[Tumor necrosis factor during the course of neuromalaria: new therapeutic perspectives]

Malaria remains one of the major public health problem in tropical and subtropical world. Malaria pathogeny depends partly on parasite multiplication and partly on some elements of the immunological response. It has recently become evident that one of these elements, Tumor Necrosis Factor (TNF), is directly implicated in the pathogenesis of cerebral malaria. TNF increase cytoadherence of infected erythrocytes to the brain microvascular endothelium. In a study involving african children with cerebral malaria high levels of TNF were positively correlated with a fatal outcome. We have previously demonstrated that in vitro Plasmodium falciparum products can directly stimulate the production of TNF from human macrophages. The aim of this work was to identify this soluble parasitic substance. Our results demonstrated that this substance could be a repetitive amino-acid sequence of the Ring-infected Erythrocyte Surface Antigen (RESA). The immunization against this kind of well-known peptides may be used as anti-disease vaccine. The elimination of mortality would be an essential target instead of parasitic clearance.