Plasmodium falciparum var genes expressed in children with severe malaria encode CIDRα1 domains

Jakob S Jespersen1, Christian W Wang1, Sixbert I Mkumbaye2

  • 1Centre for Medical Parasitology, Department of Immunology & Microbiology, University of Copenhagen, Copenhagen, Denmark Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.

Insights

Severe malaria in children is linked to Plasmodium falciparum parasites expressing specific PfEMP1 proteins with CIDRα1 domains that bind EPCR. This interaction is a key factor in severe malaria pathogenesis.

Area of Science:

  • Malariology
  • Immunology
  • Molecular Biology

Background:

  • Severe Plasmodium falciparum malaria disproportionately affects young children.
  • Vascular sequestration of infected erythrocytes expressing specific Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) variants causes severe symptoms.
  • Parasites binding the endothelial protein C receptor (EPCR) via PfEMP1's CIDRα1 domain are associated with severe malaria.

Purpose of the Study:

  • To investigate the extent to which EPCR-binding CIDRα1 domains represent PfEMP1 expressed in severe malaria.
  • To characterize the dominant var transcripts in children with severe malaria.

Main Methods:

  • Analysis of near full-length transcripts from the var gene family in children with severe malaria.
  • Transcriptome characterization to identify common features of PfEMP1 proteins.

Main Results:

  • The only common feature among PfEMP1 proteins encoded by dominant var transcripts in severe malaria cases was the presence of CIDRα1 domains.
  • Genes encoding CIDRα1 domains were highly and dominantly expressed in children with severe malarial anemia and cerebral malaria.

Conclusions:

  • The CIDRα1-EPCR interaction is a critical factor in the pathogenesis of severe malaria.
  • These findings support the development of vaccines or treatments targeting the CIDRα1-EPCR interaction to combat severe malaria.