Dual fluorescent labelling of the human malaria parasite Plasmodium falciparum for the analysis of the ABC type transporter pfmdr2

The development of the in vitro culturing technique of Plasmodium falciparum by Trager and Jensen[1] revolutionized the understanding of various aspects in the life cycle of this deadly parasite. The adoption of this technique in the research of malaria enabled the development of biochemical, physiological, immunological and genetic techniques[2‐5] which resulted in a more comprehensive understanding of the biology of the parasite. In spite of this advancement, falciparum malaria remains the most prevalent infectious disease resulting in a high level of morbidity and mortality[6]. The major reasons for this state is the lack of an appropriate vaccine[7, 8] and the evolving phenomenon of anti-malarial drug resistance[9, 10]. The gaps which still exist in understanding the biology of the parasite contribute, although to a lesser extent, to this state. Since much of the studies on P. falciparum are done on the intact infected red blood cell (RBC) unit, it is preferable to be able to localize unequivocally the activity within the infected unit. This paper describes an assay of that nature which localizes heavy metal resistance to the parasite itself. By comparing heavy metal resistant and sensitive P. falciparum lines, it was previously shown[11] that this property, which prevents the accumulation of the heavy metal, is probably determined by the parasite's P. falciparum multidrug resistance 2 (pfmdr2) gene. However, as the labelling technique used a radioactive heavy metal, it was not possible to assess the resistance/sensitivity state at the level of a single infected RBC whereas the technique described in this paper allows it. This was achieved by dual labelling with Fluo-3/AM which labels the heavy metal whose transport is studied and Hoechst which labels the parasite by binding to its DNA. Fluo-3/AM was scarcely used in the study of P. falciparum and in those cases it served for determination of Ca⁺² metabolism[12‐15]. Hoechst and derivatives is used more commonly and in all cases for the visualization of the parasite e.g.[16‐20]. No dual labelling with these two dyes was reported hitherto in the literature.

To evaluate the Cd uptake by the malaria parasite we used Cd labelled with the fluorescent dye Fluo-3/AM. Flow cytometry was performed for quantitative evaluation and confocal microscopy for qualitative measurement. Compared to the previous method of radioactive Cd detection[11], the fluorescent detection allows to differentiate between the fluorescence of the infected RBC and that of the non-infected one. This separation is of utmost importance as it allows the detection of low number of infected RBCs in the total cell population. For detection of infected RBCs we used the DNA dye Hoechst 33342. As RBCs lack DNA, the only population that will be stained will be that of the infected RBCs due to the staining of the parasite's DNA. Hoechst staining to identify RBC infected with malaria has been used in many studies e.g. [16–20].

Using this approach it can be seen that Hoechst staining clearly differentiates, by flow cytometry, between two RBCs populations of high and low Hoechst fluorescence (Figure1A). Furthermore, analysis of these two populations using confocal microscopy shows unequivocally that: a) the high intensity Hoechst population consists of only infected RBCs, whereas the low intensity population contains only non-infected cells (Figure1B, two upper panels). b) Only the parasite within the RBC is stained (Figure1B, lower panels). Thus, the Hoechst staining enables us to focus directly on the infected RBCs.

To assess the fluorescent method of Fluo-3/AM staining for Cd uptake, the P. falciparum pfmdr2 system, an ABC-type transporter that is involved in heavy metal homeostasis[11] was used. In this system, the Cd-resistant strain has a functional form of pfmdr2 gene, enabling its survival in the presence of high Cd concentrations. On the other hand, the sensitive strain has an impaired form of this gene, due to a premature translational termination, thus it cannot survive the high concentrations of Cd accumulated[11]. First, the uptake at different Cd concentrations was assessed. The results show that the sensitive strain has a higher Fluo-3/AM fluorescence in a Cd concentration dependent manner, while in the resistant strain Fluo-3/AM fluorescence levels increases only at high concentrations of Cd, but to a lesser extent than the sensitive line (Figure2A-B). Similar results were obtained by confocal microscopy (Figure2C). Furthermore, the confocal microscopy overlay of Fluo-3/AM and Hoechst staining (Figure2C enlarged image) shows that the Fluo-3/AM and the Hoechst staining are localized within the parasite (yellow arrow). No Cd uptake is observed in uninfected RBCs populations originating from cultures infected either with the sensitive or the resistant lines (Figure2A-C). These last two points demonstrate that the Cd uptake measured by Fluo-3/AM is specific to infected RBCs, and that this Cd uptake accumulates mainly within the parasite.

To further characterize the Cd accumulation by Fluo-3/AM in comparison to the radioactive method, a time curve of Cd uptake experiments was performed. As measured by flow cytometry, Fluo-3/AM fluorescence increases in a time dependent manner in the RBCs infected with the P. falciparum sensitive line whereas the level of fluorescence in those infected with the resistant line was low and not time dependent (Figure3A). In accordance with the results in Figure2, the uninfected RBCs did not show any change in fluorescence levels with incubation time (Figure3A). The confocal microscopy images confirmed the results obtained by flow cytometry (Figure3B), namely, levels of Fluo-3/AM increase in the sensitive strain in a time dependent manner.

The results demonstrate that Fluo-3/AM fluorescent labelling is a reliable method for following a physiological process occurring in living cells, in this case the active accumulation of Cd in P. falciparum infected RBCs. The method is time and concentration dependent, the two basic biological parameters needed for the characterization of a biological process. It is also shown that the use of Hoechst dye enables the distinction between the different populations existing in a P. falciparum infected RBCs culture and thus actually study a phenomenon at the level of a single cell. This is the major advantage of this procedure over the previous radioactive method which yielded information only on the entire population. The method described here can be used both for quantitative measurements (flow cytometry) as well as for qualitative assessments (confocal microscopy). As was shown recently for studying oxidative stress in P. falciparum infected RBCs[22], the basic idea underlying this method can be extended to the study of other properties of the parasite once the appropriate fluorescent tag is available.