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. 2009 Mar 6:2:36.
doi: 10.1186/1756-0500-2-36.

Macrophage migration inhibitory factor is associated with mortality in cerebral malaria patients in India

Vidhan Jain  1 , Shannon McClintock, Avinash C Nagpal, Aditya P Dash, Jonathan K Stiles, Venkatachalam Udhayakumar, Neeru Singh, Naomi W Lucchi
Affiliations

Macrophage migration inhibitory factor is associated with mortality in cerebral malaria patients in India

Vidhan Jain et al. BMC Res Notes. .

Abstract

Background: Macrophage migration inhibitory factor (MIF) is a multifunctional cytokine implicated in the pathogenesis of a number of human diseases including inflammatory neurological diseases. Its role in the pathogenesis of cerebral malaria is unknown. Cerebral malaria is a life-threatening complication of falciparum malaria with approximately 20%-30% of patients dying despite appropriate anti-malarial treatment. The reason for this cerebral malaria mortality is still unknown although host proinflammatory factors have been shown to be evidently important. The current study investigated the role of circulating MIF in the pathogenesis and outcomes of cerebral malaria.

Findings: Three categories of subjects contributed to this study: healthy controls subjects, mild malaria patients, and cerebral malaria patients. The cerebral malaria patients were further grouped into cerebral malaria survivors and cerebral malaria non-survivors. MIF levels in the peripheral blood plasma, obtained at the time of enrollment, were measured using standard ELISA methods. In logistic regression on cerebral malaria patients, log MIF levels were found to be significantly associated with fatal outcome (odds ratio 4.0; 95%CI 1.6, 9.8; p = 0.003). In multinomial logistic regression log MIF levels were found to be significantly associated with patient category (p = 0.004).

Conclusion: This study suggests that elevated levels of MIF in the peripheral blood of cerebral malaria patients may be associated with fatal outcomes.

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Figures

Figure 1
Figure 1
Peripheral blood MIF levels in different groups of patients. The log median values of plasma levels of MIF in healthy controls (HC, n = 23), mild malaria patients (MM, n = 47), cerebral malaria survivors (CMS, n = 54) and cerebral malaria non-survivors (CMNS, n = 14) are plotted as box plot with 25th- and 75th-percentile values represented by the bottom and top edges of boxes. Small filled diamonds indicate values that fall outside of the error bars. Differences were not significant after Bonferroni correction at alpha 0.008.
Figure 2
Figure 2
MIF levels are associated with different disease outcomes. The results from a multinomial logistic regression analysis are reported. The odds ratios of disease outcomes were plotted against log MIF levels. The different lines represent comparisons of the disease category to the reference healthy control (HC) group, as indicated in the figure legend. A horizontal reference line was drawn at odds ratio of 1 at which point there is a difference between a harmful and a protective factor. It is noted that the odds ratios in each of these three comparisons cross the null value of 1 at a log MIF value of approximately 10.8 (arrow).
See this image and copyright information in PMC

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