Thrombospondin mediates the cytoadherence of Plasmodium falciparum- infected red cells to vascular endothelium in shear flow conditions

Cerebral malaria is thought to involve specific attachment of Plasmodium falciparum-infected knobby red cells to venular endothelium. The nature of surface ligands on host endothelial cells that may mediate cytoadherence is poorly understood. We have investigated the effects of soluble thrombospondin, rabbit antiserum raised against thrombospondin, and human immune serum on cytoadherence of parasitized erythrocytes in ex vivo mesocecum vasculature. Preincubation of infected red cells with soluble thrombospondin or human immune serum inhibits binding of infected red cells to rat venular endothelium. Infusion of the microcirculatory preparation with rabbit antithrombospondin antibodies before perfusion of parasitized erythrocytes also resulted in decreased cytoadherence. In addition, incubation of infected cells with human immune sera obtained from malaria patients significantly inhibited the observed cytoadherence. Our results indicate that thrombospondin mediates binding of infected red cells to venular endothelium and may thus be involved in the pathogenesis of cerebral malaria.     

Ultrastructural alterations of human red blood cells infected by Plasmodium vivax

The case history of a patient heavily infested with Plasmodium vivax is reported. Numerous peripheral red blood cells, containing trophozytes, permitted to observe the parasites with a transmission and scanning electron microscope.     

CD36 folding revealed by conformational epitope expression is essential for cytoadherence of Plasmodium falciparum-infected red blood cells

CD36 is a membrane glycoprotein and a putative scavenger receptor expressed by several cell types. In capillary endothelial cells, it mediates the adherence of erythrocytes infected with Plasmodium falciparum. The CD36 sequence contains two hydrophobic domains located at the amino-and carboxyl-termini of the protein, but the topology of this protein and the functional significance of these domains are still not clearly defined. We generated soluble CD36-IgG chimeric molecules by fusion of the extracellular domains of CD36 with human immunoglobulin domains. The construct containing the N-terminal hydrophobic domain of CD36 was completely retained intracellularly as membrane-associated molecule, suggesting that the N-terminal hydrophobic domain of the CD36 is a real transmembrane domain and that CD36 has hairpin topology. A small amount of the CD36-IgG chimeric construct lacking both transmembrane domains escaped retention, was correctly processed, and accumulated in the extracellular medium as a soluble molecule. This CD36-IgG construct failed to bind Plasmodium falciparum-infected erythrocytes. Using monoclonal antibodies specific for either conformational or structural epitopes, we demonstrate that failure of this CD36-IgG construct to bind infected erythrocytes was due to incorrect folding of the soluble chimeric molecule.     

Human natural killer cells control Plasmodium falciparum infection by eliminating infected red blood cells

