Medical Student Faculty of Medicine Universitas Airlangga Surabaya, Jawa Timur, Indonesia
Background: Endothelial activation contributes to severe malaria progression and is a common condition in critically ill patients. The von Willebrand Factor (VWF), a disintegrin-like and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS13), and factor VIII (FVIII) are endothelial activation and regulator markers.
Aims: This study aims to evaluate the impacts of altered VWF, ADAMTS13, and FVIII in malaria patients.
Methods: Comprehensive literature searching using predefined keywords was performed through online databases Pubmed, EMBASE, ScienceDirect, and The Cochrane Library. This study followed the PRISMA guideline. The included and extracted studies were all relevant clinical studies that provide the impacts of altered VWF, ADAMTS13, or FVIII on pathogenesis and severity in malaria patients. The quality of studies was accessed by using the Newcastle-Ottawa Scale.
Results: Thirteen clinical studies matched the inclusion criteria. The median concentration of VWF and propeptide levels were higher in cerebral malaria (CM) than in uncomplicated malaria patients. The VWF concentration showed significant correlation with circulating parasite biomass and significant association with the acute kidney injury incidence in CM patients. The VWF also showed significant correlation with peripheral parasitemia in vivax malaria. A post-mortem study revealed incremental VWF alveolar edema staining in malaria-associated acute respiratory distress syndrome. Both ADAMTS13 antigen and activity concentrations significantly correlated with severity and parasitemia in falciparum malaria and the microvascular reactivity in vivax malaria. Single nucleotide polymorphism study of ADAMTS13 suggested significant association of protection against CM. The FVIII concentration is significantly increased in severe falciparum malaria.
Conclusion(s): The VWF, ADAMTS13, and Factor VIII might provide prospective advances in severe malaria. Nevertheless, further clinical studies are warranted to confirm the importance.
