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Proc Natl Acad Sci U S A. Apr 20, 2004; 101(16): 6206–6211.
Published online Apr 8, 2004. doi:  10.1073/pnas.0307742101
PMCID: PMC395947

A pathway for phosphatidylcholine biosynthesis in Plasmodium falciparum involving phosphoethanolamine methylation


Plasmodium falciparum is the causative agent of the most severe form of human malaria. The rapid multiplication of the parasite within human erythrocytes requires an active production of new membranes. Phosphatidylcholine is the most abundant phospholipid in Plasmodium membranes, and the pathways leading to its synthesis are attractive targets for chemotherapy. In addition to its synthesis from choline, phosphatidylcholine is synthesized from serine via an unknown pathway. Serine, which is actively transported by Plasmodium from human serum and readily available in the parasite, is subsequently converted into phosphoethanolamine. Here, we describe in P. falciparum a plant-like S-adenosyl-l-methionine-dependent three-step methylation reaction that converts phosphoethanolamine into phosphocholine, a precursor for the synthesis of phosphatidylcholine. We have identified the gene, PfPMT, encoding this activity and shown that its product is an unusual phosphoethanolamine methyltransferase with no human homologs. P. falciparum phosphoethanolamine methyltransferase (Pfpmt) is a monopartite enzyme with a single catalytic domain that is responsible for the three-step methylation reaction. Interestingly, Pfpmt activity is inhibited by its product phosphocholine and by the phosphocholine analog, miltefosine. We show that miltefosine can also inhibit parasite proliferation within human erythrocytes. The importance of this enzyme in P. falciparum membrane biogenesis makes it a potential target for malaria chemotherapy.

Malaria, the world's most important parasitic disease, is caused by intraerythrocytic protozoan parasites of the genus Plasmodium. Plasmodium falciparum is responsible for the most severe clinical cases of human malaria and kills >1 million children annually (1). The worldwide emergence of drug-resistant P. falciparum strains has made treatment and prophylaxis of malaria increasingly difficult, thus emphasizing the need for new chemotherapeutic strategies to combat this disease. Previous studies in P. falciparum have indicated that the enzymes for synthesis of the major phospholipids are critical for the rapid multiplication of the parasite within human erythrocytes and display properties that are different enough from their human counterparts to be considered good targets for chemotherapy (25). Accordingly, compounds that interfere with membrane biogenesis inhibit parasite multiplication in vitro and clear malaria infection in mice and monkeys (3). In most eukaryotic organisms, phosphatidylcholine (PtdCho) and phosphatidylethanolamine (PtdEtn) are the major phospholipids of cellular membranes. Whereas PtdCho and PtdEtn represent 44% and 18% of total phospholipids in yeast, respectively (6), these two phospholipids represent 40–50% and 35–40% of the total phospholipids in P. falciparum (5). How the parasite maintains such unusually high levels of PtdEtn and the implications of such a lipid composition on parasite development and survival are not known.

Genetic and biochemical studies in various organisms revealed three major routes for synthesis of PtdCho and PtdEtn: de novo CDP–choline and CDP–ethanolamine (Kennedy) pathways and the CDP–diacylglycerol pathway (79). The Kennedy pathways synthesize PtdCho and PtdEtn from choline and ethanolamine, respectively. The CDP–diacylglycerol pathway initiates from serine and CDP–diacylglycerol to form phosphatidylserine, which is then converted into PtdEtn via the activity of phosphatidylserine decarboxylase enzymes. PtdEtn is subsequently methylated into PtdCho by PtdEtn methyltransferases (10, 11). Whereas in most mammalian cells the de novo CDP–choline pathway is the major route for synthesis of PtdCho (9), in yeast cells and mammalian hepatocytes, the CDP–diacylglycerol pathway is the primary route for synthesis of PtdCho. Plant cells, however, lack phosphatidylserine decarboxylases but instead catalyze the decarboxylation of serine into ethanolamine (12), which is subsequently phosphorylated into phosphoethanolamine (P-Etn). The P-Etn formed is either incorporated into PtdEtn via the CDP–ethanolamine pathway or converted into phosphocholine (P-Cho) by a P-Etn methyltransferase (PEAMT) (1315). P-Cho then serves as a precursor for the synthesis of PtdCho.

