Kidney Drug Could Save Children From Malaria Brain Damage

Researchers have discovered that a drug, widely used in the West by kidney-failure patients, could protect millions of children from the brain damage inflicted by severe malaria. The breakthrough is the work of scientists based at laboratories run by Britain's Medical Research Council in Gambia. They found that children whose blood contains high levels of the hormone erythropoietin (Epo) recover from cerebral malaria, the deadliest form of the disease, better than those who have less.

An artificial version of Epo is used in the West to stimulate red blood cell production in kidney-failure patients and offers the prospect of alleviating the suffering of millions of malaria victims and of saving countless numbers of lives. The disease, the world's deadliest, kills around one million people a year.

Cerebral malaria is triggered when the malaria parasite Plasmodium falciparum moves into the brain. It kills one in five children who develop the condition. Survivors often suffer impaired vision, speech and movement problems, as well as serious neurological problems and epilepsy.

'The malaria parasite sticks to brain blood vessels and blocks them,' said Climent Casals-Pascual, one of the project's leaders. 'This reduces the oxygen supply to brain tissue and destroys neurones, the brain cells. This causes the brain damage associated with cerebral malaria.'

The team's research - carried out in collaboration with researchers funded by the Wellcome Trust - involved measuring Epo levels in blood and spinal fluid samples from 124 children admitted to hospital with cerebral malaria. Epo encourages multiplication and production of new red blood cells and has been shown to help protect nerve cells in the brain from long-term damage.

The team compared the levels from those who developed brain damage with those who didn't and found that a high level of erythropoietin helps protect a child against the damage caused when malaria infects the brain. Crucially this protective effect is influenced by age. Children less than two years old with a high concentration of erythropoietin were least likely to suffer neurological problems after cerebral malaria.

The results demonstrate that erythropoietin could play a key role in the battle against malaria. 'These results clearly indicate the potential of erythropoietin as a therapy for cerebral malaria,' added Casals-Pascual. 'Epo rescues these cells just before they die. However, before we study the efficacy of these molecules to prevent brain damage in children, we must study the optimal timing and dosing of Epo to achieve protection.

'We are also planning to study the protective effect of Epo in other populations where cerebral malaria is an important cause of death.'