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Antimicrobial Agents and Chemotherapy, April 2007, p. 1217-1222, Vol. 51, No. 4
0066-4804/07/$08.00+0 doi:10.1128/AAC.00895-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Institute of Medical Microbiology, University of Göttingen, Kreuzbergring 57, Göttingen D-37075, Germany,1 FB Biologie/Parasitologie, Philipps-Universität Marburg, Karl von Frisch Strasse 8, D-35032 Marburg, Germany2
Received 20 July 2006/ Returned for modification 25 October 2006/ Accepted 3 January 2007
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A pathway which is well known as an effective drug target against malaria and toxoplasmosis is the mitochondrial electron transport chain. Several components of the electron transport chain in Plasmodium and Toxoplasma display significant differences from their mammalian counterparts which can be exploited for chemotherapy (4, 22-24). Atovaquone is a recently developed antimalarial agent which inhibits electron transport at the bc1 complex (complex III) by interfering with the ubiquinol oxidation site of cytochrome b (19, 20, 25). The resulting collapse of the mitochondrial membrane potential (19) is lethal for the parasite.
The most fundamental difference in the architectures of the human and Plasmodium electron transport chains is in the activity of NADH:quinone oxidoreductase, which is also called NADH dehydrogenase (2, 8). Mammals possess a rotenone-sensitive type I NADH dehydrogenase (multisubunit complex I), which is localized inside the inner mitochondrial membrane. In contrast, genomic data reveal that Plasmodium species and Toxoplasma gondii lack complex I but instead possess an alternative (type II) NADH dehydrogenase(s), which is encoded by a single gene (Pfndh2 [GenBank accession no. PFI0735c]) in Plasmodium falciparum and by two genes in T. gondii (Tgndh2-I [accession no. DQ211932] and Tgndh2-II [accession no. DQ228957]) (8; A. Saleh, unpublished data; http://www.toxodb.org).
Alternative NADH dehydrogenases are rotenone-insensitive single-subunit enzymes and are present in the plasma membranes of many bacteria and in the inner mitochondrial membranes of various fungi and plants and some protozoa (10, 13, 16). The rotenone insensitivity of NADH:quinone oxidoreductase activity in Plasmodium species and T. gondii was confirmed in biochemical assays (2, 22, 25). In contrast to the case for type I enzymes, the transfer of electrons from NADH to quinones by alternative NADH dehydrogenases is not coupled to proton translocation. The absence of alternative NADH dehydrogenases in mammalian cells defines these enzymes as promising antimicrobial drug targets. A type II NADH:menaquinone oxidoreductase inhibitor was shown to interfere with Mycobacterium tuberculosis growth (26, 27). For P. falciparum, micromolar concentrations of low-affinity flavin reagents were shown to inhibit PfNDH2 activity, to collapse the parasite's mitochondrial membrane potential, and to inhibit P. falciparum replication (2).
Recently, the compound 1-hydroxy-2-dodecyl-4(1H)quinolone (HDQ) was identified in enzymatic assays as a high-affinity inhibitor of the alternative NADH dehydrogenase from the fungus Yarrowia lipolytica (5). In this study, we describe that HDQ is a highly effective drug for inhibiting the replication of P. falciparum and T. gondii in nanomolar concentrations and that it acts in synergism with atovaquone.
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Cultivation of Plasmodium falciparum. The P. falciparum isolate FCBR (15) was cultivated in RPMI 1640 medium supplemented with 10% human plasma and human erythrocytes of blood group A (rhesus factor positive), as described elsewhere (21). For maintenance of the culture and for drug susceptibility assays, parasites were cultured in T25 flasks in a total volume of 10 ml. Flasks were flushed with gas composed of 90% nitrogen, 5% O2, and 5% CO2. Cultures were synchronized by the sorbitol method, as described elsewhere (11).
