Uptake of a fluorescently tagged chloroquine analogue is reduced in CQ-resistant compared to CQ-sensitive Plasmodium falciparum parasites

Sarah J Reiling,Petra Rohrbach

doi:10.1186/s12936-019-2980-y

Abstract

BackgroundChloroquine (CQ) was the drug of choice for decades in the treatment of falciparum malaria until resistance emerged. CQ is suggested to accumulate in the parasite’s digestive vacuole (DV), where it unfolds its anti-malarial properties. Discrepancies of CQ accumulation in CQ-sensitive (CQS) and CQ-resistant (CQR) strains are thought to play a significant role in drug susceptibility. Analysis of CQ transport and intracellular localization using a fluorescently tagged CQ analogue could provide much needed information to distinguish susceptible from resistant parasite strains. The fluorescently tagged CQ analogue LynxTag-CQ™GREEN (CQGREEN) is commercially available and was assessed for its suitability.MethodsIC50 values were determined for both CQ and CQGREEN in two CQS and two CQR Plasmodium falciparum strains. Buffer solutions with varying pH were used to determine pH-dependent localization of CQGREEN in infected red blood cells. Before CQS or CQR parasites were exposed to different pH buffers, they were pre-loaded with varying concentrations of CQGREEN for up to 7 h. Intracellular accumulation was analysed using live cell confocal microscopy. CQGREEN uptake rates were determined for the cytosol and DV in the presence and absence of verapamil.ResultsIn CQS strains, twofold higher IC50 values were determined for the CQGREEN analogue compared to CQ. No significant differences in IC50 values were observed in CQR strains. Addition of verapamil reversed drug resistance of CQR strains to both CQ and CQGREEN. Live cell imaging revealed that CQGREEN fluorescence was mainly seen in the cytosol of most parasites, independent of the concentration used. Incubation periods of up to 7 h did not influence intracellular localization of CQGREEN. Nevertheless, CQGREEN uptake rates in CQR strains were reduced by 50% compared to CQS strains.ConclusionAlthough fluorescence of CQGREEN was mainly seen in the cytosol of parasites, IC50 assays showed comparable efficacy of CQGREEN and CQ in parasite killing of CQS and CQR strains. Reduced uptake rates of CQGREEN in CQR strains compared to CQS strains indicate parasite-specific responses to CQGREEN exposure. The data contains valuable information when CQGREEN is used as an analogue for CQ.

Highlights

Chloroquine (CQ) was the drug of choice for decades in the treatment of falciparum malaria until resistance emerged
The findings show that, CQ and chloroquine analogue LynxTag-CQTMGREEN (CQGREEN) show comparable half maximal inhibitory concentration (IC50) values in CQS and CQR parasites, discrepancies were seen between CQGREEN and unmodified CQ in their expected intracellular localization
For Dd2, IC50 values of 169 ± 4 nM were obtained for CQ and 174 ± 27 nM for CQGREEN (p = 0.85)

Summary

Introduction

Chloroquine (CQ) was the drug of choice for decades in the treatment of falciparum malaria until resistance emerged. Analysis of CQ transport and intracellular localization using a fluorescently tagged CQ analogue could provide much needed information to distinguish susceptible from resistant parasite strains. Chloroquine (CQ) was the safest, most affordable and effective drug against malaria, saving the lives of millions of people until resistance emerged [2]. Some researchers suggest that CQ could have more than one intracellular target, making it more difficult for parasites to develop resistance [3,4,5]. To effectively use CQ as an anti-malarial treatment in areas where CQ resistance has been reported, it is imperative to gain more insight into its mechanism of action. The small size and uncharged form of CQ at neutral pH makes it difficult to use for molecular biological experiments to determine its accumulation in intracellular compartments or its affinity to other molecules

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