Abstract
Multinucleated Giant Cells (MGCs) are specialized cells that develop from the fusion of multiple cells, and their presence is commonly observed in human cells during various infections. However, MGC formation is not restricted to infections alone but can also occur through different mechanisms, such as endoreplication and abortive cell cycle. These processes lead to the formation of polyploid cells, eventually resulting in the formation of MGCs. In Entamoeba, a protozoan parasite that causes amoebic dysentery and liver abscesses in humans, the formation of MGCs is a unique phenomenon and not been reported in any other protozoa. This organism is exposed to various hostile environmental conditions, including changes in temperature, pH, and nutrient availability, which can lead to stress and damage to its cells. The formation of MGCs in Entamoeba is thought to be a survival strategy to cope with these adverse conditions. This organism forms MGCs through cell aggregation and fusion in response to osmotic and heat stress. The MGCs in Entamoeba are thought to have increased resistance to various stresses and can survive longer than normal cells under adverse conditions. This increased survival could be due to the presence of multiple nuclei, which could provide redundancy in case of DNA damage or mutations. Additionally, MGCs may play a role in the virulence of Entamoeba as they are found in the inflammatory foci of amoebic liver abscesses and other infections caused by Entamoeba. The presence of MGCs in these infections suggests that they may contribute to the pathogenesis of the disease. Overall, this article offers valuable insights into the intriguing phenomenon of MGC formation in Entamoeba. By unraveling the mechanisms behind this process and examining its implications, researchers can gain a deeper understanding of the complex biology of Entamoeba and potentially identify new targets for therapeutic interventions. The study of MGCs in Entamoeba serves as a gateway to exploring the broader field of cell fusion in various organisms, providing a foundation for future investigations into related cellular processes and their significance in health and disease.
Introduction
Fusion of cells and the subsequent creation of multinucleated giant cells (MGC) is a common occurrence in animals, particularly in response to inflammatory reactions such as infections with tuberculosis, HIV, herpes, or foreign bodies (; ; ; ). There are various lineages of cells in the human body, including monocytes and macrophages, that are capable of forming multinucleated giant cells (MGCs) (; ). There are several types of giant cells that have been observed in medical research. These include: i) Foreign-body giant cells, which are a group of macrophages that form in the presence of large foreign bodies (; ; ); ii) Langhans giant cells, which are formed by the fusion of epithelioid cells and contain nuclei arranged in a horseshoe-shaped pattern in the cell periphery (; ); iii) Touton giant cells, which contain a ring of nuclei surrounding a central homogeneous cytoplasm, while foamy cytoplasm surrounds the nuclei (); iv) Giant-cell arteritis (); v) Reed-Sternberg cells, which are abnormal lymphocytes found in people with Hodgkin lymphoma (; ). Figure 1 illustrates a schematic representation of the transformation of a macrophage into a multinucleated giant cell (MGC).
Figure 1
It is evident that multinucleation in macrophages occur in vivo under chronic inflammatory conditions (
The formation of multinucleated giant cells (MGC) in protozoan parasite Entamoeba is mainly observed under conditions of starvation, osmotic stress, or heat stress. However, there have been no reports of MGC formation in other protozoa to date. It is worth noting that other protozoan parasites are capable of inducing MGC formation in human cells. For example, Leishmania parasites induce multinucleation of bone marrow-derived macrophages (
In E. histolytica, the absence of cell cycle checkpoints results in the separation of nuclear division and cytokinesis, which leads to multinucleation events associated with cytokinesis failure and the termination of ongoing cell division (
Figure 2

Encystation and heat-shock response triggers formation of MGCs (Multinucleated Giant Cells). Schematic showing different morphological changes during encystation and heat-shock response in Entamoeba. Cells form aggregates due to glucose depletion, hypo-osmotic stress or heat-stress. Transcription factor ERM-BP works downstream of aggregate formations and induce MGC formation whereas overexpression of EhPC4 has been shown to increase cell size and lead to the accumulation of multinucleated cells. With the progression of encystation nuclear division takes place to make quadrinucleated cyst or cyst like structure. Cell fusion also involves in low frequency that transform trophozoites into MGC which are highly motile under confinement observed in Entamoeba.