Drugs. HDQ (Fig. 1) and all other 1-hydroxy-2-alkyl-4(1)quinolone derivatives were kindly provided by Walter Oettmeier (Ruhr-Universität, Bochum, Germany). The derivatives were dissolved in tissue culture-grade dimethyl sulfoxide (DMSO) at a concentration of 2.5 mM. All further dilutions were performed in tissue culture medium. Atovaquone was dissolved in DMSO at a concentration of 5 mM. Non-drug-treated controls of T. gondii- and P. falciparum-infected cultures were incubated with DMSO at identical concentrations to those used for drug-treated samples. Due to the limited amounts of C5, C6, C8, and C14 derivatives, most of the experiments were performed with HDQ.
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FIG. 1. Structure of HDQ.
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Replication rate determined by beta-galactosidase activity. The beta-galactosidase activity of T. gondii parasites which are stably transfected with the Escherichia coli lacZ gene can be used to accurately quantify the parasite replication rate by using a colorimetric assay (12). Freshly lysed parasites of a beta-galactosidase-expressing RH strain (3) were used to infect HFF monolayers (1 x 104 parasites/well) grown in 24-well plates in 1% Dulbecco's modified Eagle's medium without phenol red for 4 h at 37°C. The infected monolayers were washed twice with 1% Dulbecco's modified Eagle's medium without phenol red and incubated with different concentrations of HDQ in duplicate (1, 0.1, 0.01, and 0.001 µM) and with a final concentration of 100 µM chlorophenol red-ß-D-galactopyranoside at 37°C. Absorbance at 570 nm and 630 nm was determined photometrically.
Quantification of P. falciparum replication rate by using a fluorometric assay. An 800-µl aliquot of a P. falciparum culture was added to 1 ml 0.08% saponin in PBS in order to lyse red blood cells. Subsequent sample preparation steps were performed as previously described (18). Briefly, samples were centrifuged at 15,800 x g for 4 min, and the supernatants were carefully removed. The parasite pellets were solubilized in 25 µl of a solution (pH 5.5) containing 6 M guanidium-HCl and 6 M sodium acetate. Afterwards, 2 ml of a solution containing 2 M NaCl, 50 mM Tris-HCl (pH 7.8), and 0.33 µg/ml of Hoechst 33258 was added. Finally, 50 µl of a 24:1 mixture of chloroform-isoamyl alcohol was added, and samples were mixed by vortexing. After centrifugation at 15,800 x g for 1 min, 1.9 ml of the supernatant was transferred to a 24-well plate. Triplicates of each sample were measured in a fluorometer (Victor 5; Wallac) at wavelengths of 340 and 460 nm. Each well was measured at two different spots.
Host cell metabolic assay. The metabolic activity of the host cells was tested by using an AlamarBlue assay (Biosources International Inc., Camarillo, CA). AlamarBlue is an indicator dye formulated to quantitatively measure the proliferation of a variety of human or animal cells, bacteria, mycobacteria, or fungi. It consists of an oxidation-reduction (redox) indicator that yields a colorimetric change and a fluorescent signal in response to metabolic activity. Briefly, HFF were grown to confluence in 24-well plates, treated for 48 h with different concentrations of HDQ, and processed according to the instructions provided by the manufacturer.
Genome data mining. Preliminary genomic and/or cDNA sequence data were accessed via http://toxodB.org (version 3.0) and/or http://www.tigr.org/tdb/t_gondii/.
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FIG. 2. HDQ inhibits the T. gondii replication rate. (A) HFF monolayers were infected with T. gondii and treated with either the indicated concentrations of HDQ or a DMSO control. After 24 h of drug treatment, the average number of parasites per vacuole was determined by immunofluorescence microscopy for two independent experiments and given as the mean ± standard deviation (SD). (B) HFF monolayers were infected with a beta-galactosidase-expressing T. gondii RH strain (3) and treated with either the indicated concentrations of HDQ or a DMSO control. Beta-galactosidase activity was determined at 30 h postinfection, using a colorimetric assay. The figure shows the means ± SD of optical densities at 570 to 630 nm for duplicates.
