Abstract
BackgroundA large-scale study was set up in order to study the epidemiology, clinical aspects, and immunopathology of gestational and placental malaria in north-west Colombia. In this region, recent reports using a qPCR technique, confirmed frequencies of infection, by Plasmodium falciparum or Plasmodium vivax, up to 45%. Given the high rates of infection observed both in mother and placenta, a first exploratory study was proposed in order to characterize the effect on the inflammation status, tissue damage and hypoxia in Plasmodium spp. infected placentas.MethodsA descriptive, prospective, cross-sectional design was applied to pregnant women with (PM+) and without (PM-) placental malaria. Messenger RNA expression of Fas, FasL; COX-1, COX-2, HIF, VEGF, and the cytokines IL-2, IL-4, IL-10, IFN-γ and TNF, were measured in peripheral and placental blood using a quantitative PCR. The percentage of apoptotic cells was determined with a TUNEL assay.ResultsIn total 50 placentas were studied: 25 were positive for submicroscopic infection and 25 were negative for Plasmodium infection. Expression of IL-4 and IL-10 was observed high in placental tissue of PM+, while IL-2 was high in peripheral blood of the same group. Expression of TNF and IFNγ in peripheral blood of the PM + group was high. Similarly, the apoptotic index and Fas expression were significantly high in PM+. However, FasL expression was observed low in PM + compared to PM-. Inflammation markers (HIF, VEGF) and hypoxia markers (COX-1, COX-2) were high in the PM + group.ConclusionDuring placental malaria expression of some pro-inflammatory cytokines is up-regulated and markers of hypoxia and tissue damage are increased in cases of submicroscopic infection.
Highlights
A large-scale study was set up in order to study the epidemiology, clinical aspects, and immunopathology of gestational and placental malaria in north-west Colombia
Based on the availability and quality of material collected from peripheral blood and placental tissue, a subset of subjects was selected from the records of the 2,000 women recruited in the main project, to explore the effect of malaria infection on the pathophysiology of placental damage
Relative quantitation for expression analysis was performed using a Results All fifty placentas were negative for Plasmodium spp. by microscopy, and 25 of them were positive for infection by qPCR: 16 P. falciparum, six P. vivax and three mixed infection
Summary
Study site Women were recruited from January 2007 to April 2011, at the hospital obstetric facilities in the municipalities of Monteria (08°45′N, 75°53′W), and Puerto Libertador (07°53′35′ N, 75°40′′16′′ W) of the Uraba-Sinu-San JorgeBajo Cauca region of Colombia This region has an estimated area of 43,506 km, a population of 2.5 million at risk of malaria, with a mean annual parasite index of 35.8 cases/1,000 inhabitants [23]. Based on the availability and quality of material collected from peripheral blood and placental tissue, a subset of subjects was selected from the records of the 2,000 women recruited in the main project, to explore the effect of malaria infection on the pathophysiology of placental damage. The status of infection was defined by thick smear and real-time PCR (qPCR) of placental blood.
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