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Sanna A, Lambert Y, Jimeno Maroto I, Galindo MS, Plessis L, Bardon T, Carboni C, Bordalo J, Hiwat H, Cairo H, Musset L, Lazrek Y, Pelleau S, White M, Suárez Mutis M, Vreden S, Douine M. CUREMA project: a further step towards malaria elimination among hard-to-reach and mobile populations. Malar J 2024; 23:271. [PMID: 39256842 PMCID: PMC11385508 DOI: 10.1186/s12936-024-05040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/09/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND In most countries engaged on the last mile towards malaria elimination, residual transmission mainly persists among vulnerable populations represented by isolated and mobile (often cross-border) communities. These populations are sometimes involved in informal or even illegal activities. In regions with Plasmodium vivax transmission, the specific biology of this parasite poses additional difficulties related to the need for a radical treatment against hypnozoites to prevent relapses. Among hard-to-reach communities, case management, a pillar of elimination strategy, is deficient: acute malaria attacks often occur in remote areas, where there is limited access to care, and drugs acquired outside formal healthcare are often inadequately used for treatment, which typically does not include radical treatment against P. vivax. For these reasons, P. vivax circulation among these communities represents one of the main challenges for malaria elimination in many non-African countries. The objective of this article is to describe the protocol of the CUREMA study, which aims to meet the challenge of targeting malaria in hard-to-reach populations with a focus on P. vivax. RESULTS CUREMA is a multi-centre, international public health intervention research project. The study population is represented by persons involved in artisanal and small-scale gold mining who are active and mobile in the Guiana Shield, deep inside the Amazon Forest. The CUREMA project includes a complex intervention composed of a package of actions: (1) health education activities; (2) targeted administration of treatment against P. vivax after screening against G6PD deficiency to asymptomatic persons considered at risk of silently carrying the parasite; (3) distribution of a self-testing and self-treatment kit (malakit) associated with user training for self-management of malaria symptoms occurring while in extreme isolation. These actions are offered by community health workers at settlements and neighbourhoods (often cross-border) that represent transit and logistic bases of gold miners. The study relies on hybrid design, aiming to evaluate both the effectiveness of the intervention on malaria transmission with a pre/post quasi-experimental design, and its implementation with a mixed methods approach. CONCLUSIONS The purpose of this study is to experiment an intervention that addresses both Plasmodium falciparum and P. vivax malaria elimination in a mobile and isolated population and to produce results that can be transferred to many contexts facing the same challenges around the world.
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Affiliation(s)
- Alice Sanna
- French West Indies-French Guiana Center for Clinical Investigation (CIC Inserm 1424), Department of Research, Innovation, and Public Health, Cayenne Hospital, Cayenne, French Guiana, France.
| | - Yann Lambert
- French West Indies-French Guiana Center for Clinical Investigation (CIC Inserm 1424), Department of Research, Innovation, and Public Health, Cayenne Hospital, Cayenne, French Guiana, France
| | - Irene Jimeno Maroto
- French West Indies-French Guiana Center for Clinical Investigation (CIC Inserm 1424), Department of Research, Innovation, and Public Health, Cayenne Hospital, Cayenne, French Guiana, France
| | - Muriel Suzanne Galindo
- French West Indies-French Guiana Center for Clinical Investigation (CIC Inserm 1424), Department of Research, Innovation, and Public Health, Cayenne Hospital, Cayenne, French Guiana, France
| | - Lorraine Plessis
- French West Indies-French Guiana Center for Clinical Investigation (CIC Inserm 1424), Department of Research, Innovation, and Public Health, Cayenne Hospital, Cayenne, French Guiana, France
| | - Teddy Bardon
- French West Indies-French Guiana Center for Clinical Investigation (CIC Inserm 1424), Department of Research, Innovation, and Public Health, Cayenne Hospital, Cayenne, French Guiana, France
| | - Carlotta Carboni
- French West Indies-French Guiana Center for Clinical Investigation (CIC Inserm 1424), Department of Research, Innovation, and Public Health, Cayenne Hospital, Cayenne, French Guiana, France
| | - Jane Bordalo
- Associação Desenvolvimento, Prevenção, Acompanhamento e Cooperação de Fronteiras (DPAC), Oiapoque, Brazil
| | - Helene Hiwat
- National Malaria Programme, Ministry of Health, Paramaribo, Suriname
| | - Hedley Cairo
- National Malaria Programme, Ministry of Health, Paramaribo, Suriname
| | - Lise Musset
- Laboratoire de Parasitologie, Institut Pasteur de la Guyane, Centre National de Référence du Paludisme, Cayenne, French Guiana, France
| | - Yassamine Lazrek
- Laboratoire de Parasitologie, Institut Pasteur de la Guyane, Centre National de Référence du Paludisme, Cayenne, French Guiana, France
| | - Stéphane Pelleau
- Infectious Disease Epidemiology and Analytics, Institut Pasteur, Université Paris Cité, Paris, France
| | - Michael White
- Infectious Disease Epidemiology and Analytics, Institut Pasteur, Université Paris Cité, Paris, France
| | - Martha Suárez Mutis
- Laboratory of Parasitic Diseases, Graduate Program in Tropical Medicine, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Stephen Vreden
- Foundation for the Advancement of Scientific Research in Suriname (SWOS), Paramaribo, Suriname
| | - Maylis Douine
- French West Indies-French Guiana Center for Clinical Investigation (CIC Inserm 1424), Department of Research, Innovation, and Public Health, Cayenne Hospital, Cayenne, French Guiana, France
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Fowkes FJ, Robinson LJ, Simpson JA, Thriemer K, Laman M, Oo WH. The challenges of malaria elimination in the Asia-Pacific region. Med J Aust 2024; 221:182-185. [PMID: 39104144 DOI: 10.5694/mja2.52398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/11/2024] [Indexed: 08/07/2024]
Affiliation(s)
- Freya Ji Fowkes
- University of Melbourne, Melbourne, VIC
- Burnet Institute, Melbourne, VIC
- Monash University, Melbourne, VIC
| | | | | | | | - Moses Laman
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Win Han Oo
- University of Melbourne, Melbourne, VIC
- Burnet Institute, Melbourne, VIC
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Hernández-Zambrano LJ, Alfonso-González H, Buitrago SP, Castro-Cavadía CJ, Garzón-Ospina D. Exploring the genetic diversity pattern of PvEBP/DBP2: A promising candidate for an effective Plasmodium vivax vaccine. Acta Trop 2024; 255:107231. [PMID: 38685340 DOI: 10.1016/j.actatropica.2024.107231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
Malaria remains a public health challenge. Since many control strategies have proven ineffective in eradicating this disease, new strategies are required, among which the design of a multivalent vaccine stands out. However, the effectiveness of this strategy has been hindered, among other reasons, by the genetic diversity observed in parasite antigens. In Plasmodium vivax, the Erythrocyte Binding Protein (PvEBP, also known as DBP2) is an alternate ligand to Duffy Binding Protein (DBP); given its structural resemblance to DBP, EBP/DBP2 is proposed as a promising antigen for inclusion in vaccine design. However, the extent of genetic diversity within the locus encoding this protein has not been comprehensively assessed. Thus, this study aimed to characterize the genetic diversity of the locus encoding the P. vivax EBP/DBP2 protein and to determine the evolutionary mechanisms modulating this diversity. Several intrapopulation genetic variation parameters were estimated using 36 gene sequences of PvEBP/DBP2 from Colombian P. vivax clinical isolates and 186 sequences available in databases. The study then evaluated the worldwide genetic structure and the evolutionary forces that may influence the observed patterns of genetic variation. It was found that the PvEBP/DBP2 gene exhibits one of the lowest levels of genetic diversity compared to other vaccine-candidate antigens. Four major haplotypes were shared worldwide. Analysis of the protein's 3D structure and epitope prediction identified five regions with potential antigenic properties. The results suggest that the PvEBP/DBP2 protein possesses ideal characteristics to be considered when designing a multivalent effective antimalarial vaccine against P. vivax.
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Affiliation(s)
- Laura J Hernández-Zambrano
- Grupo de Estudios en Genética y Biología Molecular (GEBIMOL), School of Biological Sciences, Universidad Pedagógica y Tecnológica de Colombia - UPTC, Tunja, Boyacá, Colombia; Population Genetics And Molecular Evolution (PGAME), Fundación Scient, Tunja, Boyacá, Colombia
| | - Heliairis Alfonso-González
- Grupo de Estudios en Genética y Biología Molecular (GEBIMOL), School of Biological Sciences, Universidad Pedagógica y Tecnológica de Colombia - UPTC, Tunja, Boyacá, Colombia; Population Genetics And Molecular Evolution (PGAME), Fundación Scient, Tunja, Boyacá, Colombia
| | - Sindy P Buitrago
- Grupo de Estudios en Genética y Biología Molecular (GEBIMOL), School of Biological Sciences, Universidad Pedagógica y Tecnológica de Colombia - UPTC, Tunja, Boyacá, Colombia; Population Genetics And Molecular Evolution (PGAME), Fundación Scient, Tunja, Boyacá, Colombia
| | - Carlos J Castro-Cavadía
- Grupo de Investigaciones Microbiológicas y Biomédicas de Córdoba (GIMBIC), School of Health Sciences, Universidad de Córdoba, Montería, Córdoba, Colombia
| | - Diego Garzón-Ospina
- Grupo de Estudios en Genética y Biología Molecular (GEBIMOL), School of Biological Sciences, Universidad Pedagógica y Tecnológica de Colombia - UPTC, Tunja, Boyacá, Colombia; Population Genetics And Molecular Evolution (PGAME), Fundación Scient, Tunja, Boyacá, Colombia.
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Marzano-Miranda A, Pereira Cardoso-Oliveira G, Carla de Oliveira I, Carvalho Mourão L, Reis Cussat L, Gomes Fraga V, Delfin Chávez Olórtegui C, Jesus Fernandes Fontes C, Castanheira Bartholomeu D, Braga EM. Identification and serological responses to a novel Plasmodium vivax merozoite surface protein 1 ( PvMSP-1) derived synthetic peptide: a putative biomarker for malaria exposure. PeerJ 2024; 12:e17632. [PMID: 38948214 PMCID: PMC11212635 DOI: 10.7717/peerj.17632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024] Open
Abstract
Background The integration of diagnostic methods holds promise for advancing the surveillance of malaria transmission in both endemic and non-endemic regions. Serological assays emerge as valuable tools to identify and delimit malaria transmission, serving as a complementary method to rapid diagnostic tests (RDT) and thick smear microscopy. Here, we evaluate the potential of antibodies directed against peptides encompassing the entire amino acid sequence of the PvMSP-1 Sal-I strain as viable serological biomarkers for P. vivax exposure. Methods We screened peptides encompassing the complete amino acid sequence of the Plasmodium vivax Merozoite Surface Protein 1 (PvMSP-1) Sal-I strain as potential biomarkers for P. vivax exposure. Here, immunodominant peptides specifically recognized by antibodies from individuals infected with P. vivax were identified using the SPOT-synthesis technique followed by immunoblotting. Two 15-mer peptides were selected based on their higher and specific reactivity in immunoblotting assays. Subsequently, peptides p70 and p314 were synthesized in soluble form using SPPS (Solid Phase Peptide Synthesis) and tested by ELISA (IgG, and subclasses). Results This study unveils the presence of IgG antibodies against the peptide p314 in most P. vivax-infected individuals from the Brazilian Amazon region. In silico B-cell epitope prediction further supports the utilization of p314 as a potential biomarker for evaluating malaria transmission, strengthened by its amino acid sequence being part of a conserved block of PvMSP-1. Indeed, compared to patients infected with P. falciparum and uninfected individuals never exposed to malaria, P. vivax-infected patients have a notably higher recognition of p314 by IgG1 and IgG3.
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Affiliation(s)
- Aline Marzano-Miranda
- Department of Parasitology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Luiza Carvalho Mourão
- Department of Parasitology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Letícia Reis Cussat
- Department of Parasitology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Vanessa Gomes Fraga
- Department of Parasitology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Erika M. Braga
- Department of Parasitology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Lu F, Xu J, Liu Y, Ren Z, Chen J, Gong W, Yin Y, Li Y, Qian L, He X, Han X, Lin Z, Lu J, Zhang W, Liu J, Menard D, Han ET, Cao J. Plasmodium vivax serological exposure markers: PvMSP1-42-induced humoral and memory B-cell response generates long-lived antibodies. PLoS Pathog 2024; 20:e1012334. [PMID: 38941356 PMCID: PMC11239109 DOI: 10.1371/journal.ppat.1012334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 07/11/2024] [Accepted: 06/10/2024] [Indexed: 06/30/2024] Open
Abstract
Plasmodium vivax serological exposure markers (SEMs) have emerged as promising tools for the actionable surveillance and implementation of targeted interventions to accelerate malaria elimination. To determine the dynamic profiles of SEMs in current and past P. vivax infections, we screened and selected 11 P. vivax proteins from 210 putative proteins using protein arrays, with a set of serum samples obtained from patients with acute P. vivax and documented past P. vivax infections. Then we used a murine protein immune model to initially investigate the humoral and memory B cell response involved in the generation of long-lived antibodies. We show that of the 11 proteins, especially C-terminal 42-kDa region of P. vivax merozoite surface protein 1 (PvMSP1-42) induced longer-lasting long-lived antibodies, as these antibodies were detected in individuals infected with P. vivax in the 1960-1970s who were not re-infected until 2012. In addition, we provide a potential mechanism for the maintenance of long-lived antibodies after the induction of PvMSP1-42. The results indicate that PvMSP1-42 induces more CD73+CD80+ memory B cells (MBCs) compared to P. vivax GPI-anchored micronemal antigen (PvGAMA), allowing IgG anti-PvMSP1-42 antibodies to be maintained for a long time.
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Affiliation(s)
- Feng Lu
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jiahui Xu
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yaobao Liu
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Provincial Medical Key Laboratory, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Zhenyu Ren
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Junhu Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
| | - Weijuan Gong
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yi Yin
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yinyue Li
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Li Qian
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xinlong He
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xiu Han
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Zhijie Lin
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jingyuan Lu
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Wenwen Zhang
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jiali Liu
- Department of Pathogenic Biology and Immunology, School of Medicine, Key laboratory of Jiangsu province university for Nucleic Acid & Cell Fate Manipulation, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Didier Menard
- Institut Pasteur, Université Paris Cité, Malaria Parasite Biology and Vaccines Unit, Paris, France
- Université de Strasbourg, UR 3073—Pathogens Host Arthropods Vectors Interactions Unit, Malaria Genetics and Resistance Team (MEGATEAM), Strasbourg, France
- CHU Strasbourg, Laboratory of Parasitology and Medical Mycology, Strasbourg, France
| | - Eun-Taek Han
- Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Jun Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Provincial Medical Key Laboratory, Jiangsu Institute of Parasitic Diseases, Wuxi, China
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Iv S, Nguon C, Kong P, Sieng T, Srun S, Christiansen-Jucht C, Kul C, Lorn T, Chy S, Popovici J, Vantaux A, Witkowski B, Berry A, Piola P, Flamand C. Intermittent preventive treatment for forest goers by forest malaria workers: an observational study on a key intervention for malaria elimination in Cambodia. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 47:101093. [PMID: 38799614 PMCID: PMC11127514 DOI: 10.1016/j.lanwpc.2024.101093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/04/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Abstract
Background Cambodia targets P. falciparum malaria elimination by 2023 and all human malaria species by 2025, aligning with WHO's Mekong Malaria Elimination program. The Intermittent Preventive Treatment for Forest Goers (IPTf) project aimed at forest-specific malaria elimination. The study aims to pinpoint the main factors driving malaria transmission in Cambodian forests and evaluate the initial implementation and effectiveness of IPTf in accelerating the elimination of malaria by treating and preventing infections among at-risk populations in these areas. Methods From March 11, 2019, to January 30, 2021, a malaria intervention program took place in isolated forests in Northeast Cambodia. The first phase focused on observing forest goers (FGs) within the forests, documenting their malaria risk. In the second phase, a monthly artesunate-mefloquine IPTf was implemented by trained forest malaria workers who were former FGs conducting interviews, blood collection, and IPTf administration. Findings Throughout the two-year period, 2198 FGs were involved in 3579 interviews, with 284 in both the observation and intervention phases. Following IPTf implementation, PCR-confirmed malaria prevalence significantly decreased from 2.9% to 0.5% for P. falciparum and from 21.0% to 4.7% for P. vivax. Among the 284 participants tracked through both phases, malaria prevalence fell from 2.5% to 0.3% for P. falciparum and from 22.5% to 3.7% for P. vivax. The intervention phase demonstrated a rapid decline in P. falciparum prevalence among mobile and previously inaccessible populations, while also revealing a higher P. falciparum infection risk associated with activities inaccurately labelled as farming, underscoring the need for customized interventions. Interpretation The successful implementation of IPTf in Cambodia's remote forests has markedly decreased malaria prevalence among high-risk groups. Cambodia's National Malaria Program has acknowledged this strategy as essential for malaria elimination intervention, endorsing forest-specific approaches to meet the 2025 goal of eradicating all human malaria species in Cambodia. Funding The study received funding from the French 5% Initiative (Initiative Canal 2-17SANIN205).
