title: CTLA-4 positive T cells in contrast to procalcitonin plasma levels discriminate between severe and uncomplicated Plasmodium falciparum malaria in Ghanaian children.
abstract: Procalcitonin (PCT) plasma levels and the fraction of CTLA-4-positive T cells are both elevated in acute Plasmodium falciparum malaria in human adults and the degree of elevation is positively correlated with other markers of disease severity, for example with parasitaemia. However, the clinical manifestations of malaria are strongly age-dependent and children from endemic areas carry the main disease burden. Therefore, we measured PCT plasma levels and CTLA-4 expression by T cells in four groups of children from the Ashanti Region in Ghana: asymptomatic children with or without parasitaemia, children with uncomplicated P. falciparum malaria and children with severe disease. PCT levels were highly elevated in both groups with acute malaria but they did not discriminate between uncomplicated and severe disease. In contrast, CTLA-4-expression by T cells was increased only in severe malaria. The fraction of CTLA-4 positive T cells in the blood of children with severe disease differed significantly from that in uncomplicated malaria, which was not elevated in spite of the high parasite loads observed in these children. This was unexpected, as in adults uncomplicated malaria is associated with a dramatic sixfold increase of the fraction of CTLA-4-positive T cells. The data from this study support the hypothesis that strong T cell activation as measured here by CTLA-4 expression is not just the by-product of a high parasite burden, but that it contributes to the pathogenesis of P. falciparum malaria.
authors: Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany. bni@bni-hamburg.de
authors: Nele
authors: N
authors: Braun
authors: Yeboah
authors: Y
authors: Marfo
authors: Christiane
authors: C
authors: Von Gärtner
authors: Gerd D
authors: GD
authors: Burchard
authors: P F
authors: PF
authors: Zipfel
authors: N Edmund N
authors: NE
authors: Browne
authors: Bernhard
authors: B
authors: Fleischer
authors: Barbara M
authors: BM
authors: Bröker
mesh_terms: D015703:Antigens, CD; D000943:Antigens, Differentiation / Q000032:analysis*; D060908:CTLA-4 Antigen; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D005869:Ghana; D006801:Humans; D007166:Immunosuppressive Agents / Q000276:immunology*; D007223:Infant; D016778:Malaria, Falciparum / Q000097:blood / Q000276:immunology*; D011498:Protein Precursors / Q000097:blood*; D012720:Severity of Illness Index; D013601:T-Lymphocytes / Q000276:immunology*
chemical_list: D015703:Antigens, CD; D000943:Antigens, Differentiation; C000606589:CALCA protein, human; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; D007166:Immunosuppressive Agents; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide