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Plasmodium falciparum during pregnancy: a puzzling parasite tissue adhesion tropism

Published online by Cambridge University Press:  25 October 2007

M. C. NUNES  and
A. SCHERF
M. C. NUNES
Affiliation:
Unité de Biologie des Interactions Hôte-Parasite, Institut Pasteur, CNRS, 75724 Paris, France
A. SCHERF*
Affiliation:
Unité de Biologie des Interactions Hôte-Parasite, Institut Pasteur, CNRS, 75724 Paris, France
*
*Corresponding author: Artur Scherf, Unité de Biologie des Interactions Hôte-Parasite, CNRS URA 2581, Institut Pasteur, 25, rue du Dr. Roux, 75724 Paris Cedex 15, France. Tel: 33-1-45688616. Fax: 33-1-45688348. E-mail: ascherf@pasteur.fr
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Summary

P. falciparum malaria severely affects pregnant women and children. Despite immunity through lifelong exposure to malaria, pregnant women become susceptible to infections causing anaemia, abortions and low birth weight. They experience massive accumulation of infected erythrocytes (IEs) in the placenta. Adhesion of IEs to host endothelial receptors is mediated by members of a large diverse protein family called P. falciparum erythrocyte membrane protein 1 (PfEMP1). Pregnancy malaria is generally associated with the emergence of a distinct subset of parasites expressing a unique PfEMP1 that binds to the host-receptor chondroitin sulfate A (CSA). Resistance to pregnancy malaria is associated with the acquisition of antibodies that block IEs binding to placental CSA. The absence (or rare occurrence) of CSA-binding parasites in malaria patients (children, men and non-pregnant women) suggests that these parasites become virulent only during pregnancy. The molecular mechanisms used by P. falciparum to achieve the timely expression of the Pf-CSA ligand in pregnant women remain puzzling. In this review we will discuss two hypothetical mechanisms by which CSA-binding parasites may arise during pregnancy. The first, a selection process by the placenta of a distinct sub-population of P. falciparum expressing a particular PfEMP1. The second, an induction mechanism that facilitates the expression of a particular PfEMP1 protein by specific host factor(s) present only during pregnancy.

Keywords

MalariaplacentaPlasmodium falciparumvar2CSA
Type
Research Article
Information
Parasitology , Volume 134 , Special Issue 13: PARASITES IN PREGNANCY , December 2007 , pp. 1863 - 1869
Copyright
Copyright © Cambridge University Press 2007

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