Available data and the finished genome sequence of P. falciparum indicated that the parasite possesses various enzymes that are important for synthesis of phospholipids from precursors produced by the parasite metabolic machineries or scavenged from human serum (fatty acids, serine, inositol, choline) (16, 17). The genes involved in the synthesis of phospholipids have only recently started to be elucidated (1821). The de novo CDP–choline pathway has been proposed to be the primary route for synthesis of PtdCho in Plasmodium (16, 17); however, in vitro growth assays using dialyzed serum indicated that choline was not essential for parasite intraerythrocytic development and survival (22, 23). These results thus suggest that the CDP–choline is not the sole route for synthesis of PtdCho in P. falciparum and indicate that alternative pathways for synthesis of this phospholipid from precursors other than choline must exist in this parasite.

Here, we provide molecular and biochemical evidence for the presence in P. falciparum of an alternative pathway for PtdCho biosynthesis. Serine, which is transported from human serum and readily available in the parasite cytoplasm (24), is converted into ethanolamine and then phosphorylated into P-Etn (25). We show that P. falciparum catalyzes a PEAMT reaction that converts P-Etn into P-Cho, which is then incorporated into PtdCho. We suggest that this alternative pathway for PtdCho biosynthesis plays a critical role in P. falciparum membrane biogenesis and could potentially be a good target for design of new antimalarial compounds.

Materials and Methods

Strain, Growth Conditions, and Media. Human blood was obtained from the General Clinical Research Center at the University of Connecticut Health Center. P. falciparum (strain 3D7) was grown by using the method developed by Trager and Jensen (26). Albumax I (0.5%; Invitrogen) replaced serum in the culture medium.

Drug Response Assay. Hypoxanthine proliferation assay with increasing concentrations of miltefosine (0–180 μM) (Cayman) in the P. falciparum strain 3D7 grown in RPMI–Albumax medium was performed in triplicate according to the method of Desjardins et al. (27).

Labeling Assays and Pfpmt Activity in P. falciparum. An asynchronous P. falciparum 3D7-infected erythrocyte culture (7 ml, 15–16% hematocrit, 18–20% parasitemia with 9–10% trophozoites) was incubated at 37°C in the presence of 5.1 μM [14C]ethanolamine (55 mCi/mmol; ARC, St. Louis; 1 Ci = 37 GBq) in RPMI–Albumax medium, which contains 20 μM choline. After a 3-min incubation, the culture was chased with 28 ml of RPMI medium containing 20 mM ethanolamine (Etn) for 15 min. The Plasmodium-infected erythrocytes were then washed twice, and organic and aqueous phases were extracted by using standard procedures (28). The organic and aqueous phases of the Folch extract were evaporated, and the dried materials were dissolved in 200 μl of chloroform/methanol (2:1) and 200 μl of water/ethanol (1:1), respectively. The organic phase was analyzed by TLC using UV-coated silica gel (Whatman) and chloroform/methanol/acetic acid/0.1 M sodium borate (75:45:12:4.5) as mobile phase. The identity of the radioactive spots was determined by TLC analysis using appropriate standards and by exposure to iodine stain. Aqueous-phase material was separated on cellulose plates (Selecto Scientific, Suwanee, GA) by using a solvent system consisting of 2.7 M ammonium acetate/95% ethanol (3:7, vol/vol) adjusted to pH 10 with 28% ammonia and detected by autoradiography (25). This solvent system allows clear separation of the aqueous compounds Etn (RF = 0.82), choline (RF = 0.85), P-Etn (RF = 0.36), and P-Cho (RF = 0.6). The standards Etn, P-Etn, and CDP–Etn were detected by spraying the plates with 0.3% ninhydrin in butanol: acetic acid (100:3) and heating to 110°C for 3 min. In this solvent, P-Etn and CDP–Etn were not separated. To assay native PEAMT activity, P. falciparum-infected erythrocytes (15% parasitemia, 12% trophozoites) were grown in RPMI–Albumax medium and then treated with 0.05% saponin in PBS for 15 min on ice. The released parasites were washed twice in PBS, and the pellet was resuspended in a 500-μl reaction buffer (100 mM Hepes-KOH, pH 7.8/5 mM DTT/2 mM EDTA/10% glycerol, protease inhibitor mix). P. falciparum protein extracts (600 μg) were prepared by sonication. After centrifugation, the supernatant was incubated for 30 min at 37°C with 100 nCi of [methyl-14C]adenosyl-l-methionine (SAM) (52 mCi/mmol, NEN) in the presence of 100 μM P-Etn (substrate) and 100 μM SAM (methyl donor). The reaction products were purified by ion-exchange chromatography as described by Nuccio et al. (13).

