Rosetting in Plasmodium vivax: a cytoadhesion phenotype associated with anaemia

PLoS Negl Trop Dis. 2013 Apr 4;7(4):e2155. doi: 10.1371/journal.pntd.0002155. Print 2013.


Background: Plasmodium vivax can potentially lead to life-threatening episodes but the mechanisms underlying severe disease remain poorly defined. Cytoadhesion of infected erythrocytes may contribute to P. vivax sequestration and organ injury although its physiological impact is still unknown. Here, we aimed to describe clinically-relevant cytoadhesive phenotypes of P. vivax isolates.

Methodology/principal findings: Rosetting and adhesion to CSA, CD36, ICAM1, placental and brain cryosections were determined in P. vivax peripheral isolates from 12 pregnant women, 24 non-pregnant women and 23 men from Manaus (Brazil). P. falciparum co-infection was excluded by PCR and P. vivax isolates were genotyped by assessing the size polymorphism of microsatellites ms2, ms20 and msp1F3 through capillary electrophoresis of PCR products. P. vivax monoinfection was confirmed by PCR in 59 isolates, with 50 (85%) of them being single-clone infections. One P. vivax haplotype was more frequently found among pregnant women (33%) than in non-pregnant women (0%) and men (4%; p=0.010). Rosetting was observed in 64% of the isolates, adhesion to CSA in 15%, to ICAM1 in 12% and to placental cryosections in 9%, being similar among pregnant and non-pregnant groups. Intensity of rosetting was higher among anaemic individuals compared to non-anaemic (p=0.010) and decreased with increasing haematocrit (p=0.033) and haemoglobin levels (p=0.015).

Conclusions/significance: P. vivax peripheral isolates from pregnant women do not exhibit a prominent adhesion to CSA, although other parasite phenotypes still unknown may increase the propagation of certain P. vivax clones observed among pregnant hosts. Rosetting is a frequent cytoadhesive phenotype in P. vivax infections that may contribute to the development of anaemia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anemia / parasitology*
  • Brain / parasitology
  • Brazil
  • CD36 Antigens / metabolism
  • Cell Adhesion / physiology*
  • Chondroitin Sulfates / metabolism
  • Female
  • Genotype
  • Humans
  • In Vitro Techniques
  • Intercellular Adhesion Molecule-1 / metabolism
  • Male
  • Middle Aged
  • Placenta / parasitology
  • Plasmodium vivax / physiology*
  • Polymerase Chain Reaction
  • Pregnancy
  • Young Adult


  • CD36 Antigens
  • Intercellular Adhesion Molecule-1
  • Chondroitin Sulfates

Grant support

This work was supported by the European Union's Seventh Framework Programme (FP7-2007-HEALTH) under grant agreement n° 201588 and the Malaria in Pregnancy Consortium (MiPc). A. Mayor receives salary support from the Instituto de Salud Carlos III [grant number CP-04/00220]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.