Antimalarials Flashcards
1
Q
LO
A
identify the key events in the life cycle of the malaria parasite and how these may be affected by antimalarial agents
2
Q
Topics covered
A
- The prevalence/ vector / parasite / disease / diagnosis/ susceptibility
- Parasite life cycle
- Vector control (including larvicides, insecticides, genetics)
- Vaccine
- Drugs for prophylaxis, acute treatment, and radical cure
- Resistance and future therapies/targets
3
Q
What is malaria?
A
RBC are invaded by the Plasmodium species which is carried by mosquitoes
Its eukaryotic, parasitic protozoan
Infection by mosquito vector (and mother-foetus)
4
Q
Where is the term ‘malaria’ from and what is also sometimes referred to as?
A
Literally bad air (from Old Italian “mal” ‘aria”)
Sometimes known as “intermittent fever” / “marsh fever”
5
Q
When were cases of Malaria first recorded?
A
Recorded as far back as 3000 BC in China, India, and Egypt / Roman times in the UK (parasite in humans ~100,000 years)
6
Q
Why do the number of UK cases rise?
A
Number of UK cases on the rise due to global travel (~2,000 a year – ‘suitcase’ malaria)
Also climate change
7
Q
Malaria is described as being one of the ‘big three’ diseases, alongside what two others?
A
HIV
TB
8
Q
in 2019, what were the reported cases and deaths of malaria by the WHO
Who was it more prevelant in and why?
A
229 million cases a year / 409,000 deaths (WHO 2019)
Found mostly children <5 because they have not been exposed to it and have no defences against it
9
Q
What are the regions in which malaria is endemic?
endemic: when a diseases is generally found among certain populations and places
A
Primarily in tropical and subtropical regions as that is where the mosquitoes are present
10
Q
Tell me about the stats for the Morbidity and mortality in sub-saharan Africa where its mainly concentrated
A
Morbidity: The state of having a specific illness or condition
Mortality: Refers to the nunber of deaths that have occurred due to a specific illness or condition
Under 5s account for 52% of deaths (2/3rds for under 14s)
Sub-Saharan Africa: 94% cases and 95% of deaths
11
Q
The global cases are falling but, successes in this since the 2000 are slowing due to what factors?
A
‘Success’ – sustainability/removal of funds
Resistance (mosquito and Plasmodium)
12
Q
How is malaria transmitted?
A
Transmitted through the “bite” of the female mosquito genus Anopheles (~40 species associated with malaria)
13
Q
What happens when a mosquito bites its target?
A
Parasite initially ingested during a blood meal of an infected individual, it grows replicates in gut, and is then passed on during subsequent meal (8-15 sporozoites)
Sporozoites: a motile spore-like stage in the life cycle of some parasitic sporozoans (e.g. the malaria organism), that is typically the infective agent introduced into a host.
14
Q
Where are mosquitos usually found?
A
Abundant and distributed all over the globe, including the Arctic, but particularly widespread in tropical / sub-tropical regions, particularly around stagnant water (as larvae grow in stagnant water. Issue in places like Africa who will have large rainfalls and large water pools forming so trying to target this is quite difficult)
15
Q
How can the parasites be transmitted/
A
Parasites can be transmitted through blood transfusions and contaminated needles (but generally rare), as well as intra-uterine (mother-baby); can lead to complications and potentially miscarriage
16
Q
What are the 5 species of parasite that can form malaria and rank them from most to least dangerous
Which ones require radical cure and why?
A
P. falciparum (most serious / 90% deaths)
P. vivax*, ovale*, malariae (milder disease)
P. knowlesi (zoonotic - monkey & human)
*Requires radical cure- because they have a dormant state in the liver which can hide from the immune system and then erupt and come back later in life
17
Q
How does the parasite uptake the nutrients it requires from the red blood cells?
