Malaria elicits type 1 cytokines in the human placenta: IFN-gamma and TNF-alpha associated with pregnancy outcomes

Pregnant women, especially primigravidas, are highly susceptible to malaria infection, resulting in maternal anemia and low birth weight infants. Because circulating parasitemia is rare in the newborn, the cause of poor fetal outcomes has been unclear. We measured cytokine concentrations in placenta...

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Bibliographic Details
Published in:The Journal of immunology (1950) 1998-03, Vol.160 (5), p.2523-2530
Main Authors: Fried, M, Muga, R O, Misore, A O, Duffy, P E
Format: Article
Language:English
Subjects:
AIDS/HIV
Cytokines - blood
Female
Fetal Blood - immunology
Humans
Infant, Low Birth Weight
Infant, Newborn
Interferon-gamma - biosynthesis
Interferon-gamma - blood
Kenya
Malaria, Falciparum - immunology
Malaria, Falciparum - metabolism
Placenta - immunology
Placenta - metabolism
Placenta - parasitology
Pregnancy
Pregnancy Complications, Hematologic - immunology
Pregnancy Complications, Parasitic - immunology
Th1 Cells - metabolism
Tumor Necrosis Factor-alpha - biosynthesis
Tumor Necrosis Factor-alpha - metabolism
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Summary:Pregnant women, especially primigravidas, are highly susceptible to malaria infection, resulting in maternal anemia and low birth weight infants. Because circulating parasitemia is rare in the newborn, the cause of poor fetal outcomes has been unclear. We measured cytokine concentrations in placentas collected from women delivering in urban hospitals in malaria-holoendemic or nonendemic areas of Kenya. Normal placentas displayed a bias toward type 2 cytokines; type 1 cytokines IFN-gamma and IL-2 were absent in placentas not exposed to malaria but present in a large proportion of placentas from a holoendemic area. TNF-alpha and TGF-beta concentrations were significantly higher, and IL-10 concentrations significantly lower, in placentas from the holoendemic area. Among primigravidas, placental TNF-alpha concentrations were significantly higher in the presence of severe maternal anemia, and both IFN-gamma and TNF-alpha were significantly elevated when a low birth weight, rather than normal weight, infant was delivered. We conclude that maternal malaria decreases IL-10 concentrations and elicits IFN-gamma, IL-2, and TNF-alpha in the placenta, shifting the balance toward type 1 cytokines. This is the first demonstration that these placental cytokine changes are associated with poor pregnancy outcomes in humans.
ISSN:0022-1767
1550-6606
DOI:10.4049/jimmunol.160.5.2523