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HDQ inhibits P. falciparum replication. To determine the HDQ susceptibility of P. falciparum, ring-stage parasites were cultivated in the presence of HDQ at concentrations of 1 µM, 100 nM, 10 nM, and 1 nM for 48 h. Like the case for Toxoplasma gondii, HDQ treatment resulted in a dose-dependent decrease of parasitemia, as determined with Giemsa-stained blood smears (Fig. 3A). A reduction of the parasitemia to 50% of the control level was achieved at an HDQ concentration of 54 ± 25 nM. To accurately determine the IC50 of HDQ for P. falciparum, a quantitative growth assay was applied, based on binding of the fluorescent Hoechst 33258 dye to parasite DNA (18). Cultures of young trophozoites with an initial parasitemia of 2% were incubated for 36 h in the presence of 1 µM, 100 nM, 10 nM, or 1 nM HDQ. Chloroquine-diphosphate at 2 µM, a concentration which completely inhibits parasite replication, was used as a control to determine the background fluorescence of nonreplicating parasites. The fluorescence intensity decreased dose dependently with increasing HDQ concentrations, indicating that parasite replication was effectively inhibited. The IC50 of HDQ for P. falciparum was determined to be 14.0 ± 1.9 nM (Fig. 3B).
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FIG. 3. (A) HDQ treatment of P. falciparum cultures results in reduced parasitemia. Sorbitol-synchronized ring-stage parasites of the P. falciparum FCBR isolate (initial parasitemia, 3.2%) were incubated with the indicated concentrations of HDQ in T25 flasks. DMSO was added to untreated controls to identical concentrations as those in drug-treated samples. The final parasitemia was determined 48 h later for Giemsa-stained blood smears by counting 1,000 to 2,000 red blood cells. The values represent the means of duplicates from a representative experiment. HDQ dose-dependently inhibits P. falciparum growth, with a 50% reduction of parasitemia at 54.7 ± 25.2 nM. (B) IC50 determinations for HDQ with Plasmodium falciparum. Young trophozoites (2% parasitemia) were incubated for 36 h in T25 flasks in the presence of the indicated HDQ concentrations. Each HDQ concentration was tested in triplicate. DMSO was added to untreated controls to the same concentration as that used for drug-treated samples. Chloroquine-diphosphate (CQ; 2 µM) was used in one sample to completely block parasite replication. Sample preparation for the fluorometric assay was performed as previously described (18). Samples were measured in a fluorometer (Victor 5; Wallac) at wavelengths of 340 and 460 nm. The means of triplicates ± SD are given as fluorescence units. The IC50 of HDQ for P. falciparum is 14.0 ± 1.9 nM and was defined as the HDQ concentration which results in a fluorescence signal which is exactly between the signal of the untreated control and that of the chloroquine-diphosphate-treated sample.
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FIG. 4. HDQ acts in synergism with atovaquone. An HFF monolayer was infected with tachyzoites of the T. gondii RH strain and treated with the indicated concentrations of HDQ and atovaquone (ATV), either alone or in combination. The average number of parasites per parasitophorous vacuole was determined at 36 h postinfection for at least 100 vacuoles for triplicate samples by immunofluorescence microscopy and is given as the mean ± SD.
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FIG. 5. Susceptibility of T. gondii to various 1-hydroxy-2-alkyl-4(1)quinolone derivatives. HFF monolayers were infected with a beta-galactosidase-expressing T. gondii RH strain (3) and treated with 10 nM 1-hydroxy-2-alkyl-4(1)quinolone derivatives with alkyl side chain lengths of C5, C6, C8, C12 (HDQ), and C14. Beta-galactosidase activity was determined at 30 h postinfection, using a colorimetric assay. Bars in the figure show the growth of drug-treated samples as percentages of the growth of untreated controls. Means from two independent experiments ± SD are given.
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FIG. 6. Recovery of parasite growth after 24 h of HDQ treatment. T. gondii (strain RH)-infected HFF were treated for the indicated times (A and B) with either 0.1 or 1 µM HDQ, followed by cultivation for another 72 h without the drug. The sizes of the parasitophorous vacuoles in the samples were determined by immunofluorescence microscopy. Parasitophorous vacuoles with eight or more parasites were considered to contain viable parasites that recovered from drug inhibition. The figure indicates the fractions of vacuoles containing eight or more parasites of the total number of vacuoles from a representative experiment. In samples treated with 0.1 µM HDQ, about 50% of the vacuoles recovered from HDQ treatment. In contrast, the recovery rate strongly decreased, to <3%, after treatment with 1 µM HDQ.
