Intermittent preventive sulfadoxine-pyrimethamine treatment of primigravidae reduces levels of plasma immunoglobulin G, which protects against pregnancy-associated Plasmodium falciparum malaria
Intermittent preventive sulfadoxine-pyrimethamine treatment of primigravidae reduces levels of plasma immunoglobulin G, which protects against pregnancy-associated Plasmodium falciparum malaria
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DOI：
10.1128/iai.72.9.5027-5030.2004
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发表时间：
2004-09-01
影响因子：
3.1
通讯作者：
Hviid, L
中科院分区：
文献类型：
--
作者：
Staalsoe, T;Shulman, CE;Hviid, L
妊娠相关疟疾（PAM）是孕产妇和新生儿痛苦的一个重要原因。它是由恶性疟原虫引起的，恶性疟原虫能够通过表达对蛋白聚糖如硫酸软骨素A具有亲和力的特定变体表面抗原（VSA）来抑制胎盘。接触胎盘寄生虫后，会产生对PAM的保护性免疫，因此初产妇对PAM特别敏感。PAM的不良后果是可以预防的间歇性预防性治疗（IPTp），其中妇女在怀孕期间在指定的时间间隔给予抗疟药，但这可能会干扰收购的保护性PAM免疫。我们发现，接受磺胺嘧啶-乙胺嘧啶IPTp的肯尼亚孕妇的免疫球蛋白G（IgG）水平显着降低，特异性针对寄生虫编码的VSA类型-称为VSA（PAM）-特异性介导对PAM的保护比接受安慰剂的妇女。VSA（PAM）特异性IgG水平取决于接受的IPTp剂量数量，并且足够低，足以引起多剂量接受者的临床问题。我们的数据表明，IPTp应扩展到所有经产妇女，符合目前世界卫生组织的建议。
Pregnancy-associated malaria (PAM) is an important cause of maternal and neonatal suffering. It is caused by Plasmodium falciparum capable of inhabiting the placenta through expression of particular variant surface antigens (VSA) with affinity for proteoglycans such as chondroitin sulfate A. Protective immunity to PAM develops following exposure to parasites inhabiting the placenta, and primigravidae are therefore particularly susceptible to PAM. The adverse consequences of PAM in primigravidae are preventable by intermittent preventive treatment (IPTp), where women are given antimalarials at specified intervals during pregnancy, but this may interfere with acquisition of protective PAM immunity. We found that Kenyan primigravidae receiving sulfadoxine-pyrimethamine IPTp had significantly lower levels of immunoglobulin G (IgG) with specificity for the type of parasite-encoded VSA-called VSA(PAM)-that specifically mediate protection against PAM than did women receiving a placebo. VSA(PAM)-specific IgG levels depended on the number of IPTp doses received and were sufficiently low to be of clinical concern among multidose recipients. Our data suggest that IPTp should be extended to women of all parities, in line with current World Health Organization recommendations.