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Randall LM, Kenangalem E, Lampah DA, Tjitra E, Mwaikambo ED, Handojo T, Piera KA, Zhao ZZ, de Labastida Rivera F, Zhou Y, McSweeney KM, Le L, Amante FH, Haque A, Stanley AC, Woodberry T, Salwati E, Granger DL, Hobbs MR, Price RN, Weinberg JB, Montgomery GW, Anstey NM, Engwerda CR. A study of the TNF/LTA/LTB locus and susceptibility to severe malaria in highland papuan children and adults. Malar J 2010; 9:302. [PMID: 21029472 PMCID: PMC2978234 DOI: 10.1186/1475-2875-9-302] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 10/29/2010] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Severe malaria (SM) syndromes caused by Plasmodium falciparum infection result in major morbidity and mortality each year. However, only a fraction of P. falciparum infections develop into SM, implicating host genetic factors as important determinants of disease outcome. Previous studies indicate that tumour necrosis factor (TNF) and lymphotoxin alpha (LTα) may be important for the development of cerebral malaria (CM) and other SM syndromes. METHODS An extensive analysis was conducted of single nucleotide polymorphisms (SNPs) in the TNF, LTA and LTB genes in highland Papuan children and adults, a population historically unexposed to malaria that has migrated to a malaria endemic region. Generated P-values for SNPs spanning the LTA/TNF/LTB locus were corrected for multiple testing of all the SNPs and haplotype blocks within the region tested through 10,000 permutations. A global P-value of < 0.05 was considered statistically significant. RESULTS No associations between SNPs in the TNF/LTA/LTB locus and susceptibility to SM in highland Papuan children and adults were found. CONCLUSIONS These results support the notion that unique selective pressure on the TNF/LTA/LTB locus in different populations has influenced the contribution of the gene products from this region to SM susceptibility.
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Affiliation(s)
- Louise M Randall
- Queensland Institute of Medical Research and Australian Centre for Vaccine Development, 300 Herston Road, Herston, QLD 4006, Australia
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Randall LM, Kenangalem E, Lampah DA, Tjitra E, Mwaikambo ED, Handojo T, Piera KA, Zhao ZZ, de Labastida Rivera F, Zhou Y, McSweeney KM, Le L, Amante FH, Haque A, Stanley AC, Woodberry T, Salwati E, Granger DL, Hobbs MR, Price RN, Weinberg JB, Montgomery GW, Anstey NM, Engwerda CR. Age-related susceptibility to severe malaria associated with galectin-2 in highland Papuans. J Infect Dis 2010; 202:117-24. [PMID: 20500087 DOI: 10.1086/653125] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Age and host genetics are important determinants of malaria severity. Lymphotoxin-alpha (LTalpha) has been associated with the development of cerebral malaria (CM) and other severe malaria (SM) syndromes. Mutations in genes regulating LTalpha production contribute to other acute vascular diseases and may contribute to malaria pathogenesis. METHODS We tested the association between rs7291467, a single-nucleotide polymorphism (SNP) in the LTalpha-related gene encoding galectin-2 (LGALS2), disease severity, and function in a case-control study of ethnic Highland Papuan adults and children with SM (n = 380) and asymptomatic malaria-exposed controls (n = 356) originating from a non-malaria-endemic region but residing in a lowland malaria-endemic area of Papua, Indonesia. RESULTS The LGALS2 SNP showed a significant association with susceptibility to SM (including CM), in children (odds ratio, 2.02 [95% confidence interval, 1.14-3.57]) but not in adults. In SM, the C allele at rs7291467 was associated with enhanced galectin-2 transcript levels. In a separate group of Tanzanian children originating from a malaria-endemic region, we found preservation of the major ancestral LGALS2 allele and no association with susceptibility to CM. CONCLUSIONS Results suggest differences in the inflammatory contribution to the development of SM between children and adults in the same population and potential differences between individuals originating from malaria-endemic and non-malaria-endemic areas.
