Short Report

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

Vidhan Jain¹ , Shannon McClintock^2,3 , Avinash C Nagpal⁴ , Aditya P Dash⁵ , Jonathan K Stiles⁶ , Venkatachalam Udhayakumar^2,3 , Neeru Singh¹ and Naomi W Lucchi²

¹  National Institute of Malaria Research, Regional Medical Research Center for Tribals, Indian Council of Medical Research, Jabalpur, India

²  Malaria Branch, Division of Parasitic Diseases, National Center for Zoonotic Vector-Borne and Enteric Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

³  Atlanta Research and Education Foundation, Decatur GA, USA

⁴  Netaji Subash Chandra Bose Medical College, Jabalpur, India

⁵  National Institute of Malaria Research, ICMR, New Delhi, India

⁶  Morehouse School of Medicine, Atlanta, GA, USA

author email corresponding author email

BMC Research Notes 2009, 2:36doi:10.1186/1756-0500-2-36

Published:	6 March 2009

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.