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      Inhibition of an Erythrocyte Tyrosine Kinase with Imatinib Prevents Plasmodium falciparum Egress and Terminates Parasitemia

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          Abstract

          With half of the world’s population at risk for malaria infection and with drug resistance on the rise, the search for mutation-resistant therapies has intensified. We report here a therapy for Plasmodium falciparum malaria that acts by inhibiting the phosphorylation of erythrocyte membrane band 3 by an erythrocyte tyrosine kinase. Because tyrosine phosphorylation of band 3 causes a destabilization of the erythrocyte membrane required for parasite egress, inhibition of the erythrocyte tyrosine kinase leads to parasite entrapment and termination of the infection. Moreover, because one of the kinase inhibitors to demonstrate antimalarial activity is imatinib, i.e. an FDA-approved drug authorized for use in children, translation of the therapy into the clinic will be facilitated. At a time when drug resistant strains of P. falciparum are emerging, a strategy that targets a host enzyme that cannot be mutated by the parasite should constitute a therapeutic mechanism that will retard evolution of resistance.

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          Most cited references60

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          Human malaria parasites in continuous culture.

          Plasmodium falciparum can now be maintained in continuous culture in human erythrocytes incubated at 38 degrees C in RPMI 1640 medium with human serum under an atmosphere with 7 percent carbon dioxide and low oxygen (1 or 5 percent). The original parasite material, derived from an infected Aotus trivirgatus monkey, was diluted more than 100 million times by the addition of human erythrocytes at 3- or 4-day intervals. The parasites continued to reproduce in their normal asexual cycle of approximately 48 hours but were no longer highly synchronous. The have remained infective to Aotus.
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            A molecular mechanism of artemisinin resistance in Plasmodium falciparum malaria

            Artemisinins are the corner stone of anti-malarial drugs 1 . Emergence and spread of resistance to them 2–4 raises risk of wiping out recent gains achieved in reducing world-wide malaria burden and threatens future malaria control and elimination on a global level. Genome wide association studies (GWAS) have revealed parasite genetic loci associated with artemisinin resistance 5–10 . However, there is no consensus on biochemical targets of artemisinin. Whether and how these targets interact with genes identified by GWAS, remains unknown. Here we provide biochemical and cellular evidence that artemisinins are potent inhibitors of Plasmodium falciparum phosphatidylinositol-3-kinase (PfPI3K), revealing an unexpected mechanism of action. In resistant clinical strains, increased PfPI3K was associated with the C580Y mutation in P. falciparum Kelch13 (PfKelch13), a primary marker of artemisinin resistance. Polyubiquitination of PfPI3K and its binding to PfKelch13 were reduced by PfKelch13 mutation, which limited proteolysis of PfPI3K and thus increased levels of the kinase as well as its lipid product phosphatidylinositol 3-phosphate (PI3P). We find PI3P levels to be predictive of artemisinin resistance in both clinical and engineered laboratory parasites as well as across non-isogenic strains. Elevated PI3P induced artemisinin resistance in absence of PfKelch13 mutations, but remained responsive to regulation by PfKelch13. Evidence is presented for PI3P-dependent signaling, where transgenic expression of an additional kinase confers resistance. Together these data present PI3P as the key mediator of artemisinin resistance and the sole PfPI3K as an important target for malaria elimination.
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              Malaria biology and disease pathogenesis: insights for new treatments.

              Plasmodium falciparum malaria, an infectious disease caused by a parasitic protozoan, claims the lives of nearly a million children each year in Africa alone and is a top public health concern. Evidence is accumulating that resistance to artemisinin derivatives, the frontline therapy for the asexual blood stage of the infection, is developing in southeast Asia. Renewed initiatives to eliminate malaria will benefit from an expanded repertoire of antimalarials, including new drugs that kill circulating P. falciparum gametocytes, thereby preventing transmission. Our current understanding of the biology of asexual blood-stage parasites and gametocytes and the ability to culture them in vitro lends optimism that high-throughput screenings of large chemical libraries will produce a new generation of antimalarial drugs. There is also a need for new therapies to reduce the high mortality of severe malaria. An understanding of the pathophysiology of severe disease may identify rational targets for drugs that improve survival.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 October 2016
                2016
                : 11
                : 10
                : e0164895
                Affiliations
                [1 ]Purdue Institute for Drug Discovery, Purdue University, West Lafayette, 47907, United States of America
                [2 ]Purdue Department of Chemistry, Purdue University, West Lafayette, 47907, United States of America
                [3 ]Department of Biomedical Sciences, University of Sassari, Sassari, Italy
                [4 ]Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy
                [5 ]Department of Paediatrics/Research Unit, Mbale Regional Referral Hospital, Mbale, Uganda
                Liverpool School of Tropical Medicine, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: KRK AP FT PSL.

                • Formal analysis: KRK AP.

                • Funding acquisition: PSL.

                • Investigation: KRK AP FT.

                • Methodology: KRK AP FT PSL.

                • Project administration: KRK AP FT PO.

                • Resources: AP FT PO PSL.

                • Supervision: FT PO PSL.

                • Validation: KRK AP PSL.

                • Writing – original draft: KRK PSL.

                • Writing – review & editing: KRK PSL.

                Author information
                http://orcid.org/0000-0001-9042-5528
                Article
                PONE-D-16-26863
                10.1371/journal.pone.0164895
                5074466
                27768734
                2d2233df-4147-4cf4-a04f-f325ed8b91ee
                © 2016 Kesely et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 5 July 2016
                : 3 October 2016
                Page count
                Figures: 6, Tables: 1, Pages: 19
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000009, Foundation for the National Institutes of Health;
                Award ID: 5R01GM024417-35
                Award Recipient :
                Funded by: Hurvis Foundation
                Award Recipient :
                This study was supported (in part) by research funding by a grant from the National Institutes of Health (5R01GM024417-35) and a gift from the Hurvis Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Parasitic Diseases
                Biology and Life Sciences
                Developmental Biology
                Life Cycles
                Parasitic Life Cycles
                Biology and Life Sciences
                Parasitology
                Parasitic Life Cycles
                Biology and Life Sciences
                Parasitology
                Quantitative Parasitology
                Parasitemia
                Biology and Life Sciences
                Organisms
                Protozoans
                Parasitic Protozoans
                Malarial Parasites
                Biology and Life Sciences
                Parasitology
                Parasite Groups
                Apicomplexa
                Plasmodium
                Biology and Life Sciences
                Cell Biology
                Cellular Types
                Animal Cells
                Blood Cells
                Red Blood Cells
                Biology and Life Sciences
                Biochemistry
                Enzymology
                Enzymes
                Protein Kinases
                Tyrosine Kinases
                Biology and Life Sciences
                Biochemistry
                Proteins
                Enzymes
                Protein Kinases
                Tyrosine Kinases
                Medicine and Health Sciences
                Parasitic Diseases
                Malaria
                Medicine and Health Sciences
                Tropical Diseases
                Malaria
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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                Uncategorized

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