JULIE MOORE, PhD, Assistant Professor, Center for Tropical and Emerging Global Diseases and Department of Infectious Diseases , College of Veterinary Medicine, University of Georgia.

My research focuses on immunity to infectious agents during pregnancy. For the past four years, we have worked on understanding immunity to malaria at the placental level in women living under intense malaria transmission conditions in Kisumu, western Kenya (see Map). Kisumu, located on the shores of Lake Victoria, is 10 kilometers south of the Equator. Malaria, which is a protozoal infection that is spread by Anopheles mosquitoes, is transmitted year round in this warm and sunny climate. In fact, people living in this area receive one malaria-infective mosquito bite almost every day! Under these conditions, adult men and women develop an effective "anti-disease" immunity to malaria; while they may harbor parasites in their blood circulation, they do not have symptomatic infections. When women become pregnant, however, their susceptibility to malaria increases dramatically. The hallmark of malaria during pregnancy is accumulation of malarial parasite-infected red blood cells in the maternal blood space of the placenta (the intervillous space; see figure below). This accumulation is associated with pathologic changes in the placental tissue and intra-uterine growth retardation and low birth weight, conditions that seriously threaten the survival of newborns. Interestingly, these clinical conditions are worst in primigravidae (women in their first pregnancy); women seem to gain the ability to control local parasitemia in the placenta over successive malaria-exposed pregnancies. By performing in depth studies of maternal cell-mediated in the intervillous blood, we are working to understand how this gravidity-dependent resistance to placental malaria develops and is maintained over successive pregnancies. We are also working to understand how and why immunity is modulated during pregnancy, with a specific focus on immunomodulatory hormones. We are using both human studies and rodent models for malaria during pregnancy to pursue this area of investigation.

Our research also focuses on the interaction between malaria and HIV during pregnancy. Although it is not so obvious in other groups, malaria is clearly an opportunisitic infection in HIV-infected pregnant women. In western Kenya, close to 30% of reproductive age-women are infected with HIV. We are working to understand how HIV impacts immunity to malaria and how changes in immunity in the placenta may influence transmission of the virus from mother to fetus/infant.

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