Renal control of disease tolerance to malaria

Proc Natl Acad Sci U S A. 2019 Mar 19;116(12):5681-5686. doi: 10.1073/pnas.1822024116. Epub 2019 Mar 4.


Malaria, the disease caused by Plasmodium spp. infection, remains a major global cause of morbidity and mortality. Host protection from malaria relies on immune-driven resistance mechanisms that kill Plasmodium However, these mechanisms are not sufficient per se to avoid the development of severe forms of disease. This is accomplished instead via the establishment of disease tolerance to malaria, a defense strategy that does not target Plasmodium directly. Here we demonstrate that the establishment of disease tolerance to malaria relies on a tissue damage-control mechanism that operates specifically in renal proximal tubule epithelial cells (RPTEC). This protective response relies on the induction of heme oxygenase-1 (HMOX1; HO-1) and ferritin H chain (FTH) via a mechanism that involves the transcription-factor nuclear-factor E2-related factor-2 (NRF2). As it accumulates in plasma and urine during the blood stage of Plasmodium infection, labile heme is detoxified in RPTEC by HO-1 and FTH, preventing the development of acute kidney injury, a clinical hallmark of severe malaria.

Keywords: disease tolerance; heme; infection; kidney; malaria.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Apoferritins / metabolism
  • Cell Line
  • Disease Progression
  • Epithelial Cells / metabolism
  • Ferritins / metabolism
  • Ferritins / physiology
  • Heme / metabolism*
  • Heme Oxygenase-1 / metabolism
  • Heme Oxygenase-1 / physiology
  • Humans
  • Immune Tolerance / physiology
  • Kidney / metabolism*
  • Malaria / physiopathology*
  • Mice
  • Mice, Inbred C57BL
  • NF-E2-Related Factor 2 / metabolism
  • NF-E2-Related Factor 2 / physiology
  • Oxidoreductases
  • Plasmodium berghei / metabolism
  • Plasmodium berghei / parasitology
  • Up-Regulation


  • NF-E2-Related Factor 2
  • Heme
  • Ferritins
  • Apoferritins
  • FTH1 protein, human
  • Oxidoreductases
  • HMOX1 protein, human
  • Heme Oxygenase-1