The human malaria parasite Plasmodium falciparum can cause infected red blood cells (iRBC) to form rosettes with uninfected RBC, a phenotype associated with severe malaria. Rosetting is mediated by a subset of the Plasmodium falciparum membrane protein 1 (PfEMP1) variant adhesins expressed on the infected host-cell surface. Heparin and other sulfated oligosaccharides, however, can disrupt rosettes, suggesting that therapeutic approaches to this form of severe malaria are feasible. We present a structural and functional study of the N-terminal domain of PfEMP1 from the VarO variant comprising the N-terminal segment (NTS) and the first DBL domain (DBL1α 1 ), which is directly implicated in rosetting. We demonstrate that NTS-DBL1α 1 -VarO binds to RBC and that heparin inhibits this interaction in a dose-dependent manner, thus mimicking heparin-mediated rosette disruption. We have determined the crystal structure of NTS-DBL1α 1 , showing that NTS, previously thought to be a structurally independent component of PfEMP1, forms an integral part of the DBL1α domain. Using mutagenesis and docking studies, we have located the heparin-binding site, which includes NTS. NTS, unique to the DBL α-class domain, is thus an intrinsic structural and functional component of the N-terminal VarO domain. The specific interaction observed with heparin opens the way for developing antirosetting therapeutic strategies.
Severe Plasmodium falciparum malaria is frequently associated with infected red blood cells (iRBC) forming rosettes with uninfected RBC (1-3). Although the relationship between rosetting and malaria pathology is not thoroughly understood, enhanced invasion of RBC (4) and microvascular obstruction caused by high rosette densities (5) are probably major contributing factors. Rosetting is mediated by a subset of the P. falciparum erythrocyte membrane protein 1 (PfEMP1) adhesins (2, 6, 7), a protein family involved in falciparum cyto-adhesion. PfEMP1 adhesins are expressed on the surface of the iRBC during the trophozoite and schizont phases and are clustered in knob-like structures, where they interact with diverse host receptors (8).PfEMP1 has a large N-terminal extracellular region comprising an N-terminal segment (NTS), and several Duffy binding-like (DBL) domains and cysteine-rich interdomain regions (CIDR) (8-10). DBL and CIDR domains can be assigned to a small number of sequence classes. The arrangement of these domains is modular, but most variants begin with NTS followed by DBL1α. Indeed, α-class DBL domains occur only at the N-terminal position of PfEMP1 (11). Studies on laboratory parasite strains have shown that the DBL1α 1 subclass is directly implicated in rosette formation (2, 7). In spite of a diversity of rosetting phenotypes, which interact with a variety of receptors, rosettes are frequently disrupted by sulfated glycosaminoglycans (GAG), such as heparin (6,(12)(13)(14)(15)(16). Heparin efficiently disrupts rosettes but may enhance CD36-dependent adhesion of iRBC to microvascular endothelium cells (17). The ...