Knob proteins in falciparum malaria.

Knob proteins play a significant role in the pathophysiology of cerebral malaria caused by Plasmodium falciparum. Most of these proteins are of parasite origin and can be divided into two major classes: (i) the cytoadherent proteins present at the surface of the knobs; and (ii) the submembranous structural proteins which are placed towards the cytoplasmic side in the knobs. Several surface proteins [viz., P. falciparum-infected erythrocyte membrane protein-1 (PFEMP-1), sequestrin, pfalhesin] and submembranous structural proteins [viz., knob-associated histidine-rich protein (KAHRP), PFEMP-2, PFEMP-3] of the knobs have been identified and characterized to a certain extent. The structural proteins interact with several host (e.g., spectrin, actin, band 4.1 etc.) as well as parasite (e.g., PFEMP-1) molecules to produce functional knobs. The surface proteins on the other hand interact with several adhesion molecules of the endothelial cell through receptor-ligand type of binding. Knob proteins are important from the point of view of malaria control since immunotherapeutic agents can be developed to block as well as reverse the cytoadherence phenomenon. The surface proteins are also good vaccine candidates except that they show a high rate of antigenic variation. Nevertheless, the use of ribozyme or antisense oligonucleotides to inhibit the expression of knob proteins (e.g., KAHRP alone or with surface protein) can be used as a molecular therapeutic agent.

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