title: Experimental conditions affect the outcome of Plasmodium falciparum platelet-mediated clumping assays.
abstract: BACKGROUND
  Platelet-mediated clumping of Plasmodium falciparum-infected erythrocytes (IE) is a parasite adhesion phenotype that has been associated with severe malaria in some, but not all, field isolate studies. A variety of experimental conditions have been used to study clumping in vitro, with substantial differences in parasitaemia (Pt), haematocrit (Ht), and time of reaction between studies. It is unknown whether these experimental variables affect the outcome of parasite clumping assays.
  
  
  METHODS
  The effects of Pt (1, 4 and 12%), Ht (2, 5 and 10%) and time (15 min, 30 min, 1 h, 2 h) on the clumping of P. falciparum clone HB3 were examined. The effects of platelet freshness and parasite maturity were also studied.
  
  
  RESULTS
  At low Ht (2%), the Pt of the culture has a large effect on clumping, with significantly higher clumping occurring at 12% Pt (mean 47% of IE in clumps) compared to 4% Pt (mean 26% IE in clumps) or 1% Pt (mean 7% IE in clumps) (ANOVA, p=0.0004). Similarly, at low Pt (1%), the Ht of the culture has a large effect on clumping, with significantly higher clumping occurring at 10% Ht (mean 62% IE in clumps) compared to 5% Ht (mean 25% IE in clumps) or 2% Ht (mean 10% IE in clumps) (ANOVA, p=0.0004). Combinations of high Ht and high Pt were impractical because of the difficulty assessing clumping in densely packed IE and the rapid formation of enormous clumps that could not be counted accurately. There was no significant difference in clumping when fresh platelets were used compared to platelets stored at 4 degrees C for 10 days. Clumping was a property of mature pigmented-trophozoites and schizonts but not ring stage parasites.
  
  
  CONCLUSIONS
  The Pt and Ht at which in vitro clumping assays are set up have a profound effect on the outcome. All previous field isolate studies on clumping and malaria severity suffer from potential problems in experimental design and methodology. Future studies of clumping should use standardized conditions and control for Pt, and should take into account the limitations and variability inherent in the assay.
authors.affiliation: Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, West Mains Rd, Edinburgh, EH9 3JT, UK.
authors.forename: Mònica
authors.initials: M
authors.lastname: Arman
authors.forename: J Alexandra
authors.initials: JA
authors.lastname: Rowe
mesh_terms: D000371:Agglutination / Q000187:drug effects / Q000502:physiology; D000372:Agglutination Tests / Q000379:methods*; D000818:Animals; D000925:Anticoagulants / Q000494:pharmacology; D001792:Blood Platelets / Q000469:parasitology* / Q000502:physiology; D006400:Hematocrit; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood*; D018512:Parasitemia; D010963:Plasmodium falciparum / Q000502:physiology*; D013045:Species Specificity
chemical_list: D000925:Anticoagulants