Immunodeficient mouse–human chimeras provide a powerful approach to study host-specific pathogens, such as Plasmodium falciparum that causes human malaria. Supplementation of immunodeficient mice with human RBCs supports infection by human Plasmodium parasites, but these mice lack the human immune system. By combining human RBC supplementation and humanized mice that are optimized for human immune cell reconstitution, we have developed RBC-supplemented, immune cell-optimized humanized (RICH) mice that support multiple cycles of P. falciparum infection. Depletion of human natural killer (NK) cells, but not macrophages, in RICH mice results in a significant increase in parasitemia. Further studies in vitro show that NK cells preferentially interact with infected RBCs (iRBCs), resulting in the activation of NK cells and the elimination of iRBCs in a contact-dependent manner. We show that the adhesion molecule lymphocyte-associated antigen 1 is required for NK cell interaction with and elimination of iRBCs. Development of RICH mice and validation of P. falciparum infection should facilitate the dissection of human immune responses to malaria parasite infection and the evaluation of therapeutics and vaccines.Malaria is caused by infection with parasites of the Plasmodium species which are transmitted by bites of infected Anopheles mosquitoes. Plasmodium species are highly host specific. making it difficult to model human parasite infection in laboratory animals. So far, most in vivo experimental studies of malaria have been carried out with mouse and rat Plasmodium strains in rodents. Differences in invasion and disease pathology between human and rodent parasite species have impeded the translation of findings from rodents into human. The lack of appropriate small animal models also has hampered the evaluation of new drugs and vaccines before clinical trials (1).To overcome this challenge, one approach is to supplement SCID mice with human RBCs. The resulting mice support a limited blood-stage P. falciparum infection (2–4). The need to inject large volumes of human RBCs repeatedly and to treat mice with anti-neutrophil antibody and highly toxic clodronate liposomes to suppress the rapid clearance of the injected human RBCs by macrophages in the recipient mice makes working with this system difficult. More recently NOD-SCID Il2rg^−/− (NSG) mice have been shown to support a more efficient P. falciparum infection without the treatment of clodronate liposomes or anti-neutrophil antibody (5). Furthermore, a recent report shows the development of liver-stage P. falciparum infection in immunocompromised and fumarylacetoacetate hydrolase-deficient (Fah^−/−, Rag2^−/−, Il2rg^−/−) (FRG) mice. Backcrossing of FRG mice to the NOD background and supplementing the resulting mice with human RBCs led to reproducible transition from liver-stage infection to blood-stage infection (6). Despite such progress, none of the existing mouse models of human parasite infection has a human immune system.The immune system plays a critical role in the control of parasite infection. Studies in mice using mouse Plasmodium strains have shown that mouse immune cells such as natural killer (NK) cells, T cells, dendritic cells, and B cells all contribute to antiparasitic immunity (7–10). Notably, depletion of NK cells in a mouse model of Plasmodium chabaudi infection results in more severe disease associated with higher parasitemia and mortality (11). In vitro, P. falciparum-infected human RBCs are shown to interact with human NK cells, leading to the induction of IFN-γ (12). Compared with P. falciparum schizonts, live infected RBCs (iRBCs) induce more rapid activation and more production of IFN-γ by NK cells (13). More recently, it has been shown that, in addition to IFN-γ, activated human NK cells also produce perforin and granzyme against P. falciparum-infected RBCs (14). However, because of the lack of appropriate models, little is known about the role of human NK cells in the control of P. falciparum infection in vivo. NK cells are cytolytic and can lyse virus-infected cells and tumor cells (15). However, whether NK cells also can eliminate parasite-infected RBCs directly has not been demonstrated comprehensively.In our study of humanized mice, we previously had developed a simple and effective method of enhancing human cell reconstitution by hydrodynamic expression of human cytokines. Expression of human IL-15 and Flt-3/Flk-2 ligand (Flt-3L) enhances the reconstitution of human NK cells, monocytes, and macrophages (16). In this study, we have constructed humanized mice that have an optimized human immune cell reconstitution as well as high levels of human RBCs through supplementation. We show that such humanized mice support an efficient infection by P. falciparum. Depletion of human NK cells, but not macrophages, in these mice results in a significant increase in parasitemia. Our additional studies in vitro show that NK cells interact preferentially with iRBCs and become activated, resulting in the elimination of iRBCs in a contact-dependent manner. We further show that the cell adhesion molecules lymphocyte-associated antigen 1 (LFA-1) and to some extent DNAX accessory molecule 1 (DNAM-1) mediate NK cell interaction with and elimination of iRBCs. Development of humanized mice with robust reconstitution of human immune cells and human RBCs and validation of the model for P. falciparum infection should facilitate the dissection of human immune responses to malaria parasite infection and the evaluation of therapeutics and vaccines.     

