Abstract
BackgroundThe sequestration of Plasmodium falciparum infected cells in the placenta results in placental malaria (PM). It activates the mother's immune cells and induces secretion of inflammatory cytokines, which might influence pregnancy outcomes. This study aims to investigate the cytokines (levels IL-4, IL-6, IL-10, IL-17A, and INF γ) in maternal peripheral, placental, and umbilical cord blood in response to PM and the extent to which this may influence maternal haemoglobin levels and birth weight.MethodsA total of 185 consenting Sudanese women from Blue Nile State were enrolled at delivery time in a cross-sectional study conducted between Jan 2012-Dec 2015. Malaria infection in the collected maternal peripheral, placental, umbilical cord samples was determined microscopically, and ELISA was used to measure the plasma levels IL-4, IL-6, IL-10, IL-17A, and INF γ in the collected positive and negative malaria samples.ResultsElevated levels of IL-4 and IL-10 and reduced levels of IL-6 were detected in the malaria positive samples in comparison to the negative ones in the three types of the samples investigated. Maternal, IL-4 and IL-10 were significantly higher in the samples collected from the PM infected group compared to the non-infected control (P < 0.001). While the absence of PM was significantly associated with the IL-6 and maternal IFN-γ levels, maternal IL-17A, placental and umbilical cord IFN-γ levels showed no significant difference (P = 0.214, P = 0.065, P = 0.536, respectively) due to infection. Haemoglobin level and birth weight were increased in the group with high levels of IL-6 and IL-17A, but not in the group with IL-4 and IL-10 levels. While significantly negative correlation was found between IFN-γ levels and birth weight for all three types of samples, only maternal peripheral IFN-γ level was significantly positively correlated with maternal haemoglobin (r = 0.171, P = 0.020).ConclusionThese results suggest that PM induces mother’s immune response and impairs her cytokine profile, which might alter maternal haemoglobin levels and the baby's birth weight.
Highlights
The sequestration of Plasmodium falciparum infected cells in the placenta results in placental malaria (PM)
It is known that P. falciparum infected erythrocytes (IEs) induce inflammation by monocytic infiltration of the malaria infected placenta, which is associated with maternal anaemia and low birth weight (LBW) [9, 10]
The present study found that malaria infection altered the investigated cytokines (IL-4, IL-6, IL-10, IL-17A and INF-γ) in Sudanese maternal, placental and neonatal plasma collected from Blue Nile State
Summary
The sequestration of Plasmodium falciparum infected cells in the placenta results in placental malaria (PM). It is known that P. falciparum IEs induce inflammation by monocytic infiltration of the malaria infected placenta, which is associated with maternal anaemia and low birth weight (LBW) [9, 10]. This inflammation may influence cellular functions by altering the balance of cytokines and chemokines in the peripheral and placental blood of the women [11, 12], and some cytokines can help resolve infections while others may contribute to pathology [13,14,15]. Among the cytokines that are produced, IL-27 and IL-6 can elicit both pro-inflammatory and anti-inflammatory effects, and high concentrations of IL-6 may protect against PM [17]
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