Expression and Cloning of PfPMT. cDNA was obtained from RNA isolated from the different blood stages (rings, trophozoites, and schizonts) of P. falciparum. RNA (2 μg) was reverse-transcribed by using SuperScript II and random primers (Life Technologies, Grand Island, NY) as described (29). Quantitative RT-PCR was performed by using primers ocho31 5′-GTGGTTAAAACCAACAGGTACC-3′ and Pfpmt-B 5′-CCGCGGATCCAATTTTTGGTGGCCTTAAAATAAC-3′ to amplify a 300-bp PfPMT fragment, and primers 5′C2143 5′-GAGGAATTTTACGTGTTCATCAA-3′ and 3′C2143 5′-GATTACTTGTAGGAAAGAATCCTTC-3′ were used to amplify a 300-bp fragment corresponding to the seryl tRNA synthetase-encoding gene (29). The real-time PCR reaction was performed in duplicate following the manufacturer's instructions (LightCyclerFastStart DNA Master SYBR Green I, Roche Molecular Biochemicals). Data were normalized to expression levels of the seryl tRNA synthetase-encoding gene, which is constitutively expressed during the intraerythrocytic life cycle (29). Using the primers Pfpmt-B and Pfpmt-X 5′-CCGCGCTCGAGATGACTTTGATTGAAAACTTA-3′, an 880-bp fragment corresponding to PfPMT cDNA was PCR-amplified and cloned in the expression vector pET-15b (Novagen).

Isolation and Purification of Recombinant Pfpmt. Pfpmt was expressed in the Escherichia coli BL21-CodonPlus strain (Stratagene). Expression clones were grown at 37°C in Luria broth medium containing 100 μg/ml ampicillin and 34 μg/ml chloramphenicol. A 1-liter culture of E. coli was grown to an A600 of 0.6, and Pfpmt expression was induced by addition of 1 mM isopropyl-β-d-thiogalactopyranoside. Recombinant protein was extracted under native conditions by using the BugBuster protein extraction reagent (Novagen, 6 ml/g of cell pellet) containing a protease inhibitor mix (Roche Diagnostics) and 10 μg/ml lysozyme. The His-tagged Pfpmt was purified by using nickel-affinity chromatography according to the manufacturer's instructions (Qiagen, Valencia, CA). The eluate was dialyzed by using a buffer containing 5 mM Hepes-KOH (pH 7.8) and 0.5 mM DTT and then kept at 4°C. The purity of the recombinant enzyme was determined by SDS/PAGE, and the protein concentration was measured by the method of Bradford using BSA as a standard.

Enzyme Assays. Recombinant Pfpmt activity was determined by measuring the incorporation of a radioactive labeled methyl donor [methyl-14C]SAM into P-Etn. The incubation mixture contained 100 mM Hepes-KOH buffer, pH 8.6, 2 mM EDTA, 10% glycerol, 100 μM P-Etn, 100 μM SAM (100 nCi [methyl-14C]SAM), and 10 μg of recombinant enzyme in a final volume of 100 μl. The reaction was incubated for 30 min at 37°C and terminated by the addition of 1 ml of ice-cold H2O. The product was purified through a AG (H+) resin as described by Nuccio et al. (13). The identity of the reaction product was confirmed by TLC using [14C]P-Cho (55 mCi/mmol, ARC) as a standard. Control reaction mixtures lacking the enzyme were always included. Pfpmt activity assay using the alternative substrates ethanolamine and PtdEtn were performed as described (13, 30, 31), using 100 μM of each substrate. The kinetic properties of Pfpmt for the P-Etn substrate were determined under a saturating concentration of the cosubstrate SAM (3 mM) and with increasing concentrations of P-Etn (20 μM to 1 mM). Similarly, the affinity of Pfpmt for its cosubstrate SAM was determined by using different concentrations of SAM (20 μM to 1 mM) and a saturating concentration of P-Etn (3 mM). Enzyme inhibition assays were performed by adding various concentrations of P-Cho (0, 10, 25, 50, 75, 100, 200, and 500 μM) or miltefosine (0, 1, 10, 50, and 100 μM) or 50 μM S-adenosyl-l-homocysteine to the reaction mixture containing 100 μM P-Etn, 100 μM SAM (100 nCi of [methyl-14C]SAM), and 10 μg of recombinant Pfpmt enzyme. The reaction was incubated for 30 min at 37°C and terminated by the addition of 1 ml of ice-cold H2O. The product was analyzed and counted as described above.


