Antibody recognition of plasmodium falciparum infected red blood cells by symptomatic and asymptomatic individuals in the brazilian Amazon

In the Amazon Region, there is a virtual absence of severe malaria and few fatal cases of naturally occurring Plasmodium falciparum infections; this presents an intriguing and underexplored area of research. In addition to the rapid access of infected persons to effective treatment, one cause of this phenomenon might be the recognition of cytoadherent variant proteins on the infected red blood cell (IRBC) surface, including the var gene encoded P. falciparum erythrocyte membrane protein 1. In order to establish a link between cytoadherence, IRBC surface antibody recognition and the presence or absence of malaria symptoms, we phenotype-selected four Amazonian P. falciparum isolates and the laboratory strain 3D7 for their cytoadherence to CD36 and ICAM1 expressed on CHO cells. We then mapped the dominantly expressed var transcripts and tested whether antibodies from symptomatic or asymptomatic infections showed a differential recognition of the IRBC surface. As controls, the 3D7 lineages expressing severe disease-associated phenotypes were used. We showed that there was no profound difference between the frequency and intensity of antibody recognition of the IRBC-exposed P. falciparum proteins in symptomatic vs. asymptomatic infections. The 3D7 lineages, which expressed severe malaria-associated phenotypes, were strongly recognised by most, but not all plasmas, meaning that the recognition of these phenotypes is frequent in asymptomatic carriers, but is not necessarily a prerequisite to staying free of symptoms.In the Amazon Region, there is a virtual absence of severe malaria and few fatal cases of naturally occurring Plasmodium falciparum infectionsthis presents an intriguing and underexplored area of research. In addition to the rapid access of infected p1095598601FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO2009/17114-3576128/2008-2To Wolfgang Fischer and Márcio Yamamoto, for sequencing of DBLα tag sequences, and to Drs Mauro Shugiro Tada and Tony Katsuragawa, for help with data and sample collection at the site

Expression and immune recognition of conserved alleles of Plasmodium falciparum variant antigens.

Um importante fator de patogenicidade de P. falciparum, causador da malária, é a presença de antígenos altamente polimórficos, codificados por famílias multigênicas como var e rif. O grande polimorfismo destes genes em isolados de diferentes regiões contrasta com o fato de existirem, em diferentes isolados de campo brasileiros, alelos conservados. Respostas humorais contra estas proteínas são consideradas importantes na aquisição de proteção contra os sintomas da doença em regiões endêmicas. Portanto, medimos a resposta humoral contra antígenos recombinantes PfEMP1 e RIFIN e detectamos níveis baixos de resposta tanto em indivíduos sintomáticos quanto em indivíduos assintomáticos infectados pelo parasita. Estas respostas foram baixas quando comparadas às respostas contra MSP119 da superfície do merozoíta e parecem ser de curta duração. Com base nestes resultados, as respostas contra domínios DBLa, em situações hipoendêmicas, parecem ocorrer em função da presença do parasita circulante, e não são relacionadas à proteção contra os sintomas clínicos da doença.An important factor in the pathogenicity of P. falciparum, the causing agent of malaria is the expression of highly polymorphic antigens encoded by the multigene families var and rif. The extreme polymorphism of these genes in strains from different geographical regions is in contrast with the observation of a number of conserved alleles found in Amazonian isolates. The humoral response against these proteins is considered an important factor in the immunity against symptomatic infection in áreas with high transmission. We measured the antibody response against recombinant PfEMP1 and RIFIN antigens and detected low responsiveness of symptomatic and asymptomatic malaria infected individuals. These responses were not only weak when compared to the anti-merozoite surface protein 1 response, but also ceased rapidly after the removal of circulating parasites. On the basis of these results, the response against DBLa seems to be dependent on the presence of parasites and not important for the observed protection against symptomatic infection in hypoendemic settings

Asymptomatic cases of malaria in the Brazilian Amazon: cytoadherence, antibodies against the surface of infected red blood cells and protection in natural infections caused by Plasmodium falciparum.

Um importante fator na virulência do P. falciparum é sua capacidade de aderência a receptores endoteliais, mediada por proteínas PfEMP1. No Brasil, o número de variantes PfEMP1 é limitado, com raras evoluções graves da doença, e presença de indivíduos portadores do parasita e sem sintomas. Localizamos anticorpos contra a membrana do eritrócito infectado em plasmas de indivíduos de Rondônia; sem diferenças na resposta imune nos dois grupos (selecionados tanto para ICAM1 quanto CD36), tanto em frequência quanto em; encontramos diferenças significativas em capacidade de inibição de citoadência apenas em casos pontuais, sem correlação com índice de reatividade ou fenótipo; observamos presença de anticorpos pan-reativos, capazes de aglutinar diferentes isolados, porém sem diferenças entre os isolados selecionados para ICAM1 e CD36. Os dados indicam que a resposta contra a superfície da hemácia infectada - ao menos dos isolados e fenótipos testados neste trabalho - não parece ser um critério decisivo para o tipo de evolução de malaria sofrida pelo paciente.An important factor in P. falciparum\'s virulence is its ability to adhere to endothelial receptors, mediated by PfEMP1 proteins. In Brazil the number of PfEMP1 variants is limited, severe disease is rare, and there are many individuals carrying the parasite without symptoms. We detected antibodies against the membrane of erythrocytes using plasma of infected individuals from Rondônia, finding only in some cases differences in the immune response, both in frequency and degree; we also could not find differences between the ability to inhibit cytoadherence in static condition. There was no correlation between this capacity and the reactivity index or phenotype; we observed the presence of pan-reactive antibodies that were capable of agglutinating different isolates, but without any difference between ICAM1 and CD36 selected isolates. Taken together, our data indicate the immune response against the infected red blood cell is not decisive for the outcome of malaria suffered by the patients