Khalid Abdelsamea Mohamedahmed
1,2* 
, Bakri Yousif Mohammed Nour
3, Mohamed Youisf Mohamed Elshiekh
3, Adam Dawoud Abakar
3, Yousef Gharedaghi
4 , Salah Eldin G. Elzaki
5, Yagoob Garedaghi
6* , Roa Osman Elsumani Koko
71 Department of Hematology and Immunology, Faculty of Medical Laboratory Sciences, University of Gezira, Wad Medani, Sudan
2 Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jerash University, Jerash, Jordan
3 Department of Medical Parasitology, Faculty of Medical Laboratory Sciences, University of Gezira, Wad Medani, Sudan
4 Department of Basic Sciences, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
5 Department of Epidemiology, Tropical Medicine Research Institute, National Centre for Research, Khartoum, Sudan
6 Department of Parasitology, Faculty of Veterinary Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran
7 Department of Molecular Biology, Faculty of Medical Laboratory Sciences, University of Gezira, Wad Medani, Sudan
Abstract
Introduction: Tumor necrosis factor alpha (TNF-α) levels overproduction and promoter polymorphisms at TNF-α 238 alleles may play central role in reduced red cell production and malaria-related anemia through suppression of bone marrow erythropoiesis and dyserythropoiesis. This study aimed to evaluate the TNF-α 238 allele’s polymorphism and its association with TNF-α levels in the children with falciparum malaria.
Methods: A longitudinal hospital-based study was conducted among 100 children with severe falciparum malaria (mean age 8.63±3.40 years) and 100 children with uncomplicated falciparum malaria (mean age 8.83±4.20 years). TNF-α level was measured using Human TNF-α ELISA MAX™ Deluxe Sets. PCR was used for detecting TNF-α 238 allele’s polymorphism. Obtained data were analyzed by SPSS (Version 20.0) and StatDisk (Version 13.0).
Results: TNF-α 238A allele was a common allele (66.8%). Falciparum malaria-related anemia accounted for 32%, commonly in severe malaria (SM) (55%) compared to uncomplicated malaria (UM) (9%) (P=0.000). Otherwise, the average of TNF-α levels strongly positively correlated with the severity of anemia (r+0.309; P=0.000). The TNF-α 238 A allele accounts for 83.6% of malaria anemia (P=0.000) and 100% severe anemia (P=0.000).
Conclusion: Overproduction of TNF-α is essential for the elimination and clearance of falciparum parasite but may be associated with severity of malaria and malaria anemia. Overproduction of TNF-α in children with TNF-α 238 A allele may result in falciparum malaria-related anemia among children. These findings will assist clinicians in better managing severe malaria-related anemia cases.