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Affiliation(s)
- Sophea Iv
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- UMR 1043 – INFINITY – Institut Toulousain des Maladies Infectieuses et Inflammatoires, Toulouse, France
| | - Chea Nguon
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Phanith Kong
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Téphanie Sieng
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Sreynet Srun
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Chanvong Kul
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Thornleaksmey Lorn
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Sophy Chy
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Jean Popovici
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- G5 Épidémiologie et Analyse des Maladies Infectieuse, Département de Santé Globale, Institut Pasteur, F-75015, Paris, France
| | - Amélie Vantaux
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Benoit Witkowski
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Antoine Berry
- UMR 1043 – INFINITY – Institut Toulousain des Maladies Infectieuses et Inflammatoires, Toulouse, France
| | - Patrice Piola
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Claude Flamand
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, Paris, France
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Bertran-Cobo C, Dumont E, Noordin NR, Lai MY, Stone W, Tetteh KK, Drakeley C, Krishna S, Lau YL, Wassmer SC. Plasmodium knowlesi infection is associated with elevated circulating biomarkers of brain injury and endothelial activation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.25.24306382. [PMID: 38712121 PMCID: PMC11071568 DOI: 10.1101/2024.04.25.24306382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Introduction Malaria remains a major public health concern with substantial morbidity and mortality worldwide. In Malaysia, the emergence of Plasmodium knowlesi has led to a surge in zoonotic malaria cases and deaths in recent years. Signs of cerebral involvement have been observed in a non-comatose, fatal case of severe knowlesi infection, but the potential impact of this malaria species on the brain remains underexplored. To address this gap, we investigated circulating levels of brain injury, inflammation, and vascular biomarkers in a cohort of knowlesi-infected patients and controls. Methods Archived plasma samples from 19 patients with confirmed symptomatic knowlesi infection and 19 healthy, age-matched controls from Peninsular Malaysia were analysed. A total of 52 plasma biomarkers of brain injury, inflammation, and vascular activation were measured using Luminex and SIMOA assays. Wilcoxon tests were used to examine group differences, and biomarker profiles were explored through hierarchical clustering heatmap analysis. Results Bonferroni-corrected analyses revealed significantly elevated brain injury biomarker levels in knowlesi-infected patients, including S100B (p<0.0001), Tau (p=0.0007), UCH-L1 (p<0.0001), αSyn (p<0.0001), Park7 (p=0.0006), NRGN (p=0.0022), and TDP-43 (p=0.005). Compared to controls, levels were lower in the infected group for BDNF (p<0.0001), CaBD (p<0.0001), CNTN1 (p<0.0001), NCAM-1 (p<0.0001), GFAP (p=0.0013), and KLK6 (p=0.0126). Hierarchical clustering revealed distinct group profiles for circulating levels of brain injury and vascular activation biomarkers. Conclusions Our findings highlight for the first time the impact of Plasmodium knowlesi infection on the brain, with distinct alterations in cerebral injury and endothelial activation biomarker profiles compared to healthy controls. Further studies are warranted to investigate the pathophysiology and clinical significance of these altered surrogate markers, through both neuroimaging and long-term neurocognitive assessments.
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Zhou X, Zhang Q, Chen JH, Dai JF, Kassegne K. Revisiting the antigen markers of vector-borne parasitic diseases identified by immunomics: identification and application to disease control. Expert Rev Proteomics 2024; 21:205-216. [PMID: 38584506 DOI: 10.1080/14789450.2024.2336994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/03/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Protein microarray is a promising immunomic approach for identifying biomarkers. Based on our previous study that reviewed parasite antigens and recent parasitic omics research, this article expands to include information on vector-borne parasitic diseases (VBPDs), namely, malaria, schistosomiasis, leishmaniasis, babesiosis, trypanosomiasis, lymphatic filariasis, and onchocerciasis. AREAS COVERED We revisit and systematically summarize antigen markers of vector-borne parasites identified by the immunomic approach and discuss the latest advances in identifying antigens for the rational development of diagnostics and vaccines. The applications and challenges of this approach for VBPD control are also discussed. EXPERT OPINION The immunomic approach has enabled the identification and/or validation of antigen markers for vaccine development, diagnosis, disease surveillance, and treatment. However, this approach presents several challenges, including limited sample size, variability in antigen expression, false-positive results, complexity of omics data, validation and reproducibility, and heterogeneity of diseases. In addition, antigen involvement in host immune evasion and antigen sensitivity/specificity are major issues in its application. Despite these limitations, this approach remains promising for controlling VBPD. Advances in technology and data analysis methods should continue to improve candidate antigen identification, as well as the use of a multiantigen approach in diagnostic and vaccine development for VBPD control.
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Affiliation(s)
- Xia Zhou
- MOE Key Laboratory of Geriatric Diseases and Immunology, School of Biology & Basic Medical Science, Suzhou Medical College of Soochow University, Suzhou, China
| | - Qianqian Zhang
- Institute of Biology and Medical Sciences, Jiangsu Key Laboratory of Infection and Immunity, Soochow University, Suzhou, China
| | - Jun-Hu Chen
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute of Parasitic Diseases, Chinese Center for Diseases Control and Prevention (Chinese Center for Tropical Diseases Research); National Health Commission of the People's Republic of China (NHC) Key Laboratory of Parasite and Vector Biology; World Health Organization (WHO) Collaborating Center for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai, People's Republic of China
- Hainan Tropical Diseases Research Center (Hainan Sub-Center, Chinese Center for Tropical Diseases Research), Haikou, China
| | - Jian-Feng Dai
- Institute of Biology and Medical Sciences, Jiangsu Key Laboratory of Infection and Immunity, Soochow University, Suzhou, China
| | - Kokouvi Kassegne
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- One Health Center, Shanghai Jiao Tong University, Shanghai, China
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Pepey A, Souris M, Kim S, Obadia T, Chy S, Ea M, Ouk S, Remoue F, Sovannaroth S, Mueller I, Witkowski B, Vantaux A. Comparing malaria risk exposure in rural Cambodia population using GPS tracking and questionnaires. Malar J 2024; 23:75. [PMID: 38475843 DOI: 10.1186/s12936-024-04890-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The Great Mekong Subregion has attained a major decline in malaria cases and fatalities over the last years, but residual transmission hotspots remain, supposedly fueled by forest workers and migrant populations. This study aimed to: (i) characterize the fine-scale mobility of forest-goers and understand links between their daily movement patterns and malaria transmission, using parasites detection via real time polymerase chain reaction (RT PCR) and the individual exposure to Anopheles bites by quantification of anti-Anopheles saliva antibodies via enzyme-linked immunosorbent assay; (ii) assess the concordance of questionnaires and Global Positioning System (GPS) data loggers for measuring mobility. METHODS Two 28 day follow-ups during dry and rainy seasons, including a GPS tracking, questionnaires and health examinations, were performed on male forest goers representing the population at highest risk of infection. Their time spent in different land use categories and demographic data were analyzed in order to understand the risk factors driving malaria in the study area. RESULTS Malaria risk varied with village forest cover and at a resolution of only a few kilometers: participants from villages outside the forest had the highest malaria prevalence compared to participants from forest fringe's villages. The time spent in a specific environment did not modulate the risk of malaria, in particular the time spent in forest was not associated with a higher probability to detect malaria among forest-goers. The levels of antibody response to Anopheles salivary peptide among participants were significantly higher during the rainy season, in accordance with Anopheles mosquito density variation, but was not affected by sociodemographic and mobility factors. The agreement between GPS and self-reported data was only 61.9% in reporting each kind of visited environment. CONCLUSIONS In a context of residual malaria transmission which was mainly depicted by P. vivax asymptomatic infections, the implementation of questionnaires, GPS data-loggers and quantification of anti-saliva Anopheles antibodies on the high-risk group were not powerful enough to detect malaria risk factors associated with different mobility behaviours or time spent in various environments. The joint implementation of GPS trackers and questionnaires allowed to highlight the limitations of both methodologies and the benefits of using them together. New detection and follow-up strategies are still called for.
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Affiliation(s)
- Anaïs Pepey
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Blvd Monivong, Phnom Penh 120 210, Phnom Penh, BP983, Cambodia.
| | - Marc Souris
- UMR Unité des Virus Emergents, UVE: Aix-Marseille Univ-IRD 190-Inserm 1207-IHU 5 Méditerranée Infection, 13005, Marseille, France
| | - Saorin Kim
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Blvd Monivong, Phnom Penh 120 210, Phnom Penh, BP983, Cambodia
| | - Thomas Obadia
- Institut Pasteur, G5 Infectious Disease Epidemiology and Analytics, Université Paris Cité, 75015, Paris, France
- Institut Pasteur, Bioinformatics and Biostatistics Hub, Université Paris Cité, 75015, Paris, France
| | - Sophy Chy
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Blvd Monivong, Phnom Penh 120 210, Phnom Penh, BP983, Cambodia
| | - Malen Ea
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Blvd Monivong, Phnom Penh 120 210, Phnom Penh, BP983, Cambodia
| | - Sivkeng Ouk
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Blvd Monivong, Phnom Penh 120 210, Phnom Penh, BP983, Cambodia
| | - Franck Remoue
- UMR MIVEGEC, IRD, CNRS, University of Montpellier, Montpellier, France
| | - Siv Sovannaroth
- National Centre for Parasitology Entomology and Malaria Control (CNM), Phnom Penh 120 801, Phnom Penh, Cambodia
| | - Ivo Mueller
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Benoit Witkowski
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Blvd Monivong, Phnom Penh 120 210, Phnom Penh, BP983, Cambodia
- Genetic and Biology of Plasmodium Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Amélie Vantaux
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, 5 Blvd Monivong, Phnom Penh 120 210, Phnom Penh, BP983, Cambodia
- Genetic and Biology of Plasmodium Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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10
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Grimée M, Tacoli C, Sandfort M, Obadia T, Taylor AR, Vantaux A, Robinson LJ, Lek D, Longley RJ, Mueller I, Popovici J, White MT, Witkowski B. Using serological diagnostics to characterize remaining high-incidence pockets of malaria in forest-fringe Cambodia. Malar J 2024; 23:49. [PMID: 38360625 PMCID: PMC10870639 DOI: 10.1186/s12936-024-04859-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Over the last decades, the number of malaria cases has drastically reduced in Cambodia. As the overall prevalence of malaria in Cambodia declines, residual malaria transmission becomes increasingly fragmented over smaller remote regions. The aim of this study was to get an insight into the burden and epidemiological parameters of Plasmodium infections on the forest-fringe of Cambodia. METHODS 950 participants were recruited in the province of Mondulkiri in Cambodia and followed up from 2018 to 2020. Whole-blood samples were processed for Plasmodium spp. identification by PCR as well as for a serological immunoassay. A risk factor analysis was conducted for Plasmodium vivax PCR-detected infections throughout the study, and for P. vivax seropositivity at baseline. To evaluate the predictive effect of seropositivity at baseline on subsequent PCR-positivity, an analysis of P. vivax infection-free survival time stratified by serological status at baseline was performed. RESULTS Living inside the forest significantly increased the odds of P. vivax PCR-positivity by a factor of 18.3 (95% C.I. 7.7-43.5). Being a male adult was also a significant predictor of PCR-positivity. Similar risk profiles were identified for P. vivax seropositivity. The survival analysis showed that serological status at baseline significantly correlated with subsequent infection. Serology is most informative outside of the forest, where 94.0% (95% C.I. 90.7-97.4%) of seronegative individuals survived infection-free, compared to 32.4% (95% C.I.: 22.6-46.6%) of seropositive individuals. CONCLUSION This study justifies the need for serological diagnostic assays to target interventions in this region, particularly in demographic groups where a lot of risk heterogeneity persists, such as outside of the forest.
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Affiliation(s)
- Mathilde Grimée
- Infectious Disease Epidemiology and Analytics, Institut Pasteur, Université Paris Cité, Paris, France.
- Collège Doctoral, Sorbonne Université, Paris, France.
| | - Costanza Tacoli
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Mirco Sandfort
- Collège Doctoral, Sorbonne Université, Paris, France
- Malaria Parasites and Hosts, Institut Pasteur, Université Paris Cité, Paris, France
| | - Thomas Obadia
- Infectious Disease Epidemiology and Analytics, Institut Pasteur, Université Paris Cité, Paris, France
- Bioinformatics and Biostatistics Hub, Institut Pasteur, Université Paris Cité, Paris, France
| | - Aimee R Taylor
- Infectious Disease Epidemiology and Analytics, Institut Pasteur, Université Paris Cité, Paris, France
| | - Amélie Vantaux
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Leanne J Robinson
- Burnet Institute, Melbourne, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Dysoley Lek
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Rhea J Longley
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Australia
| | - Ivo Mueller
- Malaria Parasites and Hosts, Institut Pasteur, Université Paris Cité, Paris, France
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Jean Popovici
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Michael T White
- Infectious Disease Epidemiology and Analytics, Institut Pasteur, Université Paris Cité, Paris, France.
- Malaria Parasites and Hosts, Institut Pasteur, Université Paris Cité, Paris, France.
| | - Benoît Witkowski
- Malaria Research Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
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11
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Thongpoon S, Roobsoong W, Nguitragool W, Chotirat S, Tsuboi T, Takashima E, Cui L, Ishino T, Tachibana M, Miura K, Sattabongkot J. Naturally Acquired Transmission-Blocking Immunity Against Different Strains of Plasmodium vivax in a Malaria-Endemic Area in Thailand. J Infect Dis 2024; 229:567-575. [PMID: 37943633 PMCID: PMC10873188 DOI: 10.1093/infdis/jiad469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/30/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Human immunity triggered by natural malaria infections impedes parasite transmission from humans to mosquitoes, leading to interest in transmission-blocking vaccines. However, immunity characteristics, especially strain specificity, remain largely unexplored. We investigated naturally acquired transmission-blocking immunity (TBI) against Plasmodium vivax, a major malaria parasite. METHODS Using the direct membrane-feeding assay, we assessed TBI in plasma samples and examined the role of antibodies by removing immunoglobulins through protein G/L adsorption before mosquito feeding. Strain specificity was evaluated by conducting a direct membrane-feeding assay with plasma exchange. RESULTS Blood samples from 47 patients with P vivax were evaluated, with 37 plasma samples successfully infecting mosquitoes. Among these, 26 showed inhibition before immunoglobulin depletion. Despite substantial immunoglobulin removal, 4 samples still exhibited notable inhibition, while 22 had reduced blocking activity. Testing against heterologous strains revealed some plasma samples with broad TBI and others with strain-specific TBI. CONCLUSIONS Our findings indicate that naturally acquired TBI is mainly mediated by antibodies, with possible contributions from other serum factors. The transmission-blocking activity of plasma samples varied by the tested parasite strain, suggesting single polymorphic or multiple targets for naturally acquired TBI. These observations improve understanding of immunity against P vivax and hold implications for transmission-blocking vaccine development.