P. falciparum Converts P-Etn into P-Cho for PtdCho Synthesis. To elucidate the mechanism of PtdCho synthesis from phospholipid precursors other than choline, pulse–chase labeling studies with [14C]ethanolamine in P. falciparum-infected erythrocytes were performed in RPMI medium as described in Materials and Methods. After cell lysis, the lipid fraction and the water-soluble metabolites were analyzed by TLC. Analysis of the lipid fraction showed the formation of both PtdEtn and PtdCho (Fig. 1A), indicating the presence of a functional CDP–ethanolamine pathway for PtdEtn synthesis and suggesting the presence of an alternative pathway for PtdCho synthesis from ethanolamine. Interestingly, analysis of the water-soluble fraction showed the formation of P-Cho (Fig. 1 A). No choline could be detected in the soluble fraction, indicating that P. falciparum does not catalyze the methylation of ethanolamine into choline and rule out the possibility of P-Cho formation from direct phosphorylation of choline. Similar results were obtained when P. falciparum parasites were continuously labeled with [14C]ethanolamine (data not shown). Together, these results suggest that P. falciparum catalyzes the formation of P-Cho from direct methylation of P-Etn, an enzymatic reaction that is similar to that of plant PEAMTs. To analyze this activity in a cell-free system, a P. falciparum lysate was prepared and examined for its ability to catalyze the methylation of P-Etn into P-Cho by using SAM as a methyl donor. Our results showed that P. falciparum protein extracts catalyze the SAM-dependent methylation of P-Etn into P-Cho (Fig. 1B). The P-Cho product was purified by ionexchange chromatography and was found to comigrate with a P-Cho standard by TLC analysis (Fig. 1C). No P-Cho could be purified or detected by TLC when parasite extract was omitted from the PEAMT reaction (Fig. 1C).

Fig. 1.
Evidence for a PEAMT (Pfpmt) activity in P. falciparum. (A) TLC analysis of the extracted lipid (i) and aqueous (ii) phase after labeling of P. falciparum infected erythrocytes with [14C]-Etn. The identity of phospholipids (i) and aqueous compounds ( ...

