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Blood, 1 November 2007, Vol. 110, No. 9, pp. 3426-3435. Prepublished online as a Blood First Edition Paper on August 10, 2007; DOI 10.1182/blood-2007-04-084582.
Submitted April 12, 2007
Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada * Corresponding author; email: mho{at}ucalgary.ca.
Pulmonary complication in severe P. falciparum malaria is manifested as a prolonged impairment of gas transfer or the more severe acute respiratory distress syndrome (ARDS). In either clinical presentation, vascular permeability is a major component of the pathological process. In this report, we examined the effect of clinical P. falciparum isolates on barrier function of primary dermal and lung microvascular endothelium in vitro. We showed that parasite sonicates but not intact infected erythrocytes disrupted endothelial barrier function in a Src-family kinase-dependent manner. The abnormalities were manifested both as discontinuous immunofluorescence staining of the junctional proteins ZO-1, claudin 5 and VE-cadherin, and the formation of interendothelial gaps in monolayers. These changes were associated with a loss in total protein content of claudin 5, and re-distribution of ZO-1 from the cytoskeleton to the membrane, cytosolic and nuclear fractions. There was minimal evidence of a pro-inflammatory response or direct cellular cytotoxicity or cell death. The active component in sonicates appeared to be a merozoite-associated protein. Increased permeability was also induced by P. falciparum GPIs and food vacuoles. These results demonstrate that parasite components can alter endothelial barrier function, and thus contribute to the pathogenesis of severe falciparum malaria.
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