Antigenic variation and immunity to Plasmodium knowlesi: antibodies which induce antigenic variation and antibodies which destroy parasites

Plasmodium knowlesi: the game changer for malaria eradication

Plasmodium knowlesi is a zoonotic malaria parasite that has gained increasing medical interest over the past two decades. This zoonotic parasitic infection is prevalent in Southeast Asia and causes many cases with fulminant pathology. Despite several biogeographical restrictions that limit its distribution, knowlesi malaria cases have been reported in different parts of the world due to travelling and tourism activities. Here, breakthroughs and key information generated from recent (over the past five years, but not limited to) studies conducted on P. knowlesi were reviewed, and the knowledge gap in various research aspects that need to be filled was discussed. Besides, challenges and strategies required to control and eradicate human malaria with this emerging and potentially fatal zoonosis were described.

Comparative 3D genome organization in apicomplexan parasites

The positioning of chromosomes in the nucleus of a eukaryotic cell is highly organized and has a complex and dynamic relationship with gene expression. In the human malaria parasite Plasmodium falciparum, the clustering of a family of virulence genes correlates with their coordinated silencing and has a strong influence on the overall organization of the genome. To identify conserved and species-specific principles of genome organization, we performed Hi-C experiments and generated 3D genome models for five Plasmodium species and two related apicomplexan parasites. Plasmodium species mainly showed clustering of centromeres, telomeres, and virulence genes. In P. falciparum, the heterochromatic virulence gene cluster had a strong repressive effect on the surrounding nuclear space, while this was less pronounced in Plasmodium vivax and Plasmodium berghei, and absent in Plasmodium yoelii In Plasmodium knowlesi, telomeres and virulence genes were more dispersed throughout the nucleus, but its 3D genome showed a strong correlation with gene expression. The Babesia microti genome showed a classical Rabl organization with colocalization of subtelomeric virulence genes, while the Toxoplasma gondii genome was dominated by clustering of the centromeres and lacked virulence gene clustering. Collectively, our results demonstrate that spatial genome organization in most Plasmodium species is constrained by the colocalization of virulence genes. P. falciparum and P. knowlesi, the only two Plasmodium species with gene families involved in antigenic variation, are unique in the effect of these genes on chromosome folding, indicating a potential link between genome organization and gene expression in more virulent pathogens.

Plasmodium knowlesi: a superb in vivo nonhuman primate model of antigenic variation in malaria

Antigenic variation in malaria was discovered in Plasmodium knowlesi studies involving longitudinal infections of rhesus macaques (M. mulatta). The variant proteins, known as the P. knowlesi Schizont Infected Cell Agglutination (SICA) antigens and the P. falciparum Erythrocyte Membrane Protein 1 (PfEMP1) antigens, expressed by the SICAvar and var multigene families, respectively, have been studied for over 30 years. Expression of the SICA antigens in P. knowlesi requires a splenic component, and specific antibodies are necessary for variant antigen switch events in vivo. Outstanding questions revolve around the role of the spleen and the mechanisms by which the expression of these variant antigen families are regulated. Importantly, the longitudinal dynamics and molecular mechanisms that govern variant antigen expression can be studied with P. knowlesi infection of its mammalian and vector hosts. Synchronous infections can be initiated with established clones and studied at multi-omic levels, with the benefit of computational tools from systems biology that permit the integration of datasets and the design of explanatory, predictive mathematical models. Here we provide an historical account of this topic, while highlighting the potential for maximizing the use of P. knowlesi - macaque model systems and summarizing exciting new progress in this area of research.

Antigenic Variation and the Genetics and Epigenetics of the PfEMP1 Erythrocyte Surface Antigens in Plasmodium falciparum Malaria

How immunity to malaria develops remains one of the great unresolved issues in bio-medicine and resolution of its various paradoxes is likely to be the key to developing effective malaria vaccines. The basic epidemiological observations are; under conditions of intense natural transmission, humans do become immune to P. falciparum malaria, but this is a slow process requiring multiple disease episodes which many, particularly young children, do not survive. Adult survivors are immune to the symptoms of malaria, and unless pregnant, can control the growth of most or all new inoculations. Sterile immunity is not achieved and chronic parasitization of apparently healthy adults is the norm. In this article, we analyse the best understood malaria "antigenic variation" system, that based on Plasmodium falciparum's PfEMP1-type cytoadhesion antigens, and critically review recent literature on the function and control of this multi-gene family of parasite variable surface antigens.

