Dietmann Anelia, Helbok Raimund, Lackner Peter, Fischer Marlene, Reindl Markus, Lell Bertrand, Issifou Saadou, Kremsner Peter G, Schmutzhard Erich
Clinical Department of Neurology, Innsbruck Medical University, 6020 Innsbruck, Austria.
J Infect Dis. 2009 Dec 15;200(12):1842-8. doi: 10.1086/648476.
Molecular mechanisms involved in the pathogenesis of severe Plasmodium falciparum malaria-specifically, cerebral malaria-are still unclear. Transforming growth factor beta (TGF-beta) family members are important regulators of inflammation that influence malaria pathogenesis. The soluble form of the auxiliary receptor endoglin (sEng) may play a role in malaria pathogenesis.
Serum levels of sEng were measured using enzyme-linked immunosorbent-assay in Gabonese children with cerebral malaria (n = 7) severe malaria (n = 43), or uncomplicated malaria (n = 43) and were compared with levels in healthy control subjects (n = 25) and in another infectious disease group (n = 8).
Serum sEng levels were higher in patients with cerebral malaria and all patients with severe malaria when compared with levels in patients in the other infection group and the healthy control group. Furthermore, sEng correlated significantly with disease severity. Only 7% of patients with uncomplicated malaria and none of the control patients (patients in the other infection group or the healthy control group) had serum levels higher than 12 ng/mL, whereas this was found in 85.7% of patients with cerebral malaria and 46.5% of patients with severe malaria.
High sEng levels may attenuate anti-inflammatory response resulting in clinical deterioration of patients with P. falciparum malaria. Our results further corroborate the role of the vascular compartment, especially the endothelium, in severe malaria pathogenesis.
恶性疟原虫严重疟疾（尤其是脑型疟疾）发病机制中涉及的分子机制仍不清楚。转化生长因子β（TGF-β）家族成员是影响疟疾发病机制的炎症重要调节因子。辅助受体内皮糖蛋白（sEng）的可溶性形式可能在疟疾发病机制中起作用。
采用酶联免疫吸附测定法测量加蓬患有脑型疟疾（n = 7）、重症疟疾（n = 43）或非复杂性疟疾（n = 43）的儿童血清sEng水平，并与健康对照受试者（n = 25）和另一传染病组（n = 8）的水平进行比较。
与其他感染组患者和健康对照组相比，脑型疟疾患者和所有重症疟疾患者的血清sEng水平更高。此外，sEng与疾病严重程度显著相关。非复杂性疟疾患者中只有7%以及对照患者（其他感染组患者或健康对照组患者）中无一血清水平高于12 ng/mL，而在85.7%的脑型疟疾患者和46.5%的重症疟疾患者中发现有此情况。
高sEng水平可能减弱抗炎反应，导致恶性疟原虫疟疾患者临床病情恶化。我们的结果进一步证实了血管部分，尤其是内皮，在重症疟疾发病机制中的作用。
