Endothelial Activation Biomarkers in Severe Plasmodium falciparum Malaria Among Patients with Type 1 Diabetes Mellitus

Mukisa Ian Mugaiga

Department of Pharmacology Kampala International University Uganda

Email:mugaiga.mukisa@studwc.kiu.ac.ug

ABSTRACT

Severe Plasmodium falciparum malaria constituted a life-threatening parasitic infection characterized by widespread endothelial activation, microvascular sequestration, and systemic inflammation. Type 1 diabetes mellitus is associated with baseline endothelial dysfunction, chronic hyperglycemia-induced vascular damage, and altered immune responses. The convergence of these two pathophysiological states in comorbid patients may amplify endothelial injury and modify disease severity. This review critically evaluated current evidence regarding endothelial activation biomarkers in adults and children with severe P. falciparum malaria who have pre-existing type 1 diabetes, examining how diabetic endothelial dysfunction influences malaria pathogenesis, biomarker profiles, and clinical outcomes. A comprehensive literature search of PubMed, EMBASE, and Cochrane databases was conducted for peer-reviewed studies published between 2010 and 2025 examining endothelial biomarkers in malaria-diabetes comorbidity. Type 1 diabetes potentiated malaria-induced endothelial activation through synergistic mechanisms, including advanced glycation end-product accumulation, enhanced cytoadherence receptor expression, exaggerated inflammatory responses, and impaired endothelial repair capacity. Biomarkers, including angiopoietin-2, soluble intercellular adhesion molecule-1, von Willebrand factor, and endothelial microparticles, demonstrated significantly elevated levels in diabetic patients with severe malaria compared to non-diabetic malaria patients. Diabetic comorbidity correlated with increased cerebral malaria risk, prolonged parasite clearance, and higher mortality rates. However, evidence derives predominantly from small observational studies with significant methodological heterogeneity. Pre-existing type 1 diabetes substantially modified endothelial responses to severe malaria, with biomarker elevations reflecting additive pathophysiological burden and predicting worse clinical outcomes, though robust prospective studies are needed to establish definitive risk stratification tools.

Keywords: Endothelial activation, Plasmodium falciparum, Type 1 diabetes mellitus, Angiopoietin-2, Severe malaria.

CITE AS: Mukisa Ian Mugaiga (2026). Endothelial Activation Biomarkers in Severe Plasmodium falciparum Malaria Among Patients with Type 1 Diabetes Mellitus. IAA Journal of Scientific Research 13(1):83-91. https://doi.org/10.59298/IAAJSR/2026/1318391