A
Uptake material from RBC; haemoglobin and protein component. Has a food vacuole
18
Q
Explain abit about the incubation period of the different malarial parasites
A
Can live in system for a few weeks without any symptoms. Only when its present in your blood is its known that you are infected
19
Q
Tell me what the initial symptoms are for the malarial parasites
A
- flu like
- headache
- Photophobia
- muscle aches
- nausea
- vomiting
- chills (10-15 mins)
- Fells cold but is actually feverish
- Jaundice
Jaundice as RBC breaking down and bilirubin being present
20
Q
Tell me about the periodicity of the malarial parasites
A
Goes through rounds of replications once in RBC leading to cycles of symptoms- periodicity
21
Q
Tell me about the onset of diseases the the severity and duration (hr) for malarial parasites
A
Can cross BBB, clump RBC and this can lead to blocking blood vessels and brain swelling which leads to death- if survive it can lead to chronic conditions
22
Q
With the malarial parasite if left untreated or not treated properly it can lead to relapses or recrudescences, explain this
A
If untreated by drugs, then it can come back during your lifetime
Recrudescence is when you haven’t fully cleared from blood, not completely killed, will come back
23
Q
Why can one get anaemia from malarial parasites?
A
Anaemia as breaking over blood cells and have the side effects from this
24
Q
The disease and the 5 malarial parasites
A
25
Some individuals can have genetic advantages which can help protect them against malaria. State 3 of them
* **sickle cell disease**
* **Glucose-6-phosphate dehydrogenase deficiency**
* **Lack of Duffy antigens on RBC**
26
How can sickle cell disease provide some protection against malaria?
**Sickle Cell Disease (HbS, β-thalassemia etc.)**
Heterozygous then can get resistance to malaria but homozygous you can get the disease
The sickle cells have membranes, stretched by their unusual shape, that become porous and leak nutrients that the parasites need to survive and the faulty cells eventually get eliminated quite fast by the organisms, destroying the parasite along the way.
27
How can Glucose-6-phosphate dehydrogenase deficiency (X-linked) provide one protection against malaria?
**Glucose-6-phosphate dehydrogenase deficiency (X-linked)**
if lack enzyme then the RBC are more susceptible to redox damage and breakdown, malaria is more susceptible to redox damage so is less likely to infect these cells
As G6PD deficiency leads to increased oxidative stress in red blood cells, this may in turn have a negative influence on the parasite. As such, individuals who possess this mutation have some protection against malaria
28
How can a lack of Duffy antigens provide one protection against malaria?
**Lack of Duffy antigens on RBC**
**Duffy antigens** plat a fundamental role on haematopoiesis (formation of blood cell components)
Duffy antigens are located on the surface of RBC
The protein encoded by this gene is a glycosylated membrane protein and a non-specific receptor for several chemokines
A lack of these antigens make the RBCs more resistant to invasion by a malarial parasite
29
What may some people have that puts them more at risk to malaria?
* Pregnancy
* Co-infection: HIV, helminths
30
31
What are some techniques into the clinical diagnosis of malaria?
Microscopic examination of blood smears using **Giemsa/Wright stain**
**Giemsa stain:** specific to phosphate groups of DNA. Attaches to regions of DNA with high amounts of AT bonding
**Wright stain:** Facilitates the differentiation of blood cell types. classically a mixture of eosin (red) and methylene blue dyes
**Antigen-capture assay** (‘dipsticks’) - 100 parasites/µl lower limit of detection
**PCR** for strain detection (for determining drug resistance)
32
Tell me the stages to the malarial life cycle and what can happen at each stage
1. Injection of **sporozoites** into blood stream
2. Sporozoites can pass quickly into the liver OR can remain dormant (**Hypnozoites**)
3. Go through **Asexual reproduction** over roughly 10 days. Over this time no symptoms show
4. Liver **Schizonts** are now present
5. **Merozoites** are released into the blood where they can; invade RBC, asexually reproduce, cause cells to burst, repeat cycle, cause cyclic fever
6. Blood **Schizonts** are now present
7. Some Merozoites develop into **Gametocytes** that can circulate in the blood
8. Moquito can ingest gametocytes, which develop into gametes and reproduce sexually
9. Develop inot **ookinetes** that burrow through gut wall to form **oocysts**
10. Oocyst bursts, releasing sporozoites that travel to salivary glands
11. Cycle repeats when the mosquito bites another person
33
What are **sporozoites**?
a motile spore-like stage in the life cycle of some parasitic sporozoans (e.g. the malaria organism), that is typically the infective agent introduced into a host.
