Cytoadherence of Plasmodium falciparum-infected erythrocytes to melanoma cells was analysed using strains or isolates of parasites expressing or not expressing knobs (K+ or K− phenotype) on the erythrocyte surface. Both K+ and K− parasites had the capacity to cytoadhere to melanoma cells. Using a panel of melanoma cell lines with different surface expression of the cytoadherence receptors CD36, thrombospondin and ICAM-1 indicated that CD36 was the major receptor for parasites of both K+ and K− phenotypes. Binding competition experiments between K+ and K−-infected erythrocytes suggested that K+ cytoadherence is of higher affinity than that of K− parasites. However, some K− cytoadherence was also found in isolates containing mixed populations of K+ and K− parasites. The interaction of the two types of infected erythrocytes with melanoma cells also differed ultrastructurally, erythrocytes of K+ phenotype showing intimate interdigitations with microvilli on the melanoma cells, while erythrocytes of K− phenotype displayed more separated interactions with fewer sites of contact and involving only a few melanoma cell microvilli. One and the same infected erythrocyte may co-express the ligand for CD36-mediated cytoadherence and the structures mediating binding of uninfected erythrocytes to form rosettes.

Cytoadherence of Plasmodium falciparum-infected erythrocytes plays an important role in the pathogenesis of cerebral malaria. The identity of cell surface molecules on parasitized erythrocytes involved in cytoadherence is of great interest to understand the molecular basis of this mechanism. Peptide sequences derived from exofacial loops of the erythrocyte antigen band 3 from parasitized erythrocytes have previously been shown to inhibit cytoadherence. We now report that a non-repeated region of Pf155/RESA (residues 213–218) contains a hexapeptide motif being highly homologous to cytoadherence inhibitory sequences from band 3. Synthetic peptides containing the hexapeptide motif of Pf155/RESA inhibited the binding of P.falciparum-infected erythrocytes to melanoma cells in vitro. Furthermore, individuals residing in malaria-endemic areas have antibodies reactive with epitopes involving these motifs in band 3 and in Pf155/RESA.

Antibodies to a non-repeat region of the Plasmodium falciparum antigen Pf155/RESA were investigated for their capacity to inhibit parasite cytoadherence to melanoma cells and parasite growth in vitro. The activities of these antibodies were studied since the target region in Pf155/RESA includes a cytoadherence-related motif also found in loop 3 and 7 of human erythrocyte band 3 protein. Overlapping multiple antigen peptides (MAPs) together spanning residues 199–220 of Pf155/RESA were used to raise antibodies in rabbits. Analysis of the fine specificity of these antibodies revealed that antibodies raised against largely overlapping sequences displayed highly different specificity patterns. Similarly, striking differences were seen when analysing the biological effect of antibodies to these MAPs. Antibodies to the cytoadherence-related motif of Pf155/RESA, as well as antibodies raised against a MAP based on a corresponding band 3 motif, inhibited cytoadherence but not parasite growth. In contrast, antibodies to sequences adjacent to the Pf155/RESA cytoadherence motif inhibited parasite growth in vitro but had no effect on cytoadherence.

The chronic, recrudescent nature of malaria has been linked to antigenic diversity of the parasite in which protective immunity against Plasmodium falciparum may be obtained after repeated exposure to infection during a long time. In this study we show that parasite populations with decreased sensitivity to antibody-mediated growth inhibition are readily generated in vitro. A laboratory strain, F32, was cultured for long periods (10–12 weeks) in the presence of suboptimal inhibitory antibody concentrations. The antibodies used were the human monoclonal antibody 33G2 reacting with a linear epitope of the P. falciparum blood-stage antigen 332 and rabbit antibodies to repeat sequences of the blood-stage antigen Pf155/RESA. Our data indicate that the P. falciparum parasites adapt to antibody pressure as reflected by their specifically decreased sensitivity to growth inhibition. A relative resistance of the parasite to growth inhibition mediated by the antibodies used in the culture developed successively, while the parasite remained sensitive to growth inhibition by other antibodies. When the antibody pressure was removed a successive return of sensitivity to growth inhibition developed. Immunofluorescence did not reveal any significant difference in antigen expression between the parasite populations. However, PCR analysis showed that a new population appeared in the parasites grown in the presence of mAb 33G2, while no such change was detected in those grown in the presence of the rabbit antibodies. Our data suggest that the specific decrease in sensitivity to growth inhibition may either be due to down-regulation of antigen synthesis or expression by antibody pressure or, that antibody pressure selects for parasites with low expression of a specific antigen from a heterogeneous parasite population.