Interplay of extracellular vesicles and other players in cerebral malaria pathogenesis

Abstract

Background: Malaria is a serious parasitic infection affecting millions of people worldwide each year. Cerebral malaria is the most severe complication of Plasmodium infections, predominantly affecting children. Extracellular vesicles are essential mediators of intercellular communication and include apoptotic bodies, microvesicles and exosomes. Microvesicle numbers increase during disease pathogenesis and inhibition of their release can prevent brain pathology and mortality.

Scope of review: We explore the current knowledge on microvesicles and exosomes in cerebral malaria pathogenesis.

Major conclusions: Microvesicles and exosomes are implicated in cerebral malaria pathogenesis, in the modulation of host immunity to Plasmodium, and in cell-cell communication. Blocking their production is protective in models of cerebral malaria, both in vivo and in vitro.

General significance: While anti-malarial treatments exist to combat Plasmodium infections, increasing drug resistance presents a major challenge. In order to improve diagnosis and treatment outcomes, further research is required to better appreciate extracellular vesicle involvement in cerebral malaria.

Keywords: Cerebral malaria; Exosomes; Extracellular vesicles; Immunopathology; Inflammation; Microvesicles; Pathogenesis.