34
What are **Hypnozoites**?
Hypnozoites are dormant forms in the life cycles of certain parasitic protozoa that belong to the Phylum Apicomplexa (Sporozoa) and are best known for their probable association with latency and relapse in human malarial infections caused by Plasmodium ovale and P. vivax.
35
What are **Schizonts**?
They are mature malarial parasites in host liver cells or red blood cells that are undergoing nuclear division by a process called schizogony
36
What are **gametocytes**?
A eukaryotic germ cell that divides by mitosis into other gametocytes or by meiosis into gametides during gametogenesis
37
What are **ookinetes**?
The motile zygote that forms when the microgamete (derived from the male gametocyte) fertilises the macrogamete (derived from the female gametocyte) during the sexual reproduction of certain sporozoans such as the malaria causing plasmodium
38
What are **oocysts**?
A cyst containing a zygote formed by a parasitic protozoan such as the malaia parasite
39
Whats **schizogony?**
**Asexual reproduction** by multiple fission, found in some protozoa
This occurs at a phenomenal rate
40
What can Schizogony in parasites produce?
A single parasite of P. vivax can give rise to 250 million merozoites in 14 days!
To appreciate the action required of an antimalarial drug, note that the destruction of 94% of the parasites every 48 h will serve only to maintain equilibrium and not further reduce their numbers!- rapid reproduction
**Produce a Schizont** which can rapidly divide into many cells (merozoites) and infect
41
What are some approaches being developed to eradicate the parasites (mainly P. falciparum as its the most deadly)
* Vaccines to prevent infection
* Drugs for radical cure
* Drugs for prophylaxis (try to prevent infection. However these drugs cannot be taken over a long period of time due to severe side effects)
* Drugs to treat acute attack
* Drugs to prevent transmission
42
When trying to control vectors of diseases, what are some of the things you could potentially target?
What does the combination of these approaches do?
* Target the larvae life stage
* Target adult moquito
The combination of these non-pharmacological approaches decreased the number of malaria cases in Africa by two thirds between 2000-15 (but stalling…)
43
How do you target the larvae life stage?
* Use of larvicides
* Remove/ cover standing water e.g, drain swamps, oil films
44
How can you target the adult mosquito?
* Use of insecticides / repellents
* Long-lasting insecticidal nets (LLINs)
* Indoor residual spraying (IRS)
45
Whats different forms can Larvicides be?
* Chemical agents
* Biological agents
* Biodegradable oils
46
Tell me about Larvicides as chemical agents and provide an example
Chemical agents **e.g. Methoprene**
Juvenile Hormone Analogue: increasing levels stalls larval development
Note yet routinely used in Sub-Saharan Africa (cost/easier to target adults/toxic to other aquatic life)
47
Tell me about larvicides as biological agents
provide examples
Biological agents **e.g., Bacillus thuringiensis var israelensis and Bacillus sphaericus**
Apply pellets to water
Effective but complex considerations for deployment (mosquito species, water type etc.)
48
What do biodegradable oils do as larvicides?
Prevent the larvae from breathing
49
Give an example of a main insecticide
**Dichlorodiphenyltrichlorethane (DDT)**
50
Tell me the following about the insecticide DDT...