The instability of the membrane skeleton in thalassemic red blood cells

The thalassemias are a heterogeneous group of disorders characterized by accumulation either of unmatched alpha or beta globin chains. These in turn cause the intramedullary and peripheral hemolysis that leads to varying anemia. A partial explanation for the hemolysis came our of our studies on material properties that showed that beta-thalassemia (beta- thal) intermedia ghosts were very rigid but unstable. A clue to this instability came from the observation that the spectrin/band 3 ratio was low in red blood cells (RBCs) of splenectomized beta-thal intermedia patients. The possible explanations for the apparent decrease in spectrin content included deficient or defective spectrin synthesis in thalassemic erythroid precursors or globin chain-induced membrane changes that lead to spectrin dissociation from the membrane during ghost preparation. To explore the latter alternative, samples from different thalassemic variants were obtained, ie, beta-thal intermedia, HbE/beta-thal, HbH (alpha-thal-1/alpha-thal-2), HbH/Constant Spring (CS), and homozygous HbCS/CS. We searched for the presence of spectrin in the first lysate of the standard ghost preparation. Normal individuals and patients with autoimmune hemolytic anemia, sickle cell anemia, and anemia due to chemotherapy served as controls. Using gradient sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis, no spectrin was detected in identical aliquots of the supernatants of normals and these control samples. Varying amounts of spectrin were detected in the first lysate supernatants of almost all thalassemic patients. The identification of spectrin was confirmed by Western blotting using an affinity-purified, monospecific, rabbit polyclonal antispectrin antibody. Relative amounts of spectrin detected were as follows in decreasing order: splenectomized beta-thal intermedia including HbE/beta-thal; HbCS/CS; nonsplenectomized beta-thal intermedia, HbH/CS; and, lastly, HbH. These findings were generally confirmed when we used an enzyme-linked immunosorbent assay technique to measure spectrin in the first lysate. Subsequent analyses showed that small amounts of actin and band 4.1 also appeared in lysates of thalassemic RBCs. Therefore, the three major membrane skeletal proteins are, to a varying degree, unstably attached in severe thalassemia. From these studies we could postulate that membrane association of abnormal or partially oxidized alpha- globin chains has a more deleterious effect on the membrane skeleton than do beta-globin chains.     

Impairment of Plasmodium falciparum growth in thalassemic red blood cells: further evidence by using biotin labeling and flow cytometry

Certain red blood cell (RBC) disorders, including thalassemia, have been associated with an innate protection against malaria infection. However, many in vitro correlative studies have been inconclusive. To better understand the relationship between human RBCs with thalassemia hemoglobinopathies and susceptibility to in vitro infection, we used an in vitro coculture system that involved biotin labeling and flow cytometry to study the ability of normal and variant RBC populations in supporting the growth of Plasmodium falciparum malaria parasites. Results showed that both normal and thalassemic RBCs were susceptible to P falciparum invasion, but the parasite multiplication rates were significantly reduced in the thalassemic RBC populations. The growth inhibition was especially marked in RBCs from alpha-thalassemia patients (both alpha-thalassemia1/alpha-thalassemia2 and alpha-thalassemia1 heterozygote). Our observations support the contention that thalassemia confers protection against malaria and may explain why it is more prevalent in malaria endemic areas.     

In vitro rosetting, cytoadherence, and microagglutination properties of Plasmodium falciparum-infected erythrocytes from Gambian and Tanzanian patients

To understand the molecular mechanisms that lead to sequestration of red blood cells infected with mature stages of Plasmodium falciparum and to examine the relevance of earlier studies on adherence properties of laboratory-derived P falciparum parasites to the natural parasite population, we analyzed Gambian and Tanzanian isolates for in vitro cytoadherence and antibody-mediated microagglutination. Eighteen cryopreserved isolates of ring-stage parasites were cultured for 20 to 30 hours in vitro, in the patients original erythrocytes, to the trophozoite and schizont stage. All parasites were positive in the microagglutination assay with at least one of four African hyperimmune sera. In a rosetting assay, only 2 of the 18 isolates were strongly positive (35% and 41% of parasitized erythrocytes with more than two uninfected cells bound). Thirteen isolates showed either intermediate (5% to 18%) or low (less than 5%) rosetting while three isolates did not form rosettes. Infected cell-binding of the different isolates to immobilized CD36 or thrombospondin, or C32 melanoma cells correlated with the percentage of mature parasites in the blood samples (r = .932 for CD36, r = .946 for thrombospondin, and r = .881 for C32 melanoma cells). There was a high correlation between binding to CD36 and thrombospondin (r = .982). The extent of infected cell rosetting with uninfected cells in these blood samples was not correlated with these other receptor properties. We also observed coexpression of rosetting and cytoadherence receptors on the same parasitized erythrocytes.     

