Schizont

Chalcones are one of the classes of flavonoids well known for their antiplasmodial properties. Licochalcone A (65), isolated from Chinese licorice roots, was shown to display strong in vitro activity against both chloroquine-susceptible (3D7) and chloroquine-resistant (Dd2) P. falciparum strains it also displayed a strong in vivo acitivity in mice infected with P. yoelii, when administered intraperitoneally or orally for 3 to 6 days. The compound appeared to inhibit the growth of the parasites at all stages (rings, trophozoites, and schizonts). Although licochalcone and some derivatives interred the clinical trials as anti-malarials, none of them have ever made it to the market due to severe toxicity observed in phase II clinical trials. 

Different antimalarials selectively kill the parasite s different developmental forms. The mechanism of action is known for some of them pyrimethamine and dapsone inhibit dihydrofolate reductase (p. 273), as does chlorguanide (proguanil) via its active metabolite. The sulfonamide sulfadoxine inhibits synthesis of dihydrofolic acid (p. 272). Chlo-roquine and quinine accumulate within the acidic vacuoles of blood schizonts and inhibit polymerization of heme, the latter substance being toxic for the schizonts. 

Apart from antibodies detected by (a) the schizont-infected red cell agglutination test, (b) the agglutination of sporozoites, (c) complement fixation, (d) passive hemagglutination and by the direct and indirect immunofluorescent methods [for review, see reference (V4)], malarial antibodies have also been detected by malarial antigens prepared from heavily infected human placenta, infected human brain, and short-term in vivo cultures of cells from heavily parasitized subjects (Wll) (see Tables 7 and 8). 

Thus the main quality of chloroquine that exceeds all other antimalarial drug is its effect on erythrocytic schizonts (hematoschizotropic action). However, chloroquine also possesses amebicidal action. It has also been observed to have immunodepressive and antiarrhythmic properties. 

There is a considerable difference in the antimalarial action of desferrioxamine B (DFO) and the hydrophobic chelators based on ferrichrome analogs. While the former is limited to mature forms in the life cycle of P. falciparum (trophozoites and schizonts), the latter effects to a greater extent early developing stages (ring). Therefore, studies explored... 

Experiments performed in vitro revealed that in contrast to DFO, which has a major cytotoxic effect only on trophozoites and early schizonts of P. falciparum, reversed siderophores have a cytotoxic effect on ring-stage and cytostatic effects on trophozoites and schizonts . These observations provided the basis for studying combinations of iron chelators for antimalarial therapy. When DFO is added to malaria parasites cultured in erythrocytes in combination with the more lipophilic and more permeate reversed siderophore 66, a strong synergistic inhibitory effect on parasite growth is observed. This effect may result from the different speeds of permeation of the two chelators... 

It is a highly effective erythrocytic schizonticide especially against mature trophozoite and schizont forms of malarial parasite. 

An anopheline mosquito inoculates plasmodium sporozoites to initiate human infection (Figure 52-1). Circulating sporozoites rapidly invade liver cells, and exoerythrocytic stage tissue schizonts mature in the liver. Merozoites are subsequently released from the liver and invade erythrocytes. Only erythrocytic parasites cause clinical illness. Repeated cycles of infection can lead to the infection of many erythrocytes and serious disease. Sexual stage gametocytes also develop in erythrocytes before being taken up by mosquitoes, where they develop into infective sporozoites. 

Clindamycin (see Chapter 44) is slowly active against erythrocytic schizonts and can be used after treatment courses of quinine, quinidine, or artesunate in those for whom doxycycline is not recommended, such as children and pregnant women. Azithromycin (see Chapter 44) also has antimalarial activity and is now under study as an alternative chemoprophylactic drug. Antimalarial activity of fluoroquinolones has been demonstrated, but efficacy for the therapy or chemoprophylaxis of malaria has been suboptimal. 

Agents such as quinine, quinacrine, amodiaquine, and chloroquine suppress the symptoms of malaria by destroying the schizonts and merozoites in the erythrocytes. 

Secondary tissue schizonticides. Agents such as primaquine destroy exoerythrocytic tissue schizonts such as those developing in the liver. 

Chloroquine destroys schizonts in erythrocytes by interfering with DNA synthesis. The phosphate salts are active orally, whereas the hydrochloride salt is used for intravenous purposes. It accumulates in normal and parasitized erythrocytes. Overdosage has caused reversible corneal damage and permanent retinal damage. In toxic doses, chloroquine causes visual disturbances, hyperexcitability, convulsions, and heart block. It is an antimalarial of choice in all cases except chloroquine-resistant Plasmodium falciparum. In addition, it has a certain degree of effectiveness in amebiasis and in the late stages of rheumatoid arthritis. 

The intrinsic life cycle begins when a female mosquito takes a blood meal. At this time, sporozoites that have matured in the mosquito s salivary glands are inoculated into the blood stream. These sporozoites migrate to the liver where they infect hepato-cytes and progress from early trophozoites to mature schizonts. This process is referred to as the exoerythrocytic cycle. Schizonts in the liver contain thousands of merozoites that are able to infect... 

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