Plasmodium falciparum dramatically modifies the structure and function of the membrane of the parasitized host erythrocyte. Altered membrane properties are the consequence of the interaction of a group of exported malaria proteins with host cell membrane proteins. KAHRP (the knob-associated histidine-rich protein), a member of this group, has been shown to interact with erythrocyte membrane skeletal protein spectrin. However, the molecular basis for this interaction has yet to be defined. In the present study, we defined the binding motifs in both KAHRP and spectrin and identified a functional role for this interaction. We showed that spectrin bound to a 72-amino-acid KAHRP fragment (residues 370 -441). Among nine-spectrin fragments, which encompass the entire ␣ and  spectrin molecules (four ␣ spectrin and five  spectrin fragments), KAHRP bound only to one, the ␣ N-5 fragment. The KAHRP-binding site within the ␣ N-5 fragment was localized uniquely to repeat 4. The interaction of fulllength spectrin dimer to KAHRP was inhibited by repeat 4 of ␣ spectrin. Importantly, resealing of this repeat peptide into erythrocytes mislocalized KAHRP in the parasitized cells. We concluded that the interaction of KAHRP with spectrin is critical for appropriate membrane localization of KAHRP in parasitized erythrocytes. As the presence of KAHRP at the erythrocyte membrane is necessary for cytoadherence in vivo, our findings have implications for the development of new therapies for mitigating the severity of malaria infection.Malaria caused by Plasmodium falciparum is the most serious parasitic disease of humans. Clinical symptoms occur during the asexual stage of the life cycle of the parasites, at which time it multiplies within the human erythrocyte. During intraerythrocytic growth, the parasite extensively modifies the host erythrocyte resulting in alterations of morphology, mechanical properties, and adhesive properties. It is generally believed that almost all the altered properties of parasitized erythrocytes are because of the action of a group of parasite proteins that become associated with erythrocyte membrane proteins (see Refs. 1-3 for recent reviews). Well studied members of this group include the knob-associated histidine-rich protein (KAHRP), 1 P. falciparum erythrocyte membrane protein 1 (PfEMP1), the ring parasite-infected erythrocyte surface antigen (RESA), and the mature parasite-infected erythrocyte surface antigen (MESA).KAHRP, an 85-105-kDa protein that is expressed during the middle and later stages of the asexual cycle (4, 5), has been shown to be critically important for knob formation in infected erythrocytes (6). It interacts with erythrocyte skeletal proteins such as spectrin, actin, and ankyrin (7, 8) and also with erythrocyte membrane-associated parasite protein, PfEMP1 (9). PfEMP1 mediates the adhesion of parasitized erythrocytes to the vascular endothelium (10), a process strongly implicated in the pathology of cerebral malaria (11). The absence of the KAHRP protein at the erythrocyte membrane l...