Association of IgG reactivity to full-length VAR2CSA-type PfEMP1 with pregnancy outcomes in a malaria endemic region

Abstract

Malaria still represents a burden worldwide and pregnant women are at risk of developing placental malaria, a complication of Plasmodium falciparum infections with sequestration of infected red blood cells in the placenta intervillous space. This complication is associated with placental insufficiency, which leads to adverse outcomes, such as stillbirth, low birth weight, prematurity, and fetal growth restriction. Women living in high-transmission areas with previous exposure to P. falciparum pregnancy-specific antigens might be protected from placental malaria. However, this protection might not be seen in areas of unstable transmission, such as the WHO Regions of the Americas, which account for most of P. vivax cases. Recently, data from Colombia raised questions about the possibility of cross-reactivity between P. falciparum and P. vivax antigens by reporting high levels of VAR2CSA antibodies in non-pregnant individuals. In this regard, data from Brazil are limited and require more detailed investigation. Thus, this study holds significant implications as it aims to investigate the exposure to full-length VAR2CSA-type PfEMP1 antigen related to Plasmodium spp. infection in a highly endemic region of Brazil and its association with placental alterations and pregnancy outcomes using a novel in vitro experimental method. The understanding of the mechanisms involved in the pathogenesis of infection during pregnancy, as a result of this study, will not only contribute to the knowledge of the immunobiology of the disease but also pave the way for the development of new diagnostic, intervention and treatment methodologies, thereby significantly impacting the field of malaria research.