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Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) is a major virulence factor expressed on the surface of erythrocytes infected by the P. falciparum parasite (Chen et al., 1998). The heparan-sulfate-binding adhesion interface is a critical functional site, typically located within the N-terminal Duffy-binding-like 1 alpha (DBL1α) domain of the protein (Vogt et al., 2003). This interface mediates the binding of infected red blood cells to heparan sulfate proteoglycans on the surface of uninfected erythrocytes (rosetting) and vascular endothelial cells (sequestration) (Angeletti et al., 2015). These processes are central to the pathogenesis of severe malaria, as they lead to microvascular obstruction, impaired tissue perfusion, and organ failure, particularly in the brain (Angeletti et al., 2015). Drugs like sevuparin, a heparin-derived polysaccharide, are designed to target this interface by competitively inhibiting the interaction with host heparan sulfate, thereby promoting the clearance of infected cells and improving blood flow (Leitgeb et al., 2011). However, the extreme genetic diversity of the var gene family, which encodes PfEMP1, poses a significant challenge for achieving broad therapeutic efficacy across different parasite strains (Scherf et al., 2008).
Competitive inhibition of the binding between the parasite's DBL1α domain and host heparan sulfate receptors, thereby disrupting erythrocyte rosettes and preventing microvascular sequestration (Angeletti et al., 2015; Vogt et al., 2003).
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