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Persistent endothelial activation and inflammation after Plasmodium falciparum Infection in Malawian children
Christopher A Moxon1, Ngawina V Chisala, Samuel C Wassmer
1Malawi-Liverpool-Wellcome Clinical Research Programme.
Insights
Malaria infection causes lasting endothelial activation and inflammation in children, even after treatment. These persistent vascular changes may contribute to ongoing illness and death from malaria.
Area of Science:
- Vascular Biology
- Infectious Diseases
- Malariology
Background:
- Endothelial dysregulation is key in acute Plasmodium falciparum malaria.
- Resolution of endothelial dysfunction post-treatment has been assumed but not proven.
Purpose of the Study:
- To quantify endothelial marker levels in children with malaria during acute infection and convalescence.
- To investigate persistent endothelial activation and inflammation after malaria treatment.
Main Methods:
- Plasma endothelial markers (soluble intracellular adhesion molecule 1, angiopoetin 2, C-reactive protein) were measured.
- Measurements were taken acutely and at 1-month follow-up in Malawian children with uncomplicated or cerebral malaria.
Main Results:
- Persistent elevation of soluble intracellular adhesion molecule 1, angiopoetin 2, and C-reactive protein was observed at 1 month post-treatment.
- Evidence of ongoing endothelial activation and inflammation was detected in the convalescent phase.
Conclusions:
- Endothelial activation and inflammation persist for at least one month after acute malaria.
- These vascular changes may be a significant, previously unrecognized factor in malaria-associated morbidity and mortality.
Abstract:
Endothelial dysregulation is central to the pathogenesis of acute Plasmodium falciparum infection. It has been assumed that this dysregulation resolves rapidly after treatment, but this return to normality has been neither demonstrated nor quantified. We therefore measured a panel of plasma endothelial markers acutely and in convalescence in Malawian children with uncomplicated or cerebral malaria. Evidence of persistent endothelial activation and inflammation, indicated by increased plasma levels of soluble intracellular adhesion molecule 1, angiopoetin 2, and C-reactive protein, were observed at 1 month follow-up visits. These vascular changes may represent a previously unrecognized contributor to ongoing malaria-associated morbidity and mortality.
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