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Affiliation(s)
| | | | - Wang Nguitragool
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Takafumi Tsuboi
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Eizo Takashima
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Tomoko Ishino
- Department of Parasitology and Tropical Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mayumi Tachibana
- Division of Molecular Parasitology, Proteo-Science Center, Ehime University, Toon, Ehime, Japan
| | - Kazutoyo Miura
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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Fernandez-Camacho B, Peña-Calero B, Guillermo-Roman M, Ruiz-Cabrejos J, Barboza JL, Bartolini-Arana L, Barja-Ingaruca A, Rodriguez-Ferrucci H, Soto-Calle VE, Nelli L, Byrne I, Hill M, Dumont E, Grignard L, Tetteh K, Wu L, Llanos-Cuentas A, Drakeley C, Stresman G, Carrasco-Escobar G. Malaria seroepidemiology in very low transmission settings in the Peruvian Amazon. Sci Rep 2024; 14:2806. [PMID: 38307878 PMCID: PMC10837415 DOI: 10.1038/s41598-024-52239-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
Despite progress towards malaria reduction in Peru, measuring exposure in low transmission areas is crucial for achieving elimination. This study focuses on two very low transmission areas in Loreto (Peruvian Amazon) and aims to determine the relationship between malaria exposure and proximity to health facilities. Individual data was collected from 38 villages in Indiana and Belen, including geo-referenced households and blood samples for microscopy, PCR and serological analysis. A segmented linear regression model identified significant changes in seropositivity trends among different age groups. Local Getis-Ord Gi* statistic revealed clusters of households with high (hotspots) or low (coldspots) seropositivity rates. Findings from 4000 individuals showed a seropositivity level of 2.5% (95%CI: 2.0%-3.0%) for P. falciparum and 7.8% (95%CI: 7.0%-8.7%) for P. vivax, indicating recent or historical exposure. The segmented regression showed exposure reductions in the 40-50 age group (β1 = 0.043, p = 0.003) for P. vivax and the 50-60 age group (β1 = 0.005, p = 0.010) for P. falciparum. Long and extreme distance villages from Regional Hospital of Loreto exhibited higher malaria exposure compared to proximate and medium distance villages (p < 0.001). This study showed the seropositivity of malaria in two very low transmission areas and confirmed the spatial pattern of hotspots as villages become more distant.
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Affiliation(s)
- Bryan Fernandez-Camacho
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Brian Peña-Calero
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Martina Guillermo-Roman
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jorge Ruiz-Cabrejos
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jose Luis Barboza
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lucia Bartolini-Arana
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antony Barja-Ingaruca
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Veronica E Soto-Calle
- Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luca Nelli
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Isabel Byrne
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Elin Dumont
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Lynn Grignard
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kevin Tetteh
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Lindsey Wu
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Alejandro Llanos-Cuentas
- Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
- College of Public Health, Epidemiology Concentration, University of South Florida, Tampa, FL, USA
| | - Gabriel Carrasco-Escobar
- Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
- Scripps Institution of Oceanography, University of California San Diego, San Diego, CA, USA
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13
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Fonseca A, Spytek M, Biecek P, Cordeiro C, Sepúlveda N. Antibody selection strategies and their impact in predicting clinical malaria based on multi-sera data. BioData Min 2024; 17:2. [PMID: 38273386 PMCID: PMC10811867 DOI: 10.1186/s13040-024-00354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Nowadays, the chance of discovering the best antibody candidates for predicting clinical malaria has notably increased due to the availability of multi-sera data. The analysis of these data is typically divided into a feature selection phase followed by a predictive one where several models are constructed for predicting the outcome of interest. A key question in the analysis is to determine which antibodies should be included in the predictive stage and whether they should be included in the original or a transformed scale (i.e. binary/dichotomized). METHODS To answer this question, we developed three approaches for antibody selection in the context of predicting clinical malaria: (i) a basic and simple approach based on selecting antibodies via the nonparametric Mann-Whitney-Wilcoxon test; (ii) an optimal dychotomizationdichotomization approach where each antibody was selected according to the optimal cut-off via maximization of the chi-squared (χ2) statistic for two-way tables; (iii) a hybrid parametric/non-parametric approach that integrates Box-Cox transformation followed by a t-test, together with the use of finite mixture models and the Mann-Whitney-Wilcoxon test as a last resort. We illustrated the application of these three approaches with published serological data of 36 Plasmodium falciparum antigens for predicting clinical malaria in 121 Kenyan children. The predictive analysis was based on a Super Learner where predictions from multiple classifiers including the Random Forest were pooled together. RESULTS Our results led to almost similar areas under the Receiver Operating Characteristic curves of 0.72 (95% CI = [0.62, 0.82]), 0.80 (95% CI = [0.71, 0.89]), 0.79 (95% CI = [0.7, 0.88]) for the simple, dichotomization and hybrid approaches, respectively. These approaches were based on 6, 20, and 16 antibodies, respectively. CONCLUSIONS The three feature selection strategies provided a better predictive performance of the outcome when compared to the previous results relying on Random Forest including all the 36 antibodies (AUC = 0.68, 95% CI = [0.57;0.79]). Given the similar predictive performance, we recommended that the three strategies should be used in conjunction in the same data set and selected according to their complexity.
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Affiliation(s)
- André Fonseca
- FCT - Faculdade de Ciências e Tecnologia, Universidade do Algarve, Faro, Portugal
- CEAUL - Centro de Estatística e Aplicações da Universidade de Lisboa, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Mikolaj Spytek
- Faculty of Mathematics & Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Przemysław Biecek
- Faculty of Mathematics & Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Clara Cordeiro
- FCT - Faculdade de Ciências e Tecnologia, Universidade do Algarve, Faro, Portugal
- CEAUL - Centro de Estatística e Aplicações da Universidade de Lisboa, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Nuno Sepúlveda
- CEAUL - Centro de Estatística e Aplicações da Universidade de Lisboa, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.
- Faculty of Mathematics & Information Science, Warsaw University of Technology, Warsaw, Poland.
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14
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Fonseca A, Szysz M, Ly HT, Cordeiro C, Sepúlveda N. IgG Antibody Responses to Epstein-Barr Virus in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Their Effective Potential for Disease Diagnosis and Pathological Antigenic Mimicry. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:161. [PMID: 38256421 PMCID: PMC10820613 DOI: 10.3390/medicina60010161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The diagnosis and pathology of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) remain under debate. However, there is a growing body of evidence for an autoimmune component in ME/CFS caused by the Epstein-Barr virus (EBV) and other viral infections. Materials and Methods: In this work, we analyzed a large public dataset on the IgG antibodies to 3054 EBV peptides to understand whether these immune responses could help diagnose patients and trigger pathological autoimmunity; we used healthy controls (HCs) as a comparator cohort. Subsequently, we aimed at predicting the disease status of the study participants using a super learner algorithm targeting an accuracy of 85% when splitting data into train and test datasets. Results: When we compared the data of all ME/CFS patients or the data of a subgroup of those patients with non-infectious or unknown disease triggers to the data of the HC, we could not find an antibody-based classifier that would meet the desired accuracy in the test dataset. However, we could identify a 26-antibody classifier that could distinguish ME/CFS patients with an infectious disease trigger from the HCs with 100% and 90% accuracies in the train and test sets, respectively. We finally performed a bioinformatic analysis of the EBV peptides associated with these 26 antibodies. We found no correlation between the importance metric of the selected antibodies in the classifier and the maximal sequence homology between human proteins and each EBV peptide recognized by these antibodies. Conclusions: In conclusion, these 26 antibodies against EBV have an effective potential for disease diagnosis in a subset of patients. However, the peptides associated with these antibodies are less likely to induce autoimmune B-cell responses that could explain the pathogenesis of ME/CFS.
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Affiliation(s)
- André Fonseca
- Faculty of Sciences and Technology, University of Algarve, 8005-139 Faro, Portugal; (A.F.); (C.C.)
- CEAUL—Centre of Statistics and its Applications, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal
| | - Mateusz Szysz
- Faculty of Mathematics & Information Science, Warsaw University of Technology, 00-662 Warsaw, Poland; (M.S.); (H.T.L.)
| | - Hoang Thien Ly
- Faculty of Mathematics & Information Science, Warsaw University of Technology, 00-662 Warsaw, Poland; (M.S.); (H.T.L.)
| | - Clara Cordeiro
- Faculty of Sciences and Technology, University of Algarve, 8005-139 Faro, Portugal; (A.F.); (C.C.)
- CEAUL—Centre of Statistics and its Applications, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal
| | - Nuno Sepúlveda
- CEAUL—Centre of Statistics and its Applications, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal
- Faculty of Mathematics & Information Science, Warsaw University of Technology, 00-662 Warsaw, Poland; (M.S.); (H.T.L.)
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Momoh EO, Ghag SK, White J, Mudeppa DG, Rathod PK. Multiplex Assays for Analysis of Antibody Responses to South Asian Plasmodium falciparum and Plasmodium vivax Malaria Infections. Vaccines (Basel) 2023; 12:1. [PMID: 38276660 PMCID: PMC10818873 DOI: 10.3390/vaccines12010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/01/2023] [Accepted: 12/13/2023] [Indexed: 01/27/2024] Open
Abstract
Malaria remains a major global health challenge, causing over 0.6 million yearly deaths. To understand naturally acquired immunity in adult human populations in malaria-prevalent regions, improved serological tools are needed, particularly where multiple malaria parasite species co-exist. Slide-based and bead-based multiplex approaches can help characterize antibodies in malaria patients from endemic regions, but these require pure, well-defined antigens. To efficiently bypass purification steps, codon-optimized malaria antigen genes with N-terminal FLAG-tag and C-terminal Ctag sequences were expressed in a wheat germ cell-free system and adsorbed on functionalized BioPlex beads. In a pilot study, 15 P. falciparum antigens, 8 P. vivax antigens, and a negative control (GFP) were adsorbed individually on functionalized bead types through their Ctag. To validate the multiplexing powers of this platform, 10 P. falciparum-infected patient sera from a US NIH MESA-ICEMR study site in Goa, India, were tested against all 23 parasite antigens. Serial dilution of patient sera revealed variations in potency and breadth of antibodies to various parasite antigens. Individual patients revealed informative variations in immunity to P. falciparum versus P. vivax. This multiplex approach to malaria serology captures varying immunity to different human malaria parasite species and different parasite antigens. This approach can be scaled to track the dynamics of antibody production during one or more human malaria infections.
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Affiliation(s)
| | | | | | - Devaraja G. Mudeppa
- Department of Chemistry, University of Washington, Seattle, WA 98195, USA; (E.O.M.); (S.K.G.); (J.W.)
| | - Pradipsinh K. Rathod
- Department of Chemistry, University of Washington, Seattle, WA 98195, USA; (E.O.M.); (S.K.G.); (J.W.)
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Walker IS, Rogerson SJ. Pathogenicity and virulence of malaria: Sticky problems and tricky solutions. Virulence 2023; 14:2150456. [PMID: 36419237 PMCID: PMC9815252 DOI: 10.1080/21505594.2022.2150456] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
Infections with Plasmodium falciparum and Plasmodium vivax cause over 600,000 deaths each year, concentrated in Africa and in young children, but much of the world's population remain at risk of infection. In this article, we review the latest developments in the immunogenicity and pathogenesis of malaria, with a particular focus on P. falciparum, the leading malaria killer. Pathogenic factors include parasite-derived toxins and variant surface antigens on infected erythrocytes that mediate sequestration in the deep vasculature. Host response to parasite toxins and to variant antigens is an important determinant of disease severity. Understanding how parasites sequester, and how antibody to variant antigens could prevent sequestration, may lead to new approaches to treat and prevent disease. Difficulties in malaria diagnosis, drug resistance, and specific challenges of treating P. vivax pose challenges to malaria elimination, but vaccines and other preventive strategies may offer improved disease control.
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Affiliation(s)
- Isobel S Walker
- Department of Infectious Diseases, The University of Melbourne, The Doherty Institute, Melbourne, Australia
| | - Stephen J Rogerson
- Department of Infectious Diseases, The University of Melbourne, The Doherty Institute, Melbourne, Australia
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Kojom Foko LP, Singh V. Malaria in pregnancy in India: a 50-year bird's eye. Front Public Health 2023; 11:1150466. [PMID: 37927870 PMCID: PMC10620810 DOI: 10.3389/fpubh.2023.1150466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction In 2021, India contributed for ~79% of malaria cases and ~ 83% of deaths in the South East Asia region. Here, we systematically and critically analyzed data published on malaria in pregnancy (MiP) in India. Methods Epidemiological, clinical, parasitological, preventive and therapeutic aspects of MiP and its consequences on both mother and child were reviewed and critically analyzed. Knowledge gaps and solution ways are also presented and discussed. Several electronic databases including Google scholar, Google, PubMed, Scopus, Wiley Online library, the Malaria in Pregnancy Consortium library, the World Malaria Report, The WHO regional websites, and ClinicalTrials.gov were used to identify articles dealing with MiP in India. The archives of local scientific associations/journals and website of national programs were also consulted. Results Malaria in pregnancy is mainly due to Plasmodium falciparum (Pf) and P. vivax (Pv), and on rare occasions to P. ovale spp. and P. malariae too. The overall prevalence of MiP is ~0.1-57.7% for peripheral malaria and ~ 0-29.3% for placental malaria. Peripheral Pf infection at antenatal care (ANC) visits decreased from ~13% in 1991 to ~7% in 1995-1996 in Madhya Pradesh, while placental Pf infection at delivery unit slightly decreased from ~1.5% in 2006-2007 to ~1% in 2012-2015 in Jharkhand. In contrast, the prevalence of peripheral Pv infection at ANC increased from ~1% in 2006-2007 to ~5% in 2015 in Jharkhand, and from ~0.5% in 1984-1985 to ~1.5% in 2007-2008 in Chhattisgarh. Clinical presentation of MiP is diverse ranging from asymptomatic carriage of parasites to severe malaria, and associated with comorbidities and concurrent infections such as malnutrition, COVID-19, dengue, and cardiovascular disorders. Severe anemia, cerebral malaria, severe thrombocytopenia, and hypoglycemia are commonly seen in severe MiP, and are strongly associated with tragic consequences such as abortion and stillbirth. Congenital malaria is seen at prevalence of ~0-12.9%. Infected babies are generally small-for-gestational age, premature with low birthweight, and suffer mainly from anemia, thrombocytopenia, leucopenia and clinical jaundice. Main challenges and knowledge gaps to MiP control included diagnosis, relapsing malaria, mixed Plasmodium infection treatment, self-medication, low density infections and utility of artemisinin-based combination therapies. Conclusion All taken together, the findings could be immensely helpful to control MiP in malaria endemic areas.
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de Assis GMP, de Alvarenga DAM, Souza LBE, Sánchez-Arcila JC, Silva EFE, de Pina-Costa A, Gonçalves GHP, Souza JCDJ, Nunes AJD, Pissinatti A, Moreira SB, Torres LDM, Costa HL, Tinoco HDP, Pereira VDS, Soares IDS, de Sousa TN, Ntumngia FB, Adams JH, Kano FS, Hirano ZMB, Pratt-Riccio LR, Daniel-Ribeiro CT, Ferreira JO, Carvalho LH, Alves de Brito CF. IgM antibody responses against Plasmodium antigens in neotropical primates in the Brazilian Atlantic Forest. Front Cell Infect Microbiol 2023; 13:1169552. [PMID: 37829607 PMCID: PMC10565664 DOI: 10.3389/fcimb.2023.1169552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/11/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Zoonotic transmission is a challenge for the control and elimination of malaria. It has been recorded in the Atlantic Forest, outside the Amazon which is the endemic region in Brazil. However, only very few studies have assessed the antibody response, especially of IgM antibodies, in Neotropical primates (NP). Therefore, in order to contribute to a better understanding of the immune response in different hosts and facilitate the identification of potential reservoirs, in this study, naturally acquired IgM antibody responses against Plasmodium antigens were evaluated, for the first time, in NP from the Atlantic Forest. Methods The study was carried out using 154 NP samples from three different areas of the Atlantic Forest. IgM antibodies against peptides of the circumsporozoite protein (CSP) from different Plasmodium species and different erythrocytic stage antigens were detected by ELISA. Results Fifty-nine percent of NP had IgM antibodies against at least one CSP peptide and 87% against at least one Plasmodium vivax erythrocytic stage antigen. Levels of antibodies against PvAMA-1 were the highest compared to the other antigens. All families of NP showed IgM antibodies against CSP peptides, and, most strikingly, against erythrocytic stage antigens. Generalized linear models demonstrated that IgM positivity against PvCSP and PvAMA-1 was associated with PCR-detectable blood-stage malaria infection and the host being free-living. Interestingly, animals with IgM against both PvCSP and PvAMA-1 were 4.7 times more likely to be PCR positive than animals that did not have IgM for these two antigens simultaneously. Discussion IgM antibodies against different Plasmodium spp. antigens are present in NP from the Atlantic Forest. High seroprevalence and antibody levels against blood-stage antigens were observed, which had a significant association with molecular evidence of infection. IgM antibodies against CSP and AMA-1 may be used as a potential marker for the identification of NP infected with Plasmodium, which are reservoirs of malaria in the Brazilian Atlantic Forest.
