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Journal of Parasitic Diseases: December 2006, Vol. 30, No. 2, 116–124ReviewJ P DMalaria and macrophages: cellular and molecular basisof pathogenesis and immune protectionPrati Pal SinghNational Institute of Pharmaceutical Education and Research, S. A. S. Nagar.ABSTRACT. <strong>The</strong> roles of macrophages (MØs) in the pathogenesis and resolution of malariainfection is well known. However, the mechanisms of plasmodium-infected erythrocytes (IE)interaction with MØs leading to their internalization, factors that interfere with MØ-IEinteraction, the details of the factors and the mechanism(s) which activate MØs <strong>for</strong> augmentedphagocytosis of IE, the fate of IE ingested by MØs, and the nature and functions of variouscytokines generated by IE-ingested MØs, remain poorly understood. <strong>The</strong> Fc-receptors, and not thecomplement receptors, appear to mediate the attachment and internalization of IE by MØs.Immune-complexes (ICs) <strong>for</strong>med during acute malaria may inhibit the phagocytosis of IE early inthe infection, but, over time, may induce changes in MØs which result in the enhanced phagocytosisof IE. In cultures of splenocytes from animals immune to malaria, IE-containing MØs presentantigens to sensitized T-cells, which, in turn, elaborate lymphokines (LKs); these LKs are thoughtto activate MØs <strong>for</strong> enhanced phagocytosis of IE. Neutralizing concentrations of monoclonalantibodies against mouse interferon-gamma (IFN-γ) and interleukin-4 (IL-4) blocked the MØactivating activity of these LKs, which indicate that IFN-γ and IL-4, plausibly present in these LKpreparations, were responsible <strong>for</strong> the observed MØ activation. Both plasmodial components andintact IE can activate MØs and monocytes to produce colony-stimulating factors (CSFs), de novo, ina lipopolysaccharide-independent manner. Chloroquine, a lysosomotropic drug, inhibited theplasmodial antigen-induced production of CSFs by MØs. Purified human C-reactive protein(CRP) stimulated rhesus monkey (Macaca mulatta) blood monocyte-derived MØs <strong>for</strong> enhancedphagocytosis of Plasmodium fragile-IE, in vitro. <strong>The</strong>se observations suggest that MØ-IE interactionand subsequent erythrophagocytosis constitute important steps in the pathogenesis and protectiveimmunity to malaria, and detailed molecular studies are warranted to understand the role(s) ofMØs in both parasite clearance and disease-causing mechanisms in malaria, which may be useful<strong>for</strong> the development of anti-disease and/or anti-parasite vaccine(s) against malaria.Keywords: C-reactive protein, cytokines, infected-erythrocytes, macrophages, malaria,phagocytosisINTRODUCTIONAt the end of 2004, 3.2 billion people in 107 countriesand territories lived in malaria transmission risk areas,and each year an estimated 300–500 million clinicalCorrespondence: Prof. Prati Pal Singh, National Institute ofPharmaceutical Education and Research, Sector-67, S. A. S.Nagar-160 062, India. E-mail: drppsingh2002@yahoo.commalaria cases and > 1 million falciparum malariadeaths occur (WHO, 2005). <strong>The</strong> four species of theprotozoan parasite that cause human malarias are:Plasmodium falciparum, P. vivax, P. malariae and P.ovale. Whereas, P. falciparum causes the most severe<strong>for</strong>m of malaria, P. vivax, characterized by relapses, isnot fatal; together they cause 95% of world malaria.<strong>The</strong> parasite and vector resistance to anti-malarial