* when was it used
* how does it act
Extensively used in 1950s and 1960s in US, Southern Europe and South America
**Acts by opening voltage gated Na+ channels in neurons**, causing them to fire spontaneously, which leads to spasms and eventual death (1000-fold higher affinity for insect channels = selective toxicity)
51
Tell me about DDE bio-accumulates in the fat of animals
DDE bio-accumulates in the fat of animals (rarely excreted).
Responsible for the decline in many species of birds and fish and reproductive issues in humans (carcinogenic/endocrine disruptor) – largely banned in 1970s/80s
52
Whats the **Stockholm convention**
The Stockholm Convention is a global treaty that aims to protect human health and the environment from the effects of persistent organic pollutants (POPs)
·
Stockholm Convention – should only be used for vector control (IRS)
53
DDT...
54
Give an example of another insecticide
**Pyrethrins/ Pyrethroids**
55
Compare the used of Pyrethrins/ Pyrethroids as insecticides compared to DDT
Safer (Shorter half-life) but more expensive alternative to DTT
56
What is the pyrethrin/ pyrethroid insecticide derived from?
Chrysanthemum sp. or synthetic
57
Many DDT-pyrethrin resistant strains of mosquito have also evolved. Tell me the sort of mutations that have arised from them
upregulation of CYP450s GSTe2 genes – detoxify
Mutations to sodium channels
Sequestering proteins in mosquito legs!
58
What can you combine pyrethrins with?
CYP450 inhibitors on LLINs
59
Give some examples of insecticides that target acetylcholine
Organophosphates e.g., malathion
Carbamates e.g., Bendiocarb
Acetylcholine agonists at nAChRs
All three of these are Acetylcholine esterase inhibitors
60
Tell me about **Organophosphates e.g., malathion**
Irreversible inhibition
Not typically used in residential settings – highly toxic
61
Tell me about **Carbamates e.g., Bendiocarb**
Same mechanism but reversible
62
Tell me about **Acetylcholine agonists at nAChRs**
Neonicotinoids: e.g., clothianidin - selective
General problems: environmental damage both to insects (pollinators – honeybees) and other animals
63
Insecticides structures...
64
Whats a technique used to control mosquitos?
The sterile insect technique (SIT)
65
Tell me the stages to the sterile insect technique (SIT) for controling moquitos
and or
Wolbachia (bacterial) infection (Incompatible Insect Technique)
Successful trial combination (SIT/IIT) trial in China (2019)
66
Tell me some genetic approaches...
**Oxitec Self-Limiting Gene technology**
* Males require tetracycline in diet to grow to maturity
* Release males into the wild and mate with females
* Offspring cannot mature due to lack of tetracycline
**Gene Drives:**
* Use CRISPR-Cas9 cassette to force incorporation of defective doublesex gene in offspring (makes females infertile)
67
What are the different stages of the malarial life cycle that drugs can target?
* Target the sporozoites
* Target the liver forms
* Target blood forms
* Target Gametocytes
68
What are some challenges with the malarial vaccine?
Whats an alternative to possibly overcome these challenges?
Challenge: malaria isn't one disease — it’s four!
Complexity of life cycle? Which stage to target?
Generate enough antibody to eliminate every single sporozoite before they reach the liver, as a single parasite can expand by 10,000 to 40,000 times!
Immune evasion by hiding in host cells
Most vaccines designed to target the infectious stage — the single-celled sporozoites that are injected into the body by a feeding mosquito
Alternative is to develop a vaccine against the transmission stage of life cycle (use in combination)
69
What are the current and future malarial vaccines?
**_Current and future vaccines_**
* Bill & Melinda Gates Foundation/GSK: RTS,S/AS01 (Mosquirix®) for P. falciparum
* Recombinant protein antigen (circumsporozoite protein antigens, fusion with hepatitis B surface antigen)
* Provides protection for both clinical and severe malaria in African children (with about a 55 % effectiveness over 12 months)
* Might be more effective with targeted roll out (i.e. rainy season)
* Requires 4 doses (3, per month and 1 at 18 months)
* Concerns over cost (lack of support for other programmes)
* Next generation: R21/MM has an efficacy of 75% (phase II)
70
When are drugs taken for prophylaxis/ acute attacks?
