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Background  A subset of the  Plasmodium falciparum  erythrocyte membrane protein 1 (PfEMP1 SM ) is involved in the cytoadherence of  P. falciparum -infected red blood cells (iRBC) contributing to the pathogenesis of severe disease among young children in malaria endemic areas. The PfEMP1 SM  are encoded by group A  var  genes that are composed of a more constrained range of amino acid sequences than groups B and C  var  genes encoding PfEMP1 UM  associated with uncomplicated malaria. Also, unlike  var  genes from groups B and C, those from group A do not have sequences consistent with CD36 binding – a major cytoadhesion phenotype of  P. falciparum  isolates.    Methods  A 3D7 PfEMP1 SM  sub-line (3D7 SM ) expressing VAR4 (PFD1235w/MAL8P1.207) was selected for binding to CD36. The protein expression of this parasite line was monitored by surface staining of iRBC using VAR4-specific antibodies. The serological phenotype of the 3D7 SM  parasites was determined by flow cytometry using malaria semi-immune and immune plasma and transcription of the 59  var  genes in 3D7 were analysed by real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) using  var -specific primers.    Results  A selection-induced increased adhesion of 3D7 SM  iRBC to CD36 resulted in a reduced  var4  transcription and VAR4 surface expression.    Conclusion  VAR4 is not involved in CD36 adhesion. The current findings are consistent with the notion that CD36 adhesion is not associated with particular virulent parasite phenotypes, such as those believed to be exhibited by VAR4 expressing parasites.

CD36 selection of 3D7 Plasmodium falciparum associated with severe childhood malaria results in reduced VAR4 expression