title: CNS hypoxia is more pronounced in murine cerebral than noncerebral malaria and is reversed by erythropoietin.
abstract: Cerebral malaria (CM) is associated with high mortality and risk of sequelae, and development of adjunct therapies is hampered by limited knowledge of its pathogenesis. To assess the role of cerebral hypoxia, we used two experimental models of CM, Plasmodium berghei ANKA in CBA and C57BL/6 mice, and two models of malaria without neurologic signs, P. berghei K173 in CBA mice and P. berghei ANKA in BALB/c mice. Hypoxia was demonstrated in brain sections using intravenous pimonidazole and staining with hypoxia-inducible factor-1α-specific antibody. Cytopathic hypoxia was studied using poly (ADP-ribose) polymerase-1 (PARP-1) gene knockout mice. The effect of erythropoietin, an oxygen-sensitive cytokine that mediates protection against CM, on cerebral hypoxia was studied in C57BL/6 mice. Numerous hypoxic foci of neurons and glial cells were observed in mice with CM. Substantially fewer and smaller foci were observed in mice without CM, and hypoxia seemed to be confined to neuronal cell somas. PARP-1-deficient mice were not protected against CM, which argues against a role for cytopathic hypoxia. Erythropoietin therapy reversed the development of CM and substantially reduced the degree of neural hypoxia. These findings demonstrate cerebral hypoxia in malaria, strongly associated with cerebral dysfunction and a possible target for adjunctive therapy.
authors.affiliation: Centre for Medical Parasitology, Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark. casperhempel@gmail.com
authors.forename: Casper
authors.initials: C
authors.lastname: Hempel
authors.forename: Valery
authors.initials: V
authors.lastname: Combes
authors.forename: Nicholas Henry
authors.initials: NH
authors.lastname: Hunt
authors.forename: Jørgen Anders Lindholm
authors.initials: JA
authors.lastname: Kurtzhals
authors.forename: Georges Emile Raymond
authors.initials: GE
authors.lastname: Grau
mesh_terms: D000818:Animals; D001921:Brain / Q000187:drug effects / Q000469:parasitology / Q000473:pathology*; D004195:Disease Models, Animal; D004921:Erythropoietin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005456:Fluorescent Dyes / Q000378:metabolism; D006801:Humans; D000860:Hypoxia / Q000473:pathology*; D051795:Hypoxia-Inducible Factor 1, alpha Subunit / Q000378:metabolism; D016779:Malaria, Cerebral / Q000188:drug therapy* / Q000469:parasitology / Q000473:pathology* / Q000517:prevention & control; D051379:Mice; D009593:Nitroimidazoles / Q000378:metabolism; D018512:Parasitemia / Q000150:complications / Q000473:pathology; D010962:Plasmodium berghei / Q000187:drug effects; D011065:Poly(ADP-ribose) Polymerases / Q000172:deficiency / Q000378:metabolism; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005456:Fluorescent Dyes; C497443:Hif1a protein, mouse; D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D009593:Nitroimidazoles; D004921:Erythropoietin; C033815:pimonidazole; D011065:Poly(ADP-ribose) Polymerases