Research Article: Plasma Levels of Apoliporptoein A1 in Malaria-Exposed Primigravidae Are Associated with Severe Anemia

Date Published: January 21, 2010

Publisher: Public Library of Science

Author(s): David C. Simpson, Edward Kabyemela, Atis Muehlenbachs, Yuko Ogata, Theonest K. Mutabingwa, Patrick E. Duffy, Michal Fried, Georges Snounou. http://doi.org/10.1371/journal.pone.0008822

Abstract: Plasmodium falciparum placental malaria (PM) contributes to 10,000 maternal deaths due to severe anemia (SA) each year in Africa, primarily among primigravid women who are most susceptible. Increased levels of proinflammatory cytokines like TNF-α are associated with maternal anemia in first time mothers but not in other women. Here we aimed to identify additional changes in the plasma proteome associated with pregnancy malaria that may contribute to the development of malaria-related maternal anemia.

Partial Text: Severe anemia (SA) is a common consequence of P. falciparum infection, and is a major cause of childhood and maternal mortality in Africa [1], [2], [3]. During pregnancy, P. falciparum-infected erythrocytes (IE) bind chondroitin sulfate A (CSA) [4] and accumulate in the placenta. Disease due to placental malaria (PM) is strongly associated with the macrophage-rich inflammatory infiltrates that sometimes appear in the intervillous spaces of the placenta. Women are most susceptible to infection, inflammation and disease during first pregnancy (reviewed in [5]), and become resistant over successive pregnancies as they acquire antibodies that block IE binding to CSA [6].

Global proteomic analysis is not limited to the examination of known set of factors, and therefore has been a transformative technology that facilitates the identification of novel disease pathways and markers. In this study we employed mass spectrometry-based proteomics to better understand pregnancy malaria pathogenesis by identifying biomarkers associated with inflammation and anemia during placental malaria. We found that SA in infected primigravidae is associated with a significant change in proteins involved in lipid metabolism. Several previous studies found that severe infections or chronic inflammatory diseases other than malaria will also modulate the expression of proteins involved in lipid metabolism. During severe sepsis or chronic inflammation, pro-inflammatory cytokine and triglyceride (TG) levels are increased, while HDL-cholesterol, Apo-AI, Apo-B and LPa levels are decreased [22], [23], [24], [25]. Among patients under intensive care for severe sepsis, low levels of Apo-AI are associated with exacerbations of inflammation and poor prognosis [26].

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http://doi.org/10.1371/journal.pone.0008822

 

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