Cytoadherence characteristics of Plasmodium falciparum-infected erythrocytes from Malawian children with severe and uncomplicated malaria

Cytoadherence of Plasmodium falciparum-infected erythrocytes to the microva scular endothelium is believed to be a key factor in the development of cer ebral malaria. Erythrocyte rosette formation has been correlated with malar ia severity in studies from east and west Africa. We cultured fresh isolate s from Malawian children with severe (n = 76) or uncomplicated (n = 79) mal aria to pigmented trophozoite stage and examined rosette formation and adhe rence to CD36, intercellular adhesion molecule-1 (ICAM-1), chondroitin sulf ate A (CSA), and thrombomodulin (TM). Most (126 of 148) isolates bound to C D36, and 76 of 136 bound to ICAM-1. Fewer bound to CSA (40 of 148) or TM (2 3 of 148). After controlling for parasitemia, there was an inverse associat ion between binding to CD36 (P = 0.004) or ICAM-1 (P = 0.001) and disease s everity. Parasites from children with severe malaria anemia bound least to CD36, whereas ICAM-1 binding was lowest in children with cerebral malaria. There was no difference in rosette formation between any of the groups. In Malawian children, there was no evidence of a positive association between adherence to any of the receptors examined and disease severity. The negati ve association found raises the possibility that adherence to certain recep tors could instead be an indicator of a less pathogenic infection.