4.5 Article

Treatment Reducing Endothelial Activation Protects against Experimental Cerebral Malaria

Journal

PATHOGENS
Volume 11, Issue 6, Pages -

Publisher

MDPI
DOI: 10.3390/pathogens11060643

Keywords

cerebral malaria; endothelial activation; biomarkers; adjunctive therapy; statins; ARBs

Categories

Funding

  1. NIH/National Institute of Neurological Disorders and Stroke (NINDS) [1R01NS105910]
  2. NIH/National Heart Lung and Blood Institute (NHLBI) [1R01HL150145, 1R01HL130630]
  3. NIH/National Institute of General Medical Sciences (NIGMS) [1SC2GM144168]
  4. PSC-CUNY Award cycle [51: 63445-00 51]
  5. City University of New York

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Cerebral malaria is a severe complication of malaria infection, with a high mortality rate. This study found that a combination of a statin and an angiotensin II receptor blocker as adjunctive therapy to conventional antimalarial drugs reduced endothelial activation and improved survival rates in a mouse model of CM.
Cerebral malaria (CM) is the most severe neurological complication of malaria caused by Plasmodium falciparum infection. The available antimalarial drugs are effective at clearing the parasite, but the mortality rate remains as high as 20% of CM cases. At the vascular level, CM is characterized by endothelial activation and dysfunction. Several biomarkers of endothelial activation have been associated with CM severity and mortality, making the brain vascular endothelium a potential target for adjunctive therapies. Statins and Angiotensin II Receptor Blockers (ARBs) are drugs used to treat hypercholesterolemia and hypertension, respectively, that have shown endothelial protective activity in other diseases. Here, we used a combination of a statin (atorvastatin) and an ARB (irbesartan) as adjunctive therapy to conventional antimalarial drugs in a mouse experimental model of CM. We observed that administration of atorvastatin-irbesartan combination decreased the levels of biomarkers of endothelial activation, such as the von Willebrand factor and angiopoietin-1. After mice developed neurological signs of CM, treatment with the combination plus conventional antimalarial drugs increased survival rates of animals 3-4 times compared to treatment with antimalarial drugs alone, with animals presenting lower numbers and smaller hemorrhages in the brain. Taken together, our results support the hypothesis that inhibiting endothelial activation would greatly reduce the CM-associated pathology and mortality.

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