title: Pregnancy malaria: cryptic disease, apparent solution.
abstract: Malaria during pregnancy can be severe in non-immune women, but in areas of stable transmission, where women are semi-immune and often asymptomatic during infection, malaria is an insidious cause of disease and death for mothers and their offspring. Sequelae, such as severe anaemia and hypertension in the mother and low birth weight and infant mortality in the offspring, are often not recognised as consequences of infection. Pregnancy malaria, caused by Plasmodium falciparum, is mediated by infected erythrocytes (IEs) that bind to chondroitin sulphate A and are sequestered in the placenta. These parasites have a unique adhesion phenotype and distinct antigenicity, which indicates that novel targets may be required for development of an effective vaccine. Women become resistant to malaria as they acquire antibodies against placental IE, which leads to higher haemoglobin levels and heavier babies. Proteins exported from the placental parasites have been identified, including both variant and conserved antigens, and some of these are in preclinical development for vaccines. A vaccine that prevents P. falciparum malaria in pregnant mothers is feasible and would potentially save hundreds of thousands of lives each year.
authors: Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA. patrick.duffy@nih.gov
authors: Patrick Emmet
authors: PE
authors: Duffy
authors: Michal
authors: M
authors: Fried
mesh_terms: D000913:Antibodies, Protozoan / Q000276:immunology; D000953:Antigens, Protozoan / Q000276:immunology; D002448:Cell Adhesion / Q000276:immunology; D002809:Chondroitin Sulfates / Q000378:metabolism*; D004912:Erythrocytes / Q000276:immunology / Q000469:parasitology* / Q000502:physiology; D005260:Female; D006801:Humans; D017780:Malaria Vaccines; D016778:Malaria, Falciparum / Q000097:blood / Q000276:immunology* / Q000469:parasitology; D010920:Placenta / Q000378:metabolism / Q000469:parasitology; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000097:blood / Q000276:immunology* / Q000469:parasitology
chemical_list: D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan; D017780:Malaria Vaccines; D002809:Chondroitin Sulfates