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23 January 2017

Anaemia protects children again malaria – and providing iron supplements removes this protective effect, US researchers have reported.

The discovery has implications for how patients, particularly in malaria-endemic countries that lack adequate health services, are treated for iron deficiency, the researchers say.

Writing in EBioMedicine, a team at the University of North Carolina (UNC) at Chapel Hill, USA, have confirmed that iron deficiency anaemia protects children against the blood-stage of Plasmodium falciparum malaria in Africa. Treating the anaemia with iron reverses the protection, the researchers add.

The UNC researchers, who worked with teams from the Medical Research Council Unit in The Gambia, Africa, and the London School of Hygiene & Tropical Medicine, studied the red blood cells of 135 anaemic children aged six months to two years in a malaria-endemic region of The Gambia, where sickle-cell is also common.

The youngsters were given iron via micronutrient powder for 84 days and their red blood cells were analysed at the beginning of the iron supplementation trial, as well as day 49 and day 84.

Previous studies had shown a protective effect from malaria among children with sickle-cell trait. However, during this trial, the team found that on a population-wide basis, anaemia reduced the blood-stage of malaria by 16% while the sickle-cell trait only reduced it by 4%.

“Our finding that anaemia offers greater natural protection against blood-stage malaria infection than sickle-cell trait has led us to formulate the interesting hypothesis that the widespread prevalence of anaemia in people of African descent is a genetic signature of malaria," said lead author Dr Morgan Goheen, of the UNC Department of Microbiology and Immunology.

They found that deficits in invasion and growth for blood stage P. falciparum were reversed when anaemic children received seven weeks of iron supplementation.

The team says their results back up evidence that iron supplementation increases the risk of P. falciparum malaria and also provide support for the use of malaria prophylaxis by iron supplementation programs, especially during the critical, early phases of the erythroid recovery.

Source: Anemia Offers Stronger Protection Than Sickle Cell Trait Against the Erythrocytic Stage of Falciparum Malaria and This Protection Is Reversed by Iron Supplementation EBioMedicine 8 November 2016; doi:10.1016/j.ebiom.2016.11.011

Link: http://www.ebiomedicine.com/article/S2352-3964(16)30515-1/fulltext



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