Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America.
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Sci Rep. 2019 Dec 12;9(1):18965. doi: 10.1038/s41598-019-55377-3.
Severe malarial anaemia (SMA) is the most common life-threatening complication of Plasmodium falciparum infection in African children. SMA is characterised by haemolysis and inadequate erythropoiesis, and is associated with dysregulated inflammatory responses and reduced complement regulatory protein levels (including CD35). However, a deeper mechanistic understanding of the pathogenesis requires improved animal models. In this comparative study of two closely related macaque species, we interrogated potential causal factors for their differential and temporal relationships to onset of SMA. We found that rhesus macaques inoculated with blood-stage Plasmodium coatneyi developed SMA within 2 weeks, with no other severe outcomes, whereas infected cynomolgus macaques experienced only mild/ moderate anaemia. The abrupt drop in haematocrit in rhesus was accompanied by consumption of haptoglobin (haemolysis) and poor reticulocyte production. Rhesus developed a greater inflammatory response than cynomolgus macaques, and had lower baseline levels of CD35 on red blood cells (RBCs) leading to a significant reduction in the proportion of CD35 RBCs during infection. Overall, severe anaemia in rhesus macaques infected with P. coatneyi has similar features to SMA in children. Our comparisons are consistent with an association of low baseline CD35 levels on RBCs and of early inflammatory responses with the pathogenesis of SMA.
严重疟疾性贫血(SMA)是非洲儿童感染恶性疟原虫最常见的危及生命的并发症。SMA 的特征是溶血和红细胞生成不足,并与失调的炎症反应和补体调节蛋白水平降低(包括 CD35)有关。然而,要更深入地了解发病机制,需要改进动物模型。在这项对两种密切相关的猕猴物种的比较研究中,我们研究了导致它们对 SMA 发病的差异和时间关系的潜在因果因素。我们发现,接种疟原虫 coatneyi 血期的恒河猴在 2 周内出现 SMA,没有其他严重后果,而感染的食蟹猴仅出现轻度/中度贫血。恒河猴的血细胞比容急剧下降伴随着触珠蛋白(溶血)的消耗和网织红细胞生成不良。恒河猴比食蟹猴产生更大的炎症反应,并且 RBC 上的 CD35 基线水平较低,导致感染过程中 CD35 RBC 的比例显著降低。总体而言,感染疟原虫 coatneyi 的恒河猴严重贫血具有与儿童 SMA 相似的特征。我们的比较结果与 RBC 上低基线 CD35 水平和早期炎症反应与 SMA 发病机制有关。