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Infection with Plasmodium can elicit antibodies that inhibit parasite survival in the mosquito, when they are ingested in an infectious blood meal. Here, we determine the transmission-reducing activity (TRA) of naturally acquired antibodies from 648 malaria-exposed individuals using lab-based mosquito-feeding assays. Transmission inhibition is significantly associated with antibody responses to Pfs48/45, Pfs230, and to 43 novel gametocyte proteins assessed by protein microarray. In field-based mosquito-feeding assays the likelihood and rate of mosquito infection are significantly lower for individuals reactive to Pfs48/45, Pfs230 or to combinations of the novel TRA-associated proteins. We also show that naturally acquired purified antibodies against key transmission-blocking epitopes of Pfs48/45 and Pfs230 are mechanistically involved in TRA, whereas sera depleted of these antibodies retain high-level, complement-independent TRA. Our analysis demonstrates that host antibody responses to gametocyte proteins are associated with reduced malaria transmission efficiency from humans to mosquitoes.

Natural hemozoin (nHZ), prepared after schizogony, consists of crystalline ferriprotoporphyrin-IX dimers from undigested heme bound to host and parasite proteins and lipids. Phagocytosed nHZ alters important functions of host phagocytes. Most alterations are long-term effects. We show that host fibrinogen (FG) was constantly present (at ~ 1 FG per 25 000 HZ-heme molecules) and stably bound to nHZ from plasma-cultured parasites. FG was responsible for the rapid 100-fold stimulation of reactive oxygen species production and 50-fold increase of TNF and monocyte chemotactic protein 1 by human monocytes. Those effects, starting within minutes after nHZ cell contact, were because of interaction of FG with FG-receptors TLR4 and integrin CD11b/CD18. Receptor blockage by specific mAbs or removal of FG from nHZ abrogated the effects. nHZ-opsonizing IgGs contribute to the stimulatory response but are not essential for FG effects. Immediate increase in reactive oxygen species and TNF may switch on previously described long-term effects of nHZ, largely because of HZ-generated lipo-peroxidation products 15(S,R)-hydroxy-6,8,11,13-eicosatetraenoic acid and 4-hydroxynonenal. The FG/HZ effects mediated by TLR4/integrins represent a novel paradigm of nHZ activity and allow expansion of nHZ effects to nonphagocytic cells, such as endothelia and airway epithelia, and lead to a better understanding of organ pathology in malaria.

In Plasmodium falciparum-parasitized erythrocytes, hemozoin (HZ) formation was accompanied by enhanced formation of 4-hydroxynonenal (HNE)-protein adducts on the cell surface, reaching in the HZ-rich schizont forms the 16.8-fold amount of control non-parasitized cells. The addition of 1-100 microM exogenous HNE to control non-parasitized cells generated HNE-adducts on surface proteins in amounts similar to those found in schizonts. Parasitized as well as HNE-treated non-parasitized erythrocytes showed decreased cell deformability (measured as decreased filterability through cylindrical-pore filters) related to the amount of HNE adducts. In vivo, the HZ-containing trophozoites and schizonts are phagocytic targets for monocytes/macrophages. The reduced deformability of circulating erythrocytes carrying HNE-adducts may increase their phagocytic elimination. Uncontrolled HNE production by parasitized erythrocytes may additionally modify non-parasitized bystander erythrocytes, induce their phagocytosis, and contribute to malarial anemia, which is predominantly due to the removal of large numbers of indirectly damaged non-parasitized erythrocytes.