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Although it cannot be ruled out completely that HDQ has additional effects on T. gondii and P. falciparum which are unrelated to alternative NADH dehydrogenase inhibition, the observed synergism between HDQ and the complex III inhibitor atovaquone suggests that HDQ, like atovaquone, affects the mitochondrial electron transport chain. This synergism is most likely due to the inhibition of the ubiquinone/ubiquinol cycle at two different locations, i.e., the reduction site (alternative NADH dehydrogenase) for HDQ and the oxidation site (complex III) for atovaquone. A synergism of atovaquone with low-affinity inhibitors of alternative NADH dehydrogenases was recently shown for Plasmodium falciparum, demonstrating that simultaneous inhibition of the ubiquinone/ubiquinol cycle at different points has a huge pharmacological potential (2). However, the general flavines used in the previous study, such as diphenylene iodonium chloride, have an IC50 which is 500-fold higher than that of HDQ and are most likely unsuitable for clinical studies (2, 5).
In contrast, the IC50 of HDQ in the low nanomolar range makes HDQ a highly attractive candidate for further studies, particularly since we did not observe any negative effects on the human host cells at the applied concentrations. HDQ and alkyl side chain derivatives thus represent promising compounds with a high potential for antimalarial and antitoxoplasmal therapy. In addition to Toxoplasma and Plasmodium, HDQ might be effective against a broader spectrum of pathogens/parasites, including other apicomplexan parasites with a mitochondrial respiratory chain as well as some kinetoplastids, such as Trypanosoma, which express type II NADH dehydrogenases in addition to a conventional complex I (6, 7).
It has to be mentioned that HDQ in the nanomolar range is not able to kill T. gondii parasites but rather has a static effect on the parasites. Intracellular parasites which were treated with 10 nM HDQ for 48 h were almost completely able to recover from HDQ-mediated growth arrest and to continue replication after drug removal. If the parasites were treated with 10 µM HDQ, however, a parasiticidic effect was observed. At this high concentration, which is >2,000-fold higher than the IC50, side effects of HDQ on targets which are unrelated to the alternative NADH dehydrogenases cannot be excluded.
A critical feature of the 1-hydroxy-2-alkyl-4(1)quinolone structure is the length of the alkyl side chain at position 2. While derivatives with alkyl side chains of C6, C8, C12 (HDQ), and C14 all displayed excellent antiparasitic activities in the nanomolar range, a C5 derivative completely failed to inhibit T. gondii replication. A minimal alkyl side chain length of C6 thus appears to be required for drug action. Due to their structural similarities, it is most likely that 1-hydroxy-2-alkyl-4(1)quinolones compete with ubiquinones for the same binding site in alternative NADH dehydrogenases (5). However, it has to be mentioned that steady-state inhibition kinetics of HDQ on the Y. lipolytica alternative NADH dehydrogenase displayed a noncompetitive pattern for the hydrophobic ubiquinone derivative n-decylubiquinone, which the authors of the study used as an electron acceptor (5). This unexpected finding was explained by a proposed ping-pong mechanism for the two-substrate reaction of the enzyme (5). Future biochemical analysis will reveal whether HDQ exhibits the same inhibition mode on the T. gondii and P. falciparum orthologs as on the Y. lipolytica enzyme.
Ahmad Saleh is supported by a DAAD (Deutscher Akademischer Austauschdienst) scholarship. This work was supported by a grant from the Deutsche Forschungsgemeinschaft (BO 1557/3-1). Genomic data were provided by The Institute for Genomic Research (supported by NIH grant AI05093) and by the Sanger Center (Wellcome Trust). Expressed sequence tag sequences were generated by Washington University (NIH grant 1R01AI045806-01A1).
Published ahead of print on 22 January 2007. ![]()
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