Abstract
While significant advances have been made in understanding Plasmodium falciparum gametocyte biology and its relationship with malaria parasite transmission, the gametocyte sex ratio contribution to this process still remains a relevant research question. The present review discusses the biology of sex determination in P. falciparum, the underlying host and parasite factors, the sex specific susceptibility to drugs, the effect of sex ratio dynamics on malaria parasite transmission and the development of gametocyte sex specific diagnosis tools. Despite the inherent differences across several studies and approaches, the emerging picture highlights a potentially relevant contribution of the P. falciparum gametocyte sex ratio in the modulation of malaria parasite transmission. The increasing availability of molecular methods to measure gametocyte sex ratio will enable evaluation of important parameters, such as the impact of drug treatment on gametocyte sex ratio in vitro and in vivo as well as the changes of gametocyte sex ratios in natural infections, key steps towards elucidating how these parameters affect parasite infectiousness to the mosquito vectors.
Highlights
Despite the recent public health effort, malaria remains one of the leading causes of death worldwide [1]
In the global effort aiming at disease elimination and marked by the use of effective anti-malarial drugs and insecticide-treated nets (ITNs), the Plasmodium gametocytes deserve a special attention, being the parasite blood stages responsible for human to mosquito parasite transmission [2]
In addition to host factors involved in erythropoiesis and anaemia, the immune response developed against asexual parasites and gametocytes has been proposed to affect sex ratio as the proportion of male gametocytes was reported to increase in prolonged malaria infections [75]
Summary
Despite the recent public health effort, malaria remains one of the leading causes of death worldwide [1]. *Correspondence: soulamacnrfp@gmail.com; pietro.alano@iss.it 1 Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso 2 Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy Full list of author information is available at the end of the article
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