# Activation of macrophages by extracellular vesicles derived from Babesia-infected red blood cells

## TL;DR

The study shows that extracellular vesicles from Babesia-infected red blood cells can activate macrophages and influence immune responses.

## Contribution

The novel finding is that Babesia-derived extracellular vesicles activate macrophages and modulate pro-inflammatory cytokines.

## Key findings

- EVs from Babesia-infected RBCs are associated with macrophage membranes and cytoplasm.
- EVs from Babesia iRBCs activate NF-κB and modulate pro-inflammatory cytokines in macrophages.
- EVs from infected RBCs differ in size distribution compared to those from uninfected RBCs.

## Abstract

Babesia microti is the primary cause of human babesiosis in North America. Despite the emergence of the disease in recent years, the pathogenesis and immune response to B. microti infection remain poorly understood. Studies in laboratory mice have shown a critical role for macrophages in the elimination of parasites and infected red blood cells (iRBCs). Importantly, the underlying mechanisms that activate macrophages are still unknown. Recent evidence identified the release of extracellular vesicles (EVs) from Babesia iRBCs. EVs are spherical particles released from cell membranes under natural or pathological conditions that have been suggested to play roles in host–pathogen interactions among diseases caused by protozoan parasites. The present study examined whether EVs released from cultured Babesia iRBCs could activate macrophages and alter cytokine secretion. An analysis of vesicle size in EV fractions from Babesia iRBCs showed diverse populations in the <100 nm size range compared to EVs from uninfected RBCs. In co-culture experiments, EVs released by B. microti iRBCs appeared to be associated with macrophage membranes and cytoplasm, indicating uptake of these vesicles in vitro. Interestingly, the incubation of macrophages with EVs isolated from Babesia iRBC culture supernatants resulted in the activation of NF-κB and modulation of pro-inflammatory cytokines. These results support a role for Babesia-derived EVs in macrophage activation and provide new insights into the mechanisms involved in the induction of the innate immune response during babesiosis.