Medicine (RMH) - Theses

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Author: Horne, Kylie × Subject: malaria ×

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    HLA-G and malaria in pregnancy
    Horne, Kylie ( 2011)
    HLA-G is an atypical class I MHC molecule that promotes tolerance and attenuates the immune response. It is highly expressed on the placental cells that invade the maternal tissues, and is one of the ways in which the immune system is modified in pregnancy to allow maternal tolerance of the foetus. The modification of the maternal immune response may also inadvertently promote tolerance of infections in pregnancy, and HLA-G may contribute to this tolerance of infection. Malaria is an infectious disease with high rates of morbidity and mortality globally. The most severe form is caused by the parasite Plasmodium falciparum. In endemic areas it is primarily a disease of children. Immunity is gradually acquired and disease amongst adults is uncommon. However during pregnancy, the high rates of infection return. Malaria in pregnancy is associated with morbidity and mortality for the mother and the foetus. This study is based on the hypothesis that the immune changes in pregnancy that allow maternal tolerance of the foetus may also contribute to the increased rate of malaria in pregnancy. It contributes to the understanding of the pathology of malaria in pregnancy, but also to the knowledge of the immunological response to malaria, of the role of HLA-G in response to infection and how the changes in placental immunology may contribute to other infections in the placenta. This study shows there is an association between HLA-G genotype and Plasmodium falciparum infection in the placenta, that genotype only corresponds with mRNA for a specific pattern of malaria infection in the placenta, and that HLA-G expression correlates with an important consequence of malaria in pregnancy, low birth weight. These findings suggest the hypothesis that placentae that can quickly reduce their HLA-G expression are able to mount a more efficient immune response to the pathogen. Those who have a persistently elevated HLA-G are unable to mount an efficient immune response, and develop a chronic infection. The study also demonstrates a reduction in cytokine response to Plasmodium falciparum in the presence of placental cells, although this is not mediated by HLA-G.