Identification of novel PfEMP1 variants containing domain cassettes 11, 15 and 8 that mediate the Plasmodium falciparum virulence-associated rosetting phenotype

Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) is a diverse family of variant surface antigens, encoded by var genes, that mediates binding of infected erythrocytes to human cells and plays a key role in parasite immune evasion and malaria pathology. The increased availability of parasite genome sequence data has revolutionised the ability to study PfEMP1 diversity across multiple P. falciparum isolates. However, making functional sense of genomic data relies on the ability to infer binding phenotype from var gene sequence. For P. falciparum rosetting, the binding of infected erythrocytes to uninfected erythrocytes, the analysis of var gene/PfEMP1 sequences encoding the phenotype is limited, with only eight rosette-mediating PfEMP1 variants described to date. These known rosetting PfEMP1 variants fall into two types, characterised by N- terminal domains known as “domain cassette” 11 (DC11) and DC16. Here we test the hypothesis that DC11 and DC16 are the only PfEMP1 types in the P. falciparum genome that mediate rosetting, by examining a set of thirteen recent culture-adapted Kenyan parasite lines. We first analysed the var gene/PfEMP1 repertoires of the Kenyan lines and identified an average of three DC11 or DC16 PfEMP1 variants per genotype. In vitro rosette selection of the parasite lines yielded four with a high rosette frequency, and analyses of their var gene transcription, infected erythrocyte PfEMP1 surface expression, rosette disruption and erythrocyte binding function identified four novel rosette- mediating PfEMP1 variants. Two of these were of the predicted DC11 type (one showing the dual rosetting/IgM-Fc-binding phenotype), whereas two contained DC15 (DBLα1.2-CIDRα1.5b) a PfEMP1 type not previously associated with rosetting. We also showed that a Thai parasite line expressing a DC8-like PfEMP1 binds to erythrocytes to form rosettes. Hence, these data expand current knowledge of rosetting mechanisms and emphasize that the PfEMP1 types mediating rosetting are more diverse than previously recognised.

Author summary

Malaria is an infectious tropical disease caused by the parasite Plasmodium falciparum that kills more than half a million people every year, mostly young children in sub-Saharan Africa. Life- threatening episodes of malaria are characterised by huge numbers of parasitised red blood cells in the infected host, many of which bind to blood vessel walls and block blood flow, causing tissue damage and organ failure. Sometimes parasitised red cells also bind to uninfected red cells to form clusters of cells called rosettes, which make the blockage of blood flow in vital organs even worse. Previous research has begun to decipher how parasitised red cells bind to uninfected red cells to form rosettes, but little is yet known about the process. Here we identify some new versions of the “sticky proteins” (adhesion molecules) that are made by malaria parasites and displayed on the surface of infected red cells to bring about rosette formation. The rosette-mediating adhesion molecules are members of a large family, and we identify here a few characteristic types within this family that mediate rosetting. This work is an important step towards the goal of understanding how malaria parasite rosettes form rosettes in order to develop preventions or treatments to reverse rosetting and reduce the number of people dying from severe malaria.