Role of multinucleated giant cells (MGCs) in higher eukaryotes
The occurrence and underlying factors of MGC formation in humans
The formation of MGCs serves different purposes in various biological systems. For example, in dermatology, giant cells are considered to be a significant pathological factor with diagnostic value, although their specific functions remain unclear (
Various conditions have been identified to regulate the formation of MGC in culture, including the use of conditioned media or the addition of cytokines, lectins, PMA (phorbol myristate acetate), either alone or in combination with interferon (IFN-γ). Additionally, the formation of MGC can also be facilitated by long-term culture of monocytes in vitro (
The response of macrophage to biomaterials can be schematically depicted based on the size of implanted materials. Macrophages internalize small fragments and particles (<10 μm in diameter) via phagocytosis and intracellular digestion. For particles larger than 10 μm and smaller than 100 μm, macrophages fuse together to form giant cells that engulf and digest the particles (Figure 1). For larger particles, macrophages and macrophage-fused giant cells carry out bulk digestion via extracellular degradation by releasing enzymes and/or lowering pH. The formation of multinucleated giant cells involves more than two protoplasts and prevents mitosis and subsequent development (Adapted from
Giant cells in human and their functions
It has been postulated that multinucleated giant cells (MGCs) are discovered first by Paul Langerhans and are formed from the fusion of monocyte-derived macrophages during various inflammatory states in different tissues. MGCs have been found to participate in both pathological and physiological processes (
Recent studies have shed light on the mechanism behind the formation of these giant cells, although it is still not fully understood. It has been proposed that T-helper 2 cytokines, including interleukin 4 (IL-4) and interleukin 13 (IL-13), as well as macrophage fusion receptor, signal-regulatory protein-a (SIRP-a), macrophage colony stimulating factor (M-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), IL-17A, interferon-g (IFN-g), receptor activator for nuclear factor-kB ligand (RANKL), cell-specific membrane proteins such as Dendritic cell-specific transmembrane protein (DCSTAMP), transmembrane adhesion receptor cadherin, mannose receptor (such as CD206, which detects microorganisms that express mannose as an oligosaccharide), monocyte chemoattractant protein (MCP1), and integrins (beta 1 and beta 2) all play crucial roles in the fusion process (
Various types of giant cells have been observed in human cells, including Langhans giant cells and Touton giant cells, which are produced by the fusion of macrophage-derived foam cells (
In humans, the formation of MGCs is associated with various infectious diseases, including tuberculosis, brucellosis, leprosy, and aspergillosis. In an in vitro model of human tuberculous granulomas, high-virulence Mycobacterium (Mycobacterium tuberculosis) led to the formation of large multinucleated giant cells with more than 15 nuclei, while non-pathogenic species of Mycobacterium such as M. avium and M. smegmatis formed smaller cells with fewer nuclei that are not considered MGCs (
The osteoclast-like giant cells, also known as osteoclasts, are predominantly bone-resorbing MGCs that play a crucial role in bone remodeling and homeostasis. These cells are derived from bone marrow precursors that originate as early mononuclear macrophages and then circulate in the bloodstream and attach to the bone marrow surface. The process of MGC formation is initiated when the parent Osteoclast cells interact with the osteoclast differentiation factor called Receptor Activator of Nuclear Factor k-B Ligand (RANKL), which in turn promotes the expression of Dendritic cell-specific transmembrane protein and leads to MGC formation. Calcitonin receptor (CTR) and Multinucleation tartrate-resistant acid phosphatase (TRAP) are also available markers used in detecting these osteoclasts. TRAP has a core iron center and is capable of generating ROS (reactive oxygen species), which are involved in bone matrix degradation during antigen presentation and bacterial killing (
In the context of bone tissue, giant cell tumors, also known as giant cell myeloma, are benign neoplasms that arise sporadically in long bones. These tumors display phenotypic features similar to osteoclasts. Another type of giant cell, Foreign Body Giant Cells (FBGCs), typically develop as a result of an immunological reaction in patients who use foreign bodies such as catheters. FBGCs contain numerous nuclei, sometimes up to 100, and work to eliminate foreign substances from the host by sequestering the foreign material along with inorganic substances to form an aggregate of endogenous substances. Studies suggest that the formation of FBGCs requires external stimuli and a material surface with appropriate adherent proteins. For example, vitronectin and E-cadherin have been identified as important adhesion proteins during IL-4-induced FBGC formation. In vitro models of MGCs derived from monocytes have shown elevated phagocytosis that involves components of endoplasmic reticulum proteins such as calnexin and calregulin, which localize at fusion interfaces with actin and are involved in cell-cell interactions. FBGCs also actively participate in the inflammatory response by producing various cytokines.
