Researchers have identified a novel pathway that may contribute to the high mortality associated with severe malaria in sub-Saharan African children. The study, published March 20 in the open-access journal PLoS Pathogens, reports that severe Plasmodium falciparum infection results in disruption of the endothelium, causing release of ultra-large von Willebrand factor (VWF) protein. Together with reduced levels of VWF-specific cleaving enzyme ADAMTS13, this finding may contribute to our knowledge of the pathophysiology of malaria.