Spleen-dependent regulation of antigenic variation in malaria parasites: Plasmodium knowlesi SICAvar expression profiles in splenic and asplenic hosts

Background

Antigenic variation by malaria parasites was first described in Plasmodium knowlesi, which infects humans and macaque monkeys, and subsequently in P. falciparum, the most virulent human parasite. The schizont-infected cell agglutination (SICA) variant proteins encoded by the SICAvar multigene family in P. knowlesi, and Erythrocyte Membrane Protein-1 (EMP-1) antigens encoded by the var multigene family in P. falciparum, are expressed at the surface of infected erythrocytes, are associated with virulence, and serve as determinants of naturally acquired immunity. A parental P. knowlesi clone, Pk1(A+), and a related progeny clone, Pk1(B+)1+, derived by an invivo induced variant antigen switch, were defined by the expression of distinct SICA variant protein doublets of 210/190 and 205/200 kDa, respectively. Passage of SICA[+] infected erythrocytes through splenectomized rhesus monkeys results in the SICA[-] phenotype, defined by the lack of surface expression and agglutination with variant specific antisera.

Principal Findings

We have investigated SICAvar RNA and protein expression in Pk1(A+), Pk1(B+)1+, and SICA[-] parasites. The Pk1(A+) and Pk1(B+)1+ parasites express different distinct SICAvar transcript and protein repertoires. By comparison, SICA[-] parasites are characterized by a vast reduction in SICAvar RNA expression, the lack of full-length SICAvar transcript signals on northern blots, and correspondingly, the absence of any SICA protein detected by mass spectrometry.

Significance

SICA protein expression may be under transcriptional as well as post-transcriptional control, and we show for the first time that the spleen, an organ central to blood-stage immunity in malaria, exerts an influence on these processes. Furthermore, proteomics has enabled the first in-depth characterization of SICA[+] protein phenotypes and we show that the invivo switch from Pk1(A+) to Pk1(B+)1+ parasites resulted in a complete change in SICA profiles. These results emphasize the importance of studying antigenic variation in the context of the host environment.

Small variant surface antigens and Plasmodium evasion of immunity

Antigenic variation at the Plasmodium-infected erythrocyte surface plays a critical role in malaria disease severity and host immune evasion. Our current understanding of the role of Plasmodium variant surface antigens in antigenic variation and immune evasion is largely limited to the extensive work carried out on the Plasmodium falciparum var gene family. Although homologues of var genes are not present in other malaria species, small variant gene families comprising the rif and stevor genes in P. falciparum and the pir genes in Plasmodium vivax, Plasmodium knowlesi and the rodent malaria Plasmodium chabaudi, Plasmodium berghei and Plasmodium yoelii also show features suggesting a role in antigenic variation and immune evasion. In this article, we highlight our current understanding of these variant antigens and provide insights on the mechanisms developed by malaria parasites to effectively avoid the host immune response and establish chronic infection.

Protective immunity to malaria and anti-erythrocyte autoimmunity

The intraerythrocytic development of malaria parasites results in considerable modification and destruction of erythrocytes. This may lead to the breaking of tolerance such that immune recognition of 'self' or 'modified self' erythrocyte antigens by B or T lymphocytes occurs. Such recognition may be a vital factor in the induction of protective immunity even though it may also cause immunopathology. Serological and immunocytochemical assays have been used to demonstrate, in the serum of Plasmodium berghei-infected or immune rats, antibodies to isoantigenic determinants on infected erythrocytes. Absorption studies indicated that antigens specifically associated with parasitized erythrocytes and erythrocyte isoantigens were closely associated at the surface membrane. Extensive erythrocyte modification and destruction, artificially generated by phenylhydrazine treatment, significantly enhanced immunity against rodent malaria. In contrast, the generation of an incomplete anti-erythrocyte autoantibody response in mice by the injection of cross-reacting rat erythrocytes failed to augment protective responses to P. chabaudi. The reinjection of rat erythrocytes into mice previously injected with rat erythrocytes suppresses further autoantibody synthesis and the mice revert to the normal (Coombs-negative) state. Spleen cells from rat erythrocyte-treated mice transfer this suppression when injected into syngeneic recipients. Coombs-negative mice reinjected with rat erythrocytes failed to show enhanced protective responses to P. chabaudi. Spleen cells from such Coombs-negative mice, injected into sublethally irradiated recipients, increased the protective effects of concurrently transferred spleen cells from malaria-immune donors when the recipients were challenged with P. chabaudi.

