The red blob in this picture is a human red blood cell, and the green blob in the middle of it is a pack of the malaria-causing parasites Plasmodium falciparum. Other species of the single-celled Plasmodium can give you malaria, but if you're looking for a real knock-down punch, P. falciparum is the parasite for you. It alone is responsible for almost all of the million-plus deaths due to malaria.
How did this scourge come to plague us? In a paper to be published this week in the Proceedings of the National Academy of Sciences, scientists have reconstructed a series of molecular events three million years ago that allowed Plasmodium falciparum to make us its host. They argue that a change in the receptors on the cells of hominids was the key. Ironically, this same change of receptors may have also allowed our ancestors to evolve big brains. Malaria may simply be the price we pay for our gray matter.
To uncover this ancient history, the researchers compared the malaria humans get to the malaria of our closeest relatives, chimpanzees. In 1917, scientists discovered Plasmodium parasites in chimpanzees that looked identical to human Plasmodium falciparum. But when some ethically challenged doctors tried to infect people with the chimpanzee parasites, the subjects didn't get sick. Likewise, chimpanzees have never been known to get sick with Plasmodium falciparum from humans. In the end, scientists recognized that chimpanzees carry a separate species of Plasmodium, known today as Plasmodiumreichenowi. Studies on DNA show that Plasmodium rechnowi is the closest living relative to Plasmodium falciparum--just as chimpanzees are the closest living relatives of humans.
The authors of the new study set out to find the difference between these parasitic cousins. They focused on how each species of Plasmodium gets into red blood cells. Every Plasmodium species uses special molecular hooks on its surface to latch onto receptors on the cell, and then noses its way through the membrane to get inside. The parasite has a number of hooks, each of which is adapted to latch onto particular kinds of receptors. One of the most important groups of receptors that Plasmodium needs to latch onto are sugars known as sialic acids, which are found on all mammal cells.
These sugars play a crucial but mysterious role in human evolution. As I've written here (and here), almost all mammals carry a form of the sugar called Neu5Ac on their cells, as well as a modified version of it, known as Neu5Gc. In most mammals, this modified form, Neu5Gc is very common. In humans, it's nowhere to be found. That's because the enzyme that converts the precursor Neu5Ac into Neu5Gc doesn't work. We still carry the gene for the enzyme, but it became mutated about three million years ago and stopped working.
Since chimpanzees make Neu5Gc and we don't, the researchers hypothesized that the two Plasmodium species must use different strategies to latch onto red blood cells. To test their hypothesis, they genetically engineered cells to produce the molecular hooks used by human Plasmodium falciparum, and other cells to produce the chimp parasite hooks. The researchers then mixed the engineered cells with red blood cells from humans and chimpanzees to see how well they attached. In another set of experiments, they made human blood cells more chimpanzee-like by adding Neu5Gc sugars to them, to see if the change helped the chimpanzee parasites attack them, or if it impaired the attacks of human parasites.
Their results show that humans are uniquely vulnerable to Plasmodium falciparum because our ancestors lost the Neu5Gc sugar. Plasmodium falciparum prefers to bind to Neu5Ac, the sugar we still carry. At the same time, the sugar we lost somehow blocks Plasmodium falciparum's hooks from latching onto Neu5Ac. That's why chimpanzees don't get sick with Plasmodium falciparum, despite carrying both kinds of sugars. On the other hand, we don't get sick with chimpanzee malaria, because Plasmodium reichenowi prefers attaching to Neu5Gc, the sugar we lost.
The scientists argue that some seven million years ago the common ancestor of chimpanzees and humans carried both kinds of sugars on their cells. This ancient ape would sometimes get sick with malaria, caused by the common ancestor of today's P. rechnowi and P. falciparum. This ancient parasite preferred to latch onto Neu5Gc to get into its host's blood cells.
Hominids then branched off from other apes, walking upright and moving out of the jungle into open woodlands. They still got sick with the old malaria, because they still produced both kinds of sugars. But then, about three million years ago, our ancestors lost the ability to make Neu5Gc. Initially this was a great relief, because the malaria parasites had a much harder time gaining entry into our cells.
But this relief did not last, the scientists argue. Sometimes mutant parasites emerged that did a better job of latching onto the one sugar hominids still made, Neu5Ac. They now could get into hominid red blood cells, while other Plasmodium parasites were still making do with the other apes. Over time these parasites evolved a better ability to infect hominids. But at the same time, they surrendered the ability to infect other apes, such as chimpanzees. Thus Plasmodium falciparum was born.
This new research is yet another example of how studying evolution yields new insights into medicine. (I've blogged before about similar examples with tuberculosis and HIV.) And it may also reveal something about the downside of our unique intelligence. Our ancestors lost Neu5Gc around the time that the hominid brain began to get significantly bigger than a chimp's.
In other animals, Neu5Gc is abundant on the cells of most organs, but exceedingly rare in the brain. It is very peculiar for a gene to be silenced in the brain, which suggests that it might have some sort of harmful effect. Once a mutation knocked out the gene altogether, hominids didn't have to suffer with any Neu5Gc in the brain at all.
Perhaps Neu5Gc limited brain expansion in other mammals, but once it was gone from our ancestors, our brains exploded. Along with a big brain, however, came our very own form of malaria.