Rosette formation by Plasmodium coatneyi-infected red blood cells

Animal models are needed for the study of cytoadherence in falciparum malaria. Red blood cell (RBC) rosette formation is one type of cytoadherence and appears to be associated with knob formation, endothelial cell adhesion and sequestration of Plasmodium-infected RBCs. Since Plasmodium coatneyi-infected RBCs develop knobs and sequester, we hypothesized that they also form rosettes. RBCs from P. coatneyi-infected rhesus monkeys (Macaca-mulatta) were collected, allowed to mature overnight in vitro and found to form rosettes as hypothesized. This observation adds to the known falciparum-like characteristics of P. coatneyi, and suggests that the Macaca mulatta-P. coatneyi model may be appropriate for pathophysiologic studies of cytoadherence.     

Defective spectrin dimer self-association in thalassemic red cells

The relative proportions of spectrin tetramer and dimer forms extrated from red cell membranes in a low ionic strength buffer at 4 degrees C were determined for 15 normal subjects, 27 subjects with alpha-thalassemia (7 alpha-thalassemia trait, 9 Hb H disease (alpha-thal 1/alpha-thal 2) and 11 Hb H with Hb Constant Spring (CS), 23 subjects with beta-thalassemia (6 beta-thalassemia trait, 5 homozygous beta-thalassemia, 11 beta(0)-thalassemia with Hb E and 1 beta(+)-thalassemia with Hb E), 6 subjects with Hb E (2 homozygous and 4 carriers) and 1 subject with combined alpha-thal 1/Hb CS and Hb E (AE Bart's disease). In all subjects (except carriers of Hb E and 1 splenectomized case of beta(0)-thal/Hb E) spectrin dimer forms were elevated when compared to levels in normal controls, but there were no significant differences between carrier and disease forms. Conversion of spectrin dimers to tetramers at 30 degrees C was reduced in the thalassemic subjects with disease but was within normal range for thalassemic carriers.     

Multiple stiffening effects of nanoscale knobs on human red blood cells infected with Plasmodium falciparum malaria parasite

