Cytoadherence and virulence - the case of Plasmodium knowlesi malaria.
BACKGROUND
Cytoadherence of infected red blood cells to brain endothelium is causally implicated in malarial coma, one of the severe manifestations of falciparum malaria. Cytoadherence is mediated by specific binding of variant parasite antigens, expressed on the surface of infected erythrocytes, to endothelial receptors including, ICAM-1, VCAM and CD36. In fatal cases of severe falciparum malaria with coma, blood vessels in the brain are characteristically congested with infected erythrocytes. Brain sections from a fatal case of knowlesi malaria, but without coma, were similarly congested with infected erythrocytes. The objective of this study was to determine the binding phenotype of Plasmodium knowlesi infected human erythrocytes to recombinant human ICAM-1, VCAM and CD36.


METHODS
Five patients with PCR-confirmed P. knowlesi malaria were recruited into the study with consent between April and August 2010. Pre-treatment venous blood was washed and cultured ex vivo to increase the proportion of schizont-infected erythrocytes. Cultured blood was seeded into Petri dishes with triplicate areas coated with ICAM-1, VCAM and CD36. Following incubation at 37°C for one hour the dishes were washed and the number of infected erythrocytes bound/mm2 to PBS control areas and to recombinant human ICAM-1 VCAM and CD36 coated areas were recorded. Each assay was performed in duplicate. Assay performance was monitored with the Plasmodium falciparum clone HB3.


RESULTS
Blood samples were cultured ex vivo for up to 14.5 h (mean 11.3 ± 1.9 h) to increase the relative proportion of mature trophozoite and schizont-infected red blood cells to at least 50% (mean 65.8 ± 17.51%). Three (60%) isolates bound significantly to ICAM-1 and VCAM, one (20%) isolate bound to VCAM and none of the five bound significantly to CD36.


CONCLUSIONS
Plasmodium knowlesi infected erythrocytes from human subjects bind in a specific but variable manner to the inducible endothelial receptors ICAM-1 and VCAM. Binding to the constitutively-expressed endothelial receptor CD36 was not detected. Further work will be required to define the pathological consequences of these interactions.
Centre for Infection and Immunity, St George's University of London, London SW17 0RE, UK.
Farrah A
FA
Fatih
Angela
A
Siner
Atique
A
Ahmed
Lu Chan
LC
Woon
Alister G
AG
Craig
Balbir
B
Singh
Sanjeev
S
Krishna
Janet
J
Cox-Singh
D000293:Adolescent; D000328:Adult; D018955:CD36 Antigens / Q000378:metabolism; D002448:Cell Adhesion; D002478:Cells, Cultured; D004730:Endothelium, Vascular / Q000469:parasitology / Q000503:physiopathology; D004906:Erythrocyte Count; D004912:Erythrocytes / Q000378:metabolism / Q000469:parasitology*; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism*; D008288:Malaria / Q000469:parasitology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016790:Plasmodium knowlesi / Q000472:pathogenicity* / Q000502:physiology; D011485:Protein Binding; D011994:Recombinant Proteins / Q000378:metabolism; D052939:Schizonts / Q000502:physiology; D053058:Trophozoites / Q000502:physiology; D019010:Vascular Cell Adhesion Molecule-1 / Q000378:metabolism*; D014774:Virulence
D018955:CD36 Antigens; D011994:Recombinant Proteins; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1