Generally taken daily or weekly (at lower dose) and restricted to short term visitors
71
Why are drugs for prophylaxis/ acute attacks generally not taken in endemic regions, explain a bit more about this
Often not used in **endemic regions due to cost / side effects**
Either **causal** (liver stage; ‘liver schizonticides’; required week upon return)
or
**suppressive** (blood stage, ‘blood schizonticides’; required month upon return)
72
What are the major drug targets for those targeting prophylaxis/ acute attacks?
Folate metabolism
Mitochondrial electron transport
Haem detoxification, reactive oxygen species
73
What being used in combination has also proven useful for prophylaxis/ acute attacks?
Some antibiotics, such as doxycycline and clindamycin, have also proved useful in combination
74
Give an example of drugs that targets liver forms (hypnozoites) - drugs that effect a radical cure
Tell me about it amd when they are active against
**8-aminoquinoline:** ‘tissue schizonticide’ active against the exoerythrocytic stage of the parasite AND active against liver hypnozoites (the dormant stage in P. ovale and P. vivax)
Helps to prevent relapse (that occurs sometimes weeks, or even years after infection) in combination with chloroquine
Active against gametocytes (of all four species) and helps reduce the spread of infection
**MOA** not known, not much resistance
**Tafenoquine** also approved in 2018 (70 years after primaquine!)
75
During the exo/erythrocytoc stage, what must the parasite do?
rapidly divide and synthesis folate
76
What are dihydrofolate derivates essential cofactors for?
single carbon transfer reactios in the synthesis of nucleic acids and methionine
77
Rapidly dividing parasites, such as those that reproduce asexually rely heavily on what?
Compare this to what humans rely on
Rapidly dividing parasites rely on the availability of such folates for growth
Whereas humans rely on the dietary intake of dihydrofolate, Plasmodium are capable of its de novo biosynthesis from dihydropteroate, p-amino benzoic acid (pABA) and glutamate
78
Tell me the steps to folate metabolism and the drugs that can act on each stage of this metabolism
79
In what way do structrual analogues act?
By competitive inhibition
80
Tell me the following about structural analogues...
Wha are they used in combination with?
Examples?
Most used in combination with other drugs (resistance) e.g. pyrimethamine and sulphadoxine (Fansidar ®)
Proguanil – prodrug -\> cycloguanil. Used in combination with atovaquone (see later)
Dapsone – too many side effects!
81
Atovaquone (a drug used to treat PCP) targets what?
electron transport
82
Tell me the following about Atovaquone...
* What type of inhibitor is it
* What does it inhibit
* Whats its selective toxicity based on
* What is it functional against
**Competitive inhibitor** of **ubiquinone** (UQ)
**inhibits mitochondrial electron transport chain** at the cytochrome bc1 complex
collapsing membrane potential
loss of mitochondrial function (may also inhibit purine biosynthesis)
Selective toxicity based on much **higher affinity** for parasite complex (IC50 µM vs nM)
Functional against many metabolising stages of the parasite in host and mosquito (not hypnozoites)
83
What is the combination therapy of Malarone a combination of?
(Proguanil/Atovaquone)
84
Tell me a bit about the combination therapy of Malarone
* when is it given in combination with?
* Whats it used for
* Atovaquone is almost always given in combination with proguanil (5:2) as the two act synergistically (proguanil does not act as a DHFR inhibitor – mechanism?!)
* Very useful prophylactic (UK (70% of all prescriptions): can be started 1-2 days before traveling to an area where malaria transmission occurs 7 days after traveling
* Also used for treating chloroquine-resistant malaria (complex)
* GSK lost the patent in 2014 on account of obviousness (much cheaper now!)
85
With drugs that inhibit haem detoxification (quinolines) what is their selective toxicity due to?
