Abstract:
In this study, cytoadherence of wild parasite isolates to chondroitin sulfate
(CS) A, an important host receptor for Plasmodium falciparum-infected erythrocytes
in placenta, and certain aspects of cell-mediated immunity in protection against
placental malaria (PM) were investigated.
Differences in the characteristics of parasitized erythrocyte (PE) adhesion with
respect to site and ligand domain reflects the heterogeneity of the parasite. In vitro
competitive inhibition assays were employed to define structural requirements for
adhesion of both wild and laboratory parasite isolates to CSA. Various
glycosaminoglycans and polysulfated compounds including certain drugs were used
as inhibitors to determine their interference with PE adhesion. The results suggested
that disaccharide structure of -4GlcAβ1-3GalNAc-1 and the degree of sulfation are
critical for the PE adhesion. We also demonstrated for the first time the variation in
the degree of adherence to different chondroitin sulfates among wild isolates.
Specific adherence of PE to CSD and CSE as well as heparin interference on CSAmediated
cytoadherence of PE were observed.
In the area cell-mediated immunity, cytokine responses were examined in PM
and in relation to human immunodeficiency virus (HIV)/PM co-infection. In vitro
cytokine responses by intervillous blood mononuclear cells (IVBMC) from HIVseropositive
and HIV-seronegative women both with and without PM were
investigated. In both HIV and HIV/PM co-infection, the severely defective
production of interleukin (IL)-12, but not IL-18 and interferon inducible protein (IP)-
10, has been suggested to be a critical factor contributing to impaired IFN-γ
production, leading to the loss of protection against PM.
Macrophage migration inhibitory factor (MIF) levels were also investigated in
the plasma of pregnant women with PM and/or HIV infection. MIF levels in the
intervillous blood (IVB) plasma were significantly elevated compared with peripheral
and cord plasma. PM, but not HIV, significantly up-regulated MIF levels in IVB
plasma. In vitro MIF responses by IVBMC were significantly higher when compared
with PBMC. Immunoperoxidase staining showed a consistent pattern of MIF
expression in the syncytiotrophoblasts (SCT), extravillous trophoblasts, IVB cells and
amniotic epithelial cells (AEC). Cytotrophoblasts, villous stroma, and Hofbauer cells
demonstrated focalized staining. AEC and SCT from malaria-infected placenta
consistently exhibited strong expression of MIF whereas those from non-infected
placenta showed weak expression. Malaria parasites can induce in vitro MIF
production in a human trophoblast cell line (BeWo).
Taken together, the results of the study imply that difference in pathogenic
processes leading to varying clinical manifestations depend not only on heterogeneity
of parasite factors, but also host factors.