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Affiliation(s)
- Louise M Randall
- Queensland Institute of Medical Research and Australian Centre for Vaccine Development, and The University of Queensland, School of Population Health, Herston, Queensland, Australia
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Maguire GP, Anstey NM, Ardian M, Waramori G, Tjitra E, Kenangalem E, Handojo T, Kelly PM. Pulmonary tuberculosis, impaired lung function, disability and quality of life in a high-burden setting. Int J Tuberc Lung Dis 2009; 13:1500-1506. [PMID: 19919767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
SETTING Tuberculosis treatment clinic in Papua, Indonesia. OBJECTIVE To document the impact of pulmonary tuberculosis (PTB) on lung function, exercise tolerance and quality of life (QOL). DESIGN A prospective cohort study of 115 patients with smear-positive PTB followed for 6 months. Demographics, disease history, sputum microbiology, spirometry, 6-minute weight.walk distance (6MWWD) and QOL (modified St George's Respiratory Questionnaire) were measured at diagnosis and at 2 and 6 months. Analysis was restricted to the 69/115 (60%) subjects who attended all follow-up visits. RESULTS Subjects who attended all visits were less likely than the full cohort to be of Papuan ethnicity (P < 0.05), were more likely to be cured (P < 0.001) and had better lung function at diagnosis (P < 0.05). Significant lung function impairment (forced expiratory volume in 1 second [FEV(1)] <60% predicted) was found in 27/69 (39%) at diagnosis. Although this fell during treatment (P < 0.01), 17/69 (24.6%) had persisting significant lung function impairment at treatment completion. As lung function recovered, exercise tolerance (6MWWD) rose by 12.3% (P < 0.001) and QOL improved (P < 0.001). CONCLUSION In a high-burden setting, PTB causes prolonged, significant impairment of lung function, exercise tolerance and QOL. Current measures of disease burden are likely to underestimate the true impact of disease. Earlier diagnosis and disease-modifying treatments may reduce the long-term impact of PTB.
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Affiliation(s)
- G P Maguire
- International Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.
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Anstey NM, Handojo T, Pain MCF, Kenangalem E, Tjitra E, Price RN, Maguire GP. Lung injury in vivax malaria: pathophysiological evidence for pulmonary vascular sequestration and posttreatment alveolar-capillary inflammation. J Infect Dis 2007; 195:589-96. [PMID: 17230420 PMCID: PMC2532499 DOI: 10.1086/510756] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 09/21/2006] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The mechanisms underlying lung injury in vivax malaria are not well understood. Inflammatory responses to Plasmodium falciparum and P. vivax, to our knowledge, have not previously been compared at an organ level. METHODS Respiratory symptoms and physiological aspects were measured longitudinally in Indonesian adults with uncomplicated vivax (n=50) and falciparum (n=50) malaria. Normal values were derived from 109 control subjects. Gas transfer was partitioned into its alveolar-capillary membrane (D(M)) and pulmonary capillary vascular (V(C)) components, to characterize the site and timing of impaired gas transfer. RESULTS Mean baseline V(C) volume was significantly reduced in vivax and falciparum malaria, improving with treatment in each species. Baseline D(M) function was not impaired in either species. The progressive deterioration in D(M) function after treatment was statistically significant in vivax malaria but not in uncomplicated falciparum malaria. Oxygen saturation deteriorated after treatment in vivax but improved in falciparum malaria. CONCLUSIONS The baseline reduction in V(C) volume but not in D(M) function suggests encroachment on V(C) volume by parasitized erythrocytes and suggests that P. vivax-infected erythrocytes may sequester within the pulmonary microvasculature. Progressive alveolar-capillary dysfunction after treatment of vivax malaria is consistent with a greater inflammatory response to a given parasite burden in P. vivax relative to that in P. falciparum.
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Affiliation(s)
- Nicholas M Anstey
- International Health Program, Infectious Diseases Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0811, Australia.