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Affiliation(s)
- Gabriela Maíra Pereira de Assis
- Grupo de Pesquisa em Biologia Molecular e Imunologia da malária, Instituto René Rachou/Fiocruz Minas, Belo Horizonte, Brazil
| | | | - Luisa Braga e Souza
- Grupo de Pesquisa em Biologia Molecular e Imunologia da malária, Instituto René Rachou/Fiocruz Minas, Belo Horizonte, Brazil
| | - Juan Camilo Sánchez-Arcila
- School of Natural Sciences, Molecular and Cell Biology Department, University of California, Merced, Merced, CA, United States
| | | | - Anielle de Pina-Costa
- Laboratório de Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas (INI), Fiocruz, Rio de Janeiro, Brazil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz (IOC), Fiocruz, Rio de Janeiro, Brazil
- Escola de Enfermagem Aurora de Afonso Costa, Departamento de Doenças infecciosas e Parasitárias, Universidade Federal Fluminense, Niterói, Brazil
| | | | | | - Ana Julia Dutra Nunes
- Fundação Universidade Regional de Blumenau (FURB), Blumenau, Brazil
- Centro de Pesquisas Biológicas de Indaial, Indaial, Brazil
- Programa de conservação do Bugio Ruivo, Perini Business Park, Joinville, Brazil
| | - Alcides Pissinatti
- Centro de Primatologia do Rio de Janeiro (CPRJ), Instituto Estadual do Ambiente (INEA), Guapimirim, Brazil
- Centro Universitário Serra dos Órgãos (Unifeso), Teresópolis, Brazil
| | - Silvia Bahadian Moreira
- Centro de Primatologia do Rio de Janeiro (CPRJ), Instituto Estadual do Ambiente (INEA), Guapimirim, Brazil
| | - Leticia de Menezes Torres
- Grupo de Pesquisa em Biologia Molecular e Imunologia da malária, Instituto René Rachou/Fiocruz Minas, Belo Horizonte, Brazil
| | - Helena Lott Costa
- Grupo de Pesquisa em Biologia Molecular e Imunologia da malária, Instituto René Rachou/Fiocruz Minas, Belo Horizonte, Brazil
| | | | | | - Irene da Silva Soares
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Taís Nóbrega de Sousa
- Grupo de Pesquisa em Biologia Molecular e Imunologia da malária, Instituto René Rachou/Fiocruz Minas, Belo Horizonte, Brazil
| | - Francis Babila Ntumngia
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa, FL, United States
| | - John H. Adams
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa, FL, United States
| | - Flora Satiko Kano
- Grupo de Pesquisa em Biologia Molecular e Imunologia da malária, Instituto René Rachou/Fiocruz Minas, Belo Horizonte, Brazil
| | - Zelinda Maria Braga Hirano
- Fundação Universidade Regional de Blumenau (FURB), Blumenau, Brazil
- Centro de Pesquisas Biológicas de Indaial, Indaial, Brazil
- Programa de conservação do Bugio Ruivo, Perini Business Park, Joinville, Brazil
| | - Lilian Rose Pratt-Riccio
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz (IOC), Fiocruz, Rio de Janeiro, Brazil
| | - Cláudio Tadeu Daniel-Ribeiro
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz (IOC), Fiocruz, Rio de Janeiro, Brazil
| | - Joseli Oliveira Ferreira
- Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz (IOC), Fiocruz, Rio de Janeiro, Brazil
| | - Luzia Helena Carvalho
- Grupo de Pesquisa em Biologia Molecular e Imunologia da malária, Instituto René Rachou/Fiocruz Minas, Belo Horizonte, Brazil
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Byrne I, William T, Chua TH, Patterson C, Hall T, Tan M, Chitnis C, Adams J, Singh SK, Grignard L, Tetteh KKA, Fornace KM, Drakeley CJ. Serological evaluation of risk factors for exposure to malaria in a pre-elimination setting in Malaysian Borneo. Sci Rep 2023; 13:12998. [PMID: 37563178 PMCID: PMC10415323 DOI: 10.1038/s41598-023-39670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
Malaysia has reported no indigenous cases of P. falciparum and P. vivax for over 3 years. When transmission reaches such low levels, it is important to understand the individuals and locations where exposure risks are high, as they may be at greater risk in the case of a resurgence of transmission. Serology is a useful tool in low transmission settings, providing insight into exposure over longer durations than PCR or RDT. We ran blood samples from a 2015 population-based survey in northern Sabah, Malaysian Borneo on a multiplex bead assay. Using supervised machine learning methods, we characterised recent and historic exposure to Plasmodium falciparum and P. vivax and found recent exposure to P. falciparum to be very low, with exposure to both species increasing with age. We performed a risk-factor assessment on environmental, behavioural, demographic and household factors, and identified forest activity and longer travel times to healthcare as common risk-factors for exposure to P. falciparum and P. vivax. In addition, we used remote-sensing derived data and geostatistical models to assess environmental and spatial associations with exposure. We created predictive maps of exposure to recent P. falciparum in the study area and showed 3 clear foci of exposure. This study provides useful insight into the environmental, spatial and demographic risk factors for P. falciparum and P. vivax at a period of low transmission in Malaysian Borneo. The findings would be valuable in the case of resurgence of human malarias in the region.
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Affiliation(s)
- Isabel Byrne
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK.
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Malaysia
- Gleneagles Hospital, Kota Kinabalu, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Tock H Chua
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Catriona Patterson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
| | - Tom Hall
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
| | - Mark Tan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
| | - Chetan Chitnis
- Department of Parasites and Insect Vectors, Malaria Parasite Biology and Vaccines, Institut Pasteur, Paris, France
| | - John Adams
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Susheel K Singh
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lynn Grignard
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
| | - Kevin K A Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
| | - Kimberly M Fornace
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, Scotland
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Chris J Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
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Macalinao MLM, Fornace KM, Reyes RA, Hall T, Bareng APN, Adams JH, Huon C, Chitnis CE, Luchavez JS, Tetteh KK, Yui K, Hafalla JCR, Espino FEJ, Drakeley CJ. Analytical approaches for antimalarial antibody responses to confirm historical and recent malaria transmission: an example from the Philippines. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100792. [PMID: 37693871 PMCID: PMC10485684 DOI: 10.1016/j.lanwpc.2023.100792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/20/2023] [Accepted: 04/28/2023] [Indexed: 09/12/2023]
Abstract
Background Assessing the status of malaria transmission in endemic areas becomes increasingly challenging as countries approach elimination. Serology can provide robust estimates of malaria transmission intensities, and multiplex serological assays allow for simultaneous assessment of markers of recent and historical malaria exposure. Methods Here, we evaluated different statistical and machine learning methods for analyzing multiplex malaria-specific antibody response data to classify recent and historical exposure to Plasmodium falciparum and Plasmodium vivax. To assess these methods, we utilized samples from a health-facility based survey (n = 9132) in the Philippines, where we quantified antibody responses against 8 P. falciparum and 6 P. vivax-specific antigens from 3 sites with varying transmission intensity. Findings Measurements of antibody responses and seroprevalence were consistent with the 3 sites' known endemicity status. Among the models tested, a machine learning (ML) approach (Random Forest model) using 4 serological markers (PfGLURP R2, Etramp5.Ag1, GEXP18, and PfMSP119) gave better predictions for P. falciparum recent infection in Palawan (AUC: 0.9591, CI 0.9497-0.9684) than individual antigen seropositivity. Although the ML approach did not improve P. vivax infection predictions, ML classifications confirmed the absence of recent exposure to P. falciparum and P. vivax in both Occidental Mindoro and Bataan. For predicting historical P. falciparum and P. vivax transmission, seroprevalence and seroconversion rates based on cumulative exposure markers AMA1 and MSP119 showed reliable trends in the 3 sites. Interpretation Our study emphasizes the utility of serological markers in predicting recent and historical exposure in a sub-national elimination setting, and also highlights the potential use of machine learning models using multiplex antibody responses to improve assessment of the malaria transmission status of countries aiming for elimination. This work also provides baseline antibody data for monitoring risk in malaria-endemic areas in the Philippines. Funding Newton Fund, Philippine Council for Health Research and Development, UK Medical Research Council.
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Affiliation(s)
- Maria Lourdes M. Macalinao
- Department of Parasitology and National Reference Laboratory for Malaria and Other Parasites, Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Philippines
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kimberly M. Fornace
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Ralph A. Reyes
- Department of Parasitology and National Reference Laboratory for Malaria and Other Parasites, Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Philippines
| | - Tom Hall
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alison Paolo N. Bareng
- Department of Parasitology and National Reference Laboratory for Malaria and Other Parasites, Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Philippines
| | | | - Christèle Huon
- Malaria Parasite Biology and Vaccines Unit, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Chetan E. Chitnis
- Malaria Parasite Biology and Vaccines Unit, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Jennifer S. Luchavez
- Department of Parasitology and National Reference Laboratory for Malaria and Other Parasites, Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Philippines
| | - Kevin K.A. Tetteh
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Katsuyuki Yui
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Shionogi Global Infectious Diseases Division, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Julius Clemence R. Hafalla
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fe Esperanza J. Espino
- Department of Parasitology and National Reference Laboratory for Malaria and Other Parasites, Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Philippines
| | - Chris J. Drakeley
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Nekkab N, Obadia T, Monteiro WM, Lacerda MV, White M, Mueller I. Accelerating towards P. vivax elimination with a novel serological test-and-treat strategy: a modelling case study in Brazil. LANCET REGIONAL HEALTH. AMERICAS 2023; 22:100511. [PMID: 37250687 PMCID: PMC10209700 DOI: 10.1016/j.lana.2023.100511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 05/31/2023]
Abstract
Background Plasmodium vivax malaria is challenging to control and eliminate. Treatment with radical cure drugs fails to target the hidden asymptomatic and hypnozoite reservoirs in populations. PvSeroTAT, a novel serological test-and-treat intervention using a serological diagnostic to screen hypnozoite carriers for radical cure eligibility and treatment, could accelerate P. vivax elimination. Methods Using a previously developed mathematical model of P. vivax transmission adapted to the Brazilian context as a case study for implementation, we evaluate the public health impact of various deployment strategies of PvSeroTAT as a mass campaign. We compare relative reductions in prevalence, cases averted, glucose-6-phosphate dehydrogenase (G6PD) tests, and treatment doses of PvSeroTAT campaigns to strengthened case management alone or mass drug administration (MDA) campaigns across different settings. Findings Deploying a single round of PvSeroTAT with 80% coverage to treat cases with a high efficacy radical cure regimen with primaquine is predicted to reduce point population prevalence by 22.5% [95% UI: 20.2%-24.8%] in a peri-urban setting with high transmission and by 25.2% [95% UI: 9.6%-42.2%] in an occupational setting with moderate transmission. In the latter example, while a single PvSeroTAT achieves 9.2% less impact on prevalence and averts 300 less cases per 100,000 than a single MDA (25.2% [95% UI: 9.6%-42.2%] point prevalence reduction versus 34.4% [95% UI: 24.9%-44%]), PvSeroTAT requires 4.6 times less radical cure treatments and G6PD tests. Layering strengthened case management and deploying four rounds of PvSeroTAT six months apart is predicted to reduce point prevalence by a mean of 74.1% [95% UI: 61.3%-86.3%] or more in low transmission settings with less than 10 cases per 1000 population. Interpretation Modelling predicts that mass campaigns with PvSeroTAT are predicted to reduce P. vivax parasite prevalence across a range of transmission settings and require fewer resources than MDA. In combination with strengthened case management, mass campaigns of serological test-and-treat interventions can accelerate towards P. vivax elimination. Funding This project was funded in part by the Bill and Melinda Gates Foundation and the National Health and Medical Research Council.
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Affiliation(s)
- Narimane Nekkab
- Institut Pasteur, Université Paris Cité, G5 Épidémiologie et Analyse des Maladies Infectieuses, Paris, France
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Thomas Obadia
- Institut Pasteur, Université Paris Cité, G5 Épidémiologie et Analyse des Maladies Infectieuses, Paris, France
- Institut Pasteur, Université Paris Cité, Bioinformatics and Biostatistics Hub, Paris, France
| | - Wuelton M. Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Marcus V.G. Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Michael White
- Institut Pasteur, Université Paris Cité, G5 Épidémiologie et Analyse des Maladies Infectieuses, Paris, France
| | - Ivo Mueller
- Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
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Kartal L, Mueller I, Longley RJ. Using Serological Markers for the Surveillance of Plasmodium vivax Malaria: A Scoping Review. Pathogens 2023; 12:791. [PMID: 37375481 DOI: 10.3390/pathogens12060791] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
The utilisation of serological surveillance methods for malaria has the potential to identify individuals exposed to Plasmodium vivax, including asymptomatic carriers. However, the application of serosurveillance varies globally, including variations in methodology and transmission context. No systematic review exists describing the advantages and disadvantages of utilising serosurveillance in various settings. Collation and comparison of these results is a necessary first step to standardise and validate the use of serology for the surveillance of P. vivax in specific transmission contexts. A scoping review was performed of P. vivax serosurveillance applications globally. Ninety-four studies were found that met predefined inclusion and exclusion criteria. These studies were examined to determine the advantages and disadvantages of serosurveillance experienced in each study. If studies reported seroprevalence results, this information was also captured. Measurement of antibodies serves as a proxy by which individuals exposed to P. vivax may be indirectly identified, including those with asymptomatic infections, which may be missed by other technologies. Other thematic advantages identified included the ease and simplicity of serological assays compared to both microscopy and molecular diagnostics. Seroprevalence rates varied widely from 0-93%. Methodologies must be validated across various transmission contexts to ensure the applicability and comparability of results. Other thematic disadvantages identified included challenges with species cross-reactivity and determining changes in transmission patterns in both the short- and long-term. Serosurveillance requires further refinement to be fully realised as an actionable tool. Some work has begun in this area, but more is required.
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Affiliation(s)
- Lejla Kartal
- School of Population and Global Health, The University of Melbourne, Parkville 3010, Australia
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
| | - Ivo Mueller
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Rhea J Longley
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
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23
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Gonzalez-Ceron L, Dema B, Palomeque-Culebro OL, Santillan-Valenzuela F, Montoya A, Reyes-Sandoval A. Plasmodium vivax MSP1-42 kD Variant Proteins Detected Naturally Induced IgG Antibodies in Patients Regardless of the Infecting Parasite Phenotype in Mesoamerica. Life (Basel) 2023; 13:life13030704. [PMID: 36983859 PMCID: PMC10058798 DOI: 10.3390/life13030704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Background: The serological tests using blood stage antigens might be helpful for detecting recent exposure to Plasmodium parasites, and seroepidemiological studies would aid in the elimination of malaria. This work produced recombinant proteins of PvMSP142 variants and evaluated their capacity to detect IgG antibodies in symptomatic patients from Mesoamerica. Methods: Three variant Pvmsp142 genes were cloned in the pHL-sec plasmid, expressed in the Expi293F™ eukaryotic system, and the recombinant proteins were purified by affinity chromatography. Using an ELISA, 174 plasma or eluted samples from patients infected with different P. vivax haplotypes were evaluated against PvMSP142 proteins and to a native blood stage antigen (NBSA). Results: The antibody IgG OD values toward PvMSP142 variants (v88, v21, and v274) were heterogeneous (n = 178; median = 0.84 IQR 0.28–1.64). The correlation of IgG levels among all proteins was very high (spearman’s rho = 0.96–0.98; p < 0.0001), but was lower between them and the NBSA (rho = 0.771; p < 0.0001). In only a few samples, higher reactivity to the homologous protein was evident. Patients with a past infection who were seropositive had higher IgG levels and lower parasitemia levels than those who did not (p < 0.0001). Conclusions: The PvMSP142 variants were similarly efficient in detecting specific IgG antibodies in P. vivax patients from Mesoamerica, regardless of the infecting parasite’s haplotype, and might be good candidates for malaria surveillance and epidemiological studies in the region.
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Affiliation(s)
- Lilia Gonzalez-Ceron
- Regional Centre of Public Health Research, National Institute for Public Health Research, Tapachula 30700, Mexico
- Correspondence: (L.G.-C.); (A.R.-S.); Tel.: +52-9626262219 (L.G.-C.); +52-5557296000 (A.R.-S.)
| | - Barbara Dema
- Pandemic Science Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - Olga L. Palomeque-Culebro
- Regional Centre of Public Health Research, National Institute for Public Health Research, Tapachula 30700, Mexico
| | - Frida Santillan-Valenzuela
- Regional Centre of Public Health Research, National Institute for Public Health Research, Tapachula 30700, Mexico
| | - Alberto Montoya
- Parasitology Department, National Centre for Diagnosis Reference, Ministry of Health, Managua 11165, Nicaragua
| | - Arturo Reyes-Sandoval
- Instituto Politécnico Nacional (IPN), Unidad Adolfo López Mateos, Av. Luis Enrique Erro s/n., Mexico City 07738, Mexico
- Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada (CICATA), Unidad Morelos, Instituto Politécnico Nacional (IPN), Boulevard de la Tecnología, 1036 Z-1, P 2/2, Atlacholoaya 62790, Mexico
- Correspondence: (L.G.-C.); (A.R.-S.); Tel.: +52-9626262219 (L.G.-C.); +52-5557296000 (A.R.-S.)
