Plasmodium falciparum egress disrupts endothelial junctions and activates JAK-STAT signaling in a microvascular 3D blood-brain barrier model

Livia Piatti, Alina Batzilla, Fumio Nakaki, Hannah Fleckenstein, François Korbmacher, Rory K. M. Long, Daniel Schraivogel, John A. Hawkins, Tais Romero-Uruñuela, Borja López-Gutiérrez, Silvia Sanz Sender, Yannick Schwab, Lars M. Steinmetz, James Sharpe and Maria Bernabeu ()
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Livia Piatti: European Molecular Biology Laboratory (EMBL) Barcelona
Alina Batzilla: European Molecular Biology Laboratory (EMBL) Barcelona
Fumio Nakaki: European Molecular Biology Laboratory (EMBL) Barcelona
Hannah Fleckenstein: European Molecular Biology Laboratory (EMBL) Barcelona
François Korbmacher: European Molecular Biology Laboratory (EMBL) Barcelona
Rory K. M. Long: European Molecular Biology Laboratory (EMBL) Barcelona
Daniel Schraivogel: Genome Biology Unit
John A. Hawkins: Genome Biology Unit
Tais Romero-Uruñuela: European Molecular Biology Laboratory (EMBL) Barcelona
Borja López-Gutiérrez: European Molecular Biology Laboratory (EMBL) Barcelona
Silvia Sanz Sender: European Molecular Biology Laboratory (EMBL) Barcelona
Yannick Schwab: Cell Biology and Biophysics Unit
Lars M. Steinmetz: Genome Biology Unit
James Sharpe: European Molecular Biology Laboratory (EMBL) Barcelona
Maria Bernabeu: European Molecular Biology Laboratory (EMBL) Barcelona

Nature Communications, 2025, vol. 16, issue 1, 1-19

Abstract: Abstract Cerebral malaria is a severe neurovascular complication of Plasmodium falciparum infection, with high mortality rates even after treatment with effective antimalarials. Limitations in current experimental models have hindered our knowledge of the disease. We developed a 3D blood-brain barrier (BBB) model with enhanced barrier properties using primary brain endothelial cells, astrocytes, and pericytes. Exposure to parasite egress products increases microvascular permeability, likely due to transcriptional downregulation of junctional and vascular development genes in endothelial cells. In addition, it increases the expression of ferroptosis markers, antigen presentation and type I interferon genes and upregulates the JAK-STAT pathway across all BBB cell types. Incubation with cytoadherent schizont-stage P. falciparum-infected erythrocytes induces a similar, but highly localized transcriptional shift, along with inter-endothelial gaps at sites of parasite egress, leading to enhanced permeability. Treatment with the JAK-STAT inhibitor Ruxolitinib prevents the increase in permeability induced by P. falciparum egress products. These findings provide key insights into the parasite-mediated mechanisms driving brain microvascular pathogenesis in cerebral malaria and suggest potential avenues for adjunctive therapies.

Date: 2025
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DOI: 10.1038/s41467-025-62514-2

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