Immune responses during gestational malaria: a review of the current knowledge and future trend of research

Abstract

Women pregnant with their first child are susceptible to severe P. falciparum disease from placental malaria because they lack immunity to placenta-specific cytoadherence proteins. In subsequent pregnancies, as immunity against placental parasites is acquired, there is a reduced risk of adverse effects of malaria on the mother and fetus and asymptomatic parasitaemia is common. In the case of vivax malaria, with increasing reports of severe cases in Asia and South America, the effects of infection by this species during pregnancy remain to be elucidated. This review summarized the main aspects involved in the acquisition of specific antimalarial immune responses during pregnancy with emphasis in research carried out in America and Asia, in order to offer a framework of interpretation for studies on pregnant women with malaria which are recently being produced in these regions. The authors conclude that (1) Effective humoral responses during gestational malaria are mainly directed against variant surface antigens codified by genes of the var2Csa family of P. falciparum; (2) Acquisition of immunity against these variant antigens depends on the degree and intensity of transmission, and the chance increases with age and successive pregnancies; (3) Antibody development is guided by specific cellular immune responses in cases of placental and maternal infection, and (4) The study of the significance of acquisition of specific immunity against both P. falciparum and P. vivax in America, should be performed.

Placental Malaria: A New Insight into the Pathophysiology

“…However, in malaria-infected pregnant women, an increase in CMI has been observed in the local placental environment. Elevated levels of pro-inflammatory cytokines, such as IFN-γ, IL-2, and TNF-α, in the placenta of malaria-infected women especially in primigravidae account for the observed placental pathology and adverse pregnancy outcomes (31–33). However, IFN-γ levels have also been found elevated in placenta of multigravidae and this scenario can be explained on the bases of development of placental parasite-specific immunity in second or subsequent pregnancies which neutralizes the adverse effect of IFN-γ (34–36).…”

Adaptive Immune Responses Mediated Age-related Plasmodium yoelii 17XL and 17XNL Infections in 4 and 8-week-old BALB/c Mice

“…Several studies have con rmed that immune effector mechanisms are required to eliminate malarial parasites, and B cells secrete speci c antibodies supported by Th2 cells, which can effectively remove the parasites to prevent the recidivation and recrudescence [46,47]. Similarly, infusion of malaria hyperimmune serum resulted in rapid clearance of parasitized erythrocytes [47].…”

Case Report: Severe Plasmodium vivax Malaria Mimicking Sepsis in a Neonate

“…Therefore, artesunate is the first choice for severe congenital malaria treatment. 14,25,26 Ursodeoxycholic acid is given to treat cholestatic jaundice.…”