Antibodies to variant surface antigens of Plasmodium falciparum-infected erythrocytes and adhesion inhibitory antibodies are associated with placental malaria and have overlapping and distinct targets

J Infect Dis. 2004 Feb 1;189(3):540-51. doi: 10.1086/381186. Epub 2004 Jan 21.


We measured antibodies to chondroitin sulfate A (CSA)-binding and placental Plasmodium falciparum-infected red blood cells (PRBCs) among pregnant women with or without placental malaria. Immunoglobulin G to PRBC surface antigens was rare in uninfected primigravidae (3.7%), more prevalent in infected primigravidae (70%; P<.001), and common in infected (77%) and uninfected (83%) multigravidae. Similar patterns were seen for agglutinating antibodies, and antibodies were similar among women with past or active placental infection. PRBC adhesion to CSA was inhibited 60% by serum from infected primigravidae but 24% by serum from uninfected primigravidae (P=.025), whereas infection did not alter adhesion inhibition by multigravidae (77% inhibition)[corrected]. There was substantial heterogeneity in antibody type and levels. Antibodies did not correlate with parasite density or pregnancy outcome. Comparisons between antibodies suggest that adhesion-inhibitory antibodies and those to PRBC variant antigens have distinct and overlapping epitopes, may be acquired independently, and have different roles in immunity.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Agglutinins / analysis
  • Animals
  • Antibodies, Protozoan / blood*
  • Cell Adhesion / immunology
  • Chondroitin Sulfates / metabolism
  • Erythrocytes / immunology
  • Erythrocytes / metabolism
  • Erythrocytes / parasitology*
  • Female
  • Humans
  • Immunoglobulin G / blood
  • Malaria, Falciparum / blood
  • Malaria, Falciparum / immunology*
  • Male
  • Placenta Diseases / immunology*
  • Placenta Diseases / parasitology
  • Plasmodium falciparum / immunology*
  • Pregnancy
  • Pregnancy Complications, Parasitic / blood
  • Pregnancy Complications, Parasitic / immunology*
  • Pregnancy Trimesters / immunology


  • Agglutinins
  • Antibodies, Protozoan
  • Immunoglobulin G
  • Chondroitin Sulfates