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During blood stage infection,  Plasmodium falciparum  infected erythrocytes (IE) bind to host blood vessels. This virulence determinant enables parasites to evade spleen-dependent killing mechanisms, but paradoxically in some cases may reduce parasite fitness by killing the host. Adhesion of infected erythrocytes is mediated by  P. falciparum  erythrocyte membrane protein 1 (PfEMP1), a family of polymorphic adhesion proteins encoded by  var  genes. Whereas cerebral binding and severe malaria are associated with parasites expressing DC8 and DC13  var  genes, relatively little is known about the non-brain endothelial selection on severe malaria adhesive types. In this study, we selected  P. falciparum -IEs on diverse endothelial cell types and demonstrate that DC8 and DC13  var  genes were consistently among the major  var  transcripts selected on non-brain endothelial cells (lung, heart, bone marrow). To investigate the molecular basis for this avid endothelial binding activity, recombinant proteins were expressed from the predominant upregulated DC8 transcript, IT4var19. In-depth binding comparisons revealed that multiple extracellular domains from this protein bound brain and non-brain endothelial cells, and individual domains largely did not discriminate between different endothelial cell types. Additionally, we found that recombinant DC8 and DC13 CIDR1 domains exhibited a widespread endothelial binding activity and could compete for DC8-IE binding to brain endothelial cells, suggesting they may bind the same host receptor. Our findings provide new insights into the interaction of severe malaria adhesive types and host blood vessels and support the hypothesis that parasites causing severe malaria express PfEMP1 variants with a superior ability to adhere to diverse endothelial cell types, and may therefore endow these parasites with a growth and transmission advantage.

DC8 and DC13 var Genes Associated with Severe Malaria Bind Avidly to Diverse Endothelial Cells