Enhanced virulence of Plasmodium falciparum in blood of diabetic patients

• Published in: PloS one Vol. 16; no. 6; p. e0249666
• Main Authors: Ch'ng, Jun-Hong, Moll, Kirsten, Wyss, Katja, Hammar, Ulf, Rydén, Mikael, Kämpe, Olle, Färnert, Anna, Wahlgren, Mats
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17.06.2021; Public Library of Science (PLoS)
• Subjects: Adult; Biology and Life Sciences; Blood Glucose - metabolism; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - parasitology; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - parasitology; Diabetics; Erythrocytes - parasitology; Female; Glycated Hemoglobin - analysis; Glycated Hemoglobin - metabolism; Health aspects; Humans; Malaria, Falciparum - blood; Malaria, Falciparum - parasitology; Male; Medicin och hälsovetenskap; Medicine and Health Sciences; Middle Aged; Physical Sciences; Plasmodium falciparum; Plasmodium falciparum - pathogenicity; Virulence; Sweden
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0249666

Rising prevalence of diabetes in sub-Saharan Africa, coupled with continued malaria transmission, has resulted more patients dealing with both communicable and non-communicable diseases. We previously reported that travelers with type 2 diabetes mellitus (T2DM) infected with Plasmodium falciparum were three times more likely to develop severe malaria than non-diabetics. Here we explore the biological basis for this by testing blood from uninfected subjects with type 1 and type 2 diabetes, ex vivo, for their effects on parasite growth and rosetting (binding of infected erythrocytes to uninfected erythrocytes). Rosetting was associated with type 2 diabetes, blood glucose and erythrocyte sedimentation rate (ESR), while parasite growth was positively associated with blood glucose, glycated hemoglobin (HbA1c), body mass index (BMI), fibrinogen and triglycerides. This study establishes a link between diabetes and malaria virulence assays, potentially explaining the protective effect of good glycemic control against severe malaria in subjects with diabetes.