hours after transfection. COS-7 cells were incubated with EGF (0.1 g/ml) [biotinylated, complexed to Texas Red-streptoavidin (Molecular Probes, Eugene, OR)] in binding buffer [20 mM Hepes-NaOH ( pH 7.5), 130 mM NaCl, and 0.1% bovine serum albumin] at 4°C for 60 min. Internalization of EGF was allowed by incubation in Dulbecco's modified Eagle's medium at 37°C for 10 min, then excess EGF was removed with 0.2 M AcOH ( pH 2.5) and 0.5 M NaCl at 4°C for 5 min. Cells were fixed in 3.7% formaldehyde, permeabilized with 0.2% Triton X-100, and immunostained with a polyclonal antibody to myc (Santa Cruz Biotechnology, Santa Cruz, CA) and fluorescein isothiocyanate-conjugated antibody to rabbit (Organon Teknika, Boxtel, Netherlands). Internalization of EGF was observed by confocal microscopy (Bio-Rad). 37. We thank Y. Watanabe (Ehime University, Japan) for providing us with various synthetic phosphoinositides.

Sequestration of Plasmodium falciparum-infected erythrocytes in host blood vessels is a key triggering event in the pathogenesis of severe childhood malaria, which is responsible for about one million deaths every year 1 . Sequestration is mediated by specific interactions between members of the P. falciparum erythrocyte membrane protein 1 (PfEMP1) family and receptors on the endothelial lining 2 . Severe malaria is associated with expression of specific PfEMP1 subtypes containing domain cassettes (DC) 8 and 13 3 , but the endothelial receptor for parasites expressing these proteins was unknown 4,5 . Here, we identify endothelial protein C receptor (EPCR), which mediates cytoprotective effects of activated protein C 6 , as the endothelial receptor for DC8 and DC13 PfEMP1. We show that EPCR binding is mediated through the N-terminal cysteine-rich interdomain region (CIDRα1) of DC8 and group A PfEMP1 subfamilies and that CIDRα1 interferes with protein C binding to EPCR. This PfEMP1 adhesive property links P. falciparum Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:http://www.nature.com/authors/editorial_policies/license.html#terms † Correspondence to: thomasl@sund.ku.dk and lturner@sund.ku.dk. * These authors contributed equally to the work.Supplementary Information is linked to the online version of the paper at www.nature.com/nature.Author Contributions: LT, TL, JDS and AJB produced recombinant proteins; JF performed the protein array experiments; SSB, CWW, JEVP, MAN, MA, JSJ and JDS performed the work with malaria parasites; PM, JL and TGT organized clinical work and processed clinical samples; MKK performed the surface plasmon resonance studies; LT performed the ELISA studies. The study was conceived and planned by LT, TL and TGT. The manuscript was written by TL, TGT, LT, JDS, and MH. All authors read and commented on the manuscript. LT and TL contributed equally to the work.Author Informaton: Reprints and permissions information is available at www.nature.com/reprints.The authors have no competing financial interests. To identify the DC8-PfEMP1 receptor, we produced a full-length DC8-containing PfEMP1 using the var gene IT4var20 from the FCR3/IT4 parasite. This 288 kDa His-tagged recombinant protein (rIT4VAR20) was screened against an array of 2505 full-length human plasma membrane proteins expressed on HEK293 cells (Table S1) S3) and all found to bind brain-derived endothelial cells via EPCR (Table S3). Previous work has shown that DC8-and DC13-variants selected on brain endothelial cells also bind to non-brain microvascular endothelial cells from heart and lung 4,5 . Binding of the FCR3 IT4VAR19b parasite line (described in 4 ) to brain, heart, lung and bone marrow endothelial cells was evaluated and found to be mediated by EPCR (Table S3). Altogether, these results demonstrate cytoadhesion of DC8 PfEMP1 expressing parasites via EPCR on endothelial cells of diverse tissu...

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Significance African trypanosomes are parasites that can cause African sleeping sickness in humans. Humans and some primates, but not other mammals, have a gene called APOL1 that protects against certain trypanosomes. Genetic variants in APOL1 that arose in Africa are strongly associated with kidney disease in African Americans. These kidney disease-associated variants may have risen to high frequency in Africa because they can defend humans against a particularly pathogenic trypanosome. In this paper, we show how APOL1 has evolved by analyzing the distribution of these variants in Africa and then elucidating the molecular mechanisms that enhance their trypanosome killing capacity. We also show that these antitrypanosomal APOL1 variants may have adverse consequences for the host.