F‐erythrocytes promote Plasmodium falciparum proliferation in sickle cell disease

Author:

Archer Natasha M.12ORCID,Gnangnon Bénédicte23,Mikdar Mahmoud2,Ciuculescu Marioara F.4,Petersen Nicole12,Staffa Steven J.5,Duraisingh Manoj T.2ORCID

Affiliation:

1. Pediatric Hematology/Oncology Dana‐Farber/Boston Children's Cancer and Blood Disorders Center Harvard Medical School Boston Massachusetts USA

2. Department of Immunology and Infectious Diseases Harvard T.H. Chan School of Public Health Boston Massachusetts USA

3. Center for Communicable Diseases Dynamics, Department of Epidemiology Harvard T.H. Chan School of Public Health Boston Massachusetts USA

4. The TransLab, Boston Children's Hospital Harvard Medical School Boston Massachusetts USA

5. Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Boston Massachusetts USA

Abstract

AbstractBackgroundSickle cell disease (SCD) remains prevalent because heterozygous carriers (HbAS) are partially resistant to Plasmodium falciparum malaria. Sickle hemoglobin (HbS) polymerization in low and intermediate oxygen (O2) conditions is the main driver of HbAS‐driven resistance to P. falciparum malaria. However, epidemiological studies have reported mixed malaria morbidity and mortality outcomes in individuals with sickle cell disease (SCD). While maximum‐tolerated dose hydroxyurea has been shown to lower malaria incidence, fetal hemoglobin (HbF), an inhibitor of HbS polymerization that is variably packaged in F‐erythrocytes, might provide hemoglobin that is accessible to the parasite for feeding.MethodsTo explore that risk, we examined the effect of variable mean corpuscular fetal hemoglobin (MCHF) on P. falciparum proliferation, invasion, and development in HbSS RBCs.ResultsWe found that greater MCHF in HbSS red blood cells (RBCs) is associated with increased P. falciparum proliferation in O2 environments comparable with the microcirculation. Moreover, both parasite invasion and intracellular growth, the major components of proliferation, occur predominantly in F‐erythrocytes and are augmented with increasing MCHF.ConclusionsHbF modifies P. falciparum infection in HbSS RBCs, further highlighting the complexity of the molecular interactions between these two diseases. Other inhibitors of HbS polymerization that do not increase HbF or F‐erythrocytes should be independently assessed for their effects on P. falciparum malaria proliferation in HbSS RBCs.

Funder

National Institute of Allergy and Infectious Diseases

National Institute of Diabetes and Digestive and Kidney Diseases

Publisher

Wiley

Subject

Hematology

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