Variant genes and the spleen in Plasmodium vivax malaria

It is generally accepted that Plasmodium vivax, the most widely distributed human malaria, does not cytoadhere in the deep capillaries of inner organs and thus this malaria parasite must have evolved splenic evasion mechanism in addition to sequestration. The spleen is a uniquely adapted lymphoid organ whose central function is the selective clearance of cell and other particles from the blood, and microbes including malaria. Splenomegaly is a hallmark of malaria and no other disease seems to exacerbate this organ as this disease does. Besides this major selective clearance function however, the spleen is also an erythropoietic organ which, under stress conditions, can be responsible for close to 40% of the RBC populations. Data obtained in experimental infections of human patients with P. vivax showed that anaemia is associated with acute and chronic infections and it has been postulated that the continued parasitemia might have been sufficient to infect and destroy most circulating reticulocytes. We review here the basis of our current knowledge of variant genes in P. vivax and the structure and function of the spleen during malaria. Based on this data, we propose that P. vivax specifically adhere to barrier cells in the human spleen allowing the parasite to escape spleen-clearance while favouring the release of merozoites in an environment where reticulocytes, the predominant, if not exclusive, host cell of P. vivax, are stored before their release into circulation to compensate for the anaemia associated with vivax malaria.

Antigenic variation at the infected red cell surface in malaria

Many pathogens that either rely on an insect vector to complete their life cycle (e.g., Trypanosoma spp. and Borrelia spp.) or exist in a unique ecological niche where transmission from host to host is sporadic (e.g., Neisseria spp.) have evolved strategies to maintain infection of their mammalian hosts for long periods of time in order to ensure their survival. Because they have to survive in the face of a fully functional immune system, a common feature of many of these organisms is their development of sophisticated strategies for immune evasion. For the above organisms and for malaria parasites of the genus Plasmodium, a common theme is the ability to undergo clonal antigenic variation. In all cases, surface molecules that are important targets of the humoral immune response are encoded in the genome as multicopy, nonallelic gene families. Antigenic variation is accomplished by the successive expression of members of these gene families that show little or no immunological cross-reactivity. In the case of malaria parasites, however, some of the molecules that undergo antigenic variation are also major virulence factors, adding an additional level of complication to the host-parasite interaction. In this review, we cover the history of antigenic variation in malaria and then summarize the more recent data with particular emphasis on Plasmodium falciparum, the etiological agent of the most severe form of human malaria.

Antigenic variation in Plasmodium falciparum: mechanisms and consequences

In the past year, the major advances in malaria antigenic variation have been concerned with the transcription and switching of variant antigen genes, and the functional expression of regions of the major variant antigen. Also, new variant gene families have been discovered as a result of the Malaria Genome Project.

Antigenic variation in malaria: a 3' genomic alteration associated with the expression of a P. knowlesi variant antigen

Antigenic variation of malaria parasites was discovered in P. knowlesi, using a schizont-infected cell agglutination (SICA) assay to detect variant antigens expressed at the surface of infected erythrocytes. Later studies utilizing stable clones, Pk1(A+) and its direct derivative, Pk1(B+)1+, showed that SICA[+] clones express distinct parasite-encoded antigens of approximately 200 kDa. Here we identify a P. knowlesi variant antigen gene and cDNA and demonstrate that it encodes the 205 kDa variant antigen expressed by B+ parasites. This gene belongs to a multigene family, which we term SICAvar. Its ten-exon structure with seven cysteine-rich coding modules is unique compared to P. falciparum var genes. Further, we highlight a 3' genomic alteration that we predict is related to SICAvar gene switching.

