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Glucocorticoid dysfunction in children with severe malaria.

Leen Vandermosten1, Fran Prenen1, Balotin Fogang2

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Summary

Children with severe malaria have higher cortisol levels but reduced sensitivity to glucocorticoids (GCs), contributing to disease severity. This study investigated GC responses in malaria patients, revealing impaired signaling pathways.

Keywords:
cortisolglucocorticoidsmalariametabolomicsplasmodium

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Area of Science:

  • Immunology
  • Endocrinology
  • Infectious Diseases

Background:

  • Malaria causes significant global health burden, with severe malaria being highly lethal.
  • Severe malaria involves complex pathological processes like immune activation and dysmetabolism.
  • Adrenal hormones, specifically glucocorticoids (GCs), are known to be crucial for disease tolerance during Plasmodium infection.

Purpose of the Study:

  • To investigate glucocorticoid (GC) responses in children with uncomplicated malaria (UM), severe malaria (SM), and asymptomatic controls (AC) in Cameroon.
  • To determine the transcriptional sensitivity of leukocytes to GC signaling in malaria patients.
  • To identify metabolic changes induced by GCs in peripheral blood mononuclear cells (PBMCs).

Main Methods:

  • Measured ex vivo induction of GILZ and FKBP5 by GCs in human and murine leukocytes.
  • Performed targeted tracer metabolomics on PBMCs to detect GC-induced metabolic changes.
  • Analyzed total cortisol, cortisol-binding globulin, and ACTH levels in patient cohorts.

Main Results:

  • Total cortisol levels were elevated in clinical malaria patients, particularly in the SM group.
  • GC-induced expression of GILZ and FKBP5 was significantly reduced in malaria patients and infected mice.
  • Increased pentose phosphate pathway activity was observed in patients, independent of hydrocortisone stimulation; hydrocortisone increased cAMP in controls but not in malaria patients.

Conclusions:

  • Severe malaria patients exhibit increased cortisol levels coupled with decreased GC sensitivity.
  • This impaired GC signaling may significantly contribute to the pathogenesis and severity of malaria.
  • Understanding GC dysregulation offers potential therapeutic targets for severe malaria.