Placental Malaria and the Plasmodium falciparum Erythrocyte Membrane Protein (VAR2CSA).

Abstract

Malaria is a major global health problem. Pregnant women are susceptible to infection regardless of previously acquired immunity. Placental malaria is caused by parasites sequestered in the placenta. This is mediated by VAR2CSA, a parasite antigen that interacts with chondroitin sulfate A (CSA). The adhesion of infected erythrocytes (IEs) to vascular endothelium or placenta is the key event in the pathogenesis of severe P. falciparum infection. In pregnant women, the parasites express a single and unique member of the P. falciparum erythrocyte membrane protein 1 (PfEMP1) family named VAR2CSA, which is associated with the ability of the IEs to adhere specifically to chondroitin sulphate A (CSA) in the placenta. One vaccine strategy is to block this interaction with VAR2CSA-specific antibodies. The aim of this review is to give an overview of the role of the VAR2CSA, a member of the PfEMP1 family, as the mediator of placental sequestration and as a key target for PAM vaccine development. Diagnosis of placenta malaria includes microscopy of peripheral thick blood film, histidine Rich protien2 (HRP2) and Polymerase chain reaction (PCR). Prevention and control for typical areas of high P. falciparum transmission have promoted the use of anti-malarial chemoprophylaxis to prevent placental infection and its associated adverse perinatal outcome.