There is a correlation between rheumatoid diseases and MGCs, such as rheumatoid arthritis (RA) and rheumatoid heart disease (
Sarcoidosis is an autoimmune granulomatous disease that affects the lymphatic systems, as well as the pulmonary and cutaneous systems. It is characterized by the presence of epithelioid cells, macrophages, and multinucleated giant cells. Lymphocytes and fibroblasts may also be present in sarcoidosis. The pathogenesis of this disease is associated with inflammatory cytokines, such as IL-6 and TNF-a (
Unleashing the impact of MGC on cancer
Polyploid giant cells, which often have multiple nuclei, have been observed in tumors and cell lines derived from tumors. Polyploidy is not only associated with cancer, but is also seen in aging and diabetes. In diploid organisms, polyploid cells can form via three general mechanisms, including cell fusion, endoreplication, and a variety of defects that result in an abortive cell cycle (as shown in Figure 3). It has been speculated that polyploid giant tumor cells may facilitate rapid tumor evolution and the acquisition of therapy resistance in multiple incurable cancers (
Figure 3

Schematic representation showing the mechanism of polyploid cells. The mechanisms of multinucleation, cell fusion, abortive cell cycle, and endoreplication contribute to the formation of polyploid cells. (A) Multinucleation occurs when cells undergo abnormal mitosis, resulting in multiple nuclei within a single cell. (B) Cell fusion combines genetic material from different cells, leading to increased chromosome sets. (C) Endoreplication involves repeated DNA replication without division. (D) Abortive cell cycle disrupts normal progression, causing cells to exit prematurely and generate polyploid cells. These mechanisms collectively drive the development of polyploidy in cells, which can promote genomic instability, tumor progression, and resistance to treatment in cancer cells.
The generation and maintenance of polyploid cells have been the subject of limited research, and the exact mechanisms involved remain unclear. In ovarian cancer cell lines, it was observed that Autophagy inhibitors did not prevent the formation of polyploid giant cancer cells (PGCCs) (
Role of MGC in plants
Plants, like animals, also have the ability to generate MGCs. Root Knot Nematodes (RKN) of the Meloidoyne spp obligate parasite have been reported to infect plants by inducing the redifferentiation of root cells into multinucleated and hypertrophied feeding cells, which are known as giant cells. These giant cells arise due to repeated rounds of karyokinesis without cell division (
The initiation of giant cell formation during sepal development in Arabidopsis is regulated by the fluctuation of the transcription factor ATML1, a homeobox gene of Arabidopsis. Studies have revealed that the suppression of ATML1 up to a threshold level during G2 phases of the cell cycle is highly likely to lead to giant cell establishment and entry into endoreduplication (
Role of MGC in parasites
A fascinating look into giant protozoa
Recent research on the composition of zooplankton has shed new light on the importance of giant protozoa in ocean ecosystems. Among the various types of protozoa, only a limited number exhibit a multinuclear structure. Pelomyxa, for instance, belongs to a genus of flagellar amoebae that are characterized by their large size and possession of multiple nuclei. Another genus in the Amoebidae family, Chaos, is also known for its members’ enormous size, with Chaos carolinensis being recognized as a giant amoeba.
Protozoan parasites have been extensively studied with respect to their giant cells during the formation of cysts in Entamoeba species. This occurs due to continuous cell fusion and division, leading to the aggregation of haploid nuclei and the formation of a polyploid nucleus. Moreover, polyploidy can occur without nuclear division, resulting in the accumulation of several genome contents in each nucleus of a single cell, which indicates that DNA reduplication occurs multiple times before cell division and contributes to the formation of giant cells (
E. invadens, a pathogen found in reptiles, has been extensively utilized as a model organism to investigate encystation events. However, recent studies have revealed that E. histolytica, causing amoebiasis to human, is also capable of forming cysts under in vitro conditions (
Formation of giant cell occurs naturally
The presence of multinucleation in E. histolytica has been demonstrated through in vivo observations (
It is debatable whether these Xenophyophore can be classified as amoeba or not. Initially, when they were discovered, scientists believed they were a variety of sponges. Later, it was determined that they were a type of gigantic amoeba, as they move with the help of pseudopods. However, some researchers now classify them as part of the foraminifera group, as these giant cells have a shell-like structure around them. Interestingly, the foraminifera group of organisms are amoeba-like protists that are unicellular in nature, but are also known as “armoured amoebae” due to their shells. These cells acquire minerals from sea sediment, which makes them resistant to the toxic effects of many heavy metals (
Fate of giant Entamoeba cells
Encystation is a primitive survival process used by all Amoebozoa (
The formation of multinucleated giant cells (MGC) is a survival mechanism employed by Entamoeba to cope with unfavorable environmental conditions like starvation, osmotic stress, and heat stress. The fusion of multiple cells to form MGC enables them to withstand and overcome these stressors. Additionally, when these giant cells were transferred to a nutrient-rich medium under confinement, meiosis occurred, and they were able to divide and transform into smaller trophozoites. This indicates that MGC formation is an intermediate stage for the survival of Entamoeba in adverse conditions.
