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Kotepui KU, Mahittikorn A, Wilairatana P, Masangkay FR, Kotepui M. Association between Plasmodium Infection and Nitric Oxide Levels: A Systematic Review and Meta-Analysis. Antioxidants (Basel) 2023; 12:1868. [PMID: 37891947 PMCID: PMC10604424 DOI: 10.3390/antiox12101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Nitric oxide (NO) has been implicated in the pathology of malaria. This systematic review and meta-analysis describe the association between NO levels and malaria. Embase, Ovid, PubMed, Scopus, and Google Scholar were searched to identify studies evaluating NO levels in malaria patients and uninfected controls. Meta-regression and subgroup analyses were conducted to discern differences in NO levels between the groups. Of the 4517 records identified, 21 studies were included in the systematic review and meta-analysis. The findings illustrated significant disparities in NO levels based on geographic location and study time frames. Despite the fluctuations, such as higher NO levels in adults compared to children, no significant differences in mean NO levels between patients and uninfected controls (p = 0.25, Hedge's g: 0.35, 95% confidence interval (CI): -0.25-0.96, I2: 97.39%) or between severe and non-severe malaria cases (p = 0.09, Hedge's g: 0.71, 95% CI: -0.11-1.54, I2: 96.07%) were detected. The systematic review and meta-analysis highlighted inconsistencies in NO levels in malaria patients. Given the high heterogeneity of the results, further studies using standardized metrics for NO measurements and focusing on biochemical pathways dictating NO responses in malaria are imperative to understand the association between NO and malaria.
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Affiliation(s)
- Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat 80160, Thailand;
| | - Aongart Mahittikorn
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | | | - Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat 80160, Thailand;
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Alteration of Blood Lactate Levels in Severe Falciparum Malaria: A Systematic Review and Meta-Analysis. BIOLOGY 2021; 10:biology10111085. [PMID: 34827078 PMCID: PMC8614809 DOI: 10.3390/biology10111085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022]
Abstract
Simple Summary Alteration of blood lactate levels in patients with severe falciparum malaria is well recognized. However, data on blood lactate in literatures were based on a limited number of participants. The present systematic review aimed to collate the blood lactate levels recorded in the literature and used a metaanalysis approach to pool the evidence in a larger sample size than that used in the individual studies to determine the trend. Results from this study will provide the pooled evidence of blood lactate levels in patients with severe malaria for further studies that identifying patients with a high risk of developing severe malaria or death. Abstract Metabolic acidosis in severe malaria usually occurs in the form of lactic acidosis. The present study aimed to collate articles from the literature that have reported blood lactate levels in patients with severe malaria and tested the hypothesis that blood lactate levels are elevated in patients with malaria compared to those with uncomplicated malaria. Moreover, the difference in lactate levels between patients who died and those who survived was estimated using a meta-analytic approach. Potentially relevant studies were searched for in PubMed, Web of Science, and Scopus. The quality of the included studies was assessed using the Jadad scale and strengthening the reporting of observational studies in epidemiology (STROBE). The pooled mean blood lactate in patients with severe malaria, the pooled weighted mean difference (WMD) of blood lactate between patients with severe malaria and those with uncomplicated malaria, and the pooled WMD and 95% CI of blood lactate between patients who died from and those who survived severe malaria were estimated using the random-effects model. Heterogeneity among the outcomes of the included studies was assessed using Cochran’s Q and I2 statistics. A meta-regression analysis was performed to identify the source(s) of heterogeneity of outcomes among the included studies. A subgroup analysis was further performed to separately analyze the outcomes stratified by the probable source(s) of heterogeneity. Publication bias was assessed by the visual inspection of the funnel plot asymmetry. Of 793 studies retrieved from the searches, 30 studies were included in qualitative and quantitative syntheses. The pooled mean lactate in patients with severe malaria was 5.04 mM (95% CI: 4.44–5.64; I2: 99.9%; n = 30,202 cases from 30 studies). The mean lactate in patients with severe malaria (1568 cases) was higher than in those with uncomplicated malaria (1693 cases) (p = 0.003; MD: 2.46; 95% CI: 0.85–4.07; I2: 100%; nine studies). The mean lactate in patients with severe malaria who died (272 cases) was higher than in those with severe malaria who survived (1370 cases) (p < 0.001; MD: 2.74; 95% CI: 1.74–3.75; I2: 95.8%; six studies). In conclusion, the present study showed a high mean difference in blood lactate level between patients with severe malaria and patients with uncomplicated malaria. In addition, there was a high mean difference in blood lactate level between patients with severe malaria who died compared to those with severe malaria who survived. Further studies are needed to investigate the prognostic value of blood lactate levels to identify patients who are at high risk of developing severe malaria or dying.
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Boldt ABW, van Tong H, Grobusch MP, Kalmbach Y, Dzeing Ella A, Kombila M, Meyer CG, Kun JFJ, Kremsner PG, Velavan TP. The blood transcriptome of childhood malaria. EBioMedicine 2019; 40:614-625. [PMID: 30638864 PMCID: PMC6412103 DOI: 10.1016/j.ebiom.2018.12.055] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 12/29/2022] Open
Abstract
Background Transcriptomic research of blood cell lineages supports the understanding of distinct features of the immunopathology in human malaria. Methods We used microarray hybridization, validated by real-time RT-PCR to analyze whole blood gene expression in healthy Gabonese children and children with various conditions of Plasmodium falciparum infection, including i) asymptomatic infection, ii) uncomplicated malaria, iii) malaria associated with severe anemia and iv) cerebral malaria. Findings Our data indicate that the expression profile of 22 genes significantly differed among the investigated groups. Immunoglobulin production, complement regulation and IFN beta signaling, in particular IRF7 and ISRE binding signatures in the corresponding genes, were most conspicuous. Down-regulation in cerebral malaria seems to rely on AhRF, GABP and HIF1 hypoxia transcription factors. ARG1, BPI, CD163, IFI27, HP and TNFAIP6 transcript levels correlated positively with lactatemia, and negatively with hemoglobin concentrations. Interpretation Differences in gene expression profile reflect distinct immunopathological mechanisms of P. falciparum infection. They emerge as potential prognostic markers for early therapeutic measures and need to be validated further. Fund This work was supported by a grant of the NGFN (Nationales Genomforschungsnetz 01GS0114) and by a CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil) PhD scholarship for A. B. W. Boldt. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Affiliation(s)
- Angelica B W Boldt
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; Laboratory of Human Molecular Genetics, Department of Genetics, Universidade Federal do Paraná, Curitiba, Brazil.
| | - Hoang van Tong
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi, Viet Nam
| | - Martin P Grobusch
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; Center of Medical Research Lambaréné, Lambaréné, Gabon; Center of Travel Medicine and Tropical Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, Amsterdam University Medical Centers, the Netherlands
| | - Yvonne Kalmbach
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Arnaud Dzeing Ella
- Department of Parasitology, Tropical Medicine and Mycology, University of Libreville, Libreville, Gabon
| | - Maryvonne Kombila
- Department of Parasitology, Tropical Medicine and Mycology, University of Libreville, Libreville, Gabon
| | - Christian G Meyer
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; Vietnamese-German Center for Medical Research, Hanoi, Viet Nam; Duy Tan University, Da Nang, Viet Nam
| | - Jürgen F J Kun
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Peter G Kremsner
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; Center of Medical Research Lambaréné, Lambaréné, Gabon
| | - Thirumalaisamy P Velavan
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; Vietnamese-German Center for Medical Research, Hanoi, Viet Nam; Duy Tan University, Da Nang, Viet Nam.
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Diouf S, Folquet M, Mbofung K, Ndiaye O, Brou K, Dupont C, N'dri D, Vuillerod M, Azaïs-Braesco V, Tetanye E. [Prevalence and determinants of anemia in young children in French-speaking Africa. Role of iron deficiency]. Arch Pediatr 2015; 22:1188-97. [PMID: 26433575 DOI: 10.1016/j.arcped.2015.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 05/22/2015] [Accepted: 08/21/2015] [Indexed: 02/05/2023]
Abstract
Anemia and iron deficiency are major public health issues worldwide and particularly in Africa. Reliable information about their prevalence and associated factors is required to allow for effective actions. In this study, we used data from recent (2006-2012) large population health surveys, carried out in 11 French-speaking African countries (Benin, Burkina Faso, Cameroon, Congo Brazzaville, Ivory Coast, Gabon, Guinea, Mali, Niger, Democratic Republic of Congo, and Senegal). Hemoglobin (Hb) was assessed and demographic and health-related parameters were obtained from nation-representative samples of children aged 6-59 months. Anemia (Hb<11g/dL) was found in 72.4% of the children (60.2-87.8%), with no gender difference but a slightly lower incidence in older children (62% at age 4-5 years versus 85% at age 9 months), especially for the more severe forms (2.1% versus 8.7%, respectively). Anemia was only slightly but significantly affected by location (75.5% in rural areas versus 67.3% in towns), income (79.8% in lower quintile of income versus 62.3% in higher quintile), or maternal education (74.1% in children from non-educated mothers versus 62.4% in children whose mothers had secondary education). Nearly 50% of women of child-bearing age had anemia. In the countries that report this information, less than 50% (17-65%) of children consumed iron-rich foods regularly and only 12% (7.4-20.5%) received iron supplementation. Infection and parasitism are known to affect some markers of iron status, because of the inflammatory reaction, thereby making the diagnosis of iron deficiency difficult. In the study countries, acute respiratory diseases and diarrhea affected 6.2 and 15.6% of children aged between 6 and 59 months, respectively; their distribution according to age and location is very different from the one of anemia, which is also the case for the distribution of malaria. It is thus likely that a large part of the anemia observed in young children is due to iron deficiency, although further research is needed to confirm this. This fully justifies the nationwide programs of iron fortification of flour, currently undergoing in most countries of French-speaking Africa. Their formal evaluation is still pending but the initial data suggest some efficacy, although far from optimal. It is thus likely that a more holistic approach, including iron fortification, actions against undernutrition and parasitism in children, and actions in favor of improving young women's iron and nutritional status, together with appropriate communication and education objectives, would be more effective.
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Affiliation(s)
- S Diouf
- Institut de pédiatrie, université Cheikh Anta Diop, BP 5593, Dakar, Sénégal
| | - M Folquet
- Service de pédiatrie, CHU Cocody, université Houphouet Boigny, 25 BP 567, Abidjan 25, Côte d'Ivoire
| | - K Mbofung
- Biochimie et nutrition humaine, université de Bamenda, BP 516, Bamenda, Cameroun
| | - O Ndiaye
- Service de pédiatrie et néonatologie, CHU Abass Ndao, université Cheikh Anta Diop, BP 15872, Dakar, Sénégal
| | - K Brou
- Laboratoire de nutrition et sécurité alimentaire, université Nangui Abrogoua, 02 BP 801, Abidjan 02, Côte d'Ivoire
| | - C Dupont
- Service des explorations digestives et fonctionnelles, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - D N'dri
- Recherche et développement, Danone Nutricia Africa & Overseas - Cocody, 2, plateaux Valllons, 28 BP 651, Abidjan, Côte d'Ivoire
| | - M Vuillerod
- Danone Nutricia Africa & Overseas, 383, rue Philippe-Héron, 69653 Villefranche-sur-Saône cedex, France
| | - V Azaïs-Braesco
- VAB-nutrition, 1, rue Claude-Danziger, 63100 Clermont-Ferrand, France.
| | - E Tetanye
- Université de Yaoundé, BP 2036, Yaoundé, Cameroun
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