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Mazhari R, Takashima E, Longley RJ, Ruybal-Pesantez S, White MT, Kanoi BN, Nagaoka H, Kiniboro B, Siba P, Tsuboi T, Mueller I. Identification of novel Plasmodium vivax proteins associated with protection against clinical malaria. Front Cell Infect Microbiol 2023; 13:1076150. [PMID: 36761894 PMCID: PMC9905245 DOI: 10.3389/fcimb.2023.1076150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
As progress towards malaria elimination continues, the challenge posed by the parasite species Plasmodium vivax has become more evident. In many regions co-endemic for P. vivax and Plasmodium falciparum, as transmission has declined the proportion of cases due to P. vivax has increased. Novel tools that directly target P. vivax are thus warranted for accelerated elimination. There is currently no advanced vaccine for P. vivax and only a limited number of potential candidates in the pipeline. In this study we aimed to identify promising P. vivax proteins that could be used as part of a subunit vaccination approach. We screened 342 P. vivax protein constructs for their ability to induce IgG antibody responses associated with protection from clinical disease in a cohort of children from Papua New Guinea. This approach has previously been used to successfully identify novel candidates. We were able to confirm previous results from our laboratory identifying the proteins reticulocyte binding protein 2b and StAR-related lipid transfer protein, as well as at least four novel candidates with similar levels of predicted protective efficacy. Assessment of these P. vivax proteins in further studies to confirm their potential and identify functional mechanisms of protection against clinical disease are warranted.
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Affiliation(s)
- Ramin Mazhari
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Eizo Takashima
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Ehime, Japan
| | - Rhea J Longley
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Shazia Ruybal-Pesantez
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Michael T White
- Institut Pasteur, Université de Paris Cité, G5 Épidémiologie et Analyse des Maladies Infectieuses, Département de Santé Globale, Paris, France
| | - Bernard N Kanoi
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Hikaru Nagaoka
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Ehime, Japan
| | - Benson Kiniboro
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Peter Siba
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Takafumi Tsuboi
- Division of Cell-Free Sciences, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
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25
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da Veiga GTS, Moriggi MR, Vettorazzi JF, Müller-Santos M, Albrecht L. Plasmodium vivax vaccine: What is the best way to go? Front Immunol 2023; 13:910236. [PMID: 36726991 PMCID: PMC9885200 DOI: 10.3389/fimmu.2022.910236] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
Malaria is one of the most devastating human infectious diseases caused by Plasmodium spp. parasites. A search for an effective and safe vaccine is the main challenge for its eradication. Plasmodium vivax is the second most prevalent Plasmodium species and the most geographically distributed parasite and has been neglected for decades. This has a massive gap in knowledge and consequently in the development of vaccines. The most significant difficulties in obtaining a vaccine against P. vivax are the high genetic diversity and the extremely complex life cycle. Due to its complexity, studies have evaluated P. vivax antigens from different stages as potential targets for an effective vaccine. Therefore, the main vaccine candidates are grouped into preerythrocytic stage vaccines, blood-stage vaccines, and transmission-blocking vaccines. This review aims to support future investigations by presenting the main findings of vivax malaria vaccines to date. There are only a few P. vivax vaccines in clinical trials, and thus far, the best protective efficacy was a vaccine formulated with synthetic peptide from a circumsporozoite protein and Montanide ISA-51 as an adjuvant with 54.5% efficacy in a phase IIa study. In addition, the majority of P. vivax antigen candidates are polymorphic, induce strain-specific and heterogeneous immunity and provide only partial protection. Nevertheless, immunization with recombinant proteins and multiantigen vaccines have shown promising results and have emerged as excellent strategies. However, more studies are necessary to assess the ideal vaccine combination and test it in clinical trials. Developing a safe and effective vaccine against vivax malaria is essential for controlling and eliminating the disease. Therefore, it is necessary to determine what is already known to propose and identify new candidates.
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Affiliation(s)
- Gisele Tatiane Soares da Veiga
- Laboratory of Apicomplexan Parasites Research, Carlos Chagas Institute, Oswaldo Cruz Foundation (FIOCRUZ), Curitiba, Brazil,Nitrogen Fixation Laboratory, Department of Biochemistry and Molecular Biology, Federal University of Paraná (UFPR), Curitiba, Brazil
| | | | | | - Marcelo Müller-Santos
- Nitrogen Fixation Laboratory, Department of Biochemistry and Molecular Biology, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Letusa Albrecht
- Laboratory of Apicomplexan Parasites Research, Carlos Chagas Institute, Oswaldo Cruz Foundation (FIOCRUZ), Curitiba, Brazil,*Correspondence: Letusa Albrecht,
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Rogier EW, Giorgi E, Tetteh K, Sepúlveda N. Editorial: Current research on serological analyses of infectious diseases. Front Med (Lausanne) 2023; 10:1154584. [PMID: 36873877 PMCID: PMC9982155 DOI: 10.3389/fmed.2023.1154584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Affiliation(s)
- Eric William Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Emanuele Giorgi
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Kevin Tetteh
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nuno Sepúlveda
- Department of Mathematics & Information Science, Warsaw University of Technology, Warsaw, Poland.,Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Lisbon, Portugal
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Kassa MW, Hasang W, Barateiro A, Damelang T, Brewster J, Dombrowski JG, Longley RJ, Chung AW, Wunderlich G, Mueller I, Aitken EH, Marinho CRF, Rogerson SJ. Acquisition of antibodies to Plasmodium falciparum and Plasmodium vivax antigens in pregnant women living in a low malaria transmission area of Brazil. Malar J 2022; 21:360. [PMID: 36457056 PMCID: PMC9714246 DOI: 10.1186/s12936-022-04402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pregnant women have increased susceptibility to Plasmodium falciparum malaria and acquire protective antibodies over successive pregnancies. Most studies that investigated malaria antibody responses in pregnant women are from high transmission areas in sub-Saharan Africa, while reports from Latin America are scarce and inconsistent. The present study sought to explore the development of antibodies against P. falciparum and Plasmodium vivax antigens in pregnant women living in a low transmission area in the Brazilian Amazon. METHODS In a prospective cohort study, plasma samples from 408 pregnant women (of whom 111 were infected with P. falciparum, 96 had infections with P. falciparum and P. vivax, and 201 had no Plasmodium infection) were used to measure antibody levels. Levels of IgG and opsonizing antibody to pregnancy-specific variant surface antigens (VSAs) on infected erythrocytes (IEs), 10 recombinant VAR2CSA Duffy binding like (DBL domains), 10 non-pregnancy-specific P. falciparum merozoite antigens, and 10 P. vivax antigens were measured by flow cytometry, ELISA, and multiplex assays. Antibody levels and seropositivity among the groups were compared. RESULTS Antibodies to VSAs on P. falciparum IEs were generally low but were higher in currently infected women and women with multiple P. falciparum episodes over pregnancy. Many women (21%-69%) had antibodies against each individual VAR2CSA DBL domain, and antibodies to DBLs correlated with each other (r ≥ 0.55, p < 0.0001), but not with antibody to VSA or history of infection. Infection with either malaria species was associated with higher seropositivity rate for antibodies against P. vivax proteins, adjusted odds ratios (95% CI) ranged from 5.6 (3.2, 9.7), p < 0.0001 for PVDBPII-Sal1 to 15.7 (8.3, 29.7), p < 0.0001 for PvTRAg_2. CONCLUSIONS Pregnant Brazilian women had low levels of antibodies to pregnancy-specific VSAs that increased with exposure. They frequently recognized both VAR2CSA DBL domains and P. vivax antigens, but only the latter varied with infection. Apparent antibody prevalence is highly dependent on the assay platform used.
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Affiliation(s)
- Meseret W. Kassa
- grid.1008.90000 0001 2179 088XDepartment of Medicine, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth St, University of Melbourne, Melbourne, VIC 3000 Australia
| | - Wina Hasang
- grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC Australia
| | - André Barateiro
- grid.11899.380000 0004 1937 0722Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Timon Damelang
- grid.1008.90000 0001 2179 088XDepartment of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, University of Melbourne, Melbourne, VIC Australia
| | - Jessica Brewster
- grid.1042.70000 0004 0432 4889Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC Australia
| | - Jamille G. Dombrowski
- grid.11899.380000 0004 1937 0722Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rhea J. Longley
- grid.1042.70000 0004 0432 4889Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, Melbourne, VIC Australia
| | - Amy W. Chung
- grid.1008.90000 0001 2179 088XDepartment of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, University of Melbourne, Melbourne, VIC Australia
| | - Gerhard Wunderlich
- grid.11899.380000 0004 1937 0722Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ivo Mueller
- grid.1042.70000 0004 0432 4889Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, Melbourne, VIC Australia
| | - Elizabeth H. Aitken
- grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, University of Melbourne, Melbourne, VIC Australia
| | - Claudio R. F. Marinho
- grid.11899.380000 0004 1937 0722Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Stephen J. Rogerson
- grid.1008.90000 0001 2179 088XDepartment of Medicine, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth St, University of Melbourne, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC Australia
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Tashi T, Upadhye A, Kundu P, Wu C, Menant S, Soares RR, Ferreira MU, Longley RJ, Mueller I, Hoang QQ, Tham WH, Rayner JC, Scopel KKG, Lima-Junior JC, Tran TM. Longitudinal IgG antibody responses to Plasmodium vivax blood-stage antigens during and after acute vivax malaria in individuals living in the Brazilian Amazon. PLoS Negl Trop Dis 2022; 16:e0010773. [PMID: 36417454 PMCID: PMC9728838 DOI: 10.1371/journal.pntd.0010773] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/07/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To make progress towards malaria elimination, a highly effective vaccine targeting Plasmodium vivax is urgently needed. Evaluating the kinetics of natural antibody responses to vaccine candidate antigens after acute vivax malaria can inform the design of serological markers of exposure and vaccines. METHODOLOGY/PRINCIPAL FINDINGS The responses of IgG antibodies to 9 P. vivax vaccine candidate antigens were evaluated in longitudinal serum samples from Brazilian individuals collected at the time of acute vivax malaria and 30, 60, and 180 days afterwards. Antigen-specific IgG correlations, seroprevalence, and half-lives were determined for each antigen using the longitudinal data. Antibody reactivities against Pv41 and PVX_081550 strongly correlated with each other at each of the four time points. The analysis identified robust responses in terms of magnitude and seroprevalence against Pv41 and PvGAMA at 30 and 60 days. Among the 8 P. vivax antigens demonstrating >50% seropositivity across all individuals, antibodies specific to PVX_081550 had the longest half-life (100 days; 95% CI, 83-130 days), followed by PvRBP2b (91 days; 95% CI, 76-110 days) and Pv12 (82 days; 95% CI, 64-110 days). CONCLUSION/SIGNIFICANCE This study provides an in-depth assessment of the kinetics of antibody responses to key vaccine candidate antigens in Brazilians with acute vivax malaria. Follow-up studies are needed to determine whether the longer-lived antibody responses induced by natural infection are effective in controlling blood-stage infection and mediating clinical protection.
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Affiliation(s)
- Tenzin Tashi
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Microbiology and Immunology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Aditi Upadhye
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Prasun Kundu
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, United Kingdom
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Chunxiang Wu
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Sébastien Menant
- Infectious Diseases and Immune Defence Division, Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Roberta Reis Soares
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Marcelo U. Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
| | - Rhea J. Longley
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Ivo Mueller
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Quyen Q. Hoang
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Wai-Hong Tham
- Infectious Diseases and Immune Defence Division, Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Julian C. Rayner
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, United Kingdom
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Kézia KG Scopel
- Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Josué C. Lima-Junior
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Tuan M. Tran
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Microbiology and Immunology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
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Ge J, Wang Q, Chen G, Kassegne K, Zhang H, Yu J, Tang J, Wang B, Lu F, Cao J, Han ET, Cheng Y. Immunogenicity and antigenicity of a conserved fragment of the rhoptry-associated membrane antigen of Plasmodium vivax. Parasit Vectors 2022; 15:428. [PMID: 36380374 PMCID: PMC9664424 DOI: 10.1186/s13071-022-05561-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background Plasmodium vivax rhoptry-associated membrane antigen (RAMA) is a glycophosphatidylinositol-anchored membrane protein currently under consideration as a malaria vaccine candidate. Immunoglobulin G (IgG) antibodies induced by P. vivax RAMA (PvRAMA) have been proved to persist over 12 months in the sera of people infected with P. vivax. It has also been shown that through stimulation of peripheral blood mononuclear cells with PvRAMA in vitro, the antigen can induce CD4+ T cells to produce interleukin-10. However, the genetic diversity of the RAMA gene in isolates of P. vivax (pvrama) and the immunogenicity of PvRAMA in animals remain unclear. Methods Genomic DNA was extracted from blood samples (n = 25) of patients in Jiangsu Province, China with imported infections of P. vivax from endemic countries in South and Southeast Asia. The extract genomic DNA was used as templates to amplify the P. vivax rama gene (pvrama) by PCR, and the PCR products were then sequenced and analyzed by the DnaSP, MEGA, and GeneDoc software packages. Recombinant PvRAMA (rPvRAMA) protein was expressed and purified, and then used to immunize mice. Levels of total IgG and different IgG subclasses of rPvRAMA-immunized mice were evaluated by enzyme-linked immunosorbent assay. Also, spleen cells of rPvRAMA-immunized mice were stimulated with rPvRAMA in vitro and levels of T cells were measured by flow cytometry. Results The average pairwise nucleotide diversity (π) of the pvrama gene was 0.00190, and the haplotype diversity (Hd) was 0.982. The C-terminal of PvRAMA showed lower haplotype diversity compared to the N-terminal and was completely conserved at amino acid sites related to erythrocyte binding. To further characterize immunogenicity of the C-terminal of PvRAMA, mice were immunized with rPvRAMA antigen. The rPvRAMA protein induced antibody responses, with the end-point titer ranging from 1:10,000 to 1:5,120,000. IgG1 was the predominant IgG subclass in rPvRAMA-immunized mice, followed by IgG2b. In addition, levels of CD4+ and CD8+ T cells in the rPvRAMA-stimulated group were significantly higher than those in the phosphate-buffered saline-stimulated group (normal control group). Conclusions The high conservation at specific amino acid sites and the high immunogenicity of the C-terminal of PvRAMA indicate the presence of conserved epitopes able to generate broadly reactive humoral and cellular immune responses. These findings support the potential of PvRAMA to serve as a vaccine candidate against P. vivax infection. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05561-8.
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Carrasco-Escobar G, Rosado J, Nolasco O, White MT, Mueller I, Castro MC, Rodriguez-Ferruci H, Gamboa D, Llanos-Cuentas A, Vinetz JM, Benmarhnia T. Effect of out-of-village working activities on recent malaria exposure in the Peruvian Amazon using parametric g-formula. Sci Rep 2022; 12:19144. [PMID: 36351988 PMCID: PMC9645738 DOI: 10.1038/s41598-022-23528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
In the Amazon Region of Peru, occupational activities are important drivers of human mobility and may increase the individual risk of being infected while contributing to increasing malaria community-level transmission. Even though out-of-village working activities and other mobility patterns have been identified as determinants of malaria transmission, no studies have quantified the effect of out-of-village working activities on recent malaria exposure and proposed plausible intervention scenarios. Using two population-based cross-sectional studies in the Loreto Department in Peru, and the parametric g-formula method, we simulated various hypothetical scenarios intervening in out-of-village working activities to reflect their potential health benefits. This study estimated that the standardized mean outcome (malaria seroprevalence) in the unexposed population (no out-of-village workers) was 44.6% (95% CI: 41.7%-47.5%) and 66.7% (95% CI: 61.6%-71.8%) in the exposed population resulting in a risk difference of 22.1% (95% CI: 16.3%-27.9%). However, heterogeneous patterns in the effects of interest were observed between peri-urban and rural areas (Cochran's Q test = 15.5, p < 0.001). Heterogeneous patterns were also observed in scenarios of increased prevalence of out-of-village working activities and restriction scenarios by gender (male vs. female) and age (18 and under vs. 19 and older) that inform possible occupational interventions targetting population subgroups. The findings of this study support the hypothesis that targeting out-of-village workers will considerably benefit current malaria elimination strategies in the Amazon Region. Particularly, males and adult populations that carried out out-of-village working activities in rural areas contribute the most to the malaria seropositivity (recent exposure to the parasite) in the Peruvian Amazon.