Early appearance of variant parasites in Plasmodium chabaudi infections

Previous studies have shown that the recrudescence parasitaemias seen in mice infected with Plasmodium chabaudi AS strain are antigenically different from the infecting parent population. Antigenic differences between recrudescent and parent populations were demonstrated in a passive transfer assay. In the present study, using the same assay system, it has been shown that in some mice, variant parasites (i.e. different from the parent population) can be detected at a time when the primary parasitaemia is still patent but in remission. This is the first report in Plasmodium of variant parasites being detected during the course of a patent primary parasitaemic episode of an infection initiated with a cloned line.

Molecular basis of host-parasite relationship: towards the definition of protective antigens

In spite of some remarkable progress in our understanding of the immune response to parasites and in the molecular cloning of dozens of genes encoding for potentially protective proteins, no definitive step has yet been made towards operational vaccines against major human parasitic diseases. The reasons for our present failures are no longer attributable to the lack of appropriate tools but rather to our rather primitive knowledge of the basic mechanisms governing host-parasite relationship. Mainly on the basics of our personal observations, we have attempted to review and discuss some of the prominent factors in host-parasite interactions, such as molecular mimicry, phyletic convergence, molecular mechanisms of infectivity and lures of cell communication. In many respects, the development of efficient vaccines applicable to humans appears closely dependent on a better understanding of the basic biological mechanisms underlying the natural history of parasitic diseases. In this context, the development of new concepts regarding the definition of potentially protective antigens based on the study of non-surface molecules, cross-reactive stage antigens and antibody isotype selection might represent promising alternatives.

Immune response studies in relation to protection induced by using MDP as an adjuvant in malaria

Muramyl dipeptide (MDP) was an important compound conferring protection to mice against the lethal malaria parasite Plasmodium berghei. The mode of protection of this compound was studied using different humoral and cellular parameters. The observations indicate that MDP boosts both humoral antibody response as well as delayed type hypersensitivity reactions, but as far as phagocytosis by macrophages is concerned, malarial mice are already maximally stimulated and MDP makes a marginal difference in immune phagocytosis only.

Inhibitory, opsonic and cytotoxic activities of monoclonal antibodies against asexual erythrocytic stages of Plasmodium falciparum

A range of monoclonal antibodies specific for Plasmodium falciparum were tested in vitro for their abilities to inhibit the multiplication of a partially synchronized culture of P. falciparum, to augment the phagocytosis of the parasites by macrophages, and to enhance the killing of parasites by peritoneal cells depleted of adherent cells. Seven of 17 monoclonal antibodies, ranging from culture supernatant fluid and ascitic fluid to purified IgG, showed dose- and time-dependent inhibition of parasite growth in vitro. At a concentration of 0.6 mg/ml, the inhibitory capacity of these monoclonal IgGs was above 94% over a 3-day culture period, much higher than that of the relevant polyclonal IgG. Four of 6 monoclonal antibodies tested augmented the phagocytosis of the parasites by macrophages, which occurred as a result of opsonization of the parasites. Four of 7 monoclonal antibodies examined showed cytotoxic activity on malaria parasites. Peritoneal cells depleted of adherent cells were capable of killing the parasites in the presence of monoclonal antibodies. These results indicate that there may be 'monofunction', 'bifunction', and 'multifunction' types of monoclonal antibodies against P. falciparum. The putative protective antigen of malaria parasites purified by 'multifunctional monoclonal antibody' affinity chromatography may have potential interest as a vaccine against the parasite or as an immunodiagnostic reagent for human malaria.

The effect of mosquito transmission of antigenic variants of Plasmodium chabaudi

Plasmodium chabaudi AS strain in mice is characterized by an acute primary parasitaemia, and one or more less acute recrudescences. Previous work has shown, using a passive protection assay, that the recrudescent parasites are usually antigenically different from parasites of the parent population with which the mice were first infected. In this study the effect of mosquito transmission on the antigenic expression of recrudescent populations of P. chabaudi was examined. In the first experiments the recrudescent population which was antigenically different from the parent population was uncloned. After transmission through Anopheles stephensi the recrudescent population appeared to revert to an antigenic type similar to that of the parent population. In the second experiment clones from a recrudescent population were mosquito transmitted and again the parasites of the primary patent parasitaemia in the mice, bitten by the infected mosquitoes, had reverted to the parental type. It is suggested that antigenic variants of P. chabaudi AS strain may revert to a basic type after mosquito transmission.

