Platelet disturbances correlate with endothelial cell activation in uncomplicated Plasmodium vivax malaria

Abstract

Introduction. Platelets drive endothelial cell activation in many diseases. However, if this occurs in Plasmodium vivax malaria is unclear. As platelets have been reported to be activated and to play a role in inflammatory response during malaria, we hypothesized that this would correlate with endothelial alterations during acute illness. Methods. We performed platelet flow cytometry of PAC-1 and P-selectin. We measured Platelet markers (CXCL4, CD40L, P-selectin, Thrombopoietin, IL-11) and endothelial markers (ICAM-1, von Willebrand Factor and E-selectin) in plasma with a multiplex-based assay. The values of each mediator were used to generate heatmaps, K-means clustering and Principal Component analysis. In addition, we determined pair-wise Pearson's correlation coefficients to generate correlation networks. Results. Platelet counts were reduced, and mean platelet volume increased in malaria patients. The activation of circulating platelets in flow cytometry did not differ between patients and controls. CD40L levels were significantly higher in patients, while P-selectin and CXCL4 showed a nonsignificant trend towards higher levels in patients. The network correlation approach demonstrated the correlation between markers of platelet and endothelial activation, and the heatmaps revealed a distinct pattern of activation in two subsets of P. vivax patients when compared to controls. Conclusion. platelet activation occurs in uncomplicated vivax malaria and this correlates with higher endothelial cell activation, especially in a subset of patients.