Plasma Soluble Progenitor Cell Receptors as Biomarkers for Severe Anemia Among Malaria-Infected Pediatrics: A Prospective Study in Ghana.

BACKGROUND

Soluble forms of progenitor cell receptors may be implicated in the delayed erythropoietic response during severe anemia. In this study, plasma levels of soluble erythropoietin receptor (sEPO-R) and soluble granulocyte, macrophage-colony stimulating factor receptor (sGM-CSFR) were assessed in Plasmodium falciparum-infected children in Ghana.

METHODS

This case-control study was conducted at Tamale Teaching Hospital, Ghana. One hundred and twenty P. falciparum-infected, and 60 uninfected children aged 12-144 months were recruited from April to July, 2023. About 4 mL of blood was collected for malaria microscopy, full blood count using a haematology analyser, and sEPO-R, sGM-CSFR and erythropoietin (EPO) estimation using enzyme-linked immunosorbent assays. Data were analyzed using SPSS version 26.0.

RESULTS

Plasma levels of sEPO-R were higher among participants with severe malarial anemia (SMA) than those in the non-SMA and control groups (p < 0.001). Plasma sGM-CSFR levels were higher in P. falciparum-infected children than in controls, but the levels were similar between the SMA and non-SMA groups. Hemoglobin (r = -0.823, p < 0.001), RBC (r = -0.852, p < 0.001), HCT (r = -0.790, p < 0.001) and platelets (r = -0.810, p < 0.001) negatively correlated with sEPO-R. There was a strong positive correlation between sEPO-R and EPO in P. falciparum-infected children (r = 0.901, p < 0.001). Plasma sEPO-R better predicted severe anemia among malaria-infected children (cut-off point: 161.5 pg/mL, sensitivity: 96.0%, specificity: 82.9%, AUC: 0.964, p < 0.001).

CONCLUSION

P. falciparum-infected children had higher plasma levels of sGM-CSFR, sEPO-R and EPO. Plasma sEPO-R correlated negatively with erythrocyte parameters, suggesting a possible contribution of the endogenous receptor to the development of severe anemia in children with malaria. Further studies to investigate the neutralizing effects of sEPO-R on erythropoietic response during malaria are recommended.