Department of Biochemistry, Maulana Azad Medical College, New Delhi, India.
Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
J Vector Borne Dis. 2020 Oct-Dec;57(4):285-294. doi: 10.4103/0972-9062.313969.
BACKGROUND & OBJECTIVES: Malaria continues to be a significant public health problem in tropical countries including India; however, there are limited tools to predict occurrence of severe disease due to malaria. This study was designed to evaluate the role of Angiopoietin-1 (Ang-1), Angiopoietin-2 (Ang-2), Vascular endothelial growth factor (VEGF) and Asymmetric Dimethylarginine (ADMA)as disease biomarkers in uncomplicated malaria (UM) and severe malaria (SM).
This is a prospective observational study carried out at All India Institute of Medical Sciences (AIIMS), tertiary referral hospital in New Delhi, India. The study population included patients diagnosed with malaria (Plasmodium falciparum or Plasmodium vivax) either by rapid diagnostic kit test or positive peripheral smear and age more than 12 years. Forty-nine patients (25 with SM, 24 with UM) and 22 controls were recruited. In addition to routine investigations, serum concentrations of Ang-1, Ang-2, VEGF and ADMA were measured using ELISA technique.
We observed Ang-1 serum levels to be significantly lower in patients with severe malaria (7775 pg/ml) compared to uncomplicated malaria (17629 pg/ml) and healthy controls (43472 pg/ml) [p <0.001]. Ang-2 levels were significantly higher in severe malaria (11100 pg/ml) compared to uncomplicated malaria (7315 pg/ml) and healthy controls (3679 pg/ml) (p <0.001). The ratio of Ang-2/Ang-1 was significantly higher in patients with severe malaria. VEGF serum levels was significantly lower in severe malaria (130.36 pg/ml) compared to uncomplicated malaria (317.3 pg/ml). The Ang-1, Ang-2 and VEGF levels were able to differentiate severe malaria from uncomplicated malaria caused by P. vivax but not with P. falciparum.
INTERPRETATION & CONCLUSION: We conclude that Ang-1, Ang-2 and VEGF are markers of disease severity in vivax malaria.
疟疾仍是包括印度在内的热带国家的重大公共卫生问题，但由于疟疾而导致严重疾病的预测工具有限。本研究旨在评估血管生成素-1（Ang-1）、血管生成素-2（Ang-2）、血管内皮生长因子（VEGF）和不对称二甲基精氨酸（ADMA）作为无并发症疟疾（UM）和严重疟疾（SM）疾病生物标志物的作用。
这是在印度新德里的全印度医学科学研究所（AIIMS）进行的一项前瞻性观察性研究。研究人群包括通过快速诊断试剂盒检测或外周血涂片阳性诊断为疟疾（恶性疟原虫或间日疟原虫）且年龄大于 12 岁的患者。共招募了 49 名患者（25 名 SM，24 名 UM）和 22 名对照者。除了常规检查外，还使用 ELISA 技术测量血清中 Ang-1、Ang-2、VEGF 和 ADMA 的浓度。
我们发现，与无并发症疟疾（17629 pg/ml）和健康对照者（43472 pg/ml）相比，严重疟疾患者的血清 Ang-1 水平明显较低（7775 pg/ml）[p<0.001]。与无并发症疟疾（7315 pg/ml）和健康对照者（3679 pg/ml）相比，严重疟疾患者的 Ang-2 水平明显较高（11100 pg/ml）[p<0.001]。严重疟疾患者的 Ang-2/Ang-1 比值明显较高。与无并发症疟疾（317.3 pg/ml）相比，严重疟疾患者的 VEGF 血清水平明显较低（130.36 pg/ml）。Ang-1、Ang-2 和 VEGF 水平能够区分由间日疟原虫引起的严重疟疾和无并发症疟疾，但不能区分由恶性疟原虫引起的严重疟疾和无并发症疟疾。
我们得出结论，Ang-1、Ang-2 和 VEGF 是间日疟严重程度的标志物。
