The immunology and pathogenesis of malaria during pregnancy.
The immunology and pathogenesis of malaria during pregnancy.
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妊娠期疟疾的免疫学和发病机制。
DOI：
10.1007/3-540-29967-x_6
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发表时间：
2005
影响因子：
--
通讯作者：
Duffy,PE
中科院分区：
文献类型：
--
作者：
Beeson,JG;Duffy,PE
疟疾流行地区的妇女在第一次和第二次怀孕期间对疟疾高度敏感，尽管经过多年的接触获得了免疫力。最近的见解提高了我们对恶性疟原虫引起的妊娠疟疾的认识，恶性疟原虫是造成严重疾病和死亡的主要原因。被寄生的红细胞在胎盘血腔中的积聚是母体感染P.恶性疟原虫。胎盘寄生虫表达的表面配体和抗原与其他的不同。恶性疟原虫变异体，促进逃避现有的免疫，并介导粘附到特定的分子，如硫酸软骨素A，在胎盘。多态性和克隆变异体P.由vargenes编码的恶性疟原虫红细胞膜蛋白1在体外与胎盘受体结合，可能是保护性抗体的靶点。免疫细胞（包括巨噬细胞）向胎盘绒毛间隙的强烈浸润以及促炎细胞因子的产生通常是对感染的反应，并且与低出生体重和母体贫血相关。α和β趋化因子的表达可能启动或促进胎盘疟疾期间的这种细胞浸润。针对胎盘结合寄生虫的特异性免疫可以防止感染或在炎性细胞流入之前促进寄生虫的清除，从而避免导致疾病和死亡的级联事件。对P的致病过程知之甚少。vivaxinfections和相应的免疫反应。关于妊娠期疟疾发病机理和免疫学的新知识将越来越多地为开发治疗和预防干预措施以及诊断和监测新工具带来新的机会。
Women in endemic areas become highly susceptible to malaria during first and second pregnancies, despite immunity acquired after years of exposure.Recent insights have advanced our understanding of pregnancymalaria caused byPlasmodium falciparum, which is responsible for the bulk of severe disease and death. Accumulation of parasitized erythrocytes in the blood spaces of the placenta is a key feature of maternal infection withP. falciparum. Placental parasites express surface ligands and antigens that differ from those of otherP. falciparumvariants, facilitating evasion of existing immunity, and mediate adhesion to specific molecules, such as chondroitin sulfate A, in the placenta. The polymorphic and clonally variantP. falciparumerythrocyte membrane protein 1, encoded byvargenes, binds to placental receptors in vitro and may be the target of protective antibodies. An intense infiltration of immune cells, including macrophages, into the placental intervillous spaces, and the production of pro-inflammatory cytokines often occur in response to infection, and are associated with low birth weight and maternal anemia. Expression of α and β chemokines may initiate or facilitate this cellular infiltration during placental malaria. Specific immunity against placental-binding parasites may prevent infection or facilitate clearance of parasites prior to the influx of inflammatory cells, thereby avoiding a cascade of events leading to disease and death. Much less is known about pathogenic processes inP. vivaxinfections, and corresponding immune responses. Emerging knowledge of the pathogenesis and immunology of malaria in pregnancy will increasingly lead to new opportunities for the development of therapeutic and preventive interventions and new tools for diagnosis and monitoring.