During its asexual development within the red blood cell (RBC), Plasmodium falciparum (Pf), the most virulent human malaria parasite, exports proteins that modify the host RBC membrane. The attendant increase in cell stiffness and cytoadherence leads to sequestration of infected RBCs in microvasculature, which enables the parasite to evade the spleen, and leads to organ dysfunction in severe cases of malaria. Despite progress in understanding malaria pathogenesis, the molecular mechanisms responsible for the dramatic loss of deformability of Pf-infected RBCs have remained elusive. By recourse to a coarse-grained (CG) model that captures the molecular structures of Pf-infected RBC membrane, here we show that nanoscale surface protrusions, known as “knobs,” introduce multiple stiffening mechanisms through composite strengthening, strain hardening, and knob density-dependent vertical coupling. On one hand, the knobs act as structural strengtheners for the spectrin network; on the other, the presence of knobs results in strain inhomogeneity in the spectrin network with elevated shear strain in the knob-free regions, which, given its strain-hardening property, effectively stiffens the network. From the trophozoite to the schizont stage that ensues within 24–48 h of parasite invasion into the RBC, the rise in the knob density results in the increased number of vertical constraints between the spectrin network and the lipid bilayer, which further stiffens the membrane. The shear moduli of Pf-infected RBCs predicted by the CG model at different stages of parasite maturation are in agreement with experimental results. In addition to providing a fundamental understanding of the stiffening mechanisms of Pf-infected RBCs, our simulation results suggest potential targets for antimalarial therapies.The most virulent human malaria parasite, Plasmodium falciparum (Pf), causes ∼700,000 deaths each year (1, 2). Following entry into red blood cells (RBCs), the parasite matures through the ring (0–24 h), trophozoite (24–36 h), and schizont stages (40–48 h). This intraerythrocyte maturation is accompanied by striking changes in the surface topography and membrane architecture of the infected RBC (3–5). A notable modification is the formation of nanoscale protrusions, commonly known as knobs, at the RBC surface during the second half (24–48 h) of the asexual cycle. These protrusions mainly comprise the knob-associated histidine-rich protein (KAHRP) and the membrane-embedded cytoadherence protein, Pf-erythrocyte membrane protein 1 (PfEMP1). KAHRP binds to the fourth repeat unit of the spectrin α-chain, to ankyrin, to spectrin–actin–protein 4.1 complexes, and to the cytoplasmic domain of PfEMP1 (6–9). These attachments enhance the vertical coupling between the lipid bilayer and the spectrin network. Another striking modification in the Pf-infected RBC membrane is the reorganization of the cytoskeletal network caused by parasite-induced actin remodeling (10). As a result of these molecular-level modifications, the Pf-infected RBC exhibits markedly increased stiffness [the shear modulus increases on average from ∼4−10 µN/m in normal/uninfected RBCs, to ∼40 µN/m at the trophozoite stage, and to as high as 90 µN/m at the schizont stage (11–13)] and cytoadherence to the vascular endothelium, which enable sequestration from circulation in vasculature, and evasion from the surveillance mechanisms of the spleen. Although in vitro experimental studies have revealed roles of particular parasite-encoded proteins in remodeling the host RBC (14–22), the mechanism by which Pf-infected RBCs gain dramatically increased stiffness has remained unclear. Indeed, uncertainty remains as to whether the loss of deformability arises from the structural reorganization of the host membrane components or from the deposition of parasite proteins. That is, it is not clear whether the stiffening is due to remodeling of the spectrin network, or to the formation of the knobs, or both. As experimental studies alone have heretofore not been able to determine the molecular details, numerical modeling, combined with a variety of experimental observations and measurements, offers an alternative approach to reveal the underlying mechanisms.We present here a coarse-grained (CG) molecular dynamics (MD) RBC membrane model to correlate structural modifications at the molecular ultrastructure level with the shear responses of the Pf-infected RBC membrane, focusing on the second half of the parasite’s intra-RBC asexual cycle (24–48 h), i.e., the trophozoite and schizont stages. The CG model is computationally efficient, and able to capture the molecular structures of the RBC membrane in both normal and infected states. CGMD simulations reveal that spectrin network remodeling accounts for a relatively small change in shear modulus. Instead, the knobs stiffen the membrane by multiple mechanisms, including composite strengthening, strain hardening, and knob density-dependent vertical coupling. Our findings provide molecular-level understanding of the stiffening mechanisms operating in Pf-infected RBCs and shed light on the pathogenesis of falciparum malaria.     

Phosphorylation of protein 4.1 in Plasmodium falciparum-infected human red blood cells

The composition of the erythrocyte plasma membrane is extensively modified during the intracellular growth of the malaria parasite Plasmodium falciparum. It has been previously shown that an 80-kD phosphoprotein is associated with the plasma membrane of human red blood cells (RBCs) infected with trophozoite/schizont stage malaria parasites. However, the identity of this 80-kD phosphoprotein is controversial. One line of evidence suggests that this protein is a phosphorylated form of RBC protein 4.1 and that it forms a tight complex with the mature parasite-infected erythrocyte surface antigen. In contrast, evidence from another group indicates that the 80-kD protein is derived from the intracellular malaria parasite. To resolve whether the 80-kD protein is indeed RBC protein 4.1, we made use of RBCs obtained from a patient with homozygous 4.1(-) negative hereditary elliptocytosis. RBCs from this patient are completely devoid of protein 4.1. We report here that this lack of protein 4.1 is correlated with the absence of phosphorylation of the 80-kD protein in parasite- infected RBCs, a finding that provides conclusive evidence that the 80- kD phosphoprotein is indeed protein 4.1. In addition, we also identify and partially characterize a casein kinase that phosphorylates protein 4.1 in P falciparum-infected human RBCs. Based on these results, we suggest that the maturation of malaria parasites in human RBCs is accompanied by the phosphorylation of protein 4.1. This phosphorylation of RBC protein 4.1 may provide a mechanism by which the intracellular malaria parasite alters the mechanical properties of the host plasma membrane and modulates parasite growth and survival in vivo.     

