Background
Malaria is a vector-borne disease caused by the genus
Plasmodium. It is responsible for an estimated 200 million clinical cases and approximately 580,000 deaths per year, mostly in sub-Saharan Africa [
1], particularly affecting pregnant women and children. Of the five malaria species that infect humans,
Plasmodium falciparum is the most virulent, responsible for 90 % of disease cases [
2].
Disease is associated with a 44–48 h cycle of asexual replication that takes place within the red blood cells (RBCs) of the human host, where
P. falciparum matures through the ring, trophozoite and schizont stages. Clinical symptoms range from uncomplicated fevers to life-threatening cerebral and placental malaria [
3]. During asexual cycling a portion of the parasite population commits to sexual differentiation (gametocytogenesis), thus ensuring parasite transfer to the transmission vector, an
Anopheles mosquito [
4].
Parasite sexual commitment occurs in the asexual generation preceding gametocytogenesis, where each individual schizont produces a progeny of merozoites that uniformly develop into either asexual parasites or sexual parasites of the same sex [
5‐
7]. It is currently debated whether in natural infections a constant fraction of parasites converts to sexual development during each asexual cycle or whether commitment is an environment-sensitive, triggered event [
8].
After invasion, a sexually committed parasite develops intra-erythrocytically over a period of ten to 12 days, progressing through five distinct stages of gametocyte development [
9,
10]. In the earliest stage of sexual development, the intra-erythrocytic parasite is morphologically indistinguishable from an asexual ring-stage parasite, and no specific markers are currently available to identify this ‘sexual ring’ stage. At 24–30 h post invasion (pi), about the time an asexual parasite enters the trophozoite stage, the early gametocyte (stage Ia) starts to produce the early stage-specific proteins Pfs16 and Pfg27 [
11‐
15]. At about 48 h pi, ultrastructural features of the sexual parasite first become apparent (stage Ib to stage II), such as the assembly of a bilamellar membrane structure subtended by a network of subpellicular microtubules [
16,
17].
In natural infections, stages Ib to IV gametocytes are sequestered in deep tissues, such as the bone marrow [
18,
19]. The only morphologically recognizable gametocyte stage that is visible in the peripheral circulation is stage V. Following ingestion by a mosquito, these mature gametocytes are responsive to the triggers that initiate gamete formation, the first step in transmission to the insect vector [
4,
20]. In contrast, the lack of specific markers for sexually committed parasites at the ring stage makes it impossible to answer the fundamental question of whether the earliest gametocyte stages (i.e., before 24 h pi) are formed, and remain, within the deep tissues or are freely circulating [
18,
21]. In addition, the lack of a sexual ring-stage diagnostic reagent makes it difficult to address key epidemiological questions relating to the dynamics of parasite transmission. For example, the identification of the human malaria reservoirs, such as long-term carriage of infective sub-microscopic gametocytes in asymptomatic individuals, would be facilitated by a ring stage marker [
21]. Similarly, early detection of gametocytes would be important to evaluate the effects of different treatment regimens of symptomatic individuals on gametocyte carriage [
22,
23]. Both of these questions have important implications for malaria control.
The ability of parasite lines and clones to generate gametocytes can be lost during culture in vitro. In
P. falciparum, the gametocyteless clone F12 was derived from a gametocyte-producing parental 3D7 clone in a controlled 18-month asexual propagation experiment [
24]. F12 parasites are unable to produce morphologically recognizable gametocytes, nor to express the stage I marker Pfg27 [
24]. Exon sequencing of the genomes of F12 and of independently obtained gametocyteless parasites, such as GNP-A4, was used to identify the genetic defect [
25]. Distinct null mutations in the coding sequence of a putative transcription factor of the
P. falciparum Apetala2 family member, PfAP2-G, were shown to be associated with defective gametocyte production [
25]. Gene disruption and down-regulation of the PfAP2-G expression functionally confirmed the role of this protein. PfAP2-G appears to be responsible for switching on the expression of a small set of early gametocyte proteins, which leads to the appearance of morphologically recognizable gametocytes [
25].
The loss of gametocyte production has also been observed in parasite lines with different genetic backgrounds. For example the C10 parasite line, which is derived from isolate 1776 [
26] produces no morphologically distinguishable gametocytes [
24]. In this and in other lines of different geographical origin, the loss or dramatic reduction of gametocyte production is associated with subtelomeric deletions of 100–150 kb near the right end of chromosome 9 [
24,
27], strongly suggesting that this region encodes another major genetic determinant of gametocytogenesis.
A genome-wide expression analysis identified a suite of genes that are activated early in gametocyte development [
28] and a proteomics analysis revealed that a group of putatively exported proteins are over-represented in these stages [
29]. These proteins were designated as
P. falciparum Gametocyte EXported Proteins (PfGEXP) and the export of some of these proteins has been demonstrated, including Pfg744 [
30], PfGECO [
31] and PfGEXP10 [
29].
Plasmodium falciparum Gametocyte EXported Protein-5 (PfGEXP5) is a member of this family. This work shows that PfGEXP5 is exported into the host cell cytoplasm from as early as 14 h after invasion of a sexually committed merozoite, making it the earliest gametocyte-specific marker so far described. It also shows that PfGEXP5 is expressed and exported upon exposure of the F12 and GNP-A4 parasite clones to gametocyte-inducing conditions, indicating that this early gametocyte protein functions independently of the developmental switch governed by the PfAP2-G transcription factor.
Authors’ contributions
MT purified the PfGEXP5 recombinant protein for mouse immunization and characterized the antibody, performed the time course and immunofluorescence analyses in 3D7, F12 and GNP-A4 P. falciparum lines; MWAD produced the PfGEXP5-GFP transgenic parasites, performed immunofluorescence and Western blot experiments; OL performed immunofluorescence experiments; SYY produced the PfGEXP5-GST expression plasmid and bacterial extracts; LT conceived and analysed experiments and contributed to the manuscript; PA conceived and analysed experiments and contributed to the manuscript. All authors read and approved the final manuscript.