Characterization of the P. falciparum PEAMT, Pfpmt. By searching for proteins with sequence homology to plant PEAMTs and containing a SAM binding domain, we identified a homolog, Pfpmt, in the P. falciparum genome database (32, 33) and cloned its cDNA. Quantitative RT-PCR analysis using RNA purified from the three intraerythrocytic developmental stages (rings, trophozoites, and schizonts) of P. falciparum showed that PfPMT was expressed throughout the intraerythrocytic life cycle of the parasite (Fig. 2A). Transition from the ring stage to the trophozoite stage, during which an active synthesis of new membranes takes place, resulted in a 3-fold increase in PfPMT transcription. This expression remained constant during the later stages of the parasite life cycle. The ORF of PfPMT is interrupted by three introns and encodes a polypeptide of 266 amino acid residues with a predicted molecular mass of 31 kDa and a theoretical pI of 5.43. Pfpmt shares high sequence identity with plant PEAMTs (24–27% with the N-terminal domain and 48–49% with the C-terminal domain), and two putative proteins from Caenorhabditis elegans (41%) and Anopheles gambiae (20%) (Fig. 2B). Pfpmt protein does not show any recognizable transmembrane domains or specific organellar targeting signals. Importantly, Pfpmt does not share homology with PtdEtn methyltransferases from lower and higher eukaryotes, and no other homologs of this protein could be found in human or other mammalian databases. Whereas plant PEAMTs are bipartite enzymes of 57 kDa with two SAM-dependent catalytic domains, each containing four consensus motifs (I, p-I, II, and III) important for catalysis, the malarial Pfpmt is only half the size of plant PEAMTs and possesses a single catalytic domain (Fig. 2C). The N-terminal domain of the Spinacia oleracea PEAMT is responsible for the addition of the first methylation step, whereas the C-terminal domain catalyzes the two following methylation reactions. The monopartite structure of Pfpmt suggests that this unusual enzyme could solely be responsible for the three-step methylation of P-Etn into P-Cho. To investigate this hypothesis, recombinant Pfpmt protein was expressed in E. coli, purified by affinity chromatography, and assayed for PEAMT activity in vitro, by using P-Etn and SAM as substrate and cosubstrate, respectively. The product of the reaction was purified by ion chromatography and its identity confirmed by TLC (Fig. 3A Inset). Our results showed that the purified enzyme catalyzes the conversion of P-Etn into P-Cho using SAM as a methyl donor (Fig. 3A Inset, lane 1). This activity was linear with time at 37°C for at least 90 min and could not be detected at 0°C (Fig. 3A). To determine the substrate specificity of Pfpmt, ethanolamine and PtdEtn were used in the methylation reactions. None of these molecules was found to be a substrate of Pfpmt, thus suggesting that P-Etn is the primary methyl acceptor of this enzyme (Fig. 3B). The apparent affinity values of Pfpmt for its substrate P-Etn and for its cosubstrate SAM were determined under saturating concentrations of the cosubstrate and increasing concentration of the substrate and vice versa (Fig. 4). The Lineweaver–Burk representation of the saturation curves obtained from both assays produced Km values of ≈79 μM and 153 μM for P-Etn and SAM, respectively, and a Vmax of 1.2 nmol·mg-1·min-1 for both substrates.

Fig. 2.
Expression and sequence analysis of Pfpmt. (A) Quantification of PfPMT expression by real-time PCR analysis in ring (R), trophozoite (T), and schizont (S) stages. The indicated fold change in PfPMT transcription was calculated relative to the ring stage ...
Fig. 3.
Recombinant Pfpmt specifically catalyzes the methylation of P-Etn into P-Cho. (A) Time course of Pfpmt SAM-dependent methylation of 100 μM P-Etn at 37°C (•) and 0°C ([filled square]) using 10 μg of recombinant Pfpmt. ...
Fig. 4.
Kinetics of Pfpmt reaction using recombinant enzyme. Pfpmt activity was measured in the presence of varying concentrations of P-Etn (A) and SAM (B). In A, SAM was present at a concentration of 2 mM, whereas in B, P-Etn was added at a final concentration ...

Inhibition of Pfpmt Activity and P. falciparum Growth by P-Cho and Its Analog Miltefosine. The finding that P-Etn is a substrate for Pfpmt, and knowing that this precursor is also a substrate for CDP–P-Etn transferase, which catalyzes the rate limiting step in the CDP–ethanolamine pathway, suggests that Pfpmt activity might play an important regulatory role in the synthesis of the two major phospholipids PtdEtn and PtdCho. Interestingly, we found that P-Cho inhibited Pfpmt activity. This effect was concentration dependent, with 50% decrease in Pfpmt activity when P-Cho was added at a concentration of 50 μM (Fig. 5A). The finding that Pfpmt activity was inhibited by its product P-Cho suggested that P-Cho analogs might also inhibit this enzyme. Accordingly, the P-Cho analog, hexadecylphosphocholine (miltefosine), was found to inhibit Pfpmt activity with ≈50% of this activity reduced when the compound was added at 50 μM, and ≈90% inhibition obtained when the compound was added at 100 μM (Fig. 5B). As expected for SAM-dependent enzymatic reactions, addition of S-adenosyl-l-homocysteine, a known inhibitor of these reactions, affected Pfpmt activity with ≈50% of this activity reduced when the compound was added at 50 μM (Fig. 5B). Furthermore, clofibric acid, an inhibitor of PtdEtn methyltransferases (34), had no effect on Pfpmt activity at concentrations up to 150 μM (data not shown).

