Université de Paris, Biologie Intégrée du Globule Rouge, UMR_S1134, BIGR, INSERM, F-75015 Paris, France; Institut National de la Transfusion Sanguine, 6, rue Alexandre Cabanel, 75015 Paris, France; Laboratoire d'Excellence Gr-Ex, 24, boulevard du Montparnasse, 75015 Paris, France; APHP, Hôpital Necker Enfants Malades, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Institut Imagine, 149, Rue de Sèvres, 75015 Paris, France.
Université de Paris, Biologie Intégrée du Globule Rouge, UMR_S1134, BIGR, INSERM, F-75015 Paris, France; Institut National de la Transfusion Sanguine, 6, rue Alexandre Cabanel, 75015 Paris, France; Laboratoire d'Excellence Gr-Ex, 24, boulevard du Montparnasse, 75015 Paris, France.
Trends Parasitol. 2020 May;36(5):435-446. doi: 10.1016/j.pt.2020.03.001. Epub 2020 Mar 30.
The human spleen is an immune sentinel and controls red blood cell (RBC) quality. By mechanically retaining subsets of infected RBCs, the spleen may reduce the pace at which the parasite biomass increases before the adaptive immune response operates. Conversely, the spleen may contribute to malaria pathogenesis, particularly anemia that is associated with splenomegaly. Large spleens may also shelter parasites in chronic carriers. Upon treatment with artemisinins, the spleen clears circulating parasites by pitting and releases 'once-infected' RBCs in circulation. This triggers postartesunate delayed hemolysis and explains the long post-treatment positivity of histidine-rich protein 2 (HRP2)-based dipsticks. Importantly, splenic retention of RBCs also applies to gametocytes, the clearance of which may be enhanced by stiffening them with drugs, a potential way to block malaria transmission.
人类脾脏是免疫哨兵，控制红细胞（RBC）质量。脾脏通过机械保留感染 RBC 的亚群，可以在适应性免疫反应发挥作用之前减缓寄生虫生物量增加的速度。相反，脾脏可能会导致疟疾发病机制，特别是与脾肿大相关的贫血。大的脾脏也可能藏匿慢性带虫者中的寄生虫。在用青蒿素类药物治疗后，脾脏通过凹陷清除循环中的寄生虫，并释放循环中的“曾经感染过”的 RBC。这会引发青蒿琥酯后延迟性溶血，并解释了基于富含组氨酸蛋白 2（HRP2）的检测棒在治疗后的长时间阳性。重要的是，RBC 在脾脏中的保留也适用于配子体，用药物使其变硬可以增强清除它们的效果，这可能是阻断疟疾传播的一种方法。