Rosetting of Plasmodium falciparum-infected red blood cells with uninfected red blood cells enhances microvascular obstruction under flow conditions

The occurrence of rosetting of Plasmodium falciparum-infected human red blood cells (IRBC) with uninfected red blood cells (RBC) and its potential pathophysiologic consequences were investigated under flow conditions using the perfused rat mesocecum vasculature. Perfusion experiments were performed using two knobby (K+) lines of P falciparum, ie, rosetting positive (K+R+) and rosetting negative (K+R-). The infusion of K+R+ IRBC resulted in higher peripheral resistance (PRU) than K+R- IRBC (P less than .0012). Video microscopy showed that under conditions of flow, in addition to cytoadherence of K+R+ IRBC to the venular endothelium, rosette formation was also restricted to venules, especially in the areas of slow flow. Rosettes were absent in arterioles and were presumably dissociated by higher wall shear rates. The presence of rosettes in the venules must therefore reflect their rapid reformation after disruption. Cytoadherence of K+R+ IRBC was characterized by formation of focal clusters along the venular wall. In addition, large aggregates of RBC were frequently observed at venular junctions, probably as a result of interaction between flowing rosettes, free IRBC, and uninfected RBC. In contrast, the infusion of K+R+ IRBC resulted in diffuse cytoadherence of these cells exclusively to the venular endothelium but not in rosetting or large aggregate formation. The cytoadherence of K+R+ IRBC showed strong inverse correlation with the venular diameter (r = -.856, P less than .00001). Incubation of K+R+ IRBC with heparin and with monoclonal antibodies to glycoprotein IV/CD36 abolished the rosette formation and resulted in decreased PRU and microvascular blockage. These findings demonstrate that rosetting of K+R+ IRBC with uninfected RBC enhances vasocclusion, suggesting an important in vivo role for rosetting in the microvascular sequestration of P falciparum-infected RBC.     

Transfection of Plasmodium falciparum within human red blood cells.

Plasmodium falciparum malaria parasites within human red blood cells (RBCs) have been successfully transfected to produce chloramphenicol acetyltransferase (CAT). Electroporation of parasitized RBCs was used to introduce plasmids that have CAT-encoding DNA flanked by 5' and 3' untranslated sequences of the P. falciparum hsp86, hrp3, and hrp2 genes. These flanking sequences were required for expression as their excision abolished CAT activity in transfected parasites. Transfection signals from native CAT-encoding DNA compared well with those from a synthetic DNA sequence adapted to the P. falciparum major codon bias, demonstrating effective expression of the bacterial sequence despite its use of rare P. falciparum codons. Transfected ring-stage parasites produced CAT signals at least as strong as transfected schizont-stage parasites even though ring stages are surrounded by more RBC cytoplasm than schizonts. The transfection of erythrocyte-stage P. falciparum parasites advances our ability to pursue genetic analysis of this major pathogen.     

Parasite sequestration in Plasmodium falciparum malaria: spleen and antibody modulation of cytoadherence of infected erythrocytes.

