A central role for free heme in the pathogenesis of severe malaria: the missing link?

J Mol Med (Berl). 2008 Oct;86(10):1097-111. doi: 10.1007/s00109-008-0368-5. Epub 2008 Jul 19.

Abstract

Malaria, the disease caused by Plasmodium infection, is endemic to poverty in so-called underdeveloped countries. Plasmodium falciparum, the main infectious Plasmodium species in sub-Saharan countries, can trigger the development of severe malaria, including cerebral malaria, a neurological syndrome that claims the lives of more than one million children (<5 years old) per year. Attempts to eradicate Plasmodium infection, and in particular its lethal outcomes, have so far been unsuccessful. Using well-established rodent models of malaria infection, we found that survival of a Plasmodium-infected host is strictly dependent on the host's ability to up-regulate the expression of heme oxygenase-1 (HO-1 encoded by the gene Hmox1). HO-1 is a stress-responsive enzyme that catabolizes free heme into biliverdin, via a reaction that releases Fe and generates the gas carbon monoxide (CO). Generation of CO through heme catabolism by HO-1 prevents the onset of cerebral malaria. The protective effect of CO is mediated via its binding to cell-free hemoglobin (Hb) released from infected red blood cells during the blood stage of Plasmodium infection. Binding of CO to cell-free Hb prevents heme release and thus generation of free heme, which we found to play a central role in the pathogenesis of cerebral malaria. We will address hereby how defense mechanisms that prevent the deleterious effects of free heme, including the expression of HO-1, impact on the pathologic outcome of Plasmodium infection and how these may be used therapeutically to suppress its lethal outcomes.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Carbon Monoxide / metabolism
  • Disease Models, Animal
  • Heme / metabolism
  • Heme / physiology*
  • Heme Oxygenase-1 / metabolism
  • Hemoglobins / metabolism
  • Humans
  • Malaria / enzymology
  • Malaria / metabolism
  • Malaria / physiopathology*
  • Malaria, Cerebral / enzymology
  • Malaria, Cerebral / metabolism
  • Malaria, Cerebral / physiopathology
  • Models, Biological

Substances

  • Hemoglobins
  • Heme
  • Carbon Monoxide
  • Heme Oxygenase-1