Cell fusion and meiosis, which allow genetic recombination during encystation, are believed to act as survival mechanisms allowing cells to remain dormant as cysts or as polyploid MGCs (
Cytofission in E. invadens starts randomly and daughter cells continue to divide until they reach trophozoite size, as shown in Figure 4. The distribution of nuclei during cytofission is uneven, and the arrangement of nuclei into daughter cells is detected with the help of the cell-permeable nuclear stain Hoechst33342. However, no correlation was found between the number of nuclei per cell and daughter cell size (
Figure 4

Cytofission in MGC (Multinucleated Giant Cell). Under favorable conditions, MGCs exhibit a unique behavior where they move in multiple directions and undergo a process of branching. This intermediate branching state allows the MGCs to divide and separate into smaller cells. The intermediate cells resulting from this branching are capable of continuous cytofission, a process involving the division of the cytoplasm, until they reach the size of trophozoite daughter cells. This continuous division and separation into smaller cells enable the MGCs to proliferate and generate a population of trophozoite-sized daughter cells, potentially contributing to the expansion and dissemination of the MGC population.
Although there are limited reports on whether amoebic giant cells are more phagocytic than trophozoites, studies have shown that the phagocytic property of giant macrophages increases. Specifically, reports have indicated increased phagocytosis of macrophages towards specific cells or molecules that are opsonized by the complement system (
Initial giant cells are more competent for fusion
The motile amoeba trophozoites exhibit strong adhesion to surfaces and move actively via their pseudopods. In contrast, giant cells do not adhere and instead float randomly in encystation media. When two of these non-adherent cells come into contact, they fuse and give rise to a larger giant cell. According to the collected data so far, the initial giant cells appear to be more competent and prone to fusion with other cells, resulting in the formation of even larger cells (
Concluding and future perspective
Every organism possesses unique strategies to adapt to environmental challenges, and the protozoan parasite Entamoeba exemplifies this adaptability. In the case of the protozoan parasite Entamoeba, it has a stage known as the ‘trophozoite’ that thrives and reproduces in favorable growth conditions. However, in adverse conditions, it transforms into a ‘cyst’ stage through a process called encystation. This cyst is shielded by a thick chitin wall and can endure extreme environmental conditions like high temperature, pressure, and lack of food. Entamoeba also utilizes an alternative survival pathway by forming multinucleated giant cells (MGCs) through cell fusion (
Statements
Author contributions
SH, SD, NBK, SRH, PD, AM, PM, and DM wrote the main manuscript. SH, SD, PM, and DM prepared the figures. All authors contributed to the article and approved the submitted version.
Funding
The author also thanks the DBT, Govt. of India for funding RLSFellowship (BT/RLF/Re-entry/52/2018).
Acknowledgments
We gratefully acknowledge all members of the Manna lab for helpful discussions and critical reading of the manuscript. The author also thanks the DBT, Govt. of India for funding RLS-Fellowship (BT/RLF/Re-entry/52/2018).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
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Summary
Keywords
Entamoeba, multinucleated giant cells (MGCs), encystation, heat stress, cell fusion
Citation
Hazra S, Kalyan Dinda S, Kumar Mondal N, Hossain SR, Datta P, Yasmin Mondal A, Malakar P and Manna D (2023) Giant cells: multiple cells unite to survive. Front. Cell. Infect. Microbiol. 13:1220589. doi: 10.3389/fcimb.2023.1220589
Received
10 May 2023
Accepted
26 July 2023
Published
05 September 2023
Volume
13 - 2023
Edited by
Martina Paoletta, Instituto Nacional de Tecnología Agropecuaria, Argentina
Reviewed by
Paul Dean, Teesside University, United Kingdom; Lesly Temesvari, Clemson University, United States
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Copyright
© 2023 Hazra, Kalyan Dinda, Kumar Mondal, Hossain, Datta, Yasmin Mondal, Malakar and Manna.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Dipak Manna, dipak.manna@gm.rkmvu.ac.in
†These authors have contributed equally to this work and share first authorship
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