Animal models suggest that
cytokines and
chemokines play a role in
cerebral malaria (CM) pathogenesis, but levels of a number of
cytokines and
chemokines thought to be important in the pathogenesis of other
infectious diseases are not well characterized in children with CM. Serum levels of
granulocyte-colony stimulating factor (
G-CSF),
interleukin-1 receptor antagonist (IL-1ra),
interleukin-8 (IL-8) and
monocyte chemoattractant protein-1 (MCP-1) were measured in 77 children with CM, 70 children with uncomplicated
malaria (UM) and 63 healthy community children (CC) in Uganda. Children with CM had elevated serum levels of
IL-1ra and
IL-8 as compared to children with UM (median levels in pg/ml, 11,891 vs. 6510, P=0.05, and 63 vs. 41, P=0.01, respectively). Children with CM who died (n=4) had higher serum levels than survivors of
IL-1ra (median levels in pg/ml, 65,757 vs. 10,355, P=0.02),
G-CSF (709 vs. 117, P=0.02), and MCP-1 (1275 vs. 216, P=0.03) but not
IL-8 (76 vs. 62, P=NS). Elevated
IL-1ra levels are associated with increased disease severity in children with
malaria, and very elevated levels of
IL-1ra,
G-CSF and MCP-1 are seen in children who die of CM.