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Affiliation(s)
- Gabriel Carrasco-Escobar
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.
- Health Innovation Lab, Institute of Tropical Medicine "Alexander Von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Jason Rosado
- G5 Épidémiologie Et Analyse Des Maladies Infectieuses, Département de Santé Globale, Institut Pasteur, 75015, Paris, France
| | - Oscar Nolasco
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio ICEMR-Amazonia, Laboratorios de Investigación Y Desarrollo, Facultad de Ciencias Y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michael T White
- G5 Épidémiologie Et Analyse Des Maladies Infectieuses, Département de Santé Globale, Institut Pasteur, 75015, Paris, France
| | - Ivo Mueller
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Dionicia Gamboa
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio ICEMR-Amazonia, Laboratorios de Investigación Y Desarrollo, Facultad de Ciencias Y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Ciencias Celulares Y Moleculares, Facultad de Ciencias Y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joseph M Vinetz
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio ICEMR-Amazonia, Laboratorios de Investigación Y Desarrollo, Facultad de Ciencias Y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, CA, 92037, USA
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Mueller I, Vantaux A, Karl S, Laman M, Witkowski B, Pepey A, Vinit R, White M, Barry A, Beeson JG, Robinson LJ. Asia-Pacific ICEMR: Understanding Malaria Transmission to Accelerate Malaria Elimination in the Asia Pacific Region. Am J Trop Med Hyg 2022; 107:131-137. [PMID: 36228917 PMCID: PMC9662229 DOI: 10.4269/ajtmh.21-1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 07/06/2022] [Indexed: 01/31/2023] Open
Abstract
Gaining an in-depth understanding of malaria transmission requires integrated, multifaceted research approaches. The Asia-Pacific International Center of Excellence in Malaria Research (ICEMR) is applying specifically developed molecular and immunological assays, in-depth entomological assessments, and advanced statistical and mathematical modeling approaches to a rich series of longitudinal cohort and cross-sectional studies in Papua New Guinea and Cambodia. This is revealing both the essential contribution of forest-based transmission and the particular challenges posed by Plasmodium vivax to malaria elimination in Cambodia. In Papua New Guinea, these studies document the complex host-vector-parasite interactions that are underlying both the stunning reductions in malaria burden from 2006 to 2014 and the significant resurgence in transmission in 2016 to 2018. Here we describe the novel analytical, surveillance, molecular, and immunological tools that are being applied in our ongoing Asia-Pacific ICEMR research program.
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Affiliation(s)
- Ivo Mueller
- Population Health & Immunity Division, Walter + Eliza Hall Institutes, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | | | - Stephan Karl
- Australian Institute of Tropical Health & Medicine, James Cook University, Cairns, Australia
- PNG Institute of Medical Research, Madang, Papua New Guinea
| | - Moses Laman
- PNG Institute of Medical Research, Madang, Papua New Guinea
| | | | - Anais Pepey
- Institute Pasteur Cambodia, Phnom Penh, Cambodia
| | - Rebecca Vinit
- PNG Institute of Medical Research, Madang, Papua New Guinea
| | | | - Alyssa Barry
- Deakin University, Geelong, Australia
- Burnet Institute, Melbourne, Australia
| | - James G. Beeson
- University of Melbourne, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
- Monash University, Victoria, Australia
| | - Leanne J. Robinson
- Population Health & Immunity Division, Walter + Eliza Hall Institutes, Melbourne, Australia
- PNG Institute of Medical Research, Madang, Papua New Guinea
- Burnet Institute, Melbourne, Australia
- Monash University, Victoria, Australia
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Robinson LJ, Laman M, Makita L, Lek D, Dori A, Farquhar R, Vantaux A, Witkowski B, Karl S, Mueller I. Asia-Pacific International Center of Excellence in Malaria Research: Maximizing Impact on Malaria Control Policy and Public Health in Cambodia and Papua New Guinea. Am J Trop Med Hyg 2022; 107:124-130. [PMID: 36228920 PMCID: PMC9662209 DOI: 10.4269/ajtmh.21-1324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/06/2022] [Indexed: 01/31/2023] Open
Abstract
The Asia-Pacific International Center of Excellence in Malaria Research (ICEMR) was funded in 2016 to conduct a coordinated set of field and in-depth biological studies in Cambodia and Papua New Guinea (PNG), in sites that span the range of transmission intensities currently found in the Asia-Pacific regions. The overall objective is to gain an understanding of key parasite, human host, and vector factors involved in maintaining transmission in the face of intensified control and elimination programs, and to develop novel approaches to identify and target residual transmission foci. In this article, we will describe how the ICEMR program was designed to address key knowledge gaps and priority areas for the malaria control programs in each country. In PNG, partners have worked together on two consecutive ICEMR grants (2009-2016 and 2017-2024) and we present a case study of the partnership and engagement approach that has led to stronger coordination of research activities and integration with program, informing country-level strategic planning and prioritization of control activities. In both settings, the ICEMR program has generated insights into transmission foci, risk factors for ongoing transmission, highlighting the hidden burden of vivax malaria, and the need for additional complementary vector control tools. Finally, we will summarize the emerging research questions and priority areas-namely surveillance, vivax malaria, new vector control tools, and community/health systems-oriented approaches-where further tool development and implementation research have been identified as being needed to guide policy.
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Affiliation(s)
- Leanne J. Robinson
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea;,Burnet Institute, Melbourne, Australia;,Walter & Eliza Hall Institute of Medical Research, Melbourne, Australia;,Address correspondence to Leanne J. Robinson, Burnet Institute, 85 Commercial Road, Melbourne, Australia. E-mail:
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Leo Makita
- National Department of Health, Waigani, Papua New Guinea
| | - Dysoley Lek
- National Centre for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia;,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Annie Dori
- PNG Australia Transition to Health (PATH) Program, Waigani, Papua New Guinea
| | - Rachael Farquhar
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Amelie Vantaux
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Benoit Witkowski
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Stephan Karl
- Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, Australia
| | - Ivo Mueller
- Walter & Eliza Hall Institute of Medical Research, Melbourne, Australia
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Rotich AK, Takashima E, Yanow SK, Gitaka J, Kanoi BN. Towards identification and development of alternative vaccines against pregnancy-associated malaria based on naturally acquired immunity. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.988284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pregnant women are particularly susceptible to Plasmodium falciparum malaria, leading to substantial maternal and infant morbidity and mortality. While highly effective malaria vaccines are considered an essential component towards malaria elimination, strides towards development of vaccines for pregnant women have been minimal. The leading malaria vaccine, RTS,S/AS01, has modest efficacy in children suggesting that it needs to be strengthened and optimized if it is to be beneficial for pregnant women. Clinical trials against pregnancy-associated malaria (PAM) focused on the classical VAR2CSA antigen are ongoing. However, additional antigens have not been identified to supplement these initiatives despite the new evidence that VAR2CSA is not the only molecule involved in pregnancy-associated naturally acquired immunity. This is mainly due to a lack of understanding of the immune complexities in pregnancy coupled with difficulties associated with expression of malaria recombinant proteins, low antigen immunogenicity in humans, and the anticipated complications in conducting and implementing a vaccine to protect pregnant women. With the accelerated evolution of molecular technologies catapulted by the global pandemic, identification of novel alternative vaccine antigens is timely and feasible. In this review, we discuss approaches towards novel antigen discovery to support PAM vaccine studies.
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Oulton T, Obiero J, Rodriguez I, Ssewanyana I, Dabbs RA, Bachman CM, Greenhouse B, Drakeley C, Felgner PL, Stone W, Tetteh KKA. Plasmodium falciparum serology: A comparison of two protein production methods for analysis of antibody responses by protein microarray. PLoS One 2022; 17:e0273106. [PMID: 36037183 PMCID: PMC9423672 DOI: 10.1371/journal.pone.0273106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
The evaluation of protein antigens as putative serologic biomarkers of infection has increasingly shifted to high-throughput, multiplex approaches such as the protein microarray. In vitro transcription/translation (IVTT) systems-a similarly high-throughput protein expression method-are already widely utilised in the production of protein microarrays, though purified recombinant proteins derived from more traditional whole cell based expression systems also play an important role in biomarker characterisation. Here we have performed a side-by-side comparison of antigen-matched protein targets from an IVTT and purified recombinant system, on the same protein microarray. The magnitude and range of antibody responses to purified recombinants was found to be greater than that of IVTT proteins, and responses between targets from different expression systems did not clearly correlate. However, responses between amino acid sequence-matched targets from each expression system were more closely correlated. Despite the lack of a clear correlation between antigen-matched targets produced in each expression system, our data indicate that protein microarrays produced using either method can be used confidently, in a context dependent manner, though care should be taken when comparing data derived from contrasting approaches.
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Affiliation(s)
- Tate Oulton
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joshua Obiero
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, United States of America
| | - Isabel Rodriguez
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Isaac Ssewanyana
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Rebecca A. Dabbs
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Phil L. Felgner
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, United States of America
| | - Will Stone
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin K. A. Tetteh
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Bei AK, Cordy RJ. Optimizing Plasmodium vivax serological surveillance within a coendemic epidemiological landscape. Trends Parasitol 2022; 38:829-830. [PMID: 36038428 PMCID: PMC10066934 DOI: 10.1016/j.pt.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
Abstract
Serological surveillance is a useful tool for revealing hotspots of transmission intensity or cryptic asymptomatic reservoirs, especially as malaria transmission declines. Such approaches can help us to understand malaria epidemiology, but also to guide interventions. Recently, Longley et al. refined a panel for Plasmodium vivax serological surveillance to aid in malaria elimination.
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Affiliation(s)
- Amy K Bei
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
| | - Regina J Cordy
- Department of Biology, Wake Forest University, Winston-Salem, NC, USA
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Byrne I, Cramer E, Nelli L, Rerolle F, Wu L, Patterson C, Rosado J, Dumont E, Tetteh KKA, Dantzer E, Hongvanthong B, Fornace KM, Stresman G, Lover A, Bennett A, Drakeley C. Characterizing the spatial distribution of multiple malaria diagnostic endpoints in a low-transmission setting in Lao PDR. Front Med (Lausanne) 2022; 9:929366. [PMID: 36059850 PMCID: PMC9433740 DOI: 10.3389/fmed.2022.929366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/22/2022] [Indexed: 11/21/2022] Open
Abstract
The epidemiology of malaria changes as prevalence falls in low-transmission settings, with remaining infections becoming more difficult to detect and diagnose. At this stage active surveillance is critical to detect residual hotspots of transmission. However, diagnostic tools used in active surveillance generally only detect concurrent infections, and surveys may benefit from sensitive tools such as serological assays. Serology can be used to interrogate and characterize individuals' previous exposure to malaria over longer durations, providing information essential to the detection of remaining foci of infection. We ran blood samples collected from a 2016 population-based survey in the low-transmission setting of northern Lao PDR on a multiplexed bead assay to characterize historic and recent exposures to Plasmodium falciparum and vivax. Using geostatistical methods and remote-sensing data we assessed the environmental and spatial associations with exposure, and created predictive maps of exposure within the study sites. We additionally linked the active surveillance PCR and serology data with passively collected surveillance data from health facility records. We aimed to highlight the added information which can be gained from serology as a tool in active surveillance surveys in low-transmission settings, and to identify priority areas for national surveillance programmes where malaria risk is higher. We also discuss the issues faced when linking malaria data from multiple sources using multiple diagnostic endpoints.
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Affiliation(s)
- Isabel Byrne
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- *Correspondence: Isabel Byrne
| | - Estee Cramer
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Luca Nelli
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Francois Rerolle
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Lindsey Wu
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Catriona Patterson
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jason Rosado
- Unit of Malaria: Parasites and Hosts, Institut Pasteur, Paris, France
- Infectious Diseases Epidemiology and Analytics G5 Unit, Institut Pasteur, Paris, France
| | - Elin Dumont
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin K. A. Tetteh
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emily Dantzer
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, San Francisco, CA, United States
| | - Bouasy Hongvanthong
- Center for Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Laos
| | - Kimberley M. Fornace
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew Lover
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Adam Bennett
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Tayipto Y, Rosado J, Gamboa D, White MT, Kiniboro B, Healer J, Opi DH, Beeson JG, Takashima E, Tsuboi T, Harbers M, Robinson L, Mueller I, Longley RJ. Assessment of IgG3 as a serological exposure marker for Plasmodium vivax in areas with moderate-high malaria transmission intensity. Front Cell Infect Microbiol 2022; 12:950909. [PMID: 36017364 PMCID: PMC9395743 DOI: 10.3389/fcimb.2022.950909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023] Open
Abstract
A more sensitive surveillance tool is needed to identify Plasmodium vivax infections for treatment and to accelerate malaria elimination efforts. To address this challenge, our laboratory has developed an eight-antigen panel that detects total IgG as serological markers of P. vivax exposure within the prior 9 months. The value of these markers has been established for use in areas with low transmission. In moderate-high transmission areas, there is evidence that total IgG is more long-lived than in areas with low transmission, resulting in poorer performance of these markers in these settings. Antibodies that are shorter-lived may be better markers of recent infection for use in moderate-high transmission areas. Using a multiplex assay, the antibody temporal kinetics of total IgG, IgG1, IgG3, and IgM against 29 P. vivax antigens were measured over 36 weeks following asymptomatic P. vivax infection in Papua New Guinean children (n = 31), from an area with moderate-high transmission intensity. IgG3 declined faster to background than total IgG, IgG1, and IgM. Based on these kinetics, IgG3 performance was then assessed for classifying recent exposure in a cohort of Peruvian individuals (n = 590; age 3-85 years) from an area of moderate transmission intensity. Using antibody responses against individual antigens, the highest performance of IgG3 in classifying recent P. vivax infections in the prior 9 months was to one of the Pv-fam-a proteins assessed (PVX_125728) (AUC = 0.764). Surprisingly, total IgG was overall a better marker of recent P. vivax infection, with the highest individual classification performance to RBP2b1986-2653 (PVX_094255) (AUC = 0.838). To understand the acquisition of IgG3 in this Peruvian cohort, relevant epidemiological factors were explored using a regression model. IgG3 levels were positively associated with increasing age, living in an area with (relatively) higher transmission intensity, and having three or more PCR-detected blood-stage P. vivax infections within the prior 13 months. Overall, we found that IgG3 did not have high accuracy for detecting recent exposure to P. vivax in the Peruvian cohort, with our data suggesting that this is due to the high levels of prior exposure required to acquire high IgG3 antibody levels.
