TEMPORAL ASSOCIATION BETWEEN SERUM GELSOLIN LEVELS AND CLINICAL EVENTS IN A PATIENT WITH SEVERE FALCIPARUM-MALARIA

Actin is present in high concentrations in most eukaryotic cells and c an polymerize into filaments under physiological buffer conditions. As a result of tissue injury and cell lysis, large quantities of actin a re released locally and may obstruct the downstream microvasculature, causing further damage to already injured organs. It has been postulat ed that this mechanism contributes to the development of the adult res piratory distress syndrome and to the diverse complications of falcipa rum malaria. Actin scavenging proteins-e.g., gelsolin-counteract the e ffects of extracellular actin, but the capacity of these plasma protei ns can be overwhelmed by massive tissue injury. We examined the tempor al relationship between serum levels of gelsolin (and tumor necrosis f actor-alpha) and the clinical findings for a patient with severe falci parum malaria. The level of gelsolin decreased and then increased as t he patient's status first worsened and then improved. We could not det ermine whether gelsolin served a biologically important function in th is patient's recovery or was simply an epiphenomenon of disease activi ty. Gelsolin levels may be an early prognostic indicator in patients w ith a systemic inflammatory response syndrome. Moreover, the potential therapeutic role of recombinant human plasma gelsolin in patients wit h delayed organ dysfunction that commonly follows a self-limited initi al insult merits investigation.