PPARγ Agonists Improve Survival and Neurocognitive Outcomes in Experimental Cerebral Malaria and Induce Neuroprotective Pathways in Human Malaria

• DOI: 10.1371/journal.ppat.1003980
• Publication Date: 2014-03-06T22:07:13Z
• Authors: Lena Serghides; Chloe R. McDonald; Ziyue Lu; Miriam Friedel; Cheryl Cui; Keith T. Ho; Howard T. J. Mount; John G. Sled; Kevin C. Kain
• Keywords: 0301 basic medicine; QH301-705.5; Malaria, Cerebral; Enzyme-Linked Immunosorbent Assay; Real-Time Polymerase Chain Reaction; Rosiglitazone; Antimalarials; Mice; 03 medical and health sciences; Animals; Humans; Biology (General); Randomized Controlled Trials as Topic; Mice, Knockout; Mice, Inbred BALB C; Brain-Derived Neurotrophic Factor; Brain; Ribonuclease, Pancreatic; RC581-607; 3. Good health; Mice, Inbred C57BL; PPAR gamma; Disease Models, Animal; Neuroprotective Agents; Female; Thiazolidinediones; Immunologic diseases. Allergy; Research Article

Cerebral malaria (CM) is associated with a high mortality rate, and long-term neurocognitive impairment in approximately one third of survivors. Adjunctive therapies that modify the pathophysiological processes involved in CM may improve outcome over anti-malarial therapy alone. PPARγ agonists have been reported to have immunomodulatory effects in a variety of disease models. Here we report that adjunctive therapy with PPARγ agonists improved survival and long-term neurocognitive outcomes in the Plasmodium berghei ANKA experimental model of CM. Compared to anti-malarial therapy alone, PPARγ adjunctive therapy administered to mice at the onset of CM signs, was associated with reduced endothelial activation, and enhanced expression of the anti-oxidant enzymes SOD-1 and catalase and the neurotrophic factors brain derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in the brains of infected mice. Two months following infection, mice that were treated with anti-malarials alone demonstrated cognitive dysfunction, while mice that received PPARγ adjunctive therapy were completely protected from neurocognitive impairment and from PbA-infection induced brain atrophy. In humans with P. falciparum malaria, PPARγ therapy was associated with reduced endothelial activation and with induction of neuroprotective pathways, such as BDNF. These findings provide insight into mechanisms conferring improved survival and preventing neurocognitive injury in CM, and support the evaluation of PPARγ agonists in human CM.