Malaria parasites can 'hide' inside bone marrow

Behind the Headlines

Thursday July 10 2014

If malaria is not diagnosed and treated promptly, it can be fatal

Malaria is caused by parasites called Plasmodium

“Malaria parasites can hide inside the bone marrow and evade the body's defences, research confirms,” BBC News report.

It is hoped that this insight into the activities of the parasites could lead to new treatments.

While most people associate malaria with mosquitoes, the disease is actually caused by tiny parasites called Plasmodium, which infect mosquitoes and spread the infection to humans by injecting them with spores.

These spores grow and multiply in the liver and then infect blood cells, causing the symptoms of malaria.

To continue their lifecycle, some of the parasites sexually mature and are then transferred back into mosquitoes during another bite, where they can breed. 

The researchers looked at tissue samples from autopsies of children who had died from malaria.

The study found evidence that sexual maturation of the parasite is likely to take place in the bone marrow, but outside of the blood vessels. This might be why the immune system rarely destroys them, as infection-fighting antibodies are unable to target bone marrow tissue.

It is hoped that these results can pave the way for the development of new drugs to target this key stage. This has the potential to reduce the number of infected mosquitoes, thus decreasing the number of malaria cases.

The ultimate hope is that malaria could be eradicated in the same way as smallpox.


Malaria – not your problem?

Many people in the UK wrongly believe that malaria is something that only happens to people in other countries.


However, British tourists and people that travel to areas where the disease is endemic are not immune.


The Health Protection Agency (HPA) states that there were 1,501 imported cases in the UK in 2013, and seven deaths.


If you are planning to travel to a tropical part of the world, such as Africa, South America and Asia, you should research precautions you may have to take with you, such as antimalarial drugs. The National Travel Health Network and Centre (NaTHNaC) website provides a useful country-by-country profile of potential health risks. 


There have also been warnings that climate change could lead to the disease spreading to other regions, such as Europe.

Where did the story come from?

The study was carried out by researchers from around the globe, including the Harvard School of Public Health, the Liverpool School of Tropical Medicine, the University Of Malawi College Of Medicine, and Brigham and Women’s Hospital, Boston. It was funded by the US National Institutes of Health.

The study was published in the peer-reviewed medical journal Science Translational Medicine.

The study was briefly reported by BBC News, which provided an accurate summary of the research.


What kind of research was this?

This was an autopsy study designed to investigate where a key stage in the lifecycle of the parasite that causes malaria takes place.

The tropical disease is caused by Plasmodium parasites. The most severe form of malaria is caused by Plasmodium falciparum. The lifecycle of the parasite relies on blood-feeding mosquitoes and humans. When an infected mosquito bites a human, sporozoites are injected into the human, and they travel to the liver. They mature into schizonts in the liver and then rupture to release meroziotes into the blood. These merozoites divide and multiply asexually by sticking to the sides of small blood vessels. This process causes the symptoms of malaria, which include shivering and fever.

However, for the parasites to continue their lifecycle, some of the meroziotes mature into the sexual stage; these are called gametocytes. These male and female gametocytes are then ingested by mosquitoes the next time they have a blood meal; they can then fertilise and replicate within the mosquito.

The gametocytes are only present in the bloodstream when they are mature enough to be taken up by mosquitoes. They take six to eight days to mature, and it is believed this takes place in human tissue. This stage has not been studied in depth, as the Plasmodium falciparum will only live in humans, so rodent studies are not possible. This study looked for these immature gametocytes in multiple tissue sites in autopsies of children who had died from malaria, to find out where this stage takes place.


What did the research involve?

The researchers initially used antibodies to identify the parasite in general, as well as specific antibodies to the sexual gametocytes, to detect them in various tissues from six autopsies. They looked at tissue samples from eight organs and the subcutaneous fat.

They measured the total proportion of parasites in each organ compared to the level of gametocytes.

They then measured the level of gene activity of three stages in the gametocyte maturation process in the different organs, to see if the first of these stages takes place in one particular site.

The researchers then looked in detail at the bone marrow from 30 autopsies to gather more information about where the gametocytes mature.

Finally, they performed experiments with growing Plasmodium falciparum in the laboratory.


What were the basic results?

Results from the first six autopsies revealed that:

  • The spleen, brain, heart and gut had the highest numbers of total parasites.
  • Levels of gametocytes were high in the spleen, brain, gut and bone marrow.
  • There was a significantly higher proportion of gametocytes compared to total parasites in the bone marrow (44.9%), in comparison to the gut (12.4%), the brain (4.8%) and all other organs.
  • The first stage of gametocyte gene activity was highest in the bone marrow. 

Results from the 30 autopsies of bone marrow found that:

  • The youngest gametocytes did not stick to blood vessels as happens in the asexual reproduction of merozoites; instead, they were outside of the blood vessels in the bone marrow. 
  • Immature gametocytes appeared to grow inside young red blood cells. 

The laboratory experiments confirmed that Plasmodium falciparum gametocytes can mature inside young red blood cells.


How did the researchers interpret the results?

The researchers said there is evidence that gametocytes develop within the bone marrow, probably in early red blood cells, and that this process uses a different mechanism to the asexual cell replication.

This means there is potential for drugs to be developed that could target this process.



This interesting study has found evidence of the likelihood that the sexual reproductive stage in the lifecycle of Plasmodium falciparum takes place outside of the blood vessels, in the bone marrow.

It has also shown that these immature gametocytes are rarely destroyed by the immune system.

It is hoped that these results can pave the way for the development of new drugs to target this key stage in the Plasmodium falciparum lifecycle.

While this would not treat the symptoms of malaria – which come from the asexual reproduction of merozoites – it could potentially stop the transmission of the sexual gametocytes back into mosquitoes.

This could reduce the number of infected mosquitoes, thus decreasing the number of malaria cases.

Eradicating malaria is a challenge, but many public health experts think it is plausible.

For example, Microsoft founder turned philanthropist Bill Gates has pledged billions of dollars towards this goal. What impact this would have on the planet’s ecosystem is debatable.

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Analysis by Bazian

Edited by NHS Choices

Links to the headlines

Malaria parasite 'gets down to the bone'. BBC News, July 9 2014


Links to the science

Joice R, Nilsson SK, Montgomery J, et al. Plasmodium falciparum transmission stages accumulate in the human bone marrow. Science Translational Medicine. Published online July 9 2014



How helpful is this page?

Average rating

Based on 3 ratings

All ratings

2  ratings
0  ratings
0  ratings
0  ratings
1  ratings

Add your rating

Useful links

NHS Choices links


Malaria is a tropical disease. It is spread by mosquitoes infected with malaria parasites. In this video, an expert explains how malaria attacks different areas of the body, and what you can do to avoid getting infected.

Media last reviewed: 27/08/2015

Next review due: 27/08/2017

What is Behind the Headlines?

What is Behind the Headlines?

We give you the facts without the fiction. Professor Sir Muir Gray, founder of Behind the Headlines, explains more...

Follow us on Twitter

Join more than 160,000 who follow @NHSChoices for the latest and best health news and lifestyle advice

Your NHS Health Check

Millions of people have already had their free 'midlife MOT'. Find out why this health check-up is so important

How to cut down on sugar

Practical tips to help you reduce the amount of sugar you eat throughout the day

'Malaria nearly killed me'

Mo mistakenly thought he was immune to malaria when he visited family in Sierra Leone

Before you travel

Advice for people travelling abroad, covering jet lag, vaccinations, DVT, travel insurance and sun safety