TNF-α promoter polymorphisms (G-238A and G-308A) are associated with susceptibility to Systemic Lupus Erythematosus (SLE) and P. falciparum malaria: a study in malaria endemic area

Tumor necrosis factor-alpha (TNF-alpha) is a proinflammatory cytokine associated with autoimmune and infectious diseases. Importance ofTNF-alpha in P. falciparum malaria and systemic lupus erythematosus (SLE) have been demonstrated. However, association of functional promoter variants with SLE and malaria is lacking in malaria endemic population. A total of 204 female SLE patients and 224 age and sex matched healthy controls were enrolled in the study. Three hundred fourteen P. falciparum infected patients with different clinical phenotypes were included. TNF-alpha polymorphisms (G-238A & G-308A) were genotyped by PCR-RFLP. Plasma levels of TNF-alpha was quantified by ELISA. Heterozygous mutants and minor alleles of TNF-alpha (G-238A and G-308A) polymorphisms were significantly higher in SLE patients compared to healthy controls and associated with development of lupus nephritis. In addition, both promoter variants were associated with severe P. falciparum malaria. SLE patients demonstrated higher levels of plasma TNF-alpha compared to healthy controls. TNF-alpha (G-238A and G-308A) variants were associated with higher plasma TNF-alpha. In conclusion, TNF-alpha (G-238A & G-308A) variants are associated with higher plasma TNF-alpha levels in SLE patients residing in malaria endemic areas and could be a contributing factor in the development of SLE and susceptibility to severe P. falciparum malaria.