title: Submicroscopic infection of placenta by Plasmodium produces Th1/Th2 cytokine imbalance, inflammation and hypoxia in women from north-west Colombia.
abstract: BACKGROUND
  A large-scale study was set up in order to study the epidemiology, clinical aspects, and immunopathology of gestational and placental malaria in north-west Colombia. In this region, recent reports using a qPCR technique, confirmed frequencies of infection, by Plasmodium falciparum or Plasmodium vivax, up to 45%. Given the high rates of infection observed both in mother and placenta, a first exploratory study was proposed in order to characterize the effect on the inflammation status, tissue damage and hypoxia in Plasmodium spp. infected placentas.
  
  
  METHODS
  A descriptive, prospective, cross-sectional design was applied to pregnant women with (PM+) and without (PM-) placental malaria. Messenger RNA expression of Fas, FasL; COX-1, COX-2, HIF, VEGF, and the cytokines IL-2, IL-4, IL-10, IFN-γ and TNF, were measured in peripheral and placental blood using a quantitative PCR. The percentage of apoptotic cells was determined with a TUNEL assay.
  
  
  RESULTS
  In total 50 placentas were studied: 25 were positive for submicroscopic infection and 25 were negative for Plasmodium infection. Expression of IL-4 and IL-10 was observed high in placental tissue of PM+, while IL-2 was high in peripheral blood of the same group. Expression of TNF and IFNγ in peripheral blood of the PM + group was high. Similarly, the apoptotic index and Fas expression were significantly high in PM+. However, FasL expression was observed low in PM + compared to PM-. Inflammation markers (HIF, VEGF) and hypoxia markers (COX-1, COX-2) were high in the PM + group.
  
  
  CONCLUSIONS
  During placental malaria expression of some pro-inflammatory cytokines is up-regulated and markers of hypoxia and tissue damage are increased in cases of submicroscopic infection.
authors.forename: Olga M
authors.initials: OM
authors.lastname: Agudelo
authors.forename: Beatriz H
authors.initials: BH
authors.lastname: Aristizabal
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Yanow
authors.forename: Eliana
authors.initials: E
authors.lastname: Arango
authors.forename: Jaime
authors.initials: J
authors.lastname: Carmona-Fonseca
authors.affiliation: Grupo "Salud y Comunidad-César Uribe Piedrahita", Universidad de Antioquia, Medellin, Colombia. aemaestre@gmail.com.
authors.forename: Amanda
authors.initials: A
authors.lastname: Maestre
mesh_terms: D000293:Adolescent; D000328:Adult; D017209:Apoptosis; D003105:Colombia; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000469:parasitology / Q000503:physiopathology; D007249:Inflammation / Q000469:parasitology / Q000503:physiopathology; D016778:Malaria, Falciparum / Q000097:blood / Q000469:parasitology / Q000503:physiopathology*; D016780:Malaria, Vivax / Q000097:blood / Q000469:parasitology / Q000503:physiopathology*; D010920:Placenta / Q000469:parasitology / Q000503:physiopathology*; D010963:Plasmodium falciparum / Q000302:isolation & purification; D010966:Plasmodium vivax / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000097:blood / Q000469:parasitology / Q000503:physiopathology*; D011446:Prospective Studies; D058408:Th1-Th2 Balance; D055815:Young Adult
chemical_list: D016207:Cytokines