Abstract
The structural integrity of the host red blood cell (RBC) is crucial for propagation of Plasmodium spp. during the disease-causing blood stage of malaria infection. To assess the stability of Plasmodium vivax-infected reticulocytes, we developed a flow cytometry-based assay to measure osmotic stability within characteristically heterogeneous reticulocyte and P. vivax-infected samples. We find that erythroid osmotic stability decreases during erythropoiesis and reticulocyte maturation. Of enucleated RBCs, young reticulocytes which are preferentially infected by P. vivax, are the most osmotically stable. P. vivax infection however decreases reticulocyte stability to levels close to those of RBC disorders that cause hemolytic anemia, and to a significantly greater degree than P. falciparum destabilizes normocytes. Finally, we find that P. vivax new permeability pathways contribute to the decreased osmotic stability of infected-reticulocytes. These results reveal a vulnerability of P. vivax-infected reticulocytes that could be manipulated to allow in vitro culture and develop novel therapeutics.
Highlights
The structural integrity of the host red blood cell (RBC) is crucial for propagation of Plasmodium spp. during the disease-causing blood stage of malaria infection
To confirm that the low-forward scatter (FSC)/low-side scatter (SSC) population were RBC ghosts, fluorescent phalloidin, which is excluded from intact cells but binds actin in the cytoskeleton of permeabilized cells was included in the osmotic stability assay
We found that phalloidin stained the FSC-low population that appears in lytic conditions, indicating that the flow lysis assay is sensitive to RBC ghosts (Fig. 1c and d)
Summary
The structural integrity of the host red blood cell (RBC) is crucial for propagation of Plasmodium spp. during the disease-causing blood stage of malaria infection. An example of the relationship between RBC structural integrity and osmotic stability is seen with naturally occurring polymorphisms in molecules such as PIEZO1 and Ankyrin-1, that disrupt cell volume regulation and cytoskeleton, respectively, and are associated with the clinically relevant RBC phenotypes of hereditary xerocytosis (HX)[2] and hereditary spherocytosis (HS)[3] These mutations manifest in structurally compromised RBCs with abnormal shapes (stomatocytes and spherocytes), premature hemolysis in vivo[4] and exhibit abnormal sensitivity to hypotonic challenge, which is decreased in HX and increased in HS. In the case of the most well studied of these parasites, P. falciparum, changes include disruption of the cytoskeleton by parasite proteins inserted into the RBC membrane[5] and increased plasma membrane permeability[6,7] that culminate in the infected RBC taking on a spherical shape[8] These changes compromise the structural integrity of the host RBC, and decrease the osmotic stability of P. falciparum-infected RBCs6,7,9. All P. falciparum osmotic stability studies have been done in the older, more abundant normocyte fraction
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