et P. vivax, afin d’évaluer leur compétence vectorielle. Enfin, en associant entomologie et immuno-parasitologie, nous avons analysé la contribution des vecteurs à la transmission du paludisme dans deux villages adjacents. L’ensemble des travaux réalisés durant de ma thèse contribue à une meilleure connaissance de la diversité de la transmission du paludisme à Madagascar. De plus, la mise en place de la plateforme expérimentale d’infection permettra l’analyse de la compétence des populations d’anophèles vecteurs. / Malaria remains a major health concern in sub-Saharan Africa. The limited number of antimalarial drugs, the emergence of resistances and the lack of an effective vaccine, make vector control the main preventive strategy for this disease. Current methods of vector control aim at limiting or interrupting parasite development in the vector mosquito. It is therefore necessary to improve our understanding on interactions between the Anopheles vector, its environment and the parasite Plasmodium. In Madagascar, Anopheles gambiae s.l. and Anopheles funestus are the major vectors of Plasmodium falciparum and Plasmodium vivax. Anopheles mascarensis, an endemic species, may also be an important vector. In this context, the main objective of my PhD was to deepen the knowledge on An. mascarensis through a review. The data collected indicate that An. mascarensis is a complex of sibling species. I could thus provide the foundation for targeted molecular analysis. In parallel, in order to evaluate their vector competence, I contributed in a major way to the establishment of the first experimental platform of Madagascar to infect anopheline mosquitoes by P. falciparum and P. vivax. Finally, combining entomology and immuno-parasitology, we analysed the contribution of vectors to malaria transmission in two neighbouring villages. All the work done during my PhD contributes to a better knowledge of the diversity of malaria transmission in Madagascar, especially on the effective contribution of the different vector species. In addition, the establishment of the experimental platform for infections will further allow the analysis of the competence of vector Anopheles populations.

Malariakontrolle ist von Resistenzen gegen Malariamedikamente wie Chloroquin (CQ) und Artemisininderivaten (ART) bedroht. Hier untersuchten wir das Ausmaß dieser Resistenzen in Fünf Feldstudien in Nigeria, Ruanda und Südwestindien unter Beurteilung der Prävalenzen Arzneimittelresistenz-assoziierter Mutation der Plasmodium-Parasiten (P. falciparum: K13, dhps, dhfr, mdr1 und P. vivax: mdr1) z.T. in Korrelation mit klinischen Patientendaten und ex-vivo Überlebensraten (ÜLR) unter Zugabe von ART. K13 wurde in 360 zwischen 2010-2018 gesammelte ruandischen P. falciparum Isolaten genotypisiert. Erstmals fanden wir dort niedrige Frequenzen der mit ART-Resistenz assoziierten K13-Mutation. Jedoch lassen Mutation mit niedrigen ÜLR, sowie ein Isolat mit hohen ÜLR aber ohne K13-Mutation eines Patienten der die Infektion unter Therapie nicht eliminieren konnte, Fragen offen. Ca.100 indische P. falciparum und P. vivax Isolaten aus 2015 wurden auf Mutationen in P. falciparum Markern für die Resistenz gegen Sulfadoxin-Pyrimethamin (SP) (d.h. pfdhps/pfdhfr), Artesunat (AS) (d.h. K13) und Lumefantrin (d.h. pfmdr1) sowie P. vivax Marker für CQ-Resistenz (pvmdr1) untersucht. Der Großteil der Isolate zeigt Mutationen die SP-Resistenz hervorrufen, daher könnte die Effizienz der AS+SP-Therapie begrenzen sein. Außerdem eignet sich Lumefantrin nicht als alternatives Medikament auf Grund der beobachteten Dominanz des pfmdr1-Haplotyps „NFD“. Die Abwesenheit der pvmdr1-Mutation Y976F und erfolgreiche Behandlungen zeigen, die Wirksamkeit von CQ gegen vivax Malaria im Studiengebiet. Auch Isolate von nigerianischen Schwangeren mit asymptomatischer P. falciparum Infektion zeigten hohe Prävalenzen von pfdhfr/pfdhps Vier- und Fünffachmutanten darum ist die Wirksamkeit der präventiver Therapie Schwangerer mit SP in Nigeria ernsthaft gefährdet. Die Daten spiegeln die Häufigkeit der Resistenzen gegen Malariamittel in diesen Gebieten wieder mit großen Unterschieden zwischen Regionen und Medikamenten. / The spread of resistance to antimalarial drugs such as chloroquine (CQ) and artemisinins (ART) is a great threat to malaria control. Here, we investigated the extent of such resistance in Nigeria, Rwanda and south-western India. We assessed the prevalence of mutations in few Plasmodium parasites’ markers of resistance, namely P. falciparum genes K13 (ART), pfdhps/pfdhfr (sulfadoxine-pyrimethamine, SP) and pfmdr1 (lumefantrine) as well as P. vivax gene pvmdr1 (CQ) in 5 field studies conducted in 2010-2018, and partially correlated the results to patients’ clinical outcome. Few isolates from Rwanda, were also evaluated for their parasite ex vivo survival rates (SR) upon exposure to ART. We tracked ART resistance in Rwanda by genotyping K13 in 360 P. falciparum isolates from 2010-2018. We showed for the first time that K13 mutations associated with ART resistance are present here, thus in Africa, at a low frequency. However, mutations occurred in patients who recovered and/or had low SR. Of note, one patient with high SR but no K13 mutation was still parasitemic after ART treatment. Moreover, we assessed the presence of mutations in K13, pfdhps/pfdhfr, pfmdr1 and pvmdr1 in ca 100 P. falciparum and 100 P. vivax isolates from south-western India. Most of P. falciparum isolates carried pfdhfr/pfdhps mutations conferring SP resistance, menacing the efficacy of SP-ART treatment. Also, the high prevalence of pfmdr1 haplotype “NFD” advised against the introduction of lumefantrine. The low rates of P. vivax pvmdr1 Y976F and patients’ successful parasite clearance, indicated that CQ remains effective in the area. Finally, a high rate of pfdhfr/pfdhps quadruple and quintuple mutant was observed in Nigerian pregnant women with asymptomatic P. falciparum infection, hence the effectiveness of preventive treatment with SP in pregnancy might be threatened. The data reflected the abundance of antimalarials resistance in these areas with important differences between regions and drugs.