We explored the role of CD40-CD40L (CD154) in the severe malaria elicited by Plasmodium berghei anka infection in mice. Mortality was >90% by day 8 after infection in ؉/؉ mice, but markedly decreased in CD40؊/؊ or in CD40L؊/؊ mice, as well as in ؉/؉ mice treated with anti-CD40L monoclonal antibody. Parasitemia was similar in the different conditions. Breakdown of the blood-brain barrier was evident in infected ؉/؉, but not in CD40؊/؊ mice. Thrombocytopenia was less severe in CD40؊/؊ mice than in the ؉/؉ controls. Sequestration of macrophages in brain venules and alveolar capillaries was reduced in CD40؊/؊ or in CD40L؊/؊ mice, whereas sequestration of parasitized red blood cells or polymorphonuclear leukocytes in alveolar capillaries was CD40-CD40L-independent. CD40 mRNA was increased in the brain and lung of infected mice whereas CD40L was increased in the lung. Tumor necrosis factor plasma levels were similarly increased in infected ؉/؉ or CD40؊/؊ mice. Expression of CD54 and its mRNA levels in the brain were moderately decreased in CD40-deficient mice. Thus the mortality associated with severe malaria requires CD40-CD40L interaction that contributes to the breakdown of the blood-brain barrier, macrophage sequestration, and platelet consumption.