Fig. 5.
Inhibition of recombinant Pfpmt activity and P. falciparum growth. (A) Inhibition of Pfpmt activity by P-Cho. Inhibition assay was performed by adding various concentrations of P-Cho (0–500 μM) as described in Materials and Methods. ( ...

The finding that miltefosine inhibits Pfpmt activity prompted us to examine the antimalarial activity of this compound. Interestingly, when a [3H]hypoxanthine incorporation assay was used to measure P. falciparum proliferation in human red blood cells, miltefosine was found to possess an antimalarial activity. The IC50 value of this compound in the drug-sensitive P. falciparum clone 3D7 was ≈80 μM (Fig. 5C).


Upon infection of human erythrocytes, the phospholipid content of P. falciparum increases by at least 5- to 6-fold (35). PtdCho, which represents 50% of the total phospholipid pool, has been proposed to be synthesized mainly from choline transported from human serum (5, 16). However, in vitro growth assays indicated that choline was not essential for parasite development and multiplication (22, 23). Here, our studies provide evidence that P. falciparum utilizes ethanolamine as an alternative precursor for the synthesis of PtdCho. Ethanolamine, which is absent from plasma (36), is derived from serine by decarboxylation (25). In Plasmodium-infected erythrocytes, serine is available via active transport from serum and active degradation of host proteins (37, 38). Previous studies in P. falciparum using radiolabeled serine showed that this precursor was readily incorporated into phospholipids (25). In this study, we provide evidence, using pulse–chase (Fig. 1 A) and continuous labeling (data not shown) experiments with [14C]ethanolamine, that PtdCho can be synthesized from ethanolamine in P. falciparum infected erythrocytes. Pulse–chase experiments showed that PtdEtn was rapidly formed, and only small amounts of P-Etn could be detected (data not shown), whereas continuous labeling with [14C]ethanolamine identified large amounts of PtdEtn and P-Etn (data not shown). These data suggest that ethanolamine taken by the parasite is rapidly phosphorylated and incorporated into PtdEtn via the CDP–ethanolamine pathway. Interestingly, both labeling studies revealed the formation from ethanolamine of both P-Cho and PtdCho, but not choline. These results demonstrate that P. falciparum does not synthesize choline from ethanolamine and that the P-Cho formed could result from a three-step methylation of P-Etn. Previous reports have suggested that PtdEtn methylation might occur in P. falciparum (16). However, the presence of unusually high levels of PtdEtn (35–40%) in P. falciparum membranes suggests that, if a PtdEtn methyltransferase activity exists in the parasite, it has little or no contribution to the PtdCho pool. Furthermore, no homologs of higher or lower eukaryotic PtdEtn methyltransferase genes could be identified in the finished genome sequence of P. falciparum. Instead, we identified in P. falciparum a single gene, PfPMT, encoding a protein homologous to plant PEAMTs. We found that PfPMT was expressed throughout the intraerythrocytic cycle of the parasite and primarily induced during the mature stages. Furthermore, genome-wide microarray analysis revealed that PfPMT is also expressed during the gametocyte and sporozoite stages of the parasite (32, 39). Whereas several P. falciparum proteins with plant-like properties have been shown to be targeted to the apicoplast (40), Pfpmt lacks signal and transit peptide sequences that could mediate targeting to this organelle. Plant PEAMTs are bipartite enzymes possessing two different SAM-dependent catalytic domains responsible for the three-step methylation reaction. Interestingly, Pfpmt is only half the size of plant PEAMTs, with a single catalytic domain sharing homology with both the N- and C-terminal domains of these enzymes. This unique property of Pfpmt suggests that the single catalytic domain of Pfpmt can either catalyze all of the three methylation reactions to convert P-Etn into P-Cho or that Pfpmt dimerizes to compensate for the lack of the second domain. Interestingly, multiangle laser light scattering analysis of Pfpmt revealed that this protein was a monomer (unpublished data), and ion exchange and TLC analyses indicated that this monomeric protein was able to perform all three methylation reactions (Fig. 3A). Search of Plasmodium database (PlasmoDB) revealed two proteins in C. elegans (Cepmt) and A. gambiae (Agpmt) that share homology with Pfpmt (32). Like Pfpmt, Agpmt is half the size of plant PEAMTs and possesses a single putative catalytic domain (Fig. 2 B and C). On the other hand, Cepmt is of similar size as plant PEAMTs but possesses only one recognizable putative catalytic domain in the C-terminal region of the protein (Fig. 2 B and C). It is not yet known whether these proteins are active PEAMTs and what their contribution is to the phospholipid composition of these organisms.

