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Publication Open Access Activation of nuclear factor kappa B in peripheral blood mononuclear cells from malaria patients(2012-06-10) Chuchard Punsawad; ชูชาติ พันธ์สวัสดิ์; Srivicha Krudsood; ศรีวิชา ครุฑสูตร; Yaowapa Maneerat; เยาวพา มณีรัตน์; Urai Chaisri; อุไร ไชยศรี; Noppadon Tangpukdee; นพดล ตั้งภักดี; Emsri Pongponratn; เอี่ยมศรี พงศ์พนรัตน์; Kwannan Nantavisai; Rachanee Udomsangpetch; รัชนีย์ อุดมแสงเพ็ชร; Parnpen Viriyavejakul; พรรณเพ็ญ วิริยเวชกุล; Parnpen Viriyavejakul; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Pathology; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene; Mahidol University. Faculty of Tropical Medicine. Department of Clinical Tropical Medicine; Mahidol University. Faculty of Science. Department of Pathobiology.of IL-10 and TNF were measured by using enzyme-linked immunosorbent assay (ELISA). The immunofluorescence technique was used to determine NF-κB nuclear translocation. RESULTS: At admission, patients with P. vivax and uncomplicated P. falciparum hadPublication Open Access A potential role for interleukin‑33 and γ‑epithelium sodium channel in the pathogenesis of human malaria associated lung injury(2015) Sumate Ampawong; Urai Chaisri; Parnpen Viriyavejakul; Panote Prapansilp; Grau, Georges E; Turner, Gareth D. H.; Emsri Pongponratn; Mahidol University. Faculty of Tropical Medicine. Department of Tropical PathologyBackground: The pathogenesis of pulmonary oedema (PE) in patients with severe malaria is still unclear. It has been hypothesized that lung injury depends, in addition to microvascular obstruction, on an increased pulmonary capillary pressure and altered alveolar-capillary membrane permeability, causing pulmonary fluid accumulation. Methods: This study compared the histopathological features of lung injury in Southeast Asian patients (n = 43) who died from severe Plasmodium falciparum malaria, and correlated these with clinical history in groups with or without PE. To investigate the expression of mediators that may influence fluid accumulation in PE, immunohistochemistry and image analysis were performed on controls and sub-sets of patient with or without PE. Results: The expression of leukocyte sub-set antigens, bronchial interleukin (IL)-33, γ-epithelium sodium channel (ENaC), aquaporin (AQP)-1 and -5, and control cytokeratin staining was quantified in the lung tissue of severe malaria patients. Bronchial IL-33 expression was significantly increased in severe malaria patients with PE. Malaria patients with shock showed significantly increased bronchial IL-33 compare to other clinical manifestations. Bronchial IL-33 levels were positively correlated with CD68+ monocyte and elastase + neutrophil, septal congestion and hyaline membrane formation. Moreover, the expression of both vascular smooth muscle cell (VSMC) and bronchial γ-ENaC significantly decreased in severe malaria patients with PE. Both VSMC and bronchial γ-ENaC were negatively correlated with the degree of parasitized erythrocyte sequestration, alveolar thickness, alveolar expansion score, septal congestion score, and malarial pigment score. In contrast AQP-1 and -5 and pan cytokeratin levels were similar between groups. Conclusions: The results suggest that IL-33 may play a role in lung injury during severe malaria and lead to PE. Both VSMC and bronchial γ-ENaC downregulation may explain pulmonary fluid disturbances and participate in PE pathogenesis in severe malaria patients.Publication Open Access A morphometric and histological study of placental malaria shows significant changes to villous architecture in both Plasmodium falciparum and Plasmodium vivax infection(2014-01-04) Sethawud Chaikitgosiyakul; เสฏฐวุฒิ ชัยกิตโกสิยกุล; Rijken, Marcus J.; Muehlenbachs, Atis; Lee, Sue J.; Urai Chaisri; อุไร ไชยศรี; Parnpen Viriyavejakul; พรรณเพ็ญ วิริยเวชกุล; Turner, Gareth D.; Emsri Pongponratn; เอี่ยมศรี พงศ์พนรัตน์; Nosten, Francois; McGready, Rose; Mahidol University. Faculty of Tropical Medicine. Mahidol-Oxford Research Unit; Mahidol University. Faculty of Tropical Medicine. Department of Tropical PathologyBACKGROUND: Malaria in pregnancy remains a major health problem. Placental malaria infection may cause pathophysiological changes in pregnancy and result in morphological changes to placental villi. Quantitative histomorphological image analysis of placental biopsies was performed to compare placental villous architecture between active or treated placental malaria cases and controls. METHODS: A total of 67 placentas were studied from three clinical groups: control patients who did not have malaria (n = 27), active (n = 14) and treated (n=26) malaria cases, including both Plasmodium falciparum and Plasmodium vivax infections. Image analysis of histological placental sections was performed using ImageJ software to measure the number and size (area) of terminal villi, perimeter measurement per villus and total perimeter per unit area, and number of capillaries per villus (vascularity). Histological features of placental malaria were scored and these results were correlated with malaria status and clinical outcomes. RESULTS: Villous size correlated with vascularity (p <0.0001) but was inversely correlated with observed villi per unit area, (p = 0.0001). Significantly greater villous area and vascularity was observed in UK controls. Indices of histological malaria infection were significantly greater in active versus treated malaria cases. Active placental malaria cases showed significantly smaller villous area (p <0.0084), vascularity (p <0.0139) and perimeter (p <0.0006) than treated malaria cases or controls, but significantly more villi per unit area (p <0.0001). Villous size in treated malaria cases was significantly larger than active placental malaria cases (p <0.001) and similar to controls. There was a significant relationship between villous number and anaemia at the time of infection (p <0.0034), but not placental weight, birth weight or gestational age at delivery. No differences were found between histology or villous morphology comparing infections with P. falciparum or P. vivax. CONCLUSIONS: These results imply that villous size, perimeter and vascularity are acutely decreased during active placental malaria, decreasing the surface area available for gas exchange per villus. However the increased number of villi per unit area offsets this change and persists after treatment. Histopathological and villous architectural changes may be reversed by early detection and appropriate anti-malarial treatment.