Renal control of disease tolerance to malaria.

19 Mar 2019
Ramos S, Carlos AR, Sundaram B, Jeney V, Ribeiro A, Gozzelino R, Bank C, Gjini E, Braza F, Martins R, Ademolue TW, Blankenhaus B, Gouveia Z, Faísca P, Trujillo D, Cardoso S, Rebelo S, Del Barrio L, Zarjou A, Bolisetty S, Agarwal A, Soares MP

Malaria, the disease caused by spp. infection, remains a major global cause of morbidity and mortality. Host protection from malaria relies on immune-driven resistance mechanisms that kill However, these mechanisms are not sufficient per se to avoid the development of severe forms of disease. This is accomplished instead via the establishment of disease tolerance to malaria, a defense strategy that does not target directly. Here we demonstrate that the establishment of disease tolerance to malaria relies on a tissue damage-control mechanism that operates specifically in renal proximal tubule epithelial cells (RPTEC). This protective response relies on the induction of heme oxygenase-1 (; HO-1) and ferritin H chain () via a mechanism that involves the transcription-factor nuclear-factor E2-related factor-2 (). As it accumulates in plasma and urine during the blood stage of infection, labile heme is detoxified in RPTEC by HO-1 and FTH, preventing the development of acute kidney injury, a clinical hallmark of severe malaria.