Abstract

BURDEN OF CEREBRAL MALARIA; PERSONALIZED MEDICINE TO THE RESCUE: A REVIEW OF THE NEW CONCEPT

*Balarabe S. A.

ABSTRACT

Malaria is endemic in over 100 countries and about 240 million people are at risk of developing the disease. Annually, about 20-30 million clinical malaria cases occur globally with over 1 million deaths. In 2017 alone, the global malaria parasitic infection amounted to about 200 million and death toll from the disease was almost half a million people. Unfortunately, almost 90% of all deaths due to malaria occur in tropical sub-Saharan Africa. Hence, with current rate of drug resistance and its continuing to spread, a better understanding of the molecular basis and mechanisms that control the malaria parasite’s life cycle is paramount to developing improved therapies and possible prophylaxes. The recent single-cell technology that investigate the genes in individual malaria parasites, which reveals the genetic processes each parasite undergoes as it moves through its complicated life cycle may lead to uncovering of previously hidden ways in which genes are used for the development of malaria parasites in the blood. Single-cell sequencing allows for studying the activity of each gene in individual parasites and for understanding how malaria parasites move through the life cycle and how much individual-to-individual variation there is among parasite stages that are most vulnerable to drugs and vaccines. This may eventually lead to establishment of single-cell data from the host tissues the parasite must colonize to complete its life cycle, including the mosquito gut cells and the mammalian host liver cells. Currently there is growing interest in novel precision therapies based on molecular findings. For instance, Quinidine reverses the in vitro gain of function seen with KCNT1 mutations in epilepsy with migrating focal seizures of infancy, and a clinical response to quinidine has been observed. Additionally, in a patient with a mutation in GRIN2A, encoding a glutamate receptor subunit, memantine therapy appeared effective. Furthermore, the recent discovery of the importance of mutations in DEPDC5, which is now known to be a regulator of mTOR, raises the possibility of treatment with rapamycin analogues. All of these observations clearly support the possible role of precision medicine in evaluation and management of Cerebral malaria. Certainly, in the coming years with single-cell technology which is a form of personalized medicine, management of cerebral malaria will experience a transformation in the direction of personalized diagnosis and treatment, taking the individual aspects of the patient and his or her disease into consideration.

Keywords: Burden of Cerebral Malaria, Epileptic seizures, Personalized medicine, New concept.