Antigenic variation in Plasmodium chabaudi: analysis of parent and variant populations by cloning

Nineteen of 22 recrudescent populations of Plasmodium chabaudi AS strain were found to be significantly less sensitive to the protective activity of pools of immune serum, than the parent population from which they were derived. The immune sera were collected from donor mice which had been infected with the parent population and had just reduced the patent primary parasitaemia to subpatent levels. Clones prepared from the parent population (which had previously been cloned) and recrudescent variant populations were tested for their sensitivity to the immune sera. It was found that all the clones from the parent population were sensitive to the immune sera but some were more sensitive than others and that a recrudescent variant population could include both sensitive and insensitive parasites. Two insensitive clones of the recrudescent population were found to be different from each other.

Immunochemical analysis of surface membrane antigens on erythrocytes infected with non-cloned SICA[+] or cloned SICA[-] Plasmodium knowlesi

The SICA[-] or non-agglutinable phenotype of Plasmodium knowlesi schizont-infected erythrocytes has been defined serologically but not biochemically. Similarly, non-cloned SICA[+] or agglutinable parasites have been shown serologically to express SICA or variant antigen(s) but the number and nature of such antigens have not been defined. Here we describe the immunochemical analysis of surface antigen expression on [125I]lactoperoxidase-labelled erythrocytes infected either with a SICA[-] clone or with non-cloned SICA[+] parasites using the methods developed for identification of variant antigens with cloned SICA[+] parasites. No 125I-labelled antigens in the size range Mr 190 000-225 000 were specifically immunoprecipitated from erythrocytes infected with the SICA[-] clone, even using homologous antisera produced by multiple infections or immunizations. Further, no 125I-labelled proteins of this size were seen in detergent extracts of the SICA[-] parasites that were not also seen with uninfected cells. We conclude that the SICA[-]phenotype reflects the absence of a variant antigen at the erythrocyte surface, as predicted by the serological assays. In contrast, with the non-cloned SICA[+] parasites, a complex group of proteins, Mr 195 000-225 000, was identified by [125I]lactoperoxidase labelling of intact infected erythrocytes. These proteins are SICA antigens since they not only share the characteristic detergent solubility properties and size range of SICA antigens identified previously with SICA[+] clones, but they were only immunoprecipitated by antisera which reacted specifically with the surface of infected erythrocytes. Agglutinating sera immunoprecipitated several of these 125I-labelled antigens. Sera specific for clones derived from this non-cloned SICA[+] population failed to agglutinate, but did react by indirect immunofluorescence with 10-16% of infected cells. These sera specifically immunoprecipitated single, quantitatively minor 125I-labelled antigens in this size range. The results suggest that a population of non-cloned SICA[+] parasites contains at least 10 different variant-antigen phenotypes. Indirect immunofluorescence was also performed against a non-cloned SICA[+] population derived by antigenic variation of a SICA[+] clone in vivo. The variant population contained at least 3 antigenically distinct SICA phenotypes, indicating that antigenic variation of clones may produce populations as antigenically heterogenous as antigenic variation of uncloned lines. It is therefore likely that natural malaria isolates contain a large number of different variant antigens.

Antigenic variation of bloodstage malaria parasites

An antigen on the surface of erythrocytes infected with mature asexual malaria parasites has been shown to undergo antigenic variation in two malaria species. Plasmodium falciparum-infected erythrocytes from squirrel monkeys express a new antigen that is identified by reactivity with antibody from infected animals in an indirect immunofluorescence assay. Cloned P. knowlesi parasites in rhesus monkeys undergo antigenic variation of an erythrocyte surface antigen as defined by antibody-mediated cell agglutination (the SICA test) and indirect immunofluorescence. This variant antigen is a malarial protein that changes both in size (Mr 185 000-225 000) and antigenicity in cloned parasites derived by antigenic variation in vivo. Antigenic variation on the erythrocyte surface probably contributes to the capacity of malaria parasites to establish chronic infections with multiple recrudescences and to the finding that individuals can be repeatedly reinfected. The fundamental reasons for expression of these highly immunogenic antigens on the erythrocyte membrane remain obscure. Other major questions remain to be explored: the repertoire of variant antigens; the genetic basis of antigenic variation and the structural basis for the antigenic uniqueness of each variant antigen. Some properties of malarial antigenic variation indicate that control of antigenic variation in plasmodia will be quite different to antigenic variation in the African trypanosomes. The host spleen is required both for variant antigen expression and antigenic variation, and variant-specific antibody appears to induce antigenic variation rather than select pre-existing variants.

