Rosetting of Plasmodium falciparum-infected red blood cells (parasitized RBC [pRBC]) with uninfected RBC has been associated in many studies with malaria morbidity and is one form of cytoadherence observed with malarial parasites. Rosetting is serum dependent for many isolates of P. falciparum, including the strains FCR3S1.2 and Malayan Camp studied here. We identified the three naturally occurring components of sera which confer rosetting. Complement factor D alone induced 30 to 40% of de novo rosetting. Its effect was additive to that of 0.5 mg/ml albumin and to that of 15 ng/ml of naturally occurring antibodies to the anion transport protein, band 3. The three components together mediated rosetting as effectively as 10% serum. De novo rosetting experiments showed that naturally occurring anti-band 3 antibodies as well as factor D were effective only when added to pRBC. Factor D appeared to cleave a small fraction of a protein expressed on the surface of pRBC.Cerebral malaria occurs from infections with Plasmodium falciparum, the parasite species that shows sequestration in the periphery. Sequestration is a means by which parasitized red blood cells (pRBC) escape from their clearance from the reticuloendothelial system. It is mediated by cytoadherence and rosetting of pRBC with uninfected RBC. Clinical studies and autopsies have indeed revealed rosettes in blood vessels from malaria victims (19,20,40,43), and parasites isolated from patients with severe disease formed more and larger rosettes than those from uncomplicated cases (4, 47). For many parasite isolates, in vitro rosetting is dependent on serum factors that are also present in nonimmune, healthy persons. Thus, it is more than a coincidence that the mortality from cerebral malaria is highest in very young children, who have not developed immunity against the parasite but have partially established their innate immune systems. The serum factors that have been shown to mediate rosetting are immunoglobulins (15,43,45), albumin (48), and a third so far unidentified small component which does not bind to concanavalin A (45). We embarked on a study of these serum factors in more detail because neither the specificities of the involved innate immunoglobulins (naturally occurring antibodies [NAbs]) nor the role of complement has been investigated. . When the parasitemia reached 5 to 10%, the culture was diluted to achieve 0.2 to 0.5% parasitemia and culture was continued. Twice a month, cultured parasites were enriched for the rosetting phenotype (49).
MATERIALS AND METHODSRosette disruption. A rosetting parasite culture containing P. falciparum late stages at a parasitemia of 5 to 10% was centrifuged for 5 min at 500 ϫ g. Cells were washed twice with phosphate-buffered saline (PBS)-glucose (pH 7.4) and resuspended to a 20% hematocrit in PBS-glucose containing 5 mM sodium citrate, and rosettes were disrupted by passing the resuspended cells 20 times through a 23-gauge 0.6-mm-diameter needle. Cells were then washed once with PBS-glucose containing 5 mM sodium ...