VAR2CSA Serology to Detect Plasmodium falciparum Transmission Patterns in Pregnancy
Ana Maria Fonseca, Raquel González, Azucena Bardají, Chenjerai Jairoce, Maria Rupérez, Alfons Jiménez, Llorenç Quintó, Pau Cisteró, Anifa Vala, Charfudin Sacoor, Himanshu Gupta, Jennifer Hegewisch-Taylor, Joe Brew, Nicaise Tuikue Ndam, Simon Kariuki, Marta López, Carlota Dobaño, Chetan E. Chitnis, Peter Ouma, Michael Ramharter, Salim Abdulla, John J. Aponte, Achille Massougbodji, Valerie Briand, Ghyslain Mombo-Ngoma, Meghna Desai, Michel Cot, Arsenio Nhacolo, Esperança Sevene, Eusebio Macete, Clara Menéndez, and Alfredo Mayor
Author affiliations: ISGlobal, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain (A.M. Fonseca, R. González, A. Bardají, M. Rupérez, A. Jiménez, L. Quintó, P. Cisteró, H. Gupta, J. Hegewisch-Taylor, J. Brew, C. Dobaño, J.J. Aponte, C. Menéndez, A. Mayor); ICBAS–Universidade do Porto, Porto, Portugal (A.M. Fonseca); Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique (R. González, A. Bardají, C. Jairoce, M. Rupérez, A. Vala, C. Sacoor, C. Dobaño, J.J. Aponte, A. Nhacolo, E. Sevene, E. Macete, C. Menéndez, A. Mayor); Universidade Eduardo Mondlane, Maputo (E. Sevene); CIBER Epidemiología y Salud Pública, Madrid, Spain (R. González, A. Jiménez, A. Mayor, A. Bardají); Université d’Aboméy Calavi, Cotonou, Benin (N.T. Ndam, A. Massougbodji); Kenya Medical Research Institute, Kisumu, Kenya (S. Kariuki, P. Ouma); BCNatal–Barcelona Center for Maternal-Fetal and Neonatal Medicine–Hospital Clínic and Hospital Sant Joan de Deu, Barcelona (M. López); Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (J. Brew); MERIT, Institut de Recherche pour le Développement, Paris, France (N.T. Ndam, V. Briand, M. Cot); Institut Pasteur, Paris (C.E. Chitnis); Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany (G. Mombo-Ngoma); Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany (M. Ramharter, G. Mombo-Ngoma); University Medical Center Hamburg-Eppendorf, Hamburg (M. Ramharter); Ifakara Health Institute, Dar es Salaam, Tanzania (S. Abdulla); Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon (G. Mombo-Ngoma); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M. Desai)
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Figure 2
Figure 2. IgG responses during pregnancy against selected VAR2CSA antigens and polymorphism in target sequences in serologic study of Plasmodium falciparum in pregnant women. A) P. falciparum prevalence by quantitative PCR (qPCR) in 239 pregnant women from Mozambique at recruitment, second administration of IPTp, and delivery. Cumulative prevalence at delivery refers to peripheral or placental infection detected by microscopy, qPCR, or histology at any time point. B) Ratio of nMFIs at delivery in women from Mozambique infected during pregnancy compared with uninfected women. Error bars indicate 95% CIs. C) Seroprevalence at delivery, showing the cumulative prevalence of infection during pregnancy (red dashed line) and the prevalence at delivery by qPCR (light blue line). D) Ratio of nMFIs at delivery in multigravid compared with primigravid women, adjusted by IPTp, parity, age, and HIV status. Error bars indicate 95% CIs. E) IgG dynamics during pregnancy with estimates of time to double (T2x) and half-life (T1/2) obtained from linear mixed-effect regression model. Red points represent P. falciparum infection, dark gray lines the seropositivity cutoff, red lines the fitted-estimation, and dashed lines the 95% CI. F) Space-feeling representation of DBL1X-ID1 showing p5 (blue) and p8 (red). G) Logo representation of p5 and p8 sequences obtained from 50 P. falciparum isolates (20 from Mozambique, 10 from Benin, 10 from Gabon, and 10 from Kenya). IPTp, intermittent preventive treatment during pregnancy; nMFI, normalized median fluorescent intensity.
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