Selective toxicity is due to targeting haem biocrystallisation AND that they selectively accumulate in the Plasmodiumdigestive vacuole where this occurs
86
During the erythocytic stage, what is a major nutrient source?
Haemoglobin
87
During a parasites intraerythrocytic asexual reproduction cycle what does it digest up to 80% of?
The RBCs haemoglobin to provide a source of amino acids (catabolism)
88
Tell me the following about parasitic digestion during the erythrocytic stage...
Where does it occur
What does it release
What is toxic and why
What can it bind to
During its intraerythrocytic asexual reproduction cycle parasite digests up to 80% of the RBCs haemoglobin to provide a source of amino acids (catabolism)
Digestion occurs in the **digestive vacuole** (low pH + proteases)
Releases **monomeric haem** (a ferriprotoporphyrin) / peptides + amino acids
Haem is toxic since it is a **pro-oxidant** and catalyses the production of reactive oxygen species (no haem oxygenase like us)
It can also bind to and disrupt cell membranes, damaging cell structures and causing the lysis of the host erythrocyte
Plasmodium have developed a clever strategy to remove the haem
89
Haem detoxification by biocrystallisation into what?
Hemozoin
90
Structure of hemozoin crystals
91
What happens if you prevent biocrystallisation?
Prevent biocrystallisation and lead to build up of toxic haem (e.g., CQ)
92
Why is there an accumulate in the digestive vacuole (e.g., CQ)?
What are the concentrations?
What is it due to?
Tell me about the deprotonated form of CQ
Concentrate from nanomolar (10-9 M) levels outside the parasite to levels one million times higher (millimolar levels, 10-3 M)
**Due to protonation** of the exocyclic and ring nitrogen’s of CQ (pKa is around 8.5) and the difference in pH inside the digestive vacuole (pH 4.5) compared to outside (pH 7.5)
Deprotonated form of CQ is **membrane permeable**, whereas the charged (protonated) form is not
NOTE: **CQ (chloroquine)** is used to prevent and treat malaria and amebiasis (an infection of the intestine with a parasite called E. histolytica)
93
Whats is Artemisinin isolated from?
What is it used in?
Tell me about its modern synthesis and what it is now used to treat
*Artemisia annua* (sweet wormwood)
Used in chinese traditional medicine: "emergency prescriptions kept up one's sleeve" Ge Hong
Rediscovered in 1970s by Tu Youyou who was awarded 2015 Nobel Prize for Medicine
**Modern synthesis**: recombinant yeast to make precursor molecule via an engineered mevalonate pathway so costs reduced to 0.25 US cents/dose !
**Primary treatment for severe malaria** (intravenous) P. falciparum
94
Tell me about some semi-synthetic derivatives of Artemisinin and what their properties
95
What is the proposed mechanism of action of Artemisinin?
Tell me the reaction equation?
Cleavage of endoperoxide bridge by free heme/Fe2+ produces reactive oxygen species:
Directly alkylates proteins = protein miss function
Also, a direct inhibitor of phosphatidylinositol-3-kinase (involved in stress response)
96
What is Artemisinin-based Combination Therapies (ACT) the primary treatment for?
symptomatic uncomplicated (oral) malaria (P. falciparum)
97
What is Artemisinin-based Combination Therapies (ACT) not often used for?
Tell me about its possible combination therapy?
Not often used for **prophylaxis** due to **short t1/2 **(half-life) of drug
**Combination therapy** – multiple targets to reduce resistance development and make use of longer half-life drugs e.g.
98
What does Artesunate – mefloquine = ?
Oxidative stress (protein and hemozoin crystallisation)
99
The following image shows new drug combinations/formulations that have been approved for use
100
When did the resistance to Artemisinin first emerge?
Resistance first emerged in SE Asia ~ 15 years ago. Now in Africa, India and South America
101
What does PfKelch13 C580Y mutation (and ~20 others) leads to ?
reduction in binding to PfPI3K
102
What do increased levels of PfPI3K (overcome inhibition) and increased PI3P help cope with?