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Affiliation(s)
- Yanie Tayipto
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Jason Rosado
- Unité Malaria: Parasites et Hôtes, Département Parasites et Insectes Vecteurs, Institut Pasteur, Paris, France
| | - Dionicia Gamboa
- Laboratorio International Centers of Excellence for Malaria Research (ICEMR)-Amazonia, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michael T. White
- Unité Malaria: Parasites et Hôtes, Département Parasites et Insectes Vecteurs, Institut Pasteur, Paris, France
| | - Benson Kiniboro
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Julie Healer
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - D. Herbert Opi
- Life Sciences, Burnet Institute, Melbourne, VIC, Australia,Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia,Department of Medicine, The Doherty Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - James G. Beeson
- Life Sciences, Burnet Institute, Melbourne, VIC, Australia,Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia,Department of Medicine, The Doherty Institute, The University of Melbourne, Melbourne, VIC, Australia,Department of Microbiology and Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Eizo Takashima
- Proteo-Science Center, Ehime University, Matsuyama, Japan
| | | | - Matthias Harbers
- CellFree Sciences Co., Ltd., Yokohama, Japan,RIKEN Centre for Integrative Medical Sciences, Yokohama, Japan
| | - Leanne Robinson
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,Life Sciences, Burnet Institute, Melbourne, VIC, Australia
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Rhea J. Longley
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia,*Correspondence: Rhea J. Longley,
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Santano R, Rubio R, Grau-Pujol B, Escola V, Muchisse O, Cuamba I, Vidal M, Ruiz-Olalla G, Aguilar R, Gandasegui J, Demontis M, Jamine JC, Cossa A, Sacoor C, Cano J, Izquierdo L, Chitnis CE, Coppel RL, Chauhan V, Cavanagh D, Dutta S, Angov E, van Lieshout L, Zhan B, Muñoz J, Dobaño C, Moncunill G. Evaluation of antibody serology to determine current helminth and Plasmodium falciparum infections in a co-endemic area in Southern Mozambique. PLoS Negl Trop Dis 2022; 16:e0010138. [PMID: 35727821 PMCID: PMC9212154 DOI: 10.1371/journal.pntd.0010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Soil-transmitted helminths (STH), Schistosoma spp. and Plasmodium falciparum are parasites of major public health importance and co-endemic in many sub-Saharan African countries. Management of these infections requires detection and treatment of infected people and evaluation of large-scale measures implemented. Diagnostic tools are available but their low sensitivity, especially for low intensity helminth infections, leaves room for improvement. Antibody serology could be a useful approach thanks to its potential to detect both current infection and past exposure. Methodology We evaluated total IgE responses and specific-IgG levels to 9 antigens from STH, 2 from Schistosoma spp., and 16 from P. falciparum, as potential markers of current infection in a population of children and adults from Southern Mozambique (N = 715). Antibody responses were measured by quantitative suspension array Luminex technology and their performance was evaluated by ROC curve analysis using microscopic and molecular detection of infections as reference. Principal findings IgG against the combination of EXP1, AMA1 and MSP2 (P. falciparum) in children and NIE (Strongyloides stercoralis) in adults and children had the highest accuracies (AUC = 0.942 and AUC = 0.872, respectively) as markers of current infection. IgG against the combination of MEA and Sm25 (Schistosoma spp.) were also reliable markers of current infection (AUC = 0.779). In addition, IgG seropositivity against 20 out of the 27 antigens in the panel differentiated the seropositive endemic population from the non-endemic population, suggesting a possible role as markers of exposure although sensitivity could not be assessed. Conclusions We provided evidence for the utility of antibody serology to detect current infection with parasites causing tropical diseases in endemic populations. In addition, most of the markers have potential good specificity as markers of exposure. We also showed the feasibility of measuring antibody serology with a platform that allows the integration of control and elimination programs for different pathogens. Parasitic worms and Plasmodium falciparum, the causal agent of malaria, are among the most relevant parasitic diseases of our time and efforts are under way for their control and, ultimately, elimination. An accurate diagnosis is relevant for case management, but also allows calculating the prevalence and evaluating the effectiveness of treatment and control measures. Unfortunately, current diagnostic methods for parasitic worms are not optimal and many infections remain undetected. As for P. falciparum, current diagnostic techniques are satisfactory but do not allow for ascertaining exposure, which is relevant for evaluating control measures. Here we investigated the utility of measuring antibodies to these parasites as a diagnostic method. Our results indicate that it is possible to detect current infection with parasitic worms and P. falciparum using antibody detection with a moderate to high accuracy. We also show that antibodies against the antigens in this study have potential as markers of exposure. Importantly, we used a platform that allows for the simultaneous detection of immunoglobulins to different parasites, which would be extremely useful as a tool to integrate control and elimination programs for several pathogens.
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Affiliation(s)
- Rebeca Santano
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- * E-mail: (RS); (CD); (GM)
| | - Rocío Rubio
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Berta Grau-Pujol
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Fundación Mundo Sano, Buenos Aires, Argentina
| | - Valdemiro Escola
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Osvaldo Muchisse
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Inocência Cuamba
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Marta Vidal
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Gemma Ruiz-Olalla
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Ruth Aguilar
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Javier Gandasegui
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Maria Demontis
- Department of Parasitology, Centre of Infectious Diseases, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | | | - Anélsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Jorge Cano
- Communicable and Non-communicable Diseases Cluster (UCN), WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Luis Izquierdo
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Chetan E. Chitnis
- Malaria Parasite Biology and Vaccines Unit, Department of Parasites and Insect Vectors, Institut Pasteur, Université de Paris, Paris, France
| | - Ross L. Coppel
- Department of Microbiology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Virander Chauhan
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - David Cavanagh
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Sheetij Dutta
- Walter Reed Army Institute of Research (WRAIR), Silver Spring, Maryland, United States of America
| | - Evelina Angov
- Walter Reed Army Institute of Research (WRAIR), Silver Spring, Maryland, United States of America
| | - Lisette van Lieshout
- Department of Parasitology, Centre of Infectious Diseases, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Bin Zhan
- Baylor College of Medicine (BCM), Houston, Texas, United States of America
| | - José Muñoz
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Carlota Dobaño
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
- * E-mail: (RS); (CD); (GM)
| | - Gemma Moncunill
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
- * E-mail: (RS); (CD); (GM)
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Plasmodium vivax malaria serological exposure markers: Assessing the degree and implications of cross-reactivity with P. knowlesi. Cell Rep Med 2022; 3:100662. [PMID: 35732155 PMCID: PMC9245056 DOI: 10.1016/j.xcrm.2022.100662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/22/2022] [Accepted: 05/26/2022] [Indexed: 11/21/2022]
Abstract
Serological markers are a promising tool for surveillance and targeted interventions for Plasmodium vivax malaria. P. vivax is closely related to the zoonotic parasite P. knowlesi, which also infects humans. P. vivax and P. knowlesi are co-endemic across much of South East Asia, making it important to design serological markers that minimize cross-reactivity in this region. To determine the degree of IgG cross-reactivity against a panel of P. vivax serological markers, we assayed samples from human patients with P. knowlesi malaria. IgG antibody reactivity is high against P. vivax proteins with high sequence identity with their P. knowlesi ortholog. IgG reactivity peaks at 7 days post-P. knowlesi infection and is short-lived, with minimal responses 1 year post-infection. We designed a panel of eight P. vivax proteins with low levels of cross-reactivity with P. knowlesi. This panel can accurately classify recent P. vivax infections while reducing misclassification of recent P. knowlesi infections.
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40
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African Plasmodium vivax malaria improbably rare or benign. Trends Parasitol 2022; 38:683-696. [PMID: 35667992 DOI: 10.1016/j.pt.2022.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
The overwhelming dominance of Duffy blood group negativity among most people living in sub-Saharan Africa has been considered the basis of their protection from endemic Plasmodium vivax malaria. New evidence demonstrates widespread transmission of P. vivax in Duffy-negative Africa, though currently of unknown distribution, magnitude, or consequences. Other new evidence from outside of Africa demonstrates marked tropisms of P. vivax for extravascular tissues of bone marrow and spleen. Those establish states of proliferative infection with low-grade or undetectable parasitemia of peripheral blood causing acute and chronic disease. This review examines the plausibility of those infectious processes also operating in Duffy-negative Africans and causing harm of unrecognized origin.
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Rosado J, Carrasco-Escobar G, Nolasco O, Garro K, Rodriguez-Ferruci H, Guzman-Guzman M, Llanos-Cuentas A, Vinetz JM, Nekkab N, White MT, Mueller I, Gamboa D. Malaria transmission structure in the Peruvian Amazon through antibody signatures to Plasmodium vivax. PLoS Negl Trop Dis 2022; 16:e0010415. [PMID: 35533146 PMCID: PMC9119515 DOI: 10.1371/journal.pntd.0010415] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 05/19/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The landscape of malaria transmission in the Peruvian Amazon is temporally and spatially heterogeneous, presenting different micro-geographies with particular epidemiologies. Most cases are asymptomatic and escape routine malaria surveillance based on light microscopy (LM). Following the implementation of control programs in this region, new approaches to stratify transmission and direct efforts at an individual and community level are needed. Antibody responses to serological exposure markers (SEM) to Plasmodium vivax have proven diagnostic performance to identify people exposed in the previous 9 months. METHODOLOGY We measured antibody responses against 8 SEM to identify recently exposed people and determine the transmission dynamics of P. vivax in peri-urban (Iquitos) and riverine (Mazán) communities of Loreto, communities that have seen significant recent reductions in malaria transmission. Socio-demographic, geo-reference, LM and qPCR diagnosis data were collected from two cross-sectional surveys. Spatial and multilevel analyses were implemented to describe the distribution of seropositive cases and the risk factors associated with exposure to P. vivax. PRINCIPAL FINDINGS Low local transmission was detected by qPCR in both Iquitos (5.3%) and Mazán (2.7%); however, seroprevalence indicated a higher level of (past) exposure to P. vivax in Mazán (56.5%) than Iquitos (38.2%). Age and being male were factors associated with high odds of being seropositive in both sites. Higher antibody levels were found in individuals >15 years old. The persistence of long-lived antibodies in these individuals could overestimate the detection of recent exposure. Antibody levels in younger populations (<15 years old) could be a better indicator of recent exposure to P. vivax. CONCLUSIONS The large number of current and past infections detected by SEMs allows for detailed local epidemiological analyses, in contrast to data from qPCR prevalence surveys which did not produce statistically significant associations. Serological surveillance will be increasingly important in the Peruvian Amazon as malaria transmission is reduced by continued control and elimination efforts.
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Affiliation(s)
- Jason Rosado
- Unit of Malaria: Parasites and hosts, Institut Pasteur, Paris, France
- Sorbonne Université, ED 393, Paris, France
- Infectious Disease Epidemiology and Analytics G5 Unit, Institut Pasteur, Paris, France
| | - Gabriel Carrasco-Escobar
- School of Public Health, University of California San Diego, La Jolla, California, United States of America
- Health Innovation Laboratory, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Peru
| | - Oscar Nolasco
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Malaria, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Katherine Garro
- Laboratorio de Malaria, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Mitchel Guzman-Guzman
- Laboratorio ICEMR-Amazonia, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joseph M. Vinetz
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio ICEMR-Amazonia, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Narimane Nekkab
- Unit of Malaria: Parasites and hosts, Institut Pasteur, Paris, France
| | - Michael T. White
- Unit of Malaria: Parasites and hosts, Institut Pasteur, Paris, France
- Infectious Disease Epidemiology and Analytics G5 Unit, Institut Pasteur, Paris, France
| | - Ivo Mueller
- Unit of Malaria: Parasites and hosts, Institut Pasteur, Paris, France
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Dionicia Gamboa
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio ICEMR-Amazonia, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
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Obadia T, Nekkab N, Robinson LJ, Drakeley C, Mueller I, White MT. Developing sero-diagnostic tests to facilitate Plasmodium vivax Serological Test-and-Treat approaches: modeling the balance between public health impact and overtreatment. BMC Med 2022; 20:98. [PMID: 35300700 PMCID: PMC8932240 DOI: 10.1186/s12916-022-02285-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/07/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Eliminating Plasmodium vivax will require targeting the hidden liver-stage reservoir of hypnozoites. This necessitates new interventions balancing the benefit of reducing vivax transmission against the risk of over-treating some individuals with drugs which may induce haemolysis. By measuring antibodies to a panel of vivax antigens, a strategy of serological-testing-and-treatment (PvSeroTAT) can identify individuals with recent blood-stage infections who are likely to carry hypnozoites and target them for radical cure. This provides a potential solution to selectively treat the vivax reservoir with 8-aminoquinolines. METHODS PvSeroTAT can identify likely hypnozoite carriers with ~80% sensitivity and specificity. Diagnostic test sensitivities and specificities ranging 50-100% were incorporated into a mathematical model of vivax transmission to explore how they affect the risks and benefits of different PvSeroTAT strategies involving hypnozoiticidal regimens. Risk was measured as the rate of overtreatment and benefit as reduction of community-level vivax transmission. RESULTS Across a wide range of combinations of diagnostic sensitivity and specificity, PvSeroTAT was substantially more effective than bloodstage mass screen and treat strategies and only marginally less effective than mass drug administration. The key test characteristic determining of the benefit of PvSeroTAT strategies is diagnostic sensitivity, with higher values leading to more hypnozoite carriers effectively treated and greater reductions in vivax transmission. The key determinant of risk is diagnostic specificity: higher specificity ensures that a lower proportion of uninfected individuals are unnecessarily treated with primaquine. These relationships are maintained in both moderate and low transmission settings (qPCR prevalence 10% and 2%). Increased treatment efficacy and adherence can partially compensate for lower test performance. Multiple rounds of PvSeroTAT with a lower performing test may lead to similar or higher reductions in vivax transmission than fewer rounds with a higher performing test, albeit with higher rate of overtreatment. CONCLUSIONS At current performance, PvSeroTAT is predicted to be a safe and efficacious option for targeting the hypnozoite reservoir towards vivax elimination. P. vivax sero-diagnostic tests should aim for both high performance and ease of use in the field. The target product profiles informing such development should thus reflect the trade-offs between impact, overtreatment, and ease of programmatic implementation.
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Affiliation(s)
- Thomas Obadia
- G5 Épidémiologie et Analyse des Maladies Infectieuses, Département de Santé Globale, Institut Pasteur, F-75015, Paris, France.
- Unité Malaria: Parasites et Hôtes, Département Parasites et Insectes vecteurs, Institut Pasteur, F-75015, Paris, France.
- Hub de Bioinformatique et Biostatistique, Département de Biologie Computationnelle, Institut Pasteur, F-75015, Paris, France.
| | - Narimane Nekkab
- G5 Épidémiologie et Analyse des Maladies Infectieuses, Département de Santé Globale, Institut Pasteur, F-75015, Paris, France
- Unité Malaria: Parasites et Hôtes, Département Parasites et Insectes vecteurs, Institut Pasteur, F-75015, Paris, France
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Leanne J Robinson
- Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - Ivo Mueller
- Unité Malaria: Parasites et Hôtes, Département Parasites et Insectes vecteurs, Institut Pasteur, F-75015, Paris, France
- Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Michael T White
- G5 Épidémiologie et Analyse des Maladies Infectieuses, Département de Santé Globale, Institut Pasteur, F-75015, Paris, France
- Unité Malaria: Parasites et Hôtes, Département Parasites et Insectes vecteurs, Institut Pasteur, F-75015, Paris, France
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Liu ZSJ, Sattabongkot J, White M, Chotirat S, Kumpitak C, Takashima E, Harbers M, Tham WH, Healer J, Chitnis CE, Tsuboi T, Mueller I, Longley RJ. Naturally acquired antibody kinetics against Plasmodium vivax antigens in people from a low malaria transmission region in western Thailand. BMC Med 2022; 20:89. [PMID: 35260169 PMCID: PMC8904165 DOI: 10.1186/s12916-022-02281-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Plasmodium vivax (P. vivax) is the dominant Plasmodium spp. causing the disease malaria in low-transmission regions outside of Africa. These regions often feature high proportions of asymptomatic patients with sub-microscopic parasitaemia and relapses. Naturally acquired antibody responses are induced after Plasmodium infection, providing partial protection against high parasitaemia and clinical episodes. However, previous work has failed to address the presence and maintenance of such antibody responses to P. vivax particularly in low-transmission regions. METHODS We followed 34 patients in western Thailand after symptomatic P. vivax infections to monitor antibody kinetics over 9 months, during which no recurrent infections occurred. We assessed total IgG, IgG subclass and IgM levels to up to 52 P. vivax proteins every 2-4 weeks using a multiplexed Luminex® assay and identified protein-specific variation in antibody longevity. Mathematical modelling was used to generate the estimated half-life of antibodies, long-, and short-lived antibody-secreting cells. RESULTS Generally, an increase in antibody level was observed within 1-week post symptomatic infection, followed by an exponential decay of different rates. We observed mostly IgG1 dominance and IgG3 sub-dominance in this population. IgM responses followed similar kinetic patterns to IgG, with some proteins unexpectedly inducing long-lived IgM responses. We also monitored antibody responses against 27 IgG-immunogenic antigens in 30 asymptomatic individuals from a similar region. Our results demonstrate that most antigens induced robust and long-lived total IgG responses following asymptomatic infections in the absence of (detected) boosting infections. CONCLUSIONS Our work provides new insights into the development and maintenance of naturally acquired immunity to P. vivax and will guide the potential use of serology to indicate immune status and/or identify populations at risk.
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Affiliation(s)
- Zoe Shih-Jung Liu
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Victoria, 3010, Australia.,Current affiliation: Deakin University, School of Medicine, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, Geelong, Victoria, 3220, Australia
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Michael White
- Infectious Disease Epidemiology and Analytics G5 Unit, Department of Global Health, Institut Pasteur, Paris, France
| | - Sadudee Chotirat
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chalermpon Kumpitak
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Eizo Takashima
- Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Matthias Harbers
- CellFree Sciences Co., Ltd., Yokohama, Japan and RIKEN Centre for Integrative Medical Sciences, Yokohama, Japan
| | - Wai-Hong Tham
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Julie Healer
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Chetan E Chitnis
- Malaria Parasite Biology and Vaccines, Department of Parasites & Insect Vectors, Institut Pasteur, Paris, France
| | | | - Ivo Mueller
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Rhea J Longley
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, 3052, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, Victoria, 3010, Australia.