Sequestration, the adherence of infected erythrocytes containing late developmental stages of the parasite (trophozoites and schizonts) to the endothelium of capillaries and venules, is characteristic of Plasmodium falciparum infections. We have studied two host factors, the spleen and antibody, that influence sequestration of P. falciparum in the squirrel monkey. Sequestration of trophozoite/schizont-infected erythrocytes that occurs in intact animals is reduced in splenectomized animals; in vitro, when infected blood is incubated with monolayers of human melanoma cells, trophozoite/schizont-infected erythrocytes from intact animals but not from splenectomized animals bind to the melanoma cells. The switch in cytoadherence characteristics of the infected erythrocytes from nonbinding to binding occurs with a cloned parasite. Immune serum can inhibit and reverse in vitro binding to melanoma cells of infected erythrocytes from intact animals. Similarly, antibody can reverse in vivo sequestration as shown by the appearance of trophozoite/schizont-infected erythrocytes in the peripheral blood of an intact animal after inoculation with immune serum. These results indicate that the spleen modulates the expression of parasite alterations of the infected erythrocyte membrane responsible for sequestration and suggest that the prevention and reversal of sequestration could be one of the effector mechanisms involved in antibody-mediated protection against P. falciparum malaria.     

Platelet-induced autoagglutination of Plasmodium falciparum-infected red blood cells and disease severity in Thailand

The relationship of the platelet-mediated autoagglutination of Plasmodium falciparum-infected red blood cells (IRBCs) to disease severity was investigated in 182 Thai patients with falciparum malaria; it was evident in 43% of uncomplicated malaria (n=63), 41% of severe malaria (n=104), and 100% of cerebral malaria (n=15; P=.001) isolates. The median (range) number of IRBCs in agglutinates per 1000 IRBCs was significantly higher in cerebral malaria (6 [3-42]) than in severe (0 [0-52]) and uncomplicated (0 [0-24]) malaria (P=.01). In multivariate analyses, high parasitemia and cerebral malaria were associated independently with parasite agglutination.     

Evidence of trapped red cells in the brain of rhesus monkey infected with Plasmodium knowlesi

59Fe-labelled normal red cells and 51Cr-labelled P. knowlesi infected red cells were used as tracers for a study on the trapped red cells in the brain of rhesus monkeys infected with P. knowlesi. After instantaneous injection into a common carotid artery, blood was sampled from both of the internal jugular veins at various intervals. Results in 6 experiments on 3 infected monkeys showed that about 17% of infected red cells given was trapped in the capillaries of the brain of the infected monkeys. The remainder of the infected red cells travelled on the same flow rate as the normal red cells. As the volume for the flow of the former was less than that of the latter, the mean transit time of the infected red cells (-ty) was therefore shorter than that of the normal red cells (-th). The mean difference in volume was estimated to be 3.4% in the present study. These findings indicated that some of the P. knowlesi infected red cells were trapped in capillaries of the brains of monkeys infected with P. knowlesi.     

Abnormalities in the mechanical properties of red blood cells caused by Plasmodium falciparum

Although changes in the mechanical properties of infected red cells may contribute to the pathophysiology of malaria, such changes have not previously been described in detail. In this study, the physical properties of individual cells from both clinical and cultured samples infected with Plasmodium falciparum were tested using micropipette aspiration techniques. Cells containing ring forms took about 50% longer to enter 3 microns pipettes compared with nonparasitised cells, and there was a similar increase in the critical pressure required to induce cell entry. These abnormalities were similar in clinical and cultured samples. More mature cultured parasites (ie, trophozoites and schizonts containing pigment) caused much greater loss of deformability, with entry time and pressure increased four to sixfold. The decrease in deformability of the ring forms was attributable to a deficit in cell surface area/volume ratio (based on micropipette measurement of the surface area and volume of individual cells) and slight stiffening of the cell membrane (shear elastic modulus increased 13%, as measured by pipette aspiration of small membrane tongues). Measurement of the rate of cell shape recovery indicated that the membrane of parasitised cells was not more viscous. The main factor in the drastic loss of deformability of the trophozoites and schizonts was the presence of the large very resistant parasite itself. Otherwise, the cell surface area/volume deficit was slightly less and membrane rigidification slightly greater compared with ring forms. The above abnormalities should cause the trophozoites and schizonts to have great difficulty in traversing splenic or marrow sinuses and could contribute to microvascular occlusion and sequestration. On the other hand, the ring forms may be expected to circulate relatively unhindered.