Immunoprecipitation of biosynthetically-labelled proteins from different Papua New Guinea Plasmodium falciparum isolates by sera from individuals in the endemic area

The human serum antibody response to Plasmodium falciparum infection in Papua New Guinea has been studied by electrophoretic analysis of immunoprecipitated biosynthetically-labelled malaria proteins from three different isolates maintained in long-term in vitro culture. Differences in protein antigenic composition in different lines have been described and simplified by examination of antigens recognized only by hyperimmune serum. An in vitro assay has been used to screen various human sera containing antimalarial antibody for their ability to inhibit parasite growth and the immunoprecipitation profiles of non-inhibitory sera have been compared with those of a hyperimmune serum pool. In the discussion, emphasis is placed on the value of immunoprecipitation analyses using clinically-defined sera with known in vitro function in the identification of antigens which may be responsible for the induction of host-protective immunity.

Plasmodium knowlesi variant antigens are found on schizont-infected erythrocytes but not on merozoites

In this report, we demonstrate that the variable antigens present on the surface of Plasmodium knowlesi-infected erythrocytes could not be found on the surface of merozoites. A number of technical problems had to be solved to make such a comparative study possible, including the purification of merozoites by affinity columns and gradient centrifugation, the use of hyperimmune rabbit sera instead of monkey sera, and the use of immunocytological methods (indirect immunofluorescence antibody test and electron microscopy with ferritin-labeled antibodies) instead of the schizont-infected cell agglutination test. To ensure that these new techniques were valid for variant-specific serotyping, we compared two well-characterized variant populations with both the standard and the new methods. The removal of variant antigens from the surface of infected erythrocytes by proteolytic enzymes provides further information on the biochemical nature of these antigens.

Mechanisms of malarial immunity

Immunity to malaria in many species, including man, is acquired only after long exposure to infection and is associated with chronic low-grade parasitaemia. Vaccination of Rhesus monkeys with P. knowlesi merozoites in FCA induces sterilizing immunity which is species specific. Merozoite-blocking (inhibitory) antibody usually correlates with clinical immunity and protection can be passively transferred with immune sera. However, vaccination using adjuvants other than FCA may induce inhibitory antibody without clinical protection. In addition, vaccinated animals usually become susceptible to challenge 4 to 5 weeks after splenectomy, although inhibitory antibody levels are not reduced. These observations indicate that immunity induced by merozoite vaccination involves merozoite blocking (inhibitory) antibody and also specific antibody or immune complexes acting synergistically with cytotoxic splenic cells stimulated by FCA. During natural infection on the other hand soluble circulating antigens, partly derived from the merozoite coat during red cell penetration, are produced and these may block immune effector mechanisms and promote parasite survival.

T cells and protective immunity to Plasmodium berghei in rats

Experiments were carried out in which unfractionated spleen cells, and T lymphocyte subpopulations characterized by certain experimental criteria, were isolated at various times from rats infected with Plasmodium berghei. By adoptive transfer it was shown that unfractionated spleen cells, and T cells alone, could transfer protection to syngenic recipients as early as 11 days after infection of the cell donors. The protection conferred by T cells increased with the duration of the infection in the donors, at least up to 100 days. The additional presence of B cells in transferred lymphocyte populations enhanced their protective capacity over that shown by T cells alone. The role of T cells in protective immunity to malaria is discussed.

Antibody-induced movement of protozoan surface membrane antigens

Direct and indirect immunofluorescence techniques were used to study the effects of host antibodies on surface membrane antigens of viable Leishmania parasites in vitro. Antisera to L. enriettii and L. tropica caused surface membrane antigens of these parasites to aggregate, move toward the poles of the parasite, and to eventually disappear. This sequence did not occur at low temperature or in the presence of some metabolic inhibitors. Antigen subsequently reappeared on the parasite membrane. These phenomena appear to be similar to those described in mammalian cells. Antibodies may therefore effect an alteration in the surface membrane structure of living protozoan parasites.