g Plasmodium falciparum infection during pregnancy leads to abortions, stillbirth, low birth weight, and maternal mortality. Infected erythrocytes (IEs) accumulate in the placenta by adhering to chondroitin sulfate A (CSA) via var2CSA protein exposed on the P. falciparum IE membrane. Plasmodium berghei IE infection in pregnant BALB/c mice is a model for severe placental malaria (PM). Here, we describe a transgenic P. berghei parasite expressing the full-length var2CSA extracellular region (domains DBL1X to DBL6) fused to a P. berghei exported protein (EMAP1) and characterize a var2CSA-based mouse model of PM. BALB/c mice were infected at midgestation with different doses of P. berghei-var2CSA (P. berghei-VAR) or P. berghei wild-type IEs. Infection with 10 4 P. berghei-VAR IEs induced a higher incidence of stillbirth and lower fetal weight than P. berghei. At doses of 10 5 and 10 6 IEs, P. berghei-VAR-infected mice showed increased maternal mortality during pregnancy and fetal loss, respectively. Parasite loads in infected placentas were similar between parasite lines despite differences in maternal outcomes. Fetal weight loss normalized for parasitemia was higher in P. berghei-VAR-infected mice than in P. berghei-infected mice. In vitro assays showed that higher numbers of P. berghei-VAR IEs than P. berghei IEs adhered to placental tissue. Immunization of mice with P. berghei-VAR elicited IgG antibodies reactive to DBL1-6 recombinant protein, indicating that the topology of immunogenic epitopes is maintained between DBL1-6 -EMAP1 on P. berghei-VAR and recombinant DBL1-6 (recDBL1-6). Our data suggested that impairments in pregnancy caused by P. berghei-VAR infection were attributable to var2CSA expression. This model provides a tool for preclinical evaluation of protection against PM induced by approaches that target var2CSA.
Malaria is a major health concern in countries where it is endemic. Recent reports show an incidence of 198 million cases in 2013 (82% in Africa) and 584,000 estimated deaths, 74% of which were children under 5 years of age (1). In areas of endemicity, pregnant women are under a greater risk of malaria than nonpregnant (NP) women due to immunological and hormonal changes and higher attractiveness to mosquitoes (2). Placental infection or clinical malaria during pregnancy has been shown to have a negative impact on infant health, increasing the risk of clinical malaria and mortality in infants (3).In areas of unstable malaria transmission, pregnant women can develop severe malaria due to low immunity to the parasite, which has been associated with increased mortality during pregnancy (4, 5), miscarriages, preterm deliveries, low birth weight, stillbirth, and death of neonates (6). These features can be recapitulated in a mouse model of severe placental malaria (PM) (7), which consists of infection of BALB/c mice syngeneically pregnant with parasites of the ANKA strain of the rodent malaria parasite Plasmodium berghei.Apart from physiological changes associated with gestation, increased suscep...