Edinburgh Infectious Diseases
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High surface tension in red blood cells can prevent invasion by malaria parasite

The secret of how the Dantu genetic blood variant helps to protect against malaria has been revealed for the first time by scientists at the University of Edinburgh, in collaboration with colleagues at the Wellcome Sanger Institute, the University of Cambridge and the KEMRI-Wellcome Trust Research Programme, Kenya.

A mosquito after taking a blood meal
A mosquito taking a blood meal - new work shows that the physical structure of red blood cells affects their ability to block infection by malaria parasites.

The team found that red blood cells in people with the rare Dantu blood variant have a higher surface tension that prevents them from being invaded by the world’s deadliest malaria parasite, Plasmodium falciparum.

The findings, recently published in Nature, could also be significant in the wider battle against malaria. Because the surface tension of human red blood cells increases as they age, it may be possible to design drugs that imitate this natural process to prevent malaria infection or reduce its severity.

Read the paper in Nature

Analysis of the characteristics of the red blood cell samples indicated that the Dantu variant created cells with a higher surface tension – like a drum with a tighter skin. At a certain tension, malaria parasites were no longer able to enter the cell, halting their lifecycle and preventing their ability to multiply in the blood.

Dantu blood variant can protect against malaria

Alex Rowe
Alex Rowe, School of Biological Sciences, contributed to the new study.

Malaria remains a major global health problem causing an estimated 435,000 deaths per year, with 61 per cent occurring in children under five years of age. P. falciparum is responsible for the deadliest form of malaria and is particularly prevalent in Africa, accounting for 99.7 per cent of African malaria cases and 93 per cent of global malaria deaths in 2017.

In 2017, researchers discovered that the rare Dantu blood variant, which is found regularly only in parts of East Africa, provides some degree of protection against severe malaria.  The intention behind this new study was to explain why.

Natural resistance to malaria linked to human red blood cell receptors

Red blood cell samples were collected from 42 healthy children in Kilifi, Kenya, who had either one, two or zero copies of the Dantu gene. The researchers then observed the ability of parasites to invade the cells in the laboratory, using multiple tools including time-lapse video microscopy to identify the specific step at which invasion was impaired.

The Dantu blood group has a novel ‘chimeric’ protein that is expressed on the surface of red blood cells, and alters the balance of other surface proteins.

In Kilifi, a town on the Kenyan coast, 10 per cent of the population have one copy of the Dantu gene, which confers up to 40 per cent protection against malaria. One per cent of the population have two copies, conferring up to 70 per cent protection. By contrast, the best malaria vaccines currently provide 35 per cent protection.

Malaria parasites utilise a specific ‘lock-and-key’ mechanism to infiltrate human red blood cells. The Dantu variant actually slightly increases the tension of the red blood cell surface. It’s like the parasite still has the key to the lock, but the door is too heavy for it to open.

Dr Silvia KariukiKEMRI-Wellcome Trust Research Programme, Kenya

This study shows that investigating how a naturally-occurring human red blood cell polymorphism protects against severe malaria can reveal unexpected insights into the biology of malaria parasites.

Prof Alex RoweSchool of Biological Sciences, University of Edinburgh

Because humans have evolved alongside malaria for tens of thousands of years, some people in the worst affected areas have developed genetic resistance to the disease. The most famous example is sickle cell trait, which confers 80 per cent resistance to malaria, but can cause serious illness in those with two copies of the gene. There is currently no evidence that the Dantu variant is accompanied by other health complications.

Malaria is still an incredibly destructive disease, but evolutionary adaptations like sickle cell trait and the Dantu variant may partially explain why the mortality rate is much lower than the rate of infection. We’ve been fighting malaria parasites for as long as we’ve been human, so there may be other adaptations and mechanisms yet to be discovered.

Dr Alejandro Marin-MenendezWellcome Sanger Institute

Finding offers potential for new therapies

Researchers suggest one of the most significant implications of the study stems from the fact that the surface tension of human red blood cells varies naturally, generally increasing during their approximately 90-day lifespan. This means a proportion of all of our red blood cells are naturally resistant to infection by malaria parasites, and it may be possible to develop drugs that take advantage of this process.

The explanation for how Dantu protects against malaria is potentially very important. The red cell membrane only needs to be slightly more tense than usual to block malaria parasites from entering. Developing a drug that emulates this increased tension could be a simple but effective way to prevent or treat malaria.

Dr Viola IntroiniUniversity of Cambridge

Related links

Rowe lab, University of Edinburgh

Rayner lab, University of Cambridge

Wellcome Sanger Institute

KEMRI-Wellcome Trust Research Programme