CYTOADHESION AND FALCIPARUM-MALARIA - GOING WITH THE FLOW

Sequestration of parasitized red blood cells in the cerebral vasculatu re is the predisposing event to the development of cerebral malaria du ring infection with Plasmodium falciparum. The adhesive interaction be tween these cells and receptors on the endothelial cell (cytoadhesion) occurs in the dynamic environment of the microcirculation, but most s tudies have neglected this factor and have concentrated on measuring a dhesion in static (no flow) assays. Such studies ignore the markedly d ifferent rheological properties of parasitized red blood cells that be come apparent when adhesion is examined under dynamic, flow conditions that resemble those of the circulation in vivo. Here, Brian Cooke and Ross Coppel review a number of novel aspects of cytoadhesion that hav e been identified using flow-based assays, and discuss their relevance to the pathophysiology, investigation and clinical management of falc iparum malaria.