To assess whether molecular oxygen and oxidative stress contribute to chloroquine activity, we cultivated strains of Plasmodium falciparum in erythrocytes with carboxyhemoglobin and an atmosphere containing 2% CO, 5% CO 2 and 93% N 2 . Results indicate that, contrary to common belief, oxygen is not involved in the activity of chloroquine. Reactive radicals formation is suggested. ß 2002 Federation of European Biochemical Societies. Published by Elsevier Science B.V. All rights reserved.Key words: Carboxyhemoglobin; Chloroquine; Carbon monoxide ; Oxygen; Malaria; Plasmodium falciparum Malaria continues to be a major health problem in tropical countries. Some 300^500 million clinical cases occur annually and result in 700 000^2.7 million deaths [1]. Chloroquine, a 4-amino 7-chloro quinoline, has been the mainstay of malaria control for decades. Despite years of use, its mode of action and the mechanism by which malaria parasites become resistant are only partly known. We know, however, that they are unrelated and independent [2]. Resistance of Plasmodium falciparum to chloroquine is multigenic and concerns drug accumulation in the parasite. In contrast, chloroquine and other quinoline drugs target a unique, essential metabolic pathway of the parasite, the ingestion and degradation of host cell hemoglobin (Hb) within the parasite's food vacuole. While globin-derived amino acids are used by the parasite, the remaining free heme moiety must be disposed: iron(II)protoporphyrin IX (Fe[II]PPIX) is oxidized to iron(III)protoporphyrin IX (Fe[III]PPIX) and, for the most part, converted into a crystalline pigment called hemozoin [3]. So, although chloroquine resistance is nowadays widely spread, knowing how chloroquine works is important in order to design newer and more e¡ective drugs.It is generally accepted that chloroquine prevents heme disposal through the formation of complexes with Fe[III]PPIX. Nuclear magnetic resonance, UV-visible and Mo « ssbauer spectroscopy data concur to show that Z^Z interaction between the drug and the electronic system of hematin governs the formation of these adducts. The accumulation of free heme and/or of chloroquine^Fe(III)PPIX adducts is thought to generate oxidative stress, leading to peroxidation of parasite membrane lipids and parasitic death [3^5]. However, uncertainties still exist.If the peroxidative damage hypothesis were correct, molecular oxygen would be important and play a key role in the initiation and ampli¢cation of the oxidative reactions. However, our ¢ndings are not supportive of this view. We found no signi¢cant variation in the activity of chloroquine when the oxygen tension in the culture was increased [6]. Also the presence of preformed peroxides was necessary for membranes to react with the drug^Fe[III]PPIX complexes and for lipid peroxidation to occur [7]. To further clarify if molecular oxygen and oxidative stress had a role in the mechanism of action of chloroquine, we compared P. falciparum (chloroquine resistant and susceptible clones) cultured in sta...