Hereditary red cell disorders and malaria resistance.

Human malaria is attributed to five species of the Plasmodium parasite (this includes the discovery that P. knowlesi infects humans). The most virulent form of the disease is caused by P. falciparum, which continues to have a major impact on human populations: a third of the world’s population live in malaria endemic areas and upwards of a million individuals succumb to the disease each year, predominantly children in sub-Saharan Africa. Historically, the impact was more profound and the current confinement of endemic malaria to the equatorial and sub-tropical regions is, in evolutionary terms, a very recent phenomenon. The discovery that pyruvate kinase (PK) deficient human erythrocytes are resistant to malaria has again highlighted the host-parasite relationship. This paper provides an evolutionary perspective of the interactions between P. falciparum and the human erythrocyte in the context of these developments.