A dodecasaccharide motif of the low-sulfated chondroitin 4-sulfate (C4S) mediate the binding of Plasmodium falciparuminfected red blood cells (IRBCs) in human placenta. Here we studied the detailed C4S structural requirements by assessing the ability of chemically modified C4S to inhibit IRBC binding to the placental chondroitin sulfate proteoglycan. Replacement of the N-acetyl groups with bulky N-acyl or N-benzoyl substituents had no effect on the inhibitory activity of C4S, whereas reduction of the carboxyl groups abrogated the activity. Dermatan sulfates showed ϳ50% inhibitory activity when compared with C4Ss with similar sulfate contents. These data demonstrate that the C4S carboxyl groups and their equatorial orientation but not the N-acetyl groups are critical for IRBC binding. Conjugation of bulky substituents to the reducing end N-acetylgalactosamine residues of C4S dodecasaccharide had no effect on its inhibitory activity. Based on these results, we prepared photoaffinity reagents for the identification of the parasite proteins involved in C4S binding. Cross-linking of the IRBCs with a radioiodinated photoactivable C4S dodecasaccharide labeled a ϳ22-kDa novel parasite protein, suggesting strongly for the first time that a low molecular weight IRBC surface protein rather than a 200 -400-kDa PfEMP1 is involved in C4S binding. Conjugation of biotin to the C4S dodecasaccharide photoaffinity probe afforded a strategy for the isolation of the labeled protein by avidin affinity precipitation, facilitating efforts to identify the C4S-adherent IRBC protein(s). Our results also have broader implications for designing oligosaccharide-based photoaffinity probes for the identification of proteins involved in glycosaminoglycan-dependent attachment of microbes to hosts.An unusual feature of Plasmodium falciparum infection compared with the three other human malarial parasites, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae, is that only the former parasite is able to sequester in the microvascular capillaries of various organs (1, 2). In P. falciparuminfected individuals, the infected red blood cells (IRBCs) 5 adhere to the vascular endothelial surface by binding to the cell adhesion molecules. This adherence property is believed to play an important role in the development of cerebral and other severe malaria syndromes (2-4). Several host molecules have been implicated in the IRBC adherence, including thrombospondin, CD36, intercellular adhesion molecule 1, vascular cell adhesion molecule 1, E-selectin, P-selectin, platelet endothelial cell adhesion molecule/CD31, and chondroitin 4-sulfate (1-6). In response to the development of adherent phenotypespecific immunity by hosts, parasites with different adherent receptor specificity evolve to efficiently survive in the host. However, eventually, when immunity to various adhesive parasite phenotypes is developed, the host effectively controls infection and avoids pathogenesis. This is generally true for malaria-immune people regardless of gender. However, in ...