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Fornace KM, Senyonjo L, Martin DL, Gwyn S, Schmidt E, Agyemang D, Marfo B, Addy J, Mensah E, Solomon AW, Bailey R, Drakeley CJ, Pullan RL. Characterising spatial patterns of neglected tropical disease transmission using integrated sero-surveillance in Northern Ghana. PLoS Negl Trop Dis 2022; 16:e0010227. [PMID: 35259153 PMCID: PMC8932554 DOI: 10.1371/journal.pntd.0010227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/18/2022] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background
As prevalence decreases in pre-elimination settings, identifying the spatial distribution of remaining infections to target control measures becomes increasingly challenging. By measuring multiple antibody responses indicative of past exposure to different pathogens, integrated serological surveys enable simultaneous characterisation of residual transmission of multiple pathogens.
Methodology/Principal findings
Here, we combine integrated serological surveys with geostatistical modelling and remote sensing-derived environmental data to estimate the spatial distribution of exposure to multiple diseases in children in Northern Ghana. The study utilised the trachoma surveillance survey platform (cross-sectional two-stage cluster-sampled surveys) to collect information on additional identified diseases at different stages of elimination with minimal additional cost. Geostatistical modelling of serological data allowed identification of areas with high probabilities of recent exposure to diseases of interest, including areas previously unknown to control programmes. We additionally demonstrate how serological surveys can be used to identify areas with exposure to multiple diseases and to prioritise areas with high uncertainty for future surveys. Modelled estimates of cluster-level prevalence were strongly correlated with more operationally feasible metrics of antibody responses.
Conclusions/Significance
This study demonstrates the potential of integrated serological surveillance to characterise spatial distributions of exposure to multiple pathogens in low transmission and elimination settings when the probability of detecting infections is low.
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Affiliation(s)
- Kimberly M. Fornace
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Laura Senyonjo
- Research Team, Sightsavers UK, Haywards Heath, United Kingdom
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elena Schmidt
- Research Team, Sightsavers UK, Haywards Heath, United Kingdom
| | | | - Benjamin Marfo
- Neglected Tropical Disease Team, Ghana Health Service, Accra, Ghana
| | - James Addy
- Neglected Tropical Disease Team, Ghana Health Service, Accra, Ghana
| | | | - Anthony W. Solomon
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Robin Bailey
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chris J. Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel L. Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Dharmaratne ADVTT, Dini S, O’Flaherty K, Price DJ, Beeson J, McGready R, Nosten F, Fowkes FJI, Simpson JA, Zaloumis SG. Quantification of the dynamics of antibody response to malaria to inform sero-surveillance in pregnant women. Malar J 2022; 21:75. [PMID: 35248084 PMCID: PMC8897879 DOI: 10.1186/s12936-022-04111-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Malaria remains a major public health threat and tools sensitive to detect infections in low malaria transmission areas are needed to progress elimination efforts. Pregnant women are particularly vulnerable to malaria infections. Throughout pregnancy they access routine antenatal care, presenting a unique sentinel population to apply novel sero-surveillance tools to measure malaria transmission. The aim of this study was to quantify the dynamic antibody responses to multiple antigens during pregnancy so as to identify a single or multiple antibody response of exposure to malaria in pregnancy. Methods This study involved a secondary analysis of antibody responses to six parasite antigens [five commonly studied merozoite antigens and the variant surface antigen 2-chondroitin sulphate A (VAR2CSA), a pregnancy-specific erythrocytic antigen] measured by enzyme-linked immunosorbent assay (ELISA) over the gestation period until delivery (median of 7 measurements/woman) in 250 pregnant women who attended antenatal clinics located at the Thai-Myanmar border. A multivariate mixture linear mixed model was used to cluster the pregnant women into groups that have similar longitudinal antibody responses to all six antigens over the gestational period using a Bayesian approach. The variable-specific entropy was calculated to identify the antibody responses that have the highest influence on the classification of the women into clusters, and subsequent agreement with grouping of women based on exposure to malaria during pregnancy. Results Of the 250 pregnant women, 135 had a Plasmodium infection detected by light microscopy during pregnancy (39% Plasmodium falciparum only, 33% Plasmodium vivax only and 28% mixed/other species), defined as cases. The antibody responses to all six antigens accurately identified the women who did not have a malaria infection detected during pregnancy (93%, 107/115 controls). Antibody responses to P. falciparum merozoite surface protein 3 (PfMSP3) and P. vivax apical membrane antigen 1 (PvAMA1) were the least dynamic. Antibody responses to the antigens P. falciparum apical membrane antigen 1 (PfAMA1) and PfVAR2CSA were able to identify the majority of the cases more accurately (63%, 85/135). Conclusion These findings suggest that the combination of antibodies, PfAMA1 and PfVAR2CSA, may be useful for sero-surveillance of malaria infections in pregnant women, particularly in low malaria transmission settings. Further investigation of other antibody markers is warranted considering these antibodies combined only detected 63% of the malaria infections during pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04111-y.
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Bourke C, Takashima E, Chan LJ, Dietrich MH, Mazhari R, White M, Sattabongkot J, Tham WH, Tsuboi T, Mueller I, Longley R. Comparison of total immunoglobulin G antibody responses to different protein fragments of Plasmodium vivax Reticulocyte binding protein 2b. Malar J 2022; 21:71. [PMID: 35246142 PMCID: PMC8896302 DOI: 10.1186/s12936-022-04085-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Plasmodium vivax is emerging as the dominant and prevalent species causing malaria in near-elimination settings outside of Africa. Hypnozoites, the dormant liver stage parasite of P. vivax, are undetectable to any currently available diagnostic test, yet are a major reservoir for transmission. Advances have been made to harness the naturally acquired immune response to identify recent exposure to P. vivax blood-stage parasites and, therefore, infer the presence of hypnozoites. This in-development diagnostic is currently able to detect infections within the last 9-months with 80% sensitivity and 80% specificity. Further work is required to optimize protein expression and protein constructs used for antibody detection. Methods The antibody response against the top performing predictor of recent infection, P. vivax reticulocyte binding protein 2b (PvRBP2b), was tested against multiple fragments of different sizes and from different expression systems. The IgG induced against the recombinant PvRBP2b fragments in P. vivax infected individuals was measured at the time of infection and in a year-long observational cohort; both conducted in Thailand. Results The antibody responses to some but not all different sized fragments of PvRBP2b protein are highly correlated with each other, significantly higher 1-week post-P. vivax infection, and show potential for use as predictors of recent P. vivax infection. Conclusions To achieve P. vivax elimination goals, novel diagnostics are required to aid in detection of hidden parasite reservoirs. PvRBP2b was previously shown to be the top candidate for single-antigen classification of recent P. vivax exposure and here, it is concluded that several alternative recombinant PvRBP2b fragments can achieve equal sensitivity and specificity at predicting recent P. vivax exposure. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04085-x.
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Affiliation(s)
- Caitlin Bourke
- The Walter and Eliza Hall Institute of Medical Research, 3052, Parkville, Australia.,Department of Medical Biology, The University of Melbourne, 3052, Parkville, Australia
| | - Eizo Takashima
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Li-Jin Chan
- The Walter and Eliza Hall Institute of Medical Research, 3052, Parkville, Australia.,Department of Medical Biology, The University of Melbourne, 3052, Parkville, Australia
| | - Melanie H Dietrich
- The Walter and Eliza Hall Institute of Medical Research, 3052, Parkville, Australia.,Department of Medical Biology, The University of Melbourne, 3052, Parkville, Australia
| | - Ramin Mazhari
- The Walter and Eliza Hall Institute of Medical Research, 3052, Parkville, Australia.,Department of Medical Biology, The University of Melbourne, 3052, Parkville, Australia
| | - Michael White
- Infectious Disease Epidemiology and Analytics G5 Unit, Institut Pasteur, Paris, France
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wai-Hong Tham
- The Walter and Eliza Hall Institute of Medical Research, 3052, Parkville, Australia.,Department of Medical Biology, The University of Melbourne, 3052, Parkville, Australia
| | - Takafumi Tsuboi
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Ivo Mueller
- The Walter and Eliza Hall Institute of Medical Research, 3052, Parkville, Australia.,Department of Medical Biology, The University of Melbourne, 3052, Parkville, Australia
| | - Rhea Longley
- The Walter and Eliza Hall Institute of Medical Research, 3052, Parkville, Australia. .,Department of Medical Biology, The University of Melbourne, 3052, Parkville, Australia. .,Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Wu L, Hsiang MS, Prach LM, Schrubbe L, Ntuku H, Dufour MSK, Whittemore B, Scott V, Yala J, Roberts KW, Patterson C, Biggs J, Hall T, Tetteh KK, Gueye CS, Greenhouse B, Bennett A, Smith JL, Katokele S, Uusiku P, Mumbengegwi D, Gosling R, Drakeley C, Kleinschmidt I. Serological evaluation of the effectiveness of reactive focal mass drug administration and reactive vector control to reduce malaria transmission in Zambezi Region, Namibia: Results from a secondary analysis of a cluster randomised trial. EClinicalMedicine 2022; 44:101272. [PMID: 35198913 PMCID: PMC8851292 DOI: 10.1016/j.eclinm.2022.101272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Due to challenges in measuring changes in malaria at low transmission, serology is increasingly being used to complement clinical and parasitological surveillance. Longitudinal studies have shown that serological markers, such as Etramp5.Ag1, can reflect spatio-temporal differences in malaria transmission. However, these markers have yet to be used as endpoints in intervention trials. METHODS Based on data from a 2017 cluster randomised trial conducted in Zambezi Region, Namibia, evaluating the effectiveness of reactive focal mass drug administration (rfMDA) and reactive vector control (RAVC), this study conducted a secondary analysis comparing antibody responses between intervention arms as trial endpoints. Antibody responses were measured on a multiplex immunoassay, using a panel of eight serological markers of Plasmodium falciparum infection - Etramp5.Ag1, GEXP18, HSP40.Ag1, Rh2.2030, EBA175, PfMSP119, PfAMA1, and PfGLURP.R2. FINDINGS Reductions in sero-prevalence to antigens Etramp.Ag1, PfMSP119, Rh2.2030, and PfAMA1 were observed in study arms combining rfMDA and RAVC, but only effects for Etramp5.Ag1 were statistically significant. Etramp5.Ag1 sero-prevalence was significantly lower in all intervention arms. Compared to the reference arms, adjusted prevalence ratio (aPR) for Etramp5.Ag1 was 0.78 (95%CI 0.65 - 0.91, p = 0.0007) in the rfMDA arms and 0.79 (95%CI 0.67 - 0.92, p = 0.001) in the RAVC arms. For the combined rfMDA plus RAVC intervention, aPR was 0.59 (95%CI 0.46 - 0.76, p < 0.0001). Significant reductions were also observed based on continuous antibody responses. Sero-prevalence as an endpoint was found to achieve higher study power (99.9% power to detect a 50% reduction in prevalence) compared to quantitative polymerase chain reaction (qPCR) prevalence (72.9% power to detect a 50% reduction in prevalence). INTERPRETATION While the observed relative reduction in qPCR prevalence in the study was greater than serology, the use of serological endpoints to evaluate trial outcomes measured effect size with improved precision and study power. Serology has clear application in cluster randomised trials, particularly in settings where measuring clinical incidence or infection is less reliable due to seasonal fluctuations, limitations in health care seeking, or incomplete testing and reporting. FUNDING This study was supported by Novartis Foundation (A122666), the Bill & Melinda Gates Foundation (OPP1160129), and the Horchow Family Fund (5,300,375,400).
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Affiliation(s)
- Lindsey Wu
- London School of Hygiene and Tropical Medicine, Faculty of Infectious Tropical Diseases, Department of Infection Biology, London, United Kingdom of Great Britain
| | - Michelle S. Hsiang
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, United States of America
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Lisa M. Prach
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, United States of America
| | - Leah Schrubbe
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, United States of America
| | - Henry Ntuku
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, United States of America
| | - Mi-Suk Kang Dufour
- Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Brooke Whittemore
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Valerie Scott
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, United States of America
| | - Joy Yala
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, United States of America
| | - Kathryn W. Roberts
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, United States of America
| | - Catriona Patterson
- London School of Hygiene and Tropical Medicine, Faculty of Infectious Tropical Diseases, Department of Infection Biology, London, United Kingdom of Great Britain
| | - Joseph Biggs
- London School of Hygiene and Tropical Medicine, Faculty of Infectious Tropical Diseases, Department of Infection Biology, London, United Kingdom of Great Britain
| | - Tom Hall
- St. George's University of London, London, UK
| | - Kevin K.A. Tetteh
- London School of Hygiene and Tropical Medicine, Faculty of Infectious Tropical Diseases, Department of Infection Biology, London, United Kingdom of Great Britain
| | - Cara Smith Gueye
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, United States of America
| | - Bryan Greenhouse
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, United States of America
| | - Jennifer L. Smith
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, United States of America
| | - Stark Katokele
- National Vector-Borne Diseases Control Programme, Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Petrina Uusiku
- National Vector-Borne Diseases Control Programme, Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Davis Mumbengegwi
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, United States of America
| | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, Faculty of Infectious Tropical Diseases, Department of Infection Biology, London, United Kingdom of Great Britain
| | - Immo Kleinschmidt
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London, UK
- Research Council Collaborating Centre for Multi-Disciplinary Research on Malaria, School of Pathology, Wits Institute for Malaria Research, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
- Southern African Development Community Malaria Elimination Eight Secretariat, Windhoek, Namibia
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48
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O'Flaherty K, Roe M, Fowkes FJ. The role of naturally acquired antimalarial antibodies in subclinical
Plasmodium
spp. infection. J Leukoc Biol 2022; 111:1097-1105. [PMID: 35060185 PMCID: PMC9303632 DOI: 10.1002/jlb.5mr1021-537r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/09/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Katherine O'Flaherty
- Disease Elimination Program Burnet Institute for Medical Research and Public Health Melbourne Australia
| | - Merryn Roe
- Disease Elimination Program Burnet Institute for Medical Research and Public Health Melbourne Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Freya J.I. Fowkes
- Disease Elimination Program Burnet Institute for Medical Research and Public Health Melbourne Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
- Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health, The University of Melbourne Melbourne Australia
- Department of Infectious Disease Monash University Melbourne Australia
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49
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Distinct kinetics of antibodies to 111 Plasmodium falciparum proteins identifies markers of recent malaria exposure. Nat Commun 2022; 13:331. [PMID: 35039519 PMCID: PMC8764098 DOI: 10.1038/s41467-021-27863-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/15/2021] [Indexed: 11/09/2022] Open
Abstract
Strengthening malaria surveillance is a key intervention needed to reduce the global disease burden. Reliable serological markers of recent malaria exposure could improve current surveillance methods by allowing for accurate estimates of infection incidence from limited data. We studied the IgG antibody response to 111 Plasmodium falciparum proteins in 65 adult travellers followed longitudinally after a natural malaria infection in complete absence of re-exposure. We identified a combination of five serological markers that detect exposure within the previous three months with >80% sensitivity and specificity. Using mathematical modelling, we examined the antibody kinetics and determined that responses informative of recent exposure display several distinct characteristics: rapid initial boosting and decay, less inter-individual variation in response kinetics, and minimal persistence over time. Such serological exposure markers could be incorporated into routine malaria surveillance to guide efforts for malaria control and elimination. Serological markers of recent Plasmodium falciparum infection could be useful to estimate incidence. Here, the authors identify a combination of five serological markers to detect exposure to infection within the previous three months with >80% sensitivity and specificity.
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50
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Walker IS, Chung AW, Damelang T, Rogerson SJ. Analysis of Antibody Reactivity to Malaria Antigens by Microsphere-Based Multiplex Immunoassay. Methods Mol Biol 2022; 2470:309-325. [PMID: 35881355 DOI: 10.1007/978-1-0716-2189-9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Protein multiplex assays enable serological analysis of multiple target proteins simultaneously, using relatively small volumes of patient sample per assay. Here we present a detailed protocol to analyze antibody reactivity to malaria antigens by microsphere-based multiplex assay (xMAP technology). This method involves coupling of recombinant proteins to fluorescently labeled microspheres; simultaneous exposure of all microspheres to plasma or sera, and detection of antigen-specific antibodies with a fluorescent labeled anti-human Fc region antibody. In addition to total IgG, this assay can be adapted to measure multiple properties of the antibody Fc region, including subclass, isotype, and Fc receptor or complement C1q binding.
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Affiliation(s)
- Isobel S Walker
- Department of Medicine, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
| | - Amy W Chung
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Timon Damelang
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Stephen J Rogerson
- Department of Infectious Diseases, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
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