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Antimicrobial Agents and Chemotherapy, March 1999, p. 651-654, Vol. 43, No. 3
Division of Geographic Medicine, Department
of Medicine, University of Alabama at Birmingham, Birmingham,
Alabama 35294-2170
Received 3 August 1998/Returned for modification 28 September
1998/Accepted 14 December 1998
Recent evidence suggests that the malaria parasite Plasmodium
falciparum utilizes a branched respiratory pathway including both
a cytochrome chain and an alternative oxidase. This branched respiratory pathway model has been used as a basis for
examining the mechanism of action of two antimalarial agents,
atovaquone and proguanil. In polarographic assays, atovaquone
immediately reduced the parasite oxygen consumption rate in a
concentration-dependent manner. This is consistent with its previously
described role as an inhibitor of the cytochrome bc1
complex. Atovaquone maximally inhibited the rate of P. falciparum oxygen consumption by 73% ± 10%. At all
atovaquone concentrations tested, the addition of the alternative
oxidase inhibitor, salicylhydroxamic acid, resulted in a further
decrease in the rate of parasite oxygen consumption. At the highest
concentrations of atovaquone tested, the activities of
salicylhydroxamic acid and atovaquone appear to overlap, suggesting that at these concentrations, atovaquone partially inhibits the alternative oxidase as well as the cytochrome chain. Drug
interaction studies with atovaquone and salicylhydroxamic acid indicate
atovaquone's activity against P. falciparum in vitro is
potentiated by this alternative oxidase inhibitor, with a sum
fractional inhibitory concentration of 0.6. Propyl gallate,
another alternative oxidase inhibitor, also potentiated atovaquone's
activity, with a sum fractional inhibitory concentration of 0.7. Proguanil, which potentiates atovaquone activity in vitro and in vivo,
had a small effect on parasite oxygen consumption in polarographic
assays when used alone or in the presence of atovaquone or
salicylhydroxamic acid. This suggests that proguanil does not
potentiate atovaquone by direct inhibition of either branch of the
parasite respiratory chain.
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
Alternative Oxidase Inhibitors Potentiate the
Activity of Atovaquone against Plasmodium
falciparum
*
Corresponding author. Mailing address: Division of
Geographic Medicine, UAB, BBRB Box 7, Birmingham, AL 35294-2170. Phone: (205) 975-7606. Fax: (205) 933-5671. E-mail:
nlang-unnasch{at}geomed.dom.uab.edu.
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