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Background   Plasmodium vivax  is predominant in the Amazon region, and enhanced knowledge of its development inside a natural vector,  Anopheles aquasalis , is critical for future strategies aimed at blocking parasite development. The peritrophic matrix (PM), a chitinous layer produced by the mosquito midgut in response to blood ingestion, is a protective barrier against pathogens.  Plasmodium  can only complete its life-cycle, and consequently be transmitted to a new host, after successfully passing this barrier. Interestingly, fully engorged mosquitoes that had a complete blood meal form a thicker, well-developed PM than ones that feed in small amounts. The amount of red blood cells (RBC) in the blood meal directly influences the production of digestive enzymes and can protect parasites from being killed during the meal digestion. A specific study interrupting the development of the PM associated with the proteolytic activity inhibition, and distinct RBC concentrations, during the  P. vivax  infection of the New World malaria vector  An. aquasalis  is expected to clarify whether these factors affect the parasite development.    Results  Absence of PM in the vector caused a significant reduction in  P. vivax  infection. However, the association of chitinase with trypsin inhibitor restored infection rates to those of mosquitoes with a structured PM. Also, only the ingestion of trypsin inhibitor by non-chitinase treated mosquitoes increased the infection intensity. Moreover, the RBC concentration in the infected  P. vivax  blood meal directly influenced the infection rate and its intensity. A straight correlation was observed between RBC concentrations and infection intensity.    Conclusions  This study established that there is a balance between the PM role, RBC concentration and digestive enzyme activity influencing the establishment and development of  P. vivax  infection inside  An. aquasalis . Our results indicate that the absence of PM in the midgut facilitates digestive enzyme dispersion throughout the blood meal, causing direct damage to  P. vivax . On the other hand, high RBC concentrations support a better and thick, well-developed PM and protect  P. vivax  from being killed. Further studies of this complex system may provide insights into other details of the malaria vector response to  P. vivax  infection.

The role of the peritrophic matrix and red blood cell concentration in Plasmodium vivax infection of Anopheles aquasalis