Unfolded protein response
103
What else can lead to resistance of other antimalarials within the cell host and microbe?
104
Whats coming in the antimalarial pipeline?
Artefenomel (trioxane) and piperaquine/ferroquine combination
Same mechanisms as previously but more potent and specific (can target resistant strains) – single dose cure?
Monotherapies and combination completed phase II in phase III
What do we target next?
105
Target the apicoplast with antibiotics?
Endosymbiotic organelle of algal origin
Fatty acid synthesis, isoprenoid synthesis and possibly others
Has own ribosomes – sensitive to doxycycline
Doxycycline – only prophylactic… other targets in the apicoplast?
106
**summary**
107
**Further reading**
**_Further reading_**
* **Reviews:**
* **Philips et al. (2017) “Malaria” Nature Reviews Disease Primers volume 3, 17050**
* **Duffy & Gorres (2020) “Malaria vaccines since 2000: progress, priorities, products” npj Vaccines5:48**
* **Tse E.G et al. (2019) “The past, present and future of anti‑malarial medicines” Malar J (2019) 18:93**
* **Belete T.M. (2020) “Recent Progress in the Development of New Antimalarial Drugs with Novel Targets” Drug Design, Development and Therapy 14 3875–3889**
* **Ross & Fidock (2019) “Elucidating Mechanisms of Drug-Resistant Plasmodium falciparum” Cell Host & Microbe 26, July 10, 2019**
* **Some web resources:**
* **www.who.int/malaria/en/ (WHO)**
* **www.malariavaccine.org (RTS,S vaccine)**
* **www.gatesfoundation.org/What-We-Do/Global-Health/Malaria (Vaccine)**
108
How do the chemical agents of larvicides lead to larval static states of the parasites?
Whats a down side to this chemical?
Reduction in the juvenile hormone analogue is linked to the maturation step so if you can artificially raise levels by using analogue which mimics the hormone then the mosquito larvae don’t mature properly- a larval static
Better used in places where we know stagnant water is going to form
Shown to be potentially toxic to aquatic life
109
What do the biological agents of larvicides effect of parasites?
It effects the growth of the mosquito and so these are added to certain water sources in order to prevent growth
110
Where are the biodegradable oils of larvicides added and why?
These are applied to the surface of the water to stop the larvae from brething
111
What are these two structures shown?
Tell me about the product formed
The left shows DDT and on the right shows DDE
DDE is extremely stable and hence why bioaccumulates form in animals
112
There is a large scale resistance to DDT but when is it sometimes used?
Sometimes its still used in vector control even though there is a large scale resistance to it (e.g., the Stockholm convention)
113
With the insecticides Pyrethrin and pyrethrois which on is natural and synthetic?
Pyrethrin is the natural version
Pyrethroid is the synthetic version
114
What is the benefit of using pyrethrin/ pyrethroids over DDT as an insecticide?
They degrade quicker so the toxicity is less than DDT
115
What is one of the downsides of using the pyrethrin/ pyrethroids lots?
Large scale use of them has led to resistance
116
What is one of the most targeted enzymes in any toxic organism?
Acetylcholine esterase inhibitors
117
Tell me about organophosphates, what do they mimic and hence how does this help with their use?
Are they toxic?
Mimics part of the Ach compounds and goes into the active site, reacts with serine in the active site which reversibly inhibits the enzyme
These are toxic as are not selective
Even though toxic they are still used around the world (have killed a lot of people)
118
What do carbamates bind to?
Carbamates bind to the same enzyme as the organophosphates i.e., serine
119
Tell me about Acetylcholine agonists at nAChRs
Selective agonist for nicotinic Ach receptors
Build-up of ACH In synapse that binds to muscle receptors and leads to muscle spasms and paralysis
Breakthrough as an insecticide (but an article published shows resistance against it still)
120
How does the sterile insect technique on mosquitos affect the male population?
