Nitric oxide induction as a novel immunoepidemiological
target in malaria-infected patients from endemic areas of
the Islamic Republic of Iran
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Abstract
Objective. Malaria has been prevalent for a long time in Iran and continues to be a health problem
despite substantial control programs. In addition to numerous cytokines, nitric oxide (NO) is thought
to be a key molecule and a novel target of malaria immunopathology. Material and methods. The
objective of this research was to measure reactive nitrogen intermediates (RNI) as stable metabolites
of NO induction in plasma of malaria-infected patients in Iran. In this study, 235 blood samples from
malaria patients and 80 blood samples from healthy controls were randomly collected from different
malarial endemic provinces of Iran, located in southeastern (Sistan & Balouchestan, Hormozgan,
Kerman) and northwestern (Ardabil) areas. The involvement of NO in malaria patients has been
investigated by statistical analysis of RNI values. Griess micro assay (GMA) was used during
Plasmodium vivax, P. falciparum and mixed infections, in order to evaluate whether RNI changes are
related to the provincial areas, parasite strains, clinical symptoms and age and gender parameters.
Results. The results showed a significant increase of RNI level in malaria patients compared with the
control groups of Ardabil (pv0.01), Sistan & Balouchestan, Hormozgan and Kerman (pv0.001)
provinces. The level of RNI was higher in mixed plasmodial infection than in single infection.
Conclusions. The high level of RNI was dependent on the type of infection, the plasmodia strain, the
clinical symptoms, the age groups and the endemic provinces. Although, this study did not clarify the
pathogenic and/or protective role of NO in malaria, our findings provide a novel immunoepidemiological aspect of basal NO production in patients with malaria in endemic areas in Iran