Our labeling studies revealed the incorporation of ethanolamine into PtdEtn and PtdCho, despite the presence of choline in the medium. This suggests that P. falciparum utilizes both the CDP–choline pathway and the Pfpmt-mediated alternative pathway for PtdCho biosynthesis. Synthesis of PtdCho from alternative pathways has also been shown in Saccharomyces cerevisiae. In this organism, although the transmethylation of PtdEtn in the CDP–diacylglycerol pathway is the primary route of synthesis of PtdCho, the CDP–choline pathway, which has long been viewed as an auxiliary or salvage pathway, can also contribute to the synthesis of this phospholipid. Choline used by the CDP–choline pathway is either transported from the medium or derived from phospholipase D hydrolysis (41). Unlike yeast cells where phospholipid metabolism is highly regulated by its phospholipid precursors (42, 43), no regulatory mechanisms of the different phospholipid biosynthetic pathways have been described in P. falciparum. The finding that Pfpmt activity is inhibited by its product P-Cho suggests that Pfpmt might act as a sensor of phospholipid biosynthesis to determine the metabolic outcome of P-Etn. One possibility is that PtdCho accumulation inhibits Pfpmt activity, thus shifting the equilibrium toward the utilization of P-Etn for the synthesis of PtdEtn. We found that the P-Cho analog miltefosine also inhibited Pfpmt activity. The inhibition of Pfpmt activity by miltefosine was similar to that of S-adenosyl-l-homocysteine, a specific inhibitor of SAM-dependent reactions (Fig. 5B). Furthermore, clofibric acid, an inhibitor of PtdEtn methyltransferases, had no effect on Pfpmt activity. Together, these data suggest that the inhibition of Pfpmt activity by miltefosine is specific. Interestingly, miltefosine also inhibited P. falciparum proliferation with an IC50 value of ≈80 μM. Miltefosine and its analogs are known to possess antitumor and antileishmanial activities and are already validated for treatment of cancer and leishmaniasis (4446). The low solubility of miltefosine and the presence of an active CDP–choline pathway might account for the low antimalarial activity of this compound. Studies to identify new P-Cho analogs with better antimalarial activity are warranted.

In conclusion, we provide evidence for a pathway for PtdCho biosynthesis in P. falciparum that includes two plant-like components (Fig. 6). First, P. falciparum converts serine into ethanolamine (25); then, the phosphorylated ethanolamine is converted by Pfpmt into P-Cho, which serves as a precursor for the synthesis of PtdCho (Fig. 6).

Fig. 6.
Model of the pathways for PtdCho biosynthesis in P. falciparum. Plant-like reactions are indicated as dotted lines, and the new identified pathway is shown in gray. DAG, diacylglycerol; PtdIno, phosphatidylinositol; PfPSS, phosphatidylserine synthase; ...


We are grateful to Jill Zimmermann (General Clinical Research Center, University of Connecticut Health Center) for her technical help. We thank Drs. J. Schenkman, I. Jansson, D. Choudhary, and B. Ullman for helpful discussions. This research was supported by the University of Connecticut Health Center Fund and the U.S. Army Medical Research and Material Command. This work was also supported in part by National Institutes of Health General Clinical Research Center Grant M01RR06192 (to the University of Connecticut Health Center).


This paper was submitted directly (Track II) to the PNAS office.

Abbreviations: PtdCho, phosphatidylcholine; PtdEtn, phosphatidylethanolamine; Pfpmt, P. falciparum phosphoethanolamine methyltransferase; SAM, S-adenosyl-l-methionine; P-Cho, phosphocholine; P-Etn, phosphoethanolamine; PEAMT, P-Etn methyltransferase.

Data deposition: The sequence reported in this paper has been deposited in the GenBank database (accession no. AY429590).


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