Using this on the male population makes them less fit to mate as they have been exposed to ionising radiation so it makes them less competitive by comparioson to those who haven't been exposed
121
How long has the sterile insect technique been around and what is the main aim?
Its been around since the 50s and 60s and the aim is to reduce the population and eventually eradicate the parasite
This was the case on one of the islands, however this island was small and had a small population so was easier to do then with a large island
122
What genetic approach is used more, Oxitec self-limiting gene technology or gene drives?
Gene drives are used more
123
What happens with the genetic approach, gene drive?
Use non-homologous recombination of a defective gene which is important for sex determination of mosquito
124
Tell me what the drug targets are when designing drugs to targets parasites
Which ones are the primary vaccine target and which ones are the hypnozoites?
The drug targets:
* Sporozoites
* Liver forms
* Blood forms
* Gametocytes
The primary vaccine target is: Sporozoites
The Hypnozoites is: the liver forms
The most obviousk place to targte is the blood forms
125
What is currently the only vaccine in use as an anti-malarial?
The Bill & Melinda Gates Foundation/GSK: RTS,S/AS01 (Mosquirix®) for P. falciparum-
This species is targeted because it is the most deadly
126
Tell me the use of the hepatitis B surface antigen?
Its required by the parasite to get into liver cells at the early stages of the life cycle
Its used with parts of the Hep B virus via surface antigen
Generates virus like particle with antigen on the surface
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What is the main problem with the current vaccines for malaria?
Its expensive as lots of doses are required
Also best to give it at certain times of year e.g, in the rainy season when more mosquitos are present
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Why can't drugs for prophylaxis/ acute attacks be taken over a long period of time?
They have bad side effects associated with them such as headaches, nausea, etc.,
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What are the two ways in which the drugs for prophylaxis/ acute attack can be used?
They can be used for either **causal** reasons where they are targeting the earlier stages
Or they can be used for **suppressive** reasons where they are trying to suppress the symptoms already present
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Tell me some of the major drug targets for prophylaxis/ acute attacks and why each of these are considered decent targets?
**Folate metabolism**- plasmodium needs lots of folate in order to synthesise dna and replicate rapidly
**Mitochondrial electron transport**- plasmodia only has one mitochondrion so makes it a good target
**Haem detoxification, reactive oxygen species**- cause them to kill themselves
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What is 8-aminoquinoline active against when being used to target liver forms?
Active against most of the metabolising stages of the parasite
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What is the combination therapy of Malarone used for?
Infection and it has the least side effects associated with it
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What do the quinolines all target and what is this?
How do parasites like moasquitos use this to avoid destruction?
Give an example of a quinoline antimalarial that inhibits this process of heme biocrystallisation
These all target the metabolism of haemoglobin by targeting haem biocrystallisation
**Biocrystallisation** is the formation of crystals from organic macromoleucles by living organisms
Blood feeding organisms such as mosquitos digest haemoglobin and release high quantities of free toxic haem
To avoid destruction by this molecule, the parasite biocrystallises heme to form **hemozoin**
Heme biocrystallisation is inhibited by quinoline antimalarials such as **chloroquine**
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What is the structure of the hemozoin crystals?
Heme is a prosthetic group consisting of an **iron atom (Fe2+)** contained in the centre of a **heterocyclic porphyrin ring**
**beta-hematin** crystals are made of **dimers of hematin** molecules that are joined via **hydrogen bonds** to form larger structures.
In these dimers, an **iron-oxygen coordinate bond** links the centre iron of one hematin to the oxygen of the carboxylate side chain of the adjacent hematin
Hematin can be a cyclic dimer or a linear polymer
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It what time frames are Artemisinin-based Combination Therapies (ACT) useful?
Only effective in short bursts due to negative side effects
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Whats the role of the kinases as resitance to artemisinin?
The kinases are involved in protecting the cell from oxidative damage
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