title: Plasmodium falciparum antigenic variation: relationships between in vivo selection, acquired antibody response, and disease severity.
abstract: BACKGROUND
  Variant surface antigens (VSA) on Plasmodium falciparum-infected erythrocytes are potentially important targets of immunity to malaria. We previously identified a VSA phenotype--VSA with a high frequency of antibody recognition (VSA(FoRH))--that is associated with young host age and severe malaria. We hypothesized that VSA(FoRH) are positively selected by host molecules such as intercellular adhesion molecule 1 (ICAM1) and CD36 and dominate in the absence of an effective immune response. Here, we assessed, in 115 Kenyan children, the potential role played by in vivo selection pressures in either favoring or selecting against VSA(FoRH) among parasites that cause malaria.
  
  
  METHODS
  We tested for associations between VSA(FoRH) and (1) the repertoire of VSA antibodies carried by children at the time of acute malaria and (2) polymorphisms in ICAM1 (K29M) and CD36 (T188G) that could potentially reduce the positive selection of VSA(FoRH).
  
  
  RESULTS
  An expected negative association between VSA antibody repertoire and VSA(FoRH) was observed in children with nonsevere malaria. However, this association did not extend to children with severe malaria, many of whom apparently had well-developed VSA antibody responses despite being infected by parasites expressing VSA(FoRH). There was no evidence for involvement of CD36 or ICAM1 in positive selection of VSA(FoRH). On the contrary, a weak positive association between carriage of the CD36 (T188G) allele and VSA(FoRH) was observed in children with severe malaria.
  
  
  CONCLUSIONS
  The association between the VSA(FoRH) parasite phenotype and severe malaria cannot be explained simply in terms of the total repertoire of VSA antibodies carried at the time of acute disease.
authors.affiliation: Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom. pbull@kilifi.mimcom.net
authors.forename: Peter C
authors.initials: PC
authors.lastname: Bull
authors.forename: Arnab
authors.initials: A
authors.lastname: Pain
authors.forename: Francis M
authors.initials: FM
authors.lastname: Ndungu
authors.forename: Samson M
authors.initials: SM
authors.lastname: Kinyanjui
authors.forename: David J
authors.initials: DJ
authors.lastname: Roberts
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Newbold
authors.forename: Kevin
authors.initials: K
authors.lastname: Marsh
mesh_terms: D019943:Amino Acid Substitution; D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood*; D000940:Antigenic Variation; D000953:Antigens, Protozoan / Q000276:immunology*; D018955:CD36 Antigens / Q000235:genetics; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D018799:Intercellular Adhesion Molecule-1 / Q000235:genetics; D016778:Malaria, Falciparum / Q000276:immunology / Q000469:parasitology / Q000503:physiopathology*; D010963:Plasmodium falciparum / Q000276:immunology* / Q000502:physiology; D011110:Polymorphism, Genetic; D012641:Selection, Genetic
chemical_list: D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan; D018955:CD36 Antigens; D018799:Intercellular Adhesion Molecule-1