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Handojo T, Anstey N, Kelly P, Pain M, Kenangalem E, Tjitra E, Maguire G. Normal spirometry, gas transfer and lung volume values in Papua, Indonesia. Southeast Asian J Trop Med Public Health 2006; 37:571-7. [PMID: 17120982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Spirometry is an efficient and clinically useful tool in the diagnosis and management of chronic lung disease. It relies on an appreciation of normal lung function that can vary between populations. In order to improve the utility of spirometry, gas transfer and lung volume measures for clinical and research use in Papua, Indonesia, we determined lung function in Papuan and non-Papuan Indonesian adults who did not have evidence of lung disease. A cross-sectional survey of Papuan and non-Papuan Indonesians 18 years or older with no history of chronic cough or recent wheeze was made. Spirometry, gas transfer and total lung capacity (TLC) were determined and regression models developed for normal values. The spirometry values were similar but not directly comparable to similar studies in Papua New Guinea populations. Papuan highland residents demonstrated independently greater values of gas transfer and total lung capacity in comparison to lowland Papuans. Values for lung function in apparent respiratory health were shown to differ between Papuan and non-Papuan Indonesian populations and in comparison to reference values derived from non-indonesian populations. Differences in age-related decline in lung function would suggest that simple proportional correction based on values derived from non-Indonesian populations may be inappropriate and would support the development of similar reference values in other populations. Whether differences seen here are innate or occur as a consequence of in-utero and post-partum environmental exposure remains to be accurately elucidated.
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Affiliation(s)
- Tjandra Handojo
- National Institute of Health Research and Development- Menzies School of Health Research, Timika Research Program, Mitra Masyrakat Hospital, Timika, Papua, Indonesia
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Maguire GP, Handojo T, Pain MCF, Kenangalem E, Price RN, Tjitra E, Anstey NM. Lung injury in uncomplicated and severe falciparum malaria: a longitudinal study in papua, Indonesia. J Infect Dis 2005; 192:1966-74. [PMID: 16267769 PMCID: PMC2566801 DOI: 10.1086/497697] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Accepted: 06/29/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In patients with severe malaria, acute respiratory distress syndrome usually develops after the start of drug treatment and is a major cause of death. Its pathogenesis is not well understood. METHODS Respiratory symptom, spirometry, and gas transfer analyses were performed longitudinally in adults in Papua, Indonesia, with uncomplicated (n=50) and severe (n=30) falciparum malaria; normal values were derived from 109 control subjects. Gas transfer was partitioned into its alveolar-capillary membrane (D(M)) and pulmonary vascular (Vc) components, to characterize the site of impaired gas transfer. RESULTS Cough was frequent in both patients with uncomplicated malaria (50%) and those with severe malaria (30%) and resolved by day 14. Reduced midexpiratory flow indicated obstruction of the small airways. Gas transfer was significantly impaired in patients with severe malaria. D(M) was reduced in patients with severe malaria but not in those with uncomplicated malaria and only returned to normal levels after 2 weeks. In patients with uncomplicated malaria, Vc was reduced at presentation but improved thereafter. In patients with severe malaria, Vc decreased with treatment and was lowest at day 7. CONCLUSIONS Our results suggest that pulmonary vascular occlusion occurs in both patients with uncomplicated malaria and those with severe malaria, likely from sequestration of both red blood cells (RBCs) and white blood cells. There was also impaired alveolar-capillary membrane function in patients with severe malaria but not in those with uncomplicated malaria. Persistent impairment long after clearance of parasitized RBCs suggests prolonged posttreatment inflammatory alveolar-capillary injury.
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Affiliation(s)
- Graeme P. Maguire
- International Health Program, Infectious Diseases Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Present affiliations: Kimberley Health Region, Western Australian Department of Health, Broome, Australia (G.P.M.); International Health Program, Infectious Diseases Division, Menzies School of Health Research, and Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK (R.N.P.)
| | - Tjandra Handojo
- National Institute of Health Research and Development-Menzies School of Health Research Timika Research Program, Mitra Masyrakat Hospital, Mimika District, Timika, Papua, Jakarta, Indonesia
| | - Michael C. F. Pain
- Department of Respiratory Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Enny Kenangalem
- National Institute of Health Research and Development-Menzies School of Health Research Timika Research Program, Mitra Masyrakat Hospital, Mimika District, Timika, Papua, Jakarta, Indonesia
- Ministry of Health, Mimika District, Timika, Papua, Jakarta, Indonesia
| | - Ric N. Price
- International Health Program, Infectious Diseases Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Present affiliations: Kimberley Health Region, Western Australian Department of Health, Broome, Australia (G.P.M.); International Health Program, Infectious Diseases Division, Menzies School of Health Research, and Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK (R.N.P.)
| | - Emiliana Tjitra
- National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